EYE AND KIDNEY COMPLICATION IN EYE AND KIDNEY COMPLICATION IN PATIENTS WITH TYPE 1 DIABETES MELLITUSPATIENTS WITH TYPE 1 DIABETES MELLITUS

Bùi Phương Thảo*, Nguyễn Trần Ngọc Hiếu**, Vũ Chí Dũng*, Bùi Phương Thảo*, Nguyễn Trần Ngọc Hiếu**, Vũ Chí Dũng*,

Nguyễn Ngọc Khánh*, Cấn Thị Bích Ngọc*, Trương Ngọc Dương**Nguyễn Ngọc Khánh*, Cấn Thị Bích Ngọc*, Trương Ngọc Dương**

** National Hospital of Pediatrics National Hospital of Pediatrics

**** Military Medical University – Military hospital 103Military Medical University – Military hospital 103

BackgroundBackground

-DM 1: better glucose control, glucometer, insulin pen, DM 1: better glucose control, glucometer, insulin pen,

HbA1c -> improvement life expectancyHbA1c -> improvement life expectancy

-Eye complication: most common cause of blindness in Eye complication: most common cause of blindness in

DM1 patients, closely related to glucose control, DM DM1 patients, closely related to glucose control, DM

duration. duration.

-Kidney complication: important cause of end stage of renal Kidney complication: important cause of end stage of renal

failure, dissability and death.failure, dissability and death.

-Goal: Evaluate status of eye and kidney complication in Goal: Evaluate status of eye and kidney complication in

patients with DM 1patients with DM 1

Patients and methodPatients and method

PatientsPatients

- 81 patients DM 1 in National Hospital of Pediatrics (NHP) - 81 patients DM 1 in National Hospital of Pediatrics (NHP)

diagnosed and treated from June 2011 to July 2012.diagnosed and treated from June 2011 to July 2012.

Inclusion criteriaInclusion criteria

Patients with DM 1Patients with DM 1

+ female and male+ female and male

+ newly diagnosed and previously diagnosed+ newly diagnosed and previously diagnosed

+ with or without complication+ with or without complication

Exclusion criteriaExclusion criteria

- Hematologic disorder- Hematologic disorder

- Malignant disease- Malignant disease

- Immunologic disorder- Immunologic disorder

- patient/family do not agree to participate in study- patient/family do not agree to participate in study

Patients and methodPatients and method

MethodMethod

-Research design and sample collection: Research design and sample collection: prospective and prospective and

retrospective, random collection.retrospective, random collection.

- Research parameters:- Research parameters:

+ Eye complication: examination for cataract, fundi + Eye complication: examination for cataract, fundi

examination to find retinopathy (proliferative or non-proliferative)examination to find retinopathy (proliferative or non-proliferative)

+ Kidney complication: according to chronic renal disease + Kidney complication: according to chronic renal disease

classification - NKF KDOQI, based on classification - NKF KDOQI, based on Glomerular Filtration Glomerular Filtration

RateRate

+ Evaluate renal complication (MAU), eye complication + Evaluate renal complication (MAU), eye complication

according to Vietnam Endocrine-Diabetes Association criteria.according to Vietnam Endocrine-Diabetes Association criteria.

Patients and methodPatients and method

Result and discussionResult and discussion

Diabetes durationDiabetes duration

• 42 bệnh nhân chẩn đoán lần đầu 42 bệnh nhân chẩn đoán lần đầu

Time

(year)

Cases

(n=81)

%

≤ 1 42 51,8

1-5 14 17,3

6-10 14 17,3

> 10 11 13,6

Mean 6,8±6,9

Result and discussionResult and discussion

Proportion of eye and kidney complicationProportion of eye and kidney complication

Lievre M.: Lievre M.: 25,4%25,4% eye complication, eye complication, 28,3%28,3% kidney complication kidney complication

Bognetti E.: Bognetti E.: 22,7% 22,7% eye complication,eye complication, 11%11% kidney complication kidney complication

Lepore G.: Lepore G.: 24,4%24,4% kidney complication kidney complication

Complication Cases (n=81) %

Eye 19 23,5

Kidney 18 22,2

Eye and kidney 11 13,6

Result and discussionResult and discussion

Proportion of complication to diabetes durationProportion of complication to diabetes duration

