General clinical and anthropometric parameters in patients with type 1 diabetes mellitus depending on the level of albumin in the urine

Abstract

Currently there are many experimental markers of diabetic nephropathy, but clinical practice focuses mainly on the presence of albuminuria, which usually manifests itself in both adults and children on average 5-7 years after the onset of diabetes. The aim of the study was to study the general clinical and anthropometric parameters in patients with type 1 diabetes mellitus (T1D) depending on the level of albumin in the urine. The study included 78 men and 62 women aged 22 to 26 years with T1D. The control group consisted of 8 healthy men and 13 healthy women of the same age. The level of microalbuminuria was determined in all patients by enzyme-linked immunosorbent assay. The assessment of general clinical (pulse, systolic, diastolic pressure) and anthropometric (height, weight, body surface area, waist circumference, body mass index) indicators was performed. Statistical processing of the obtained results was performed in the license package “Statistica 5.5”, using non-parametric evaluation methods. It was found that angio-, retino- and neuropathy occurred in all patients with T1D. Simultaneously with the increase in albuminuria, the percentage of patients with deeper degrees of these complications increased. It was found that with increasing levels of albumin in the urine in most cases increases the percentage of patients with a correspondingly severe degree of these complications. Thus, in patients with T1D men found: angiopathy of the III degree with normoalbuminuria – 12.5 %, with microalbuminuria – 40.0 %, with proteinuria – 53.8 %; retinopathy of the II-III degree with normoalbuminuria – 0 % and 7.5 %, with microalbuminuria – 4.0 % and 40.0 %, with proteinuria – 100 % and 0 %; II-III degree neuropathy with normoalbuminuria – 65.0 % and 0 %, with microalbuminuria – 92.0 % and 0 %, with proteinuria – 0 % and 92.3 %. In patients with T1D women were found: angiopathy of the III degree with normoalbuminuria – 29.0 %, with microalbuminuria – 13.0 %, with proteinuria – 62.5 %; retinopathy of the II-III degree with normoalbuminuria – 3.2 % and 9.7 %, with microalbuminuria – 4.3 % and 26.1 %, with proteinuria – 87.5 % and 0 %; II-III degree neuropathy with normoalbuminuria – 71.0 % and 0 %, with microalbuminuria – 91.3 % and 0 %, with proteinuria – 12.5 % and 75.0 %. In patients with T1D with normo-, microalbuminuria and proteinuria, the value of systolic, diastolic blood pressure and pulse, in most cases, significantly higher than in healthy subjects (respectively in men by 6.1-18.3 % – 3.6-20.3 % and 4.2-14.7 %; in women – by 5.0-20.0 % – 9.1-22.8 % and 8.0-31.6 %). The value of these indicators increased with the increase in the level of albumin in the urine (respectively in men by 11.4 % – 16.1 % and 10.1 %; in women –- by 13.3 % – 10.0 % and 21.8 %). Patients with T1D had lower values of growth (respectively in men by 4.6-9.2 %; in women – 2.2-4.1 %), weight (only in men by 9.0-26.4 %) and body surface area (respectively in men by 7.2-17.7 %, in women – 4.8 % only in the group of proteinuria). Body mass index in sick men, compared with healthy, was significantly lower only in the group of proteinuria (by 5.5 %); and in women it was higher in the groups of normo- and microalbuminuria (by 10.6 % and 11.2 %). Patients with T1D women compared to healthy women had a larger waist circumference (by 5.5-11.8 %), and in patients with T1D men – on the contrary, this figure was lower in the group of microalbuminuria (by 4.0 %). Thus, the differences in general clinical and anthropometric parameters between patients with T1D with different levels of albumin in the urine and the degree of complications from the vascular and nervous system allow to assess the severity and compensation of the disease, and comparison of these indicators with the control group possibilities of disease development and peculiarities of the pathological process.

Features of the frequency of angio-, retino- and neuropathy, general clinical and anthropometric parameters in patients with type 1 diabetes with different levels of albumin in the urine depending on the level of cystatin C

“…In a pairwise comparison of groups of men or women who took into account the level of cystatin C, with the corresponding sex groups of subjects, in which this biochemical indicator was not taken into account, found similar patterns and trends [12]. Thus, in the group of men with cystatin C levels <0.9 and in women with cystatin C levels >0.9, the percentage of patients with severe microvascular complications of diabetes increased with increasing albuminuria.…”

“…In our study, unfortunately, it was not possible to conduct a complete analysis of changes in general clinical and anthropometric parameters in patients with albuminuria at different levels of cystatin C, because the distribution in groups with proteinuria did not analyze women with cystatin C<0.9 and men with cystatin C>0.9 (the number of observations in these groups was only 1 and 3, respectively). For this reason, there is a limited explanation of why between patients with microalbuminuria, at different levels of cystatin C there are higher values of general clinical and anthropometric indicators at lower levels, while these indicators in general groups are characterized by diametrically opposite patterns (the value of these indicators increased as the level of albumin in the urine increases) [12].…”

Relationship between biochemical parameters and glomerular filtration rate by Cockcroft-Gault, CKD EPI and cystatin C in patients with type 1 diabetes

“…In previous publications [13][14][15][16] it was found that in patients with T1D renal dysfunction in the early stages is manifested by impaired filtration function, characterized by increased serum levels of cystatin C and, accordingly, a decrease in GFR by cystatin C, and at later stages -a decrease in GFR, calculated on creatinine (by Cockcroft-Gault and CKD EPI), increase in urinary albumin, albumincreatinine ratio and serum creatinine. Accordingly, the assessment of the rate of change of glomerular filtration and its correlation analysis with classical markers of renal pathology made it possible to detail the diagnosis in patients with T1D at different stages of DN.…”