European Journal of Cardiovascular Medicine

Introduction: Some studies have reported an association between ischaemia of the macula as seen on fundus fluorescein angiography (FFA) with diabetic nephropathy in diabetes mellitus. They have further postulated that finding of macular ischaemia on FFA can be used to predict the onset of diabetic nephropathy in diabetes mellitus. This study was undertaken to explore association between macular ischemia and nephropathy in diabetes mellitus in a rural population of Maharashtra. Aims and objectives: To explore for any correlation between ischaemic maculopathy due to diabetes and diabetic nephropathy and to find out whether ischaemic maculopathy can be used as a marker for diabetic retinopathy.

Introduction: Chronic kidney disease (CKD) is characterized by a progressive loss of renal function that often leads to end-stage renal disease (ESRD), high risk for cardiovascular disease, and high mortality. Diabetes mellitus is a growing epidemic and is the most common cause of chronic kidney disease (CKD) and kidney failure. Diabetic nephropathy affects approximately 20–40 % of individuals who have diabetes, making it one of the most common complications related to diabetes. Screening for diabetic nephropathy along with early intervention is fundamental to delaying its progression in conjunction with providing proper glycemic control. The kidneys play a vital role in the excretion of waste products and toxins such as urea, creatinine and uric acid, regulation of extracellular fluid volume, serum osmolality and electrolyte concentrations, as well as the production of hormones like erythropoietin and 1,25 dihydroxy vitamin D and renin. Material and Methods: This is a prospective and observational study was conducted in the Department of Biochemistry at Tertiary care Teaching Hospital over a period of 1 year. Either Gender aged between 18 and 70 years. The study participants were signed written informed consent before the start of data collection. The study participants were selected based on a convenient sampling technique and total of 120 study participants were included.  Subjects suffered from an acute infection and critically sick individuals were excluded from the study.  Results: There was a significant difference  between case when compared to  Control in Male and female.  There was a significant difference in case group in FBS, HbA1c, Urea and S. Creatinine when  compared to control group and no significant difference between both groups in SBP and DBP. Conclusion: The present study it can be inferred that serum urea and creatinine levels were significantly higher in CKD subjects then control subjects. Increased amount of urea and creatinine levels were seen only in CKD subjects and no difference was seen in controls. Thus, it can be recommend that urea and creatinine values can be used for screening of renal status in CKD subjects

Background: This study was conducted to evaluate the serum vitamin D levels in patients with type 2 diabetes mellitus with and without nephropathy. Methods: This was a hospital-based cross-sectional case control study conducted among 100 patients who attended OPD and IPD at the Department of Medicine, Dr. B.R. Ambedkar Medical College and Hospital, Bangalore, over a period of 18 months from December 2020 to May 2022, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: In comparison between diabetic nephropathy and non-diabetic nephropathy between both groups, a statistically significant difference (p<0.001) was noted between them with regard to serum creatinine, eGFR, UACR and vitamin D levels, suggesting that the diabetic nephropathic group has increased creatinine levels, highly reduced eGFR, highly elevated UACR and significantly decreased vitamin D levels, which are not present in the non-diabetic nephropathy patients. The eGFR and vitamin D levels were compared among the diabetic nephropathic subjects. The eGFR was split into three groups and by the ANOVA test measure, a significant association was obtained between them suggesting decreased eGFR also decreases vitamin D levels. On correlating vitamin D levels with serum creatinine and UACR a statistically significant (p<0.001) strong negative correlation was obtained (0.85 and 0.91) respectively. Conclusion: The study found that individuals with diabetic nephropathy had a higher prevalence of vitamin D insufficiency. However, at more advanced stages of diabetic kidney disease, their severity is more prevalent. Patients with CKD (Chronic Kidney Disease) should get information from health care providers on vitamin D monitoring and its dietary sources.

