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• W2902001567 abstract "INTRODUCTION:India is frequently referred to as the diabetic capital of the world. Diabetes mellitus is widely prevalent in our country and its incidence is rising in alarming proportions. The worldwide prevalence1 of diabetes has risen dramatically over the past two decades, from an estimated 30 million cases in 1985 to 177 million in 2000. Based on current trends, >360 million individuals worldwide will have diabetes by the year 2030. Although the prevalence of both type 1 and type 2 diabetes is increasing worldwide, the prevalence of type 2 diabetes is rising much more rapidly because of increasing obesity and reduced activity levels as countries become more industrialized. Worldwide estimates project that in 2030 the greatest number of individuals with diabetes will be 45–64 years of age. According to the Diabetes Atlas published by the International Diabetes Federation (IDF), there are an estimated 40 million persons with diabetes in India in 2007, now it has risen to 60 million in 2009 and this number is predicted to rise to almost 120 million people in 2025 by which time every fifth diabetic subject in the world would be an Indian. Diabetes is a major cause of mortality, but several studies indicate that diabetes is likely under reported as a cause of death. A recent estimate suggested that diabetes was the fifth leading cause of death worldwide and was responsible for almost 3 million deaths annually (1.7–5.2% of deaths worldwide).AIMS AND OBJECTIVES:The aims of the study were ;1. To identify individuals with impaired protein tolerance test as a marker of early renal dysfunction in type 2 diabetes mellitus.2. To compare individuals with impaired protein tolerance with normal population.MATERIALS AND METHODS:The study was conducted on patients attending the out patient department of Government Rajaji Hospital, Madurai. Approval from the hospital ethical committee was obtained.Study Design:The study was a case control study conducted for a period of one year between October 2008 - September 2009.Inclusion Criteria:• Patients with type 2 diabetes mellitus were included in the study.• Fifty healthy, age and sex matched controls without diabetes or its complications were also included in the study for comparison.Exclusion Criteria:• Patients with type 2 diabetes mellitus with proteinuria.• Systemic hypertension.• Renal Failure.Diagnosis of Type 2 diabetes mellitus was made by clinical details and routine blood investigations including fasting and postprandial blood sugarvalues. The WHO criteria were employed for the diagnosis of diabetes mellitus.The presence of absence of renal dysfunction was made on the basis of the following:1. Clinical details,2. Routine Blood investigations,3. Measurment of baseline creatinine clearance and. creatinine clearance after a protein meal (100 gm of protein as cottage cheese).4. Spot urinary protein estimation at baseline and after a protein meal.METHODS:After the diagnosis of Type 2 diabetes mellitus,All the selected patients were subjected to a high protein meal. To detect renal dysfunction in type 2 diabetes mellitus, blood samples were collected after 8 hours of fasting for fasting blood sugar and after two hours of postprandial state. Blood samples were collected at 0, 30, 60 and 120 minutes for serum creatinine after giving high protein meal. Serum was separated and stored in the refrigerator. Serum creatinine was measured from this serum.RESULTS:Majority of the patients were from in and around Madurai city. The total number of patients included in the study was 52. Fifty controls were also included in the study for comparative analysis. Among the total of 52 Type 2 diabetes mellitus patients [Female (F)-24; Male (M)-28], 32 diabetic patients [Female (F)-16; Male (M)-16] had no evidence of Renal Dysfunction (Group-I), whereas 9 diabetic patients (F-4; M-5) had evidence of Renal injury(Group-II) and 11 diabetic patients (F-4; M-7) had evidence of incipient Renal Failure (Group-III) Out of the 50 controls, 24 were female and 26 were male, 2 diabetic patients (F-1; M-1) had evidence of renal injury (Group-II) The age of the controls ranged from 32 to 67 years with a mean age of 52.1 years. The age of the patients in the study group ranged from 32-67 years with a mean of 54.11 years. In the study group, 9 patients were in the age groupof upto 40 years (18%) , 15 patients in 41-50 age group (30%), 22 patients in 51-60 age group (44%), 4 patients (8%) were in the age group of >60years.The age groups of the cases and controls were comparable and there was no statistical difference (p=0.3594).SUMMARY:The study “impaired protein tolerance test as a marker of early renal dysfunction in type 2 diabetes mellitus” was undertaken to find out the usefulness of protein tolerance test in detecting patients with type 2 diabetes mellitus who were at risk of developing renal dysfunction.The present study was a case control study done at Govt. Rajaji Hospital Madurai. After institutional Ethical Committee clearance, 52 patients with type2 diabetes mellitus and 50 healthy controls were selected according to the inclusion criteria. There were almost equal males and females in the study. A baseline fasting and post prandial blood sugar, serum creatine and baseline GFR was calculated. This was followed by a protein challenge with 100 grams of protein food. Serum creatinine and GFR were measured at 30, 60 and 120 minutes after protein challenge. Using statistical data, correlation was analyzed between pre/post protein challenge serum creatinine in cases and controls in relation to GFR and renal function. It was found that patients with renal failure had more persistent elevation of serum creatinine and sustained decrease inGFR as compared to patients with normal renal function or those with mild renal dysfunction. There was also an age related decline in renal function. Proteinuria was found to be an independent risk factor for renal failure.It was also found that patients with long duration of diabetes and poor glycemic control have more chance of early renal injury and dysfunction than those with short duration of diabetes and good glycemic control.CONCLUSIONS:1. Kidney damage starts in Diabetic patients even before microalbuminuria and clinical nephropathy starts.2. It was found that longer the Duration of diabetes ,more the chance of early renal injury and dysfunction.3. Renal injury and dysfunction directly correlates with poor metabolic control.4. Protein tolerance test can be a very useful test to detect such incipient renal failure in patients with normal GFR and normal serum creatinine values.5. Identifying those patients with subnormal renal function may enable us to initiate an early aggressive intervention.6. This Protein Tolerance Test may be very much useful in high risk patients like Diabetics, Hypertensive patients.7. Patients with diseases like solitary kidney, polycystic kidney disease, post renal transplants can also be subjected to this test to identify incipient renal failure.8. Protein Tolerance Test can also be used to check the borderline renal donor in order to give accurate prognostication in a progressive renal disease." @default.
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• W2902001567 date "2010-03-01" @default.
• W2902001567 modified "2023-09-26" @default.
• W2902001567 title "Impaired Protein Tolerance Test as a Marker of Early Renal Dysfunction in Type 2 Diabetes Mellitus" @default.
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