All about Diabetes > Comprehensive Tutorial > Comorbidity


Co-morbidity:

Glycohemoglobin and the risk of microalbuminuria13
Overview:

A patient with diabetes mellitus is at risk for diabetic nephropathy, which may present with microalbuminuria. Krolewski et al identified the risk for microalbuminuria in a patient with diabetes mellitus based on level of glycosylated hemoglobin and duration of disease. This can help educate the diabetic on the importance of good glucose control.
The risk of microalbuminuria in patients with insulin-dependent diabetes mellitus increase with:

  • Duration of diabetes, expect in those with diabetes for 25-32 years
  • Glycosylated hemoglobin A1 values over 10.1%, which corresponds to a hemoglobin A1c level of 8.1%

 

Odds ratio for variations in glycosylated hemoglobin A1 values and the development of microalbuminuria

Years with IDDM postpubertal

GHA1
5.9-8.8%

GHA1
8.9-9.8%

GHA1
9.7-10.7%

GHA1
10.8-11.9%

GHA1
12.0-21.3%

1-6

1.0

1.6

2.6

2.2

5.8

7-12

2.4

2.3

2.4

6.8

13.2

13-18

2.3

4.7

3.9

7.5

28.8

19-24

11.3

15.0

14.3

12.1

23.6

25-32

7.1

7.9

13.0

19.0

12.5

Where

  • IDDM = insulin dependent diabetes mellitus
  • GHA1 = glycosylated hemoglobin A1

According to the methods section for the analytical methods used:
Percent glycohemoglobin A1C = ((percent total glycohemoglobin A1)-0.14/1.23)

If this rearranged:
Percent total glycosylated A1C = (1.23* (percent hemoglobin A1)) + 0.14
Since odds ratio and probability of an event show the following relation (from Chapter 39):
Odds ratio = (probability of event as decimal fraction)/(1-probability as a decimal fraction)
Probability of an event = (odds ratio) / (odds ratio + 1)

References:
13 Krolewski AS, et .al Glycosylated Hemoglobin and the Risk of Microalbuminuria in Patients with Insulin-Dependent Diabetes Mellitus. N Eng J Med 1995;332: 1251-1255.

Diet:

One main area where diabetics can take control of their Diabetes is by regulating their food intake. Food is a main factor that directly impacts a diabetic's blood sugar levels-and one that he/she can control.
Diabetics must check their sugar level regularly, with the help of a blood glucose meter. Only when a diabetic checks his/her blood sugar level regular basis, will he/she be able to decide which diet is suitable.

Exercise:

Exercise plays a major role in a diabetic's life. Maintain a regular exercise regime in order to keep your blood sugar levels under control. Testing around exercise will help you develop a workout plan that's best for you.
For older diabetics, brisk walking is safe, easy to perform and an inexpensive exercise. All they have to do is invest in time and a pair of properly fitting and comfortable footwear. Younger and fitter diabetics can choose from swimming, running, cycling or tennis.

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