JSWMC

Background: Diabetes mellitus is the commonest metabolic abnormality in the world. Type 2 diabetes is the commonest form of diabetes, constituting nearly 90% of diabetic population in any country. The incidence and prevalence of Diabetes Mellitus have been increasing steadily in Bangladesh. Diabetes mellitus is the leading cause of end stage renal disease (ESRD) and accounts for approximately 40% of patients receiving dialysis globally each year. MetS occurs in 85% of the patients with type 2 diabetes mellitus (DM) and is associated with an increased prevalence of micro and macro vascular complications. So detection of nephropathy in subjects with metabolic syndrome at early stage and by creating awareness can significantly reduce mortality, morbidity and cost associated with kidney disease. Therefore, this study was conducted to compare the frequency of metabolic syndrome and its association in subjects with nephropathy and without nephropathy in type 2 diabetes in Bangladeshi population and whether subjects of MetS should be addressed for regular screening with greater emphasis or not. Methods: This was a cross sectional comparative study done in Mymensingh Medical College Hospital and Mymensingh Diabetic Somitee, Mymensingh from March’ 2014 to April’ 2015. A total of 200 patients were finally enrolled by considering inclusion and exclusion criteria and the participants were divided into two groups on the basis of Albumin Creatinine Ratio (ACR) of urine and designated as group I and group II. Patients having persistent ACR of urine ≥30mg/gm (nephropathy) was defined as group I (n=49) and ACR of urine (<30mg/gm) who did not develop nephropathy was defined as group II (n=151). Type 2 diabetes patients were selected as prediagnosed type 2 diabetic patients according to World Health Organization (WHO) criteria or on antidiabetic agents (ADA).Metabolic syndrome was defined according to the criteria of modified US National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) (2001). Subjects were considered to have nephropathy if the albumin creatinine ratio (ACR) of urine was persistently ≥30mg/gm which was done on two occasions, three months apart. Simplified Modification of diet in renal disease (MDRD) study equation was used. Results: In our study, subjects with nephropathy group were older than non nephropathy group. (χ 2 = 14.35 and P = 0.001), which was statistically significant (P<0.05). Among group I, more than fifty percent (61.22%) subjects were male and rest were female (38.77%). The proportion of nephropathy was significantly higher in male than female. We also observed that, the proportion of nephropathy was highest (39.47%) among component 5 (Diabetes mellitus, Increased Blood Pressure, Decreased HDL, Increased TG, Central Obesity) group. Patients, who had metabolic syndrome, 4.45 times risk of developing nephropathy in comparison to who did not have metabolic syndrome. (OR: 4.45). Conclusion: We found that higher the number of metabolic component, higher the risk of developing nephropathy. Diabetic subjects who had metabolic syndrome, had four times higher risk of developing nephropathy in comparison to who did not have metabolic syndrome.