Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
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Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



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Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




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I wish all success to your journal and look forward to sending you any suitable similar article in future"



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Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2010 | Month : June | Volume : 3 | Issue : 4 | Page : 2489 - 2494

Laboratory Assessment of the Diabetes Scenario with Respect to HbA1c and Microalbuminuria

MANJREKAR POORNIMA A , SHENOY R , HEGDE A

*Associate Professor (MD) Department of Biochemistry, *** Associate Professor (MD) Department of Biochemistry, Kasturba Medical College, **Assistant Professor (MDS) Department of Community Dentistry, Manipal College of Dental Sciences, , Constituent colleges of Manipal University, Manipal, Mangalore, Karnataka, (India).

Correspondence Address :
Dr. Anupama Hegde
Associate Professor, Dept. of Biochemistry
Centre for Basic sciences, Kasturba Medical CollegeBejai, Mangalore- 575004
Phone no: 0824-2211746 Extn-5857
anupamahegde@yahoo.com

Abstract

Background: Glycated haemoglobin (HbA1c) has proved to be a good indicator of long term glycaemic control and reflects the mean glucose value (MGV). A linear relationship with HbA1c, microalbuminuria and the incidence of diabetic nephropathy is known to exist.
Aim: To analyze the prescribing patterns of clinicians, the correlation of the plasma glucose values to HbA1c and the prevalence of microalbuminuria in a laboratory set up.
Settings and Design: Retrospective, data collection of one year from Medical records, conducted at KMC hospital, Ambdekar circle, Mangalore.
Materials and Methods: A data survey was conducted for a period of 12 months at the clinical biochemistry lab of our institution to note the number of requisitions for Fasting Plasma Glucose (FPG), Post Prandial Plasma Glucose (PPPG), Random Plasma Glucose (RPG), Glycated Haemoglobin (HbA1c) and Urinary microalbumin (UmA). Mean Glucose Value (MGV) was calculated from the HbA1c values.
Statistical analysis: All findings were expressed as summations and percentiles. The SPSS package was used for descriptive statistics. Pearson’s correlation coefficient was employed for correlational analysis.
Results: There were about 15,000 requests each for FPG and PPPG, 7,058 for RPG, 2,884 for HbA1c and only 515 for microalbuminuria. RPG showed a better correlation than FPG with HbA1c (r = 0.472 vs 0.699). The patients with HbA1c and UmA requisitions were categorized, based on their MGV values. The prevalence of UmA was found to be around 32% in all the groups, except in the group with MGV between 251-300 mg/dL, in which it was 62.06 %.
Conclusion: The number of requests for FPG and PPPG were to the same. The HbA1c requests comprised of 7.8% of the plasma glucose requests, thus indicating a probable underutilization of the same. In patients with infrequent HbA1c estimations, RPG was a better predictor of HbA1c levels. MGV resulted in a meaningful translation of the HbA1c values to the patients. Considering the high prevalence of UmA and the relatively lesser number of requisitions for the same, it would be desirable to screen the diabetes patients more rigorously.

Keywords

Diabetes, FPG, HbA1c, Laboratory data, Mean glucose value, Microalbuminuria, Random plasma glucose

How to cite this article :

MANJREKAR POORNIMA A *, SHENOY R** , HEGDE A***. LABORATORY ASSESSMENT OF THE DIABETES SCENARIO WITH RESPECT TO HBA1C AND MICROALBUMINURIA. Journal of Clinical and Diagnostic Research [serial online] 2010 June [cited: 2019 Aug 24 ]; 3:2489-2494. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2010&month=June&volume=3&issue=4&page=2489-2494&id=737

Introduction
India will be harbouring 70 million diabetics by 2025 (1). The basic metabolic abnormality in diabetes is the presence of pathological hyperglycaemia. Studies like the DCCT (2) and the UKPDS (3) and several others (4),(5) after them, have shown that strict glycaemic control can avert or at least postpone the occurrence of long term diabetic complications. Fasting plasma glucose (FPG), postprandial plasma glucose (PPPG) and random plasma glucose (RPG) are common laboratory requisitions for the screening and diagnosis of diabetes. Glycated haemoglobin or HbA1c concentration provides a better assessment of the glycaemic control over the previous two - three months and also allows the calculation of the mean glucose value (MGV) (6). Inclusion of MGV values in the patient’s report, along with HbA1c would result in a better comprehension of their glycaemic control. The presence of urinary microalbumin is a definite marker of latent or overt nephropathy (7). The prevalence of microalbuminuria at various degrees of glycaemia and the prescribing patterns of clinicians with respect to diabetes management was thus chosen to be studied.

Material and Methods

A cross sectional data survey was undertaken from September 2005 to August 2006 at the Clinical Biochemistry laboratory, Kasturba Medical College Hospital (KMCH), Ambedkar circle, Mangalore, India. The laboratory supports tertiary care to patients in and around Mangalore. Apart from samples from two of the institutional multidisciplinary hospitals, we processed samples which were received from two Government hospitals and also those from a large number of walk- in patients with requisitions from private practitioners, which constituted a major percentage of our sample input. Thus, this study represents a cross section of the prescribing patterns of clinicians in and around this city.

All investigational requisitions were scrutinized for FPG, PPPG, RPG, HbA1c and Urinary microalbumin. The values were noted after processing the samples.

Plasma glucose and HbA1c were estimated using commercially available kits from Roche- Hitachi Systems which were analyzed on a Hitachi 917 autoanalyser. The glucose oxidase- peroxidase method (8) was followed for glucose estimation. The ‘Tina quant’ method (9),(10) for the determination of HbA1c is based on the turbidimetric inhibition immunoassay for whole blood haemolysed with tetradecyl trimethyl ammonium bromide.

