Ogamba et al.,; J. Adv. Med. Med. Res., vol. 35, no. 22, pp. 129-136, 2023; Article no.JAMMR.

105680

Volume 35, Issue 22, Page 129-136, 2023; Article no.JAMMR.105680

ISSN: 2456-8899
(Past name: British Journal of Medicine and Medical Research, Past ISSN: 2231-0614,
NLM ID: 101570965)

RELATIONSHIP BETWEEN GLYCATED HAEMOGLOBIN AND RENAL FUNCTION

IN DIABETIC PATIENTS IN PORT HARCOURT, NIGERIA

1Ogamba Michael Ikechukwu, 2Kiyesi Adekemi 3Otokunefor Ochuko4Ugwu Adaeze Sylvia

1Department of Chemical Pathology, Faculty of Basic Clinical Sciences, College of Medicine and Health Sciences, PAMO
University of medical sciences, Port Harcourt
2Department of Chemical Pathology, Faculty of Basic Clinical Sciences, College of Medical Sciences, Rivers State University,

Port Harcourt, Rivers State, Nigeria.

3Department of Chemical Pathology, Faculty of Basic Clinical Sciences, College of Medicine and Health Sciences, University of

Port Harcourt, Port Harcourt, Rivers State, Nigeria.

4Department of Internal Medicine, College of Medicine and Health Sciences, University of Port Harcourt, Port Harcourt, Rivers

State, Nigeria.

ABSTRACT
Background: Diabetes mellitus (DM) is a metabolic disorder characterized by abnormal glucose concentrations in
the bloodstream, leading to chronic hyperglycemia. It is a major cause of kidney disease globally and results in
significant healthcare costs and complications in various organs. The current study was carried out to assess the
association of glycated haemoglobin and renal function in diabetic patients.
Method: Biochemical profile, such as, fasting blood glucose, post-prandial blood glucose, glycated haemoglobin,
Sodium, Potassium , Biocarbonate, serum urea and creatinine were obtained from the subjects using standard methods
from 164 apparently health persons.
Results: The respondents mostly had normal FBG level and 2-hours post-prandial glucose test, 147(89.63%) and 119
(72.56%) respectively, and the glycated haemoglobin concentration was normal in majority of them, 84(51.22%). The
concentration of sodium was normal in most respondents, 118(71.95%), just like potassium 121(73.78%), with
bicarbonate also mostly normal, 158(96.34%), urea being normal for all respondents, 164(100.00%).
Conclusion: The association between glycated haemoglobin and renal parameters were significant
Keywords: Diabetes mellitus, Hyperglycemia, Kidney disease, Glycated hemoglobin, Metabolic disorder
1.0 INTRODUCTION
Diabetes mellitus (DM) is linked to abnormal glucose renal disease (ESRD) in dialysis populations. About
levels in the bloodstream. It is a metabolic disorder 25%-45% of type 2 DM patients may develop
with chronic hyperglycemia due to irregularities in clinically evident diabetic nephropathy due to
carbohydrate, protein, and fat metabolism.1 DM can be glycosylation of tissue proteins and microvasculature
caused by insufficient insulin secretion, impaired complications.1In the USA, and other developed
insulin activity, or both, leading to severe countries, DM is the most common cause of chronic
cardiovascular, renal, neurologic, and retinal kidney disease, with approximately 400,000 people
complications.2,3 Globally, DM is a major cause of undergoing renal dialysis annually due to DM. 2 The
kidney disease, accounting for about 45% of end-stage management of DM and its complications costs the US

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government approximately 15 billion dollars 2.0 METHOD

