Utilization of Glycosylated Haemoglobin and Microalbumin in the Management of Uncontrolled Diabetes Mellitus Patients Attending Kibagabaga District Hospital Rwanda

Abstract

ABSTRACT Diabetes mellitus is a clinical syndrome described by hyperglycemia because of the total or relative lack of insulin. Diabetes has many complications. One such major chronic complication of poorly controlled diabetes is diabetic nephropathy which may prompt end-stage renal disease. The glycosylated haemoglobin (HbA1c) is tested primarily to determine the three-month average blood sugar levels. This helps clinicians to get an overall picture of what the average blood sugar levels have been over a period of months. Long-term control of diabetes is monitored by the estimation of glycosylated haemoglobin (HbA1c). This study recommends the microalbuminuria screening test is recommended annually to assess early renal damage in people who are at risk of developing kidney complications. Microalbuminuria screening test is justified on its benefit in diabetic patients monitoring while the process is still reversible. Microalbuminuria is not yet implemented at Kibagabaga District level due to cost restriction. Furthermore, early onset of renal impairment among diabetes mellitus is recommended using microalbuminuria. The fasting blood sugar is only used routinely to monitor diabetic patient at district levels. The fasting blood sugar is not accurate compared with the glycosylated haemoglobin. However, the macro albuminuria is far costly to glycosylated haemoglobin in term of reagents, materials and consumables. The main objective of this research was to estash a correlation between HBA1c and microalbumin in the management of uncontrolled c diabetes mellitus patients attending Kibagabaga District Hospital.This can be used instead of microalbuminuria at certain level of glycosylated haemoglobin to predict the renal impairment. A hospital-based cross-sectional design was used. The known uncontrolled diabetes mellitus patients were referred by medical team and recruited in the study till the sample size reached with 246 participants from April to June 2018. After sample collection instruction, random urine was collected and microalbuminuria was tested using method of albumin creatinine ratio (ACR). Microalbuminuria was defined as urinary albumin-to-creatinine ratio > 3 mg/mmol, normoalbuminuric as < 3 mg/mmol, and macro albuminuria as >300 mg/mmol. The veinous blood samples were collected in ethylenediaminetetraacetic acid (EDTA) tubes and Sodium Fluoride for HBA1c and FBS measurement respectively. Uncontrolled diabetes mellitus was defined as a cut-off value of HBA1c > 6.5 %. Data ware analyzed by statistical software SPSS version 21. Pearson correlation coefficient and Chi square were calculated to find the relationship between variables. P value was taken as significant at 5 percent confidence level (P<0.05). Out of 246 patients, 178 (72.36%) were female and 68 (27.64%) were male. The age range was 31 to 81 years old and the average age was 58 years old. The duration of diabetes range was 1 to 19 years with an average of 7 years. Eighty-one (32.9%) of study subjects had microalbuminuria and one hundred sixty-six (67.1%) had normoalbuminuric and no cases of macro albuminuria were recorded. The correlation between Microalbuminuria and HBA1c was significantly positive (r=0.800 and p < 0.05) and duration of diabetes (0.664 and p < 0.05). This correlation between microalbuminuria and HBA1c results among uncontrolled diabetes patients helped us to propose the access to glycosylated haemoglobin (HbA1c) testing at the district hospital level. This will also assist to predict the kidney complication among uncontrolled diabetes patients with HBA1c above 14%. This study recommends that HBA1c should be inculcated in routine practice for uncontrolled diabetes mellitus patients and Microalbumin test should be checked at a regular interval: if detected microalbuminuria is detected, confirmation should be made with two further tests within a 3-to-6-month period. If microalbuminuria is not detected, re-screening should be performed annually. This study recommends the ministry of Health to implement a guide line for monitoring the uncontrolled diabetes mellitus and the early diabetes nephropathy diagnosis at the district hospitals.