** p** p4-14-1<0,05, p<0,05, p4-24-2<0,05, p<0,05, p3-13-1<0,05, p<0,05, p3-23-2<0,05. *** p<0,05. *** p4-14-1<0,05<0,05

. Bouhanick B.: eye (p<0,02), kidney (p<0,001). Chirallon JJ. : OR=1,19. Bouhanick B.: eye (p<0,02), kidney (p<0,001). Chirallon JJ. : OR=1,19

Complication

≤ 1 year(n=42) (1)

>1 – 5 years(n=14) (2)

6 – 10 years(n=14) (3)

>10 years(n=11) (4)

n % n % n % n %

Eye 3 7,1 1 7,1 7 57,1 8 72,7**

Kidney 3 7,1 3 21,4 3 21,4 9 81,8*

Result and discussionResult and discussionEye complication according to diabetes durationEye complication according to diabetes duration

* p* p4-14-1<0,05, p<0,05, p4-24-2<0,05.<0,05. ** p** p4-14-1<0,05<0,05

≤ 1 year

(n=42) (1)

>1 – 5 years

(n=14) (2)

6 – 10 years

(n=14) (3)

>10 years

(n=11) (4)

n % n % n % n %

Proliferative

retinopathy0 0 0 0 1 7,1 4 36,4

Non-proliferative

retinopathy3 7,1 1 7,1 3 21,4 3 27,3

Combined 3 7,1 1 7,1 4 28,6 7 63,6*

Cataract 1 2,4 0 0 2 14,3 5 45,5**

Result and discussionResult and discussion

Kidney complication according to diabetes durationKidney complication according to diabetes duration

* p* p4-14-1<0,05, p<0,05, p4-24-2<0,05, p<0,05, p4-34-3<0,05<0,05

≤ 1 year(n=42) (1)

>1 – 5 years(n=14) (2)

6 – 10 years(n=14) (3)

>10 years(n=11) (4)

n % n % n % n %

Edema 4 36,4

Proteinuria (+) 1 7,1 1 7,1 4 18,2

MAU (+) 3 7,1 3 21,4 3 21,4 9 81,8*

Increased Urea 5 45,5

Increased Creatinine 5 45,45

Result and discussionResult and discussion

Proportion of choric renal disease according to Proportion of choric renal disease according to NKF/KDOQINKF/KDOQI

Stages Cases (n=81) %

1 8 9,9

2 5 6,2

3 5 6,2

4 0 0

5 0 0

Result and discussionResult and discussion

HbA1c level according to diabetes duration HbA1c level according to diabetes duration

* p* p4-14-1<0,05<0,05

≤≤1 year 1 year

(n=42) (1)(n=42) (1)

1 – 5 years1 – 5 years

(n=14) (2)(n=14) (2)

6 – 10 years6 – 10 years

(n=14) (3)(n=14) (3)

>10 years>10 years

(n=11) (4)(n=11) (4)

HbA1c (%)8,58±2,43 9,03±2,54 9,67±2,32

10,14±2,7

*

Result and discussionResult and discussionRelationship between eye complication and HbA1cRelationship between eye complication and HbA1c

Chirallon JJ: OR = 3,3Chirallon JJ: OR = 3,3

Eric Kilpatrick: OR=1,7Eric Kilpatrick: OR=1,7

HbA1cWithout eye complication

(n= 62)

With eye complication

(n= 19)OR

≤7,5% 2540,3%

315,8%

OR=3,6CI(1,91-15,25)

>7,5%37

59,7%16

84,2%

X±SD (%) 8,77±2,55 9,99±2,67 p<0,05

Result and discussionResult and discussionRelationship between kidney complication and HbA1cRelationship between kidney complication and HbA1c

Eric Kilpatrick: OR=1,5Eric Kilpatrick: OR=1,5

Fawar Amari: Fawar Amari: OR=1,5OR=1,5

HbA1cWithout kidney complication

(n= 62)

With kidney complication

(n= 18)OR

≤7,5% 2438,1%

422,2% OR=2,2

CI(1,12-7,96)>7,5% 39

61,9%14

77,8%

X±SD (%) 8,7±2,38 10,36±2,73 p<0,05

ConclusionConclusion

- Eye complication was found in 23,5%; Kidney Eye complication was found in 23,5%; Kidney

complication figure was 22,2%.complication figure was 22,2%.

- Both eye and kidney complication occupied Both eye and kidney complication occupied

13,6%.13,6%.

- Longer diabetes duration, more eye and Longer diabetes duration, more eye and

kidney complication were found. kidney complication were found.

- The best thing to postpone eye and renal The best thing to postpone eye and renal

complication is glucose control. complication is glucose control.