No abstract

BACKGROUND Increased levels of urinary biomarkers can be detected in type 2 diabetic patients before the onset of significant albuminuria and may be used as an early marker of renal injury in diabetic nephropathy (DN) which would play a significant role for the effective management and treatment approaches in diabetic care. We wanted to evaluate cystatin C and microalbumin as effective early biomarkers in assessing nephropathy in patients with type 2 diabetes mellitus in this study. METHODS A cross-sectional study was conducted among 180 subjects grouped into healthy controls, clinically proven T2DM without nephropathy and type 2 DM with nephropathy comprising 60 participants in each group. Fasting and postprandial blood samples and urine samples were collected and analysed by standard methods. eGFR was calculated using CKD-EPI 2012 equation. IBM - SPSS version 20 was used for statistical analysis. RESULTS Diabetic nephropathy patients had significantly elevated serum cystatin C and microalbumin (2.43 ± 0.59, 700.5 ± 591.8 mg / L, respectively), compared to T2DM (0.98 ± 0.26, 63.7 ± 102.9 mg / L, respectively), and the control study subjects (0.81 ± 0.16, 11.15 ± 8.9 mg / L, respectively). Serum cystatin C showed AUC of 0.994 (95 % CI, 0.986 - 1.00) whereas microalbumin showed 0.944 (95 % CI, 0.907 - 0.981). Serum cystatin C showed a sensitivity of 96.7 % and a specificity of 91.7 % at a cutoff point of 1.34 mg / L whereas at a cut-off point of 138.5 mg / L for microalbumin, the sensitivity and specificity were 90 % and 83.3 % respectively. CONCLUSIONS Serum cystatin C and microalbumin both could be considered as markers for early detection of nephropathy in T2DM patients. The more prominent rise in serum cystatin C values provide an earlier diagnosis of diabetic nephropathy among T2DM patients. KEY WORDS Biomarker, Type 2 Diabetes Mellitus, Cystatin C, Diabetic Nephropathy, Microalbumin

Background: This study was aimed to study and management of hypertension in diabetic patients.Methods: A prospective, observational study was conducted in 160 diabetic hypertensive patients admitted in general medicine wards at Andhra Pradesh Vaidya Vidhana Parishad Hospital, (APVVP), Proddatur. Patients who signed informed consent form were only included in the study. All the data were recorded from patients’ case files and analyzed.Results: Of enrolled 160 patients, 86 (53.75%) were female and 74 (46.25%) were male and maximum number of the patients 32.5% were found in the age group of 60-69 years. Out of 160 admitted patients, (51) patients treated with metformin, glibenclamide and atenolol, (18) patients treated with metformin, glimiperide, and amlodipine, (6) patients treated with metformin and amlodipine, (28) patients treated with metformin, glimiperide and atenolol, (19) patients treated with metformin and atenolol, (17) patients treated with metformin, glibenclamide and amlodipine,(9) patients treated with metformin, glibenclamide and losartan, (5) patients treated with metformin and losartan, (7) patients treated with metformin, glimiperide, and losartan.Conclusions: There was less awareness among the patients regarding the control of type-2 diabetes mellitus with hypertension. Majority of diabetic patients noticed with hypertension and β adrenergic blockers remained first choice of drug for hypertension in diabetes. Calcium channel blockers were also prescribed to many patients and were successful to achieve target blood pressure. Among anti-diabetic drugs, biguanides were most frequently prescribed class of drugs. Metformin was the most prescribed drug and Sulphonyl urea were the next most prescribed class of drug.

Vitamin D Binding Protein (VDBP), also well-known as Gc-globulin, is a plasma protein which acts as a carrier molecule for vitamin D and its metabolites. This multifunctional glycoprotein is a member of the albumin superfamily of binding proteins. It is predominantly synthesized as a single long chain glycoprotein in the liver. VDBP helps in vitamin D metabolites transport, control bone development, binds actin monomers and fatty acids and prevents their polymerization; which might be harmful in circulatory system. A less defined role in modulating immune and inflammatory response is also known. VDBP plays an important role in protection of microcirculation, inflammation, infection and also known to have antiviral and antitumoral activity. Recent studies documented its use as a early marker for diagnosis of chronic kidney disease. This review discusses the multifunctional characters of VDBP in spectra of diseases with emphasis on its use as marker for diabetic nephropathy.