Effects Of Two Diagnostic Methods Of Glycosylated Hemoglobin And Glucose Tolerance Test On Urine Microalbumin In Diabetic Patients

Background:Microalbuminuria(MAU)is a marker of early diabetic nephropathy and an effective marker of glomerular hyperperfusion and hyperfiltration.Microalbuminuria is a sensitive indicator of glomerular disease and injury.Recent clinical studies have found that microalbuminuria has the same early warning significance in the so-called "normal range" in the past.It is of great significance for the early diagnosis of diabetic nephropathy.In the past studies,a large number of studies have been conducted to investigate the relationship between glycated hemoglobin and microalbuminuria,fasting blood glucose and 2h postprandial blood glucose and microalbuminuria,but few studies have compared glycated hemoglobin(HbAlc),Glucose tolerance test(OGTT)The relationship between two diagnostic methods for diabetes and microalbuminuria.The aim of this study was to compare the relationship between these two diagnostic methods for diabetes and microalbuminuria,and to provide a theoretical basis for the early diagnosis and intervention of diabetic nephropathy.Objective:This study was designed to investigate the effects of two diagnostic methods,glycosylated hemoglobin and glucose tolerance test,on urinary microalbumin in diabetic patients.Methods:Relying on the Shandong Science and Technology Huimin Project,"Diabetes Early Screening and Prevention Clinical Medical Research Platform Construction and Grassroots Promotion Technology and Huimin Demonstration Project"(project number:2014kjhm0112),recruited in Jinan and surrounding areas from 2015/5 to 2017/2 A cross-sectional study of diabetes and its complications was performed in the high-risk population of diabetes.All enrolled subjects were enrolled in a uniform format questionnaire and performed a physical examination.Parallel laboratory tests(HbAlc,FPG,1 hPG,2 hPG,TC,TG,LDL-C,HDL-C,AST,ALT,sUA,Cr,MAU).Urinary albumin excretion rate in morning urine indicates rapid and convenient detection of morning urine albumin concentration and good correlation with 24 h urinary albumin excretion rate.OGTT is used in the history of diabetes-free patients to make a diagnosis of the glucose metabolism status of the study,and to analyze the prevalence of diabetes in high-risk populations of diabetes;according to the diagnostic criteria of glycosylated hemoglobin and the diagnostic criteria for glucose tolerance test,the testers were divided into four groups,1.A group of diabetics diagnosed only by glycosylated hemoglobin(1 group of HbAlc-DM),2.a group of diabetics diagnosed only by OGTT(2 groups of OGTT-DM),3.Both diagnostic methods can be diagnosed as a group of diabetics(3 groups of DM in Duyang).4.Both methods of diagnosis can not be diagnosed as a group of diabetes,ie,a normal group(four groups of both are normal).The difference in urine microalbumin was compared between diabetics diagnosed by two different diabetes diagnostic methods.Results:1.Comparison of general and biochemical indicators of the survey population:A total of 2,822 people were investigated in this study,excluding those who had already diagnosed diabetes,and 722 people with important data missing.2100 patients were included in the study.The average age of the sample was 53.01 years old,including 827 males,with an average age of 52.82 years.1,273 people,with an average age of 53.14 years.With OGTT as the gold standard,there were 279 new diagnosed T2DMs in the high-risk population without diabetes,accounting for 13.28%of the total sample.708 people were diagnosed with abnormal glucose regulation,accounting for 33.71%;those with complete glucose metabolism were 1,113,accounting for 53.00%of the total sample.2.Analysis of clinical characteristics of patients with microalbuminuria:Twenty-three subjects with large amounts of albuminuria in this study were excluded,with a total of 2063.According to the presence or absence of microalbuminuria,2,063 subjects were divided into two groups,1.microalbumin group;2.no microalbumin group.Statistical analysis showed that there were no trace albumin group and abnormal group in age(Age),body mass index(BMI),waist-to-hip ratio(WHR),mean systolic blood pressure(SBP),mean diastolic blood pressure(DBP),fasting blood glucose(FPG),Two hours after loading,blood glucose(2h-PG),glycated hemoglobin(HbAlc),total cholesterol(TC),triglyceride(Tg),and low-density lipoprotein cholesterol(LDL-C)all showed an upward trend,high-density lipoprotein cholesterol.