4
annually. In India, the prevalence of DM is estimated 2.1 Study Area
to rise from 40.6 million in 2006 to 79.4 million by A patient-based cross-sectional study was conducted
2030.5 in the metabolic diseases section of the Medical Out-
Glycated hemoglobin (HbA1c) is a measure of glucose patient Clinic (MOPC) of the University of Port
control, especially in type 2 DM patients. It forms Harcourt Teaching Hospital (UPTH), Port Harcourt,
when glucose attaches to hemoglobin molecules Nigeria among long-term diabetic patients between
irreversibly, remaining in red blood cells throughout December 2021 and May 2022.
6
their lifespan. Current guidelines recommend 2.2 Study Sample
maintaining HbA1c levels around 7% or lower to The minimum sample size for this study was
prevent or delay DM complications, including kidney calculated from the prevalence of a related study by
7
disease. The prognostic role of HbA1c in stage 5 CKD Abdelsalam and Me.14 which reported 12.1%. Using
is uncertain, but it has shown effectiveness in stages 1- the sample size determination formula; n= Z2pq/d2 by
4, as impaired glucose metabolism can alter HbA1c Kirkwood and Sterne15the sample size was calculated
levels.8Research indicates that poorly controlled as 164. Systematic random sampling technique was
hyperglycemia in DM promotes advanced glycation, used to recruit males and females aged 30-55 years
leading to complications like increased production of old, without co-morbid conditions such as liver
growth factors, protein deposition, and reduced diseases, endocrine diseases, and malignancies.
glomerular filtration rate.9Studies have demonstrated 2.3 Study Procedure
the benefits of intensive glycemic treatment in Blood biochemical parameters, such as, fasting blood
reducing microalbuminuria and macroalbuminuria, glucose, 2hrs post-prandial blood glucose, glycated
but its effects on clinical renal outcomes remain haemoglobin, serum urea and creatinine were obtained
inconclusive.10Patients with late-stage chronic kidney from the subjects using standard methods.
disease may experience improved glycemic control 2.4 Data Analysis
11
through assessment of random blood glucose. The Data was analyzed with statistical package for social
prevention of diabetic kidney disease may not be the sciences (SPSS) version 22, in which descriptive and
primary aim of treating chronic kidney disease stage 5 inferential statistics were performed and the results
in DM patients, but it can avert many complications of presented in tables as frequency and percent, with Chi-
hyperglycemia, even at an advanced stage.1In patients square, analysis of variance and test of significance
with chronic kidney disease, there may be a reduction conducted.
in glycated hemoglobin due to red blood cell fragility,
2.5 Ethical Considerations
altering the course of glycosylation.12The
Approval was obtained from the research and ethics
measurement of serum urea and creatinine is used to
committee of UPTH, while written Informed consent
assess renal involvement in DM, with serum creatinine
was obtained from every participant before
being more significant in this regard.13 The current
commencement of the study. All personal identifying
study was carried out to assess the Relationship
information was not collected and kept confidential.
Between Glycated Haemoglobin and Renal Function.

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3.0 RESULTS
Table 1Socio-demographic characteristics

Frequency
Variables Percent (%)
(n=164)
Gender
Male 86 52.44
Female 78 47.56
Level of education
None 13 7.93
Primary 37 22.56
Secondary 53 32.32
Post-secondary 61 37.2
Monthly income
Less than #5,000 7 4.27
#5,000-#20,000 52 31.71
#20,100-#50,000 82 50.00
Above #50,000 23 14.02
Occupation
Business 49 29.88
Artisan 31 18.90
Civil/public servant 75 45.73
Others (please specify) 9 5.49
Religion
Christian 131 79.88
Muslims 18 10.98
Traditionalists 4 2.44
Others (please specify) 11 6.71
Tribe
Ijaw 97 59.15
Igbo 41 25.00
Hausa 6 3.66
Yoruba 7 4.27
Others (please specify) 13 7.93

The table above shows that the study had more male participation, 86(56.44%), mostly had post-secondary education,
61(37.20%), with the least having no education, 13(7.93%), while 82(50.00%) respondents, being the most, had
monthly income of #20,000-#50,000 and the least, 7(4.27%) had monthly income less than #5,000. The table also
showed that they were mostly civil/public servants, 75(45.73%), followed by those in business, 49(29.88%), almost
all Christians by religion, 131(79.88%), with the least being traditionalists, 4(2.44%) and mostly of Ijaw ethnic
extraction, 97(59.15%).

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Table 2 Biochemical indices

Variables Frequency (n) Percent (%)
Fasting blood glucose
Low 6 3.66
Normal 119 72.56
High 39 23.78
2 hours post-prandial
Normal 147 89.63
Abnormal 17 10.37
Glycated heamoglobin
Low 1 0.61
Normal 84 51.22
High 79 48.17

Table 2 above shows that most participants in the study had normal FBG level, 119(72.56%), with the least having
low FBG, 6(3.66%), and the 2-hours post-prandial test is being mostly normal, 147(89.63%). The value for glycated
haemoglobin concentration was normal in majority of respondents, 84(51.22%) and high, 79(48.17%).

Table 3Renal indices

Variable Frequency (n) Percent (%)
Sodium
Low 2 1.22
Normal 118 71.95
High 44 26.83
Potassium
Low 41 25.00
Normal 121 73.78
High 2 1.22
Bicarbonate
Low 6 3.66
Normal 158 96.34
Urea
Normal 164 100.00
Creatinine
Normal 115 70.12
High 49 29.88

Table 3 above is the renal function of the respondents in this study and shows that the concentration of sodium was
normal in majority of the participants, 118(71.95%), but low in two (1.22%) persons, potassium was also normal in
majority of them, 121(73.78%) and high in 2(1.22%) respondents. Bicarbonate concentration was mostly normal,
158(96.34%), urea was normal for all the respondents, 164(100.00%).

