THESIS

DR.RAVI KUMAR THESIS 

 INTRODUCTION: 

GLYCEMIC VARIABILITY AND ASSOCIATION AND OUTCOMES WITH URINARY ALBUMIN EXCRETION IN DIABETES MELLITUS

PROBLEM STATEMENT:

Diabetes mellitus (DM) has long been recognized as a major public health problem for its adverse health impact on individuals and for its economic burden on the health care system and the society at large

Patients with Type 2 diabetes often have a long asymptomatic period of hyperglycemia and many have complications at the time of diagnosis. Diabetic Nephropathy is a common consequence of longstanding diabetes mellitus. It is characterized by the presence of large amounts of urinary proteins, mostly albumin. Like other microvascular complications, the pathogenesis of diabetic  nephropathy is related to chronic hyperglycaemia. The laboratory test for early detection of diabetic nephropathy is the measurement of microalbumin in urine (microalbuminuria). There are many conditions causing microalbuminuria but hypertension and diabetes are the two biggest risk factors, besides old age and weight gain. Microalbuminuria predicts progression to diabetic nephropathy and cardiovascular diseases. 

Increased level of microalbuminuria is associated with increased risk of progressive kidney disease leading towards ESRD and cardiovascular morbidity and mortality in diabetic patients as reported in an earlier study.

It is therefore most reliable as an indicator of incipient diabetic nephropathy within the first 10 years of type 1 diabetes, when majority of the patients with microalbuminuria will progress to overt nephropathy within further 10 years. It is also a potentially useful marker of an increased risk of macrovascular disease. According to the American Diabetes Association (ADA), micro albuminuria, defined as urinary albumin excretion rate of 20 - 200 mcg/min on a timed specimen or 30 - 300 mg/gm in urinary ACR (albumin to creatinine ratio) from a spot collection (preferred method) without an alternative clinical explanation (suchas urinary tract infection, heart failure or exercise in the past 48 hours) or urinary protein excretion rate of “300mg/day in a 24 hr collection. 24 hour collection of urine for quantitative assessment of urinary albumin excretion rate is currently considered the gold standard measurement of micro albuminuria.

 

AIM

TO EVALUATE THE ASSOCIATION BETWEEN ALBUMIN LEVELS WITH HBA1C IN TERTIARY CARE CENTRE

OBJECTIVES 

1Known Cases of Diabetic Mellitus attending General Medicine OPD and IN PATIENT of Kamineni hospitals.

2.To Study The Relationship Between HBA1C and Microalbuminemia of Diabetic patients in a hospital based cross sectional study in a Tertiary Hospital.

3.Outcomes of Microalbuminemia in Diabetes Mellitus Patients 

STUDY DESIGN :

Prospective study design with analysis of factors influencing the outcome of the patients with hypokalemia and hyperkalemia 

INCLUSION CRITERIA

1.Includes all above 14yrs age group

2.Includes both the gender

3.Includes patients who have consent given to this study

4.Includes both type 1 and type 2 diabetes 

EXCLUSION CRITERIA

1.All patients below 15yrs of age group

2. Patients who aren’t willing to participate in the study (non-consenting individuals).

PLACE OF STUDY: Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally.

STUDY PERIOD:   November 2023 - October 2025

STUDY DESIGN: Prospective Observational Qualitative study.

SAMPLE SIZE: Proposed No. of cases to be studied = 50

CASE PROFORMA

SERIAL NO:

NAME:

AGE:

OP/IP NO.:

EDUCATION: 

OCCUPATION: 

SOCIOECONOMIC STATUS: 

PHONE NUMBER: 

ADDRESS:

Complains:- 

1. Polyuria 

2. Polydipsia 

3. Polyphagia

4. Tingling and numbness 

5. Easy fatigibuability 

6. Blurring of vision 

7. Constipation 

PAST HISTORY:-

Diabetes Mellitus

Hypertension

Thyroid disorders 

PERSONAL HISTORY:-

Alcohol history

Smoking history

Appetite 

Bowel and Bladder habits

 

FAMILY HISTORY:-

History of similar illness in family

GENERAL EXAMINATION 

 Pallor                                                       

 Icterus

 Lymphadenopathy                    

 Clubbing                               

 Cyanosis                                                                    

 Chest AP and Transverse diameters                        

 Elevated JVP

 Facial Puffiness

 Pedal Edema

RESPIRATORY EXAMINATION:

Movements of chest:

Percussion:

Air entry:

Breath sounds:

CARDIOVASCULAR SYSTEM: 

Heart sounds:

 JVP:

 Added sounds:

GASTROINTESTINAL SYSTEM: 

Inspection: Palpation:

Shape of abdomen organomegaly

Umbilicus liver span

Percussion: Auscultation:

Shifting dullness Bowel sounds 

                                           

CENTRAL NERVOUS EXAMINATION:

Higher mental functions:

Motor and sensory system:

Cerebellar functions:

Meningeal signs:

INVESTIGATIONS:-

1. Haemogram

2. Fbs

3. Plbs

3. HBA1C

4. Serum creatinine

5. Cue

6. 24hr urine creatinine ratio

7. Spot urine protein creatinine ratio

 

OUTCOMES:

1)  Asymptomatic

2) Symptomatically better

3) Mortality

CONSENT: 

I/WE, relative of the patient have read and understood the information provided in the patient information sheet and have been informed the purpose of the evaluation in the language I understand.

I am aware of the fact that I may not derive any benefit from the evaluation and that I deserve the right to opt out of the study at any point of time.

I willingly agree to participate in this study.

Patients sign/thumb impression:                             witness sign/thumb impression.

Name:                                                                            name:

Date:                                                                               date:

 

Residents sign:

Resident name:

date: 

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