Diagnostic performance of urinary biomarkers and self-monitoring blood glucose in estimating microvascular complications in elderly patients with diabetes mellitus

Abstract

Aim: In elderly patients, detection of diabetes mellitus (DM)-associated complications is crucial to improve quality of life and prevent serious pathologies. This study aimed to evaluate the diagnostic performance of urine microalbumin-creatinine ratio (uMCR), urine protein-creatinine ratio (uPCR), and self-monitoring blood glucose (SMBG) in estimating microvascular complications, neuropathy, retinopathy, and nephropathy in older adults with DM. Methods: In this diagnostic methodological study, DM patients (n=99) older than 64 years were followed in the endocrinology clinic parameters; serum hemoglobin A1c (HbA1c), serum triglyceride-glucose index (TyG index), the difference between self-measured peak glucose level and nadir level (SMBGdiff), and the ratio of the SMBGdiff to the highest SMBG level (SMNGratio), uMCR and uPCR were evaluated by ROC analysis and their cut-off values and specificity were determined to evaluate the diagnostic power for microvascular complications. Results: Our findings showed that 70% of the patients were male, 48.5% had neuropathy, 25.3% had retinopathy and 25.3% had nephropathy. Although lipid metabolism and liver-related indicators were within the normal range, patients were vitamin D deficient. ROC analysis revealed that uMCR and uPCR levels were independently associated with nephropathy (p<0.001), with strong specificity and moderate sensitivity. SMBGdiff was associated with both retinopathy and neuropathy (p=0.049 and p=0.040), and both specificity and sensitivity were poor. Conclusion: In elderly patients with DM uMCR and uPCR are strong indicators of nephropathy. However, other diabetes-associated biomarkers showed poor correlations emphasizing the age-related complexities in diabetic patients and an urgent need for further research.

Keywords

• Type 2 diabetes
• retinopathy
• neuropathy
• nephropathy
• urine microalbumin-creatinine ratio
• protein-creatinine ratio

Yaşlı diyabetli hastalarda mikrovasküler komplikasyonları tahmin etmede idrar biyobelirteçlerinin ve kendi kendine kan glikozu izlemenin tanısal performansı

Abstract

Amaç: Yaşlı hastalarda yaşam kalitesini artırmak ve ciddi patolojileri önlemek için diabetes mellitus (DM) ile ilişkili komplikasyonların saptanması çok önemlidir. Bu çalışmanın amacı, DM'li yaşlı erişkinlerde üriner mikroalbümin-kreatinin oranı (uMCR), üriner protein-kreatinin oranı (uPCR) ve kendi kendine kan şekeri takibinin (SMBG) nöropati, retinopati ve nefropatiyi gibi mikrovasküler komplikasyonları tahmin etmedeki tanısal performansını değerlendirmektir. Yöntem: Bu tanısal metodolojik çalışmada, endokrinoloji kliniğinde takip edilen 64 yaş üstü DM hastalarının (n=99) serum hemoglobin A1c (HbA1c), serum trigliserid-glukoz indeksi (TyG indeksi), SMBG ile ölçülen en yüksek ve en düşük kan şekeri düzeyleri farkı (SMBGfarkı) ve SMBGfarkı ile en yüksek SMBG düzeyinin oranı (SMBGoranı), uMCR ve uPCR değerleri, mikrovasküler komplikasyonları tahmin etmedeki tanısal güçleri ROC analiziyle değerlendirildi. Tanısal performansa sahip olanların kesim değerleri ve sensitivite ve spesifiteleri hesaplanmıştır. Bulgular: DM hastalarının %70'inin erkek olduğunu, %48,5'inde nöropati, %25,3'ünde retinopati ve %25,3'ünde nefropati olduğunu göstermiştir. Lipid metabolizması ve karaciğerle ilgili göstergeler normal aralıkta olmasına rağmen, hastalarda D vitamini eksikliği görülmüştür. ROC analizi, uMCR ve uPCR düzeylerinin bağımsız olarak nefropati ile ilişkili olduğunu (p<0.001), güçlü spesifisite ve orta düzeyde duyarlılık gösterdiğini ortaya koymuştur. SMBGfarkı hem retinopati hem de nöropati açısından istatistiksel olarak anlamlı tanısal performansa sahip (p=0.049, p=0.040), ancak hem spesifite hem de sensitivite düzeyleri düşüktür. Sonuçlar: DM'lu yaşlı hastalarda uMCR ve uPCR nefropatinin güçlü göstergeleridir. Bununla birlikte, diyabetle ilişkili diğer biyobelirteçler zayıf korelasyon göstermiştir; bu da diyabetik hastalarda yaşa bağlı sorunları ve araştırmaya duyulan ihtiyacı vurgulamaktadır.

Keywords

• Tip 2 diyabet
• retinopati
• nöropati
• nefropati
• idrar mikroalbümin-kreatinin oranı
• protein-kreatinin oranı

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