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Table 4 Association between glycated haemoglobin and renal parameters

Glycated haemoglobin Df Chi-square

Sodium 1 0.000
Potassium 1 0.000
Bicarbonate 1 0.000
Urea 1 0.000
Creatinine 1 0.000

Table 4 above is the association between glycated haemoglobin and renal parameters in the respondents. All the
parameters show strong statistical significance with the glycated haemoglobin, 0.000.

Table 5. Association between glycated haemoglobin and biochemical parameters

Glycated haemoglobin Df Chi-square

Fasting blood glucose 1 0.000

2 hour post-prandial 1 0.000

Table 5 above shows strong statistical significance between glycated haemoglobin and biochemical parameters of the
respondents.

4.0 DISCUSSION in tandem with the tenets of global guidelines for

monitoring diabetes mellitus type 2 management.
Most of the respondents (72.56%), in this study had
Also, the significant number of respondents with high
normal FBG level, with the 2-hours post-prandial
glycated haemoglobin in this study confirms the
glucose test also being mostly normal(89.63%). These
findings of Mak and Kalantar-Zadeh,19 which posits
findings are those of good glycemic control. It agrees
that even in good glycemic control, involvement of the
with those of Ismail-Beigi10 , Duckworth16 and Group
kidney, chronic kidney disease, can cause some form
17,18
, which reported that in good glycemic control,
of transient glucose tolerance, thus, poor glycemic
FBG and 2HPP concentrations skews towards
control in some patients. The creatinine among
normalcy, and the glycated haemoglobin
respondents shows 29.88% of hypercreatininemia.
concentration was normal in majority of respondents
The findings agrees with that of Amartey et al 20
(51.22%) and high in 48.17%. Normal glycated
regarding a prevalence of 25% in diabetics. This is as
haemoglobin is considered between 4% and 5.6% for
a result of reduced renal excretion rate in some of the
which complications of the disease condition can be
diabetics. The renal function parameters in this study
averted19.6 The normal glycated haemoglobin is
shows that the concentration of sodium was normal in
indicative of good glycemic control and therefore, is

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majority of the participants (71.95%), but low in This finding is in conformity with the finding of Lee,24
1.22% of the participants, potassium was also normal which reported that there is a stronger negative effect
in majority (73.78%) of participants and high in 1.22% on the deterioration of the eGFR at stage 3 and 4 of
of respondents. These findings are in tandem with chronic kidney disease in patients with higher glycated
good glycemic control in diabetic patients. haemoglobin level, indicative of poor glucose control.
Specifically, increased potassium in these patients can This means that high level of glycated haemoglobin
lead to diabetic ketoacidosis, which, is a dangerous correlates with increased potential of chronicity in
consequence. Thus, the finding conforms with that of kidney disease, as well as more damage to the
21 12
Gonzalez et al. , but differs from Yokoyama, in constituent parts of the kidney. This study shows
addition to the finding that this condition could strong statistical significance between glycated
damage the microvasculature and lead to albuminuria. haemoglobin and biochemical parameters of the
22
It also agrees with the findings of Kuoet al. , which respondents (p<0.0001). This finding is in tandem
mentioned the increased potential of renal with the finding of Subramanyam et al.1 which
involvement immediately glycated haemoglobin reported that both poor glucose control and the
begins to form in diabetic patients and worsens in poor consequent formation of glycated haemoglobin, in the
glycemic control. This study also observed that course of the diabetic disease, expedites the incidence
bicarbonate concentration was normal in majority of of involvement of other organs, such as the eye,
participants (96.34%), urea was normal for all the kidney, liver and thyroid gland, which are
respondents. The findings agree with those of spontaneously damaged with progression of the
Gonzalez et al. (2021),21and Zimmet al.13on one hand disease.
22
but disagree with those of Kuoet al. and Shurraw et
5.0 CONCLUSION
al.,23 The difference may have resulted from
difference in study settings from this study and Glycated haemoglobin is crucial to monitoring
possible sample size and number of health care glucose control in diabetes mellitus with renal
facilities utilized in their studies, as against the impediment. It’s poor control manifests in the
singular setting and small sample size used in this circulation and affects the microvasculature of most
study. This will require further studies to evaluate it. organs and systems. It is therefore significant to every
required measure to ensure effective and efficient
The association between glycated haemoglobin and
control of the molecule, as this will reduce the
renal parameters of the respondents show strong
morbidity and mortality associated with the disease.
statistical association with the glycated haemoglobin.
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