Research Article

Biochemical Markers of Early Renal Impairment: An Analytical Correlation Between Glycemic Control and Nephropathy

Abstract

Type 2 Diabetes, or T2DM is not just a problem of poor control of blood glucose. It is a complex metabolic disease that impacts many organs and can lead to organ failure. As the T2DM rate increases in Iraq, specifically Najaf Governorate, the incidence of Diabetic Nephropathy (DN) is also increasing. Diabetic nephropathy (DN) occurs slowly due to long-term injury to the small blood vessels and the gradual structural damage. A serious consequence of diabetes as it progresses is kidney dysfunction, although this is closely related to liver function, blood pressure stability and measures of body size. The study was done to identify the relationship between long-term glycemic control expressed as HbA1c and multi-organ biomarkers including renal (serum urea and creatinine), liver enzymes, lipid profile and cardiovascular (systolic blood pressure [SBP] and body mass index [BMI]) parameters. A descriptive cross-sectional study was conducted on patients at German Hospital in Najaf which included 120 subjects, 60 T2DM patients and 60 healthy controls. Stratification of participants was done into age-glycemic categories (20 to 40 years with HbA1c ≈ 8.2%, 40 to 60 years with HbA1c > 8.8% AND 60 to 80 years with HbA1c > 10.2%). Measurement of HbA1c by high performance liquid chromatography. The concentration of nitrogenous waste products and liver function was carried out using some of the enzymatic methods while the standard procedures were used to measure the SBP and BMI. The diabetic group had severe metabolic disturbances. Serum urea (29.22 ± 20.32 mg/dL) and creatinine (1.13 ± 0.77 mg/dL) levels were significantly higher compared to the control (P <0.001). There was a strong and positive correlation between HbA1c and worsening of renal function (r = 0.72). Patients who had the disease for > 18 years and those belonging to 60–80-year age group showed the worst impairment. Additionally, raised SBP (137.7 ± 19.6 mmHg) and increase of BMI (28.2 ± 6.2 kg/ m2) may further aggravate combined metabolic (lipotoxic) and pressure-related damage to kidney and liver. To sum up, experiencing long-term high blood glucose levels, alongside high blood pressure and overweight, harms the organs. Thus, a clinical assessment of HbA1c alone is not enough. The Iraqi T2DM patients’ kidney and liver function along with SBP and BMI hemodynamic measures, are monitored withusing a wider diagnostic approach to detect early and prevent irreversible end-stage complications.