Introduction: Prevalence of Diabetes Mellitus is rapidly increasing in India. So are its complications, of which nephropathy is very common. Identifying these complications at early stage becomes crucial. One such proposed hypothesis is based on inflammatory markers. Their association with cardiac complications is proven. The current study is planned with this background. Objectives: To assess the serum high sensitivity C reactive protein levels in patients with type 2 diabetes mellitus with diabetic nephropathy and to estimate the levels of serum high sensitivity C reactive protein in different stages of diabetic nephropathy. Methodology: Cross sectional study design was adopted to conduct the study in a government tertiary care setting i.e. K.R. Hospital. Study population included all patients, aged more than 18 years with DM type 2 who visited the study setting (OP /IP). Patients having Congestive cardiac failure, Liver disease, Infections, Autoimmune diseases, organ damage or Cancer or habit-forming drug intake were excluded from the study. Sample size was calculated to be 60. Data was collected using pre-tested, semistructured questionnaire which included detailed history, clinical examination and investigation findings; entered in Excel and analyzed using SPSS. Results: Mean age was 60.23 years. Males constituted 70%. Mean duration of DM was 13.02 years. 40% patients were in DN stage 3. 43% patients had microalbuminuria and 30% had macroalbuminuria. S. Creatinine was elevated in one-third patients. Overall, mean hs-CRP was 9.5 (3.3) mg/L; and mean hs-CRP among patients with DN stage -1, 2, 3 and 4 respectively, were 5.1, 9.0, 12.4 and 13.1 mg/L respectively. The difference between the means was statistically significant. Conclusion: There was a significant correlation between mean Hs CRP levels and clinical stages of the diabetic nephropathy. Also, hs-CRP significantly correlates with elevated PPBS, HbA1C, S. Creatinine, and eGFR levels. Hence hs-CRP may be used as a
marker to assess development and severity of the diabetic complications like diabetic nephropathy.

This community-based observational study explored the relationship between circulating free triiodothyronine (FT3) levels and the progression of diabetic nephropathy in patients with Type 2 diabetes mellitus over one year. A total of 482 participants from Mayurbhanj, Odisha were stratified into quartiles based on their FT3 levels. The results indicated that those in the lowest FT3 quartile exhibited significantly greater progression of nephropathy, as evidenced by declines in estimated Glomerular Filtration Rate (eGFR) and increases in urine albumin to creatinine ratio (ACR), compared to those in higher quartiles. These findings suggest that FT3 could serve as a valuable prognostic marker for diabetic nephropathy progression, emphasizing the need for further research into thyroid function management as a component of diabetes care

Background In this study, we wanted to assess the diastolic dysfunction in type 2 diabetic patients using Doppler echocardiography. Methods: This was a hospital based cross-sectional study conducted among 100 patients with Type 2 Diabetes Mellitus (DM) who exhibited diastolic dysfunction, admitted to the Department of Medicine, of a tertiary care hospital, over a period of 2 years after obtaining clearance from institutional ethics committee and written informed consent from the study participants.

Results

In associations with Diastolic Dysfunction

Diastolic dysfunction was significantly associated with age (p=0.038). Older age groups (51-60 years and >60 years) had higher proportions of advanced diastolic dysfunction (Grades III and IV). Males were more likely to have milder forms of diastolic dysfunction, while females had     higher proportions in the severe grades (p=0.037). A significant association was observed between rural residency and severe diastolic dysfunction (p=0.034), with rural participants showing higher prevalence of Grade III and IV dysfunction. Higher triglyceride levels were associated with increasing diastolic dysfunction severity (p=0.006). Advanced diastolic dysfunction was significantly associated with microalbuminuria and macroalbuminuria (p=0.004), indicating kidney damage. Higher HbA1c levels were associated with more severe diastolic dysfunction (p=0.000), reflecting poor glycemic control. Longer duration of diabetes was significantly associated with worsening diastolic dysfunction (p=0.049). Overweight and obese individuals were more likely to have advanced diastolic dysfunction (p=0.000). Severe forms of neuropathy, particularly autonomic neuropathy, were associated with higher grades of diastolic dysfunction (p=0.000). Conclusion Age, sex, region, and duration of diabetes all showed a significant relationship with the severity of diastolic dysfunction. Older individuals, females, and urban residents were at higher risk for more advanced stages of diastolic dysfunction. Glycemic control (HbA1c) was a key factor, with poorer control being strongly associated with more severe dysfunction. This highlights the importance of achieving good glycemic control to prevent cardiac complications. Triglyceride levels and BMI were also significantly associated with diastolic dysfunction, pointing to the importance of managing dyslipidemia and obesity in diabetic patients. Diabetic nephropathy, retinopathy and neuropathy were more prevalent in those with advanced diastolic dysfunction, indicating that cardiovascular and renal complications often coexist in diabetic populations.

Background: Type 2 diabetes mellitus (T2DM) is a global health concern, with microvascular complications such as diabetic nephropathy contributing to significant morbidity. Glycated haemoglobin (HbA1c) is a glycemic control marker, while albuminuria is an early indicator of renal dysfunction. Their interplay remains a crucial factor in diabetes management. Methods: This cross-sectional study included 150 patients with T2DM at Sheth V. S. General Hospital, Ahmedabad. Data collection included demographic parameters, disease duration, biochemical markers (HbA1c, lipid profile, serum creatinine, urine albumin-creatinine ratio), and complications such as neuropathy, retinopathy, and hypertension. Results: Among the participants, 66.6% had normoalbuminuria, 24% had microalbuminuria, and 9.3% had macroalbuminuria. Higher HbA1c levels (>7%) were significantly associated with microalbuminuria (75%) and macroalbuminuria (50%) (p<0.05). Dyslipidemia was prevalent, with 75% of microalbuminuric patients having total cholesterol >200 mg/dL. Hypertension was significantly linked to albuminuria (p=0.0382). Retinopathy was more frequent in microalbuminuric patients (p=0.0305). Conclusion: Poor glycemic control, dyslipidemia, and hypertension were strongly associated with albuminuria in T2DM patients. Early screening and aggressive management strategies targeting glycemic and lipid control may help mitigate renal complications