(HDL-C)showed a downward trend,and the difference between the two groups was statistically significant.3.The prevalence of microalbuminuria in the general population and the prevalence of glucose metabolism in each group:In this survey,there were 23 people with a large amount of proteinuria,accounting for 1.1%of the total samples;277 people with microalbumin,accounting for 13.31%of the total samples;and 1 group(diabetes with glycosylated hemoglobin for diabetes).The number of people in the urine was 15 and the prevalence rate was 22.05%.The number of people with microalbuminuria in the 2 groups(diagnosed by OGTT only)was 24,and the prevalence rate was 21.24%.Three groups(two diagnostic methods)Can be diagnosed as diabetes group)The number of people with microalbuminuria is 55,the prevalence rate is 29.57%,and 4 groups(both diagnoses can not be diagnosed as diabetes group,ie,group of normal glucose metabolism)The number of people was 173,and the prevalence rate was 10.19%.There was a statistically significant difiference in the prevalence of microalbuminuria between the four groups(P<0.05).4.Correlation analysis between fasting blood glucose,glycosylated hemoglobin and microalbuminuria:The correlation coefficient between urinary microalbumin and glycosylated hemoglobin pearlis was 0.268,which was positively correlated.P<0.01 for the two-sided significance test of the correlation coefficient,indicating that the correlation coefficient is statistically significant.The correlation coefficient between urinary microalbumin and fasting blood glucose pearson was 0.167,which was positively correlated.The P of the two-sided significance test of the correlation coefficient is 0.000,indicating that the correlation coefficient is statistically significant.Glycated hemoglobin is more strongly associated with urinary microalbumin than fasting blood glucose.5.Levels and differences of urinary microalbumin in different diagnostic criteria for diabetes:The median concentrations of urinary microalbumin in subjects with HbAlc<6.20%and?6.20%were 0 mg/L and 10.8 mg/L,respectively,and the difference was statistically significant(P<0.001).The proportion of urinary microalbumin abnormalities was 30.83%(78/253)and 10.88%(197/1810),respectively,and the difference between the two groups was statistically significant(P<0.05).The median concentrations of urinary albumin in the FPG<7.00mmol/L and?7.00mmol/L groups were Omg/L and 11.8mg/L,respectively,and the difference was statistically significant(P<0.05).The proportion of abnormal microalbuminuria was 30.23%(52/172)and 11.79%(223/1891),respectively,and the difference between the two groups was statistically significant(P<0.05).6.The relationship between the four groups(HbAlc-DM,OGTT-DM,both Duyang,both of them)and the microalbuminuria in different diagnostic criteria for diabetes:HbAlc-DM group,OGTT-DM group and two diagnostic methods were age group,BMI,wc,SBP,DBP,FPG,2h-PG?HbAlc?TC,Tg,LDL-C,HDL-C,Cr levels(P>0.05).HbAlc-DM group,OGTT-DM group,and both Duyang group in age,BMI,we,SBP,DBP,FPG,2h-PG,HbAlc,TC,Tg,LDL-C,HDL-C(P<0.05).Cr levels were not statistically significant(P>0.05).Urinary microalbumin was compared between the HbAlc-DM group,the OGTT-DM group,the two diabetes-diagnostic methods,and the two diabetes-diagnostic methods.The HbAlc-DM group and the OGTT-DM group were compared.There was no statistical difference in the comparison of urinary microalbumin between the two groups with positive diagnosis of diabetes.The P value of HbAlc-DM group,OGTT-DM group and both Duyang group and the two Dyna group in urine microalbumin were<0.01,which were statistically different from the two groups.Conclusions:(1)The prevalence of newly diagnosed diabetes in high-risk population in this study was 13.28%,and the prevalence of diabetes was high.(2)The prevalence of urinary microalbumin in diabetic patients was significantly higher than that in non-diabetic patients.(3)Urinary microalbumin in diabetic patients under HlbAlc and OGTT were higher than non-diabetic patients;HbAlc and OGTT diagnostic methods had no difference in the effect of urine microalbumin on diabetic patients.There is no difference in the predictive efficacy of the two diagnostic methods for early diabetic kidney damage.