Background: Two of the most prevalent metabolic disorders in the world are diabetes mellitus (DM) and hypothyroidism. Both illnesses are becoming much more common, and if left untreated, they can have long-term consequences. Aim: this study aimed to evaluate the relationship between thyroid related hormones and vascular complication in type 2 diabetes mellitus patients in a tertiary level hospital. Methods: This cross-sectional study included one hundred Types 2 DM patients. Thyroid function tests were performed on the subjects. TSH was divided into three levels: 0.27–2.49 mU/L, 2.5–4.2 mU/L, and >4.2 mU/L. Every participant had their risk for diabetic retinopathy, diabetic neuropathy, and diabetic nephropathy evaluated. TSH levels and microvascular consequences of type 2 diabetes were examined in relation to each other. Results: The TSH level and HbA1c did not significantly correlate (P>0.05). Microvascular disease affected 72% of the patients overall. There was no discernible correlation between TSH levels and neuropathy or retinopathy. There was no statistically significant correlation (P>0.05) between the presence of microalbuminuria and macroalbuminuria and elevated TSH levels. Higher TSH levels were shown to be significantly correlated with both diabetic kidney disease and reduced GFR (P<0.05). Conclusions: Since elevated TSH levels in Type 2 DM patients may be a sign of underlying microvascular problems, it is desirable to screen all patients for thyroid dysfunction.

Background: A Rising Health Challenge in Andhra Pradesh. Chronic kidney disease (CKD) represents a major global health concern, with its increasing prevalence creating substantial challenges for healthcare systems worldwide. In Andhra Pradesh, a southern state in India, CKD is becoming an escalating public health issue. This study was conducted to evaluate the clinical profile of CKD patients attending Government Medical College, Kadapa, Andhra Pradesh. Specific objectives included identifying the underlying etiologies of CKD, assessing associated comorbid conditions, and examining the clinico-hematological correlation between risk factors and complications in individuals affected by chronic kidney disease. Materials and methods: Study design: Prospective observational study.  Study period: 1 year. Place of study: Department of General Medicine, Government General Hospital, Kadapa. Source of data: OPD and IPD admissions in General Medicine Department (GMC), GGH Kadapa. Sample size: 100 patients. Patients presenting to the Department of General Medicine were evaluated through a structured questionnaire, followed by a comprehensive history-taking and physical examination. Key clinical parameters recorded included a history of diabetes mellitus, hypertension, smoking habits, and alcohol consumption. Vital signs and systemic examination findings were documented. Relevant investigations were carried out.  Results: Alcohol use is strongly linked to progressive CKD (Stages 3A-5). Non-alcoholics are more common in Stage 2 (early CKD) but also present in late stages, indicating alcohol exacerbates kidney damage.  Diabetes is a major driver of CKD progression, with most cases in advanced stages (3B-5). Non-diabetics are rare, suggesting diabetes is a primary risk factor in this population.  Hypertension is strongly associated with late-stage CKD (stages 4-5). Non-hypertensive individuals are more common in early stages (2-3B), but hypertension dramatically increases the risk of kidney failure (Stage 5). Conclusion: This study highlights chronic kidney disease (CKD) as a major health issue in Andhra Pradesh, driven primarily by diabetes (69%) and hypertension (56%). Most patients were middle-aged, rural, and economically disadvantaged, with late-stage diagnosis (66% in Stages 3B–5). Key risk factors included smoking, alcohol use, and groundwater consumption, while contracted kidneys (81%) and severe albuminuria indicated advanced disease. 

Background: Metabolic syndrome is characterized by a cluster of conditions including obesity, hypertension, and dyslipidaemia and insulin resistance often leading to cardiovascular complications. Micro albuminuria and hyperuricemia have been identified as potential markers of renal and metabolic dysfunction in these patients. Aims: Hyperuricemia is an independent risk factor for kidney dysfunction in diabetic patient. On the other hand micro albuminuria is considered as the predictor of early stages of diabetic nephropathy. We investigated the correlation between hyperuricemia and albuminuria in patients with Metabolic Syndrome. The aim of this study is to evaluate the association between serum uric acid & urinary Albumin to Creatinine Ratio (ACR) among patients with Metabolic Syndrome. Materials and methods: This study is a hospital-based, observational (cross-sectional) study to evaluate serum uric acid level & urinary Albumin Creatinine Ratio (ACR) in patients of Metabolic Syndrome in both younger & older age group (40 to 80 years). The study also evaluated the relation between normo albuminuria (ACR <30 ug/ mg), micro albuminuria (ACR between 30 ug/mg & 299 ug/mg) & macro albuminuria (ACR ≥ 300ug/mg) with serum uric acid levels. Although we have contemplated a study both in younger & older age group but eventually this was not done as the number of patients with Metabolic Syndrome in younger age group was inadequate and those who are younger than 40 years were excluded. Result: It is revealed that the patient group macroalbuminuria percentage is 19%, microalbuminuria percentage is 32 % and normalbuminuria percentage is 49 %, the patients, hyperuricemia percentage is 44 %, normouricemia percentage is 56 %, the patients with  Anti lipid therapy YES percentage is 48 %, No percentage is 52 %. Conclusion: We conclude that, the patients with Metabolic Syndrome showed a strong correlation between hyperuricemia and FBG, LDL, and triglycerides. Age, sex, weight, height, BMI, hypertension, and HDL were not shown to be significantly correlated with hyperuricemia. In individuals with Metabolic Syndrome, urinary ACR strongly linked with FBG, LDL, and triglycerides. There was no discernible relationship between urine ACR and BMI, HDL, age, sex, weight, height, or hypertension. Serum uric acid level and urine albumin creatinine ratio strongly associated in patients with metabolic syndrome. According to this study, individuals with Metabolic Syndrome who have hyperuricemia are more likely to have albuminuria, and patients with type 2 diabetes mellitus have serum uric acid as an independent predictor of urine ACR.

Background: Type-2 Diabetes Mellitus (T2DM) is a chronic condition that has reached epidemic proportions worldwide, affecting millions of individuals and representing a significant public health burden. The ratio of serum uric acid to creatinine (SUA/Cr ratio) has been proposed as a novel marker for assessing the risk of kidney damage and other metabolic disturbances, including in diabetic patients. Elevated SUA/Cr ratios have been linked to the early stages of diabetic nephropathy, including proteinuria, and may help identify individuals at risk before significant kidney dysfunction develops. Objectives: To estimate the correlation between serum uric acid to creatinine ratio and proteinuria in Diabetes Mellitus patients Methods: It’s a cross-sectional study conducted on 60 Diabetic patients visiting to K R Hospital, Mysuru from April 2023 to October 2024. Serum uricacid and creatinine ratio, proteinuria will be measured and then correlating these values with diabetic patients. Results

The analysis revealed a positive correlation (r = 0.42) between the serum uric acid to creatinine ratio and proteinuria in patients with type 2 diabetes mellitus, with a statistically significant p-value of 0.05. This suggests that as the serum uric acid to creatinine ratio increases, the level of proteinuria also tends to rise, indicating a potential link between this biochemical ratio and renal involvement in diabetic individuals. Conclusion: This study highlights the importance of early detection and monitoring of kidney disfunction in individuals with Type-2 DM particularly by using SUA/Cr ratio and proteinuria as a potential marker and demonstrates clear relationship between SUA/Cr ratio and proteinuria.

Diabetes mellitus, the most common endocrine disorder is characterised by metabolic abnormalities and long-term microvascular and macrovascular complications. Diabetic nephropathy is first recognized as proteinuria. The reason for performing the test for proteinuria is for the early detection of diabetic nephropathy in a patient with diabetes for many years.  Aim and Objectives: 1. Screening of microalbuminuria in patients with diabetes mellitus. 2. To correlate microalbuminuria with the duration of diabetes mellitus and association with other microvascular and macrovascular complications of diabetes mellitus. Materials and Methods: 82 patients were selected randomly selected from outpatient and medical wards of a tertiary care hospital. Patients will be considered diabetic as per WHO criteria for diagnosis of diabetes mellitus All patients were evaluated in detail along with the testing for microalbuminuria with dipsticks (Micral). Results: The overall occurrence of microalbuminuria was 41.41 %. The occurrence of microalbuminuria showed a direct relationship with increasing age and increasing duration of diabetes since diagnosis. An HbA1c value above 7% is associated with 50% or higher incidence of microalbuminuria. The incidence of microalbuminuria is significantly associated with the presence of retinopathy, peripheral neuropathy, ischemic heart disease and hypertension.  Conclusions: Screening for Microalbuminuria in diabetic patients is essential for intervention and prevention of further complications like end stage renal disease and other cardiovascular risk factor.  By Early detection of Microalbuminuria in diabetic patients, various complications can be prevented by good control of sugar.