The Accu-Chek Micral test is a semi quantitative test for the determination of urinary microalbumin in the range of 20-100mg/L in the first void sample. The result is read against a colour scale which is expressed as –ve or 20, 50 and 100 mg/L by the laboratory.

Since clinical history is very often not written on the requisition slip, we could not consider the age, sex, type of diabetes or the purpose of the request (screening, diagnosis, treatment adjustment, follow-up etc.) while computing the data. Repetitions of investigations if any were also included. The study was initially intended for a period of two years, with subsequent follow up for the next two years. By November 2006, the semiquantitative estimation of microalbumin was replaced by the quantitative determination of the same. Hence, this part of the study was truncated and the results are

Discussion

Diabetes is now a very familiar endocrine disorder, particularly to Asian Indians. Despite the high prevalence, people are very ill informed about the cause, the subsequent course, the long term effects, the care to be exercised and the overall gravity of the problem. The vast majority of the high risk group subjects are reluctant to be screened and even when diagnosed, prefer to try diet, exercise or alternative medicines, often without adequate control, thereby aggravating the condition. These are well known facts, but not many systematic studies have been undertaken regarding these issues (11). The most common laboratory investigations to assess glycaemic status are FPG, RPG PPPG and HbA1c. Plasma glucose values are generally used in screening suspected cases of diabetes, for therapy adjustments and rarely for monitoring. In this study, there were 2884 requests for HbA1c, amounting to a meager 7.8% of all plasma glucose requests put together. When HbA1c is asked, the person is almost certainly a diabetes patient. HbA1c values provide useful information with regards to the contribution of plasma glucose towards the same i.e. for values between 6.0 – 7.3 %, maximum contribution is by PPPG; between 7.4 – 8.4 %, both FPG and PPPG contribute almost equally and beyond 10 %, it is largely a function of FPG (12). Hence, it allows the targeting of specific plasma glucose to attain better control. HbA1c is also helpful in indicating the long term complications one has to look out for. Patients with HbA1c consistently below 8 % have a high risk of cardiovascular accidents and those above 8 % are at a risk of neuropathy and retinopathy (13).

MGV calculated from HbA1c values represents the average glucose concentration over a period of 2-3 months, with maximum contribution of the glucose levels over the previous month (14). An increase in 1% of HbA1c amounts to an increase in approximately 30mg/dl of blood glucose. Thus the impact of variation in plasma glucose would be more evident as mean plasma glucose values (MGV) from the patients point of view resulting in better appreciation of otherwise minor changes in HbA1c levels.

Epidemiological studies have shown that patients with better control are those who test more often (15) and the vice versa is also true (16). In this regard, the use of Self Monitoring of Blood Glucose (SMBG) and Continuous Glucose Monitoring Systems (CGMS) would be ideal. Cost is the deterrent in the use of both SMBG and CGMS, making them unreachable for an average Indian (17). An excellent surrogate that can be used in place of SMBG and CGMS is the estimation of HbA1c. The mean glucose values of SMBG predicted HbA1c values over 3 months (18). Similarly, Nathan et a (19) demonstrated a very good correlation between mean glucose from CGMS and HbA1c. Thus, HbA1c is an important tool in the management of diabetes in the Indian set up.

In the present study, most frequent requests made along with HbA1c, were for FPG (171/239)(Table/Fig 2). FPG (20) and PPPG (21) have been found to correlate well with HbA1c values. Currently, the association of HbA1c was strongest with RPG (r = 0.699, p <.0001), followed by FPG (r= 0.472; p<.0001) and PPPG (r = 0.328; p = .036). A casual PPPG most adequately predicted HbA1c as reported by Imad et al (22) and this can be used to intensify treatment. Avignon et a (23) reported a significant correlation of HbA1c with non fasting plasma glucose. The number of requests for RPG and HbA1c was small in our study (n = 27) and hence, the association needs to be reaffirmed in larger numbers. Nevertheless, in situations where frequent HbA1c estimations are not possible, RPG could be a good substitute.

Diabetic nephropathy can be detected by the simple determination of urinary microalbumin. We recorded a total of 515 requisitions for microalbumin. UmA may be found in hypertensive patients also. Hence, to evaluate UmA which is attributable to diabetes (they may have concurrent hypertension), we tabulated the cases in whom both HbA1c and UmA were asked (n = 256). This accounted for 49.71 % of the total UmA estimations (256/515). To simplify HbA1c values into more comprehensible MGV, MGV was used for categorization (Table 3). It can be observed that the prevalence of microalbuminuria is fairly the same ( @ 33 %) for MGV between 100 – 250 mg/dL (mean HbA1c: 5.66 – 8.36 %) and also in the group with MGV >300 mg/dL (mean HbA1c: 12.09 %). The group with MGV 251-300 mg/dl (mean HbA1c: 9.19%) showed 62.06 % of microalbuminuria. As the degree of hyperglycaemia increases, the propensity to develop nephropathy also increases (24). The last group (MGV >300 mg/dL) must be the type 1 diabetes cases in whom, despite the high plasma glucose values, UmA is usually absent at diagnosis (25) or they may be the newly diagnosed type 2 patients in whom glycaemic control is yet to be initiated or the treatment regime has to be adjusted.

It is particularly important to note that, even in the tightly controlled group (MGV: 100-150 mg/dL; HbA1c: 5.66 %), the prevalence was 32.08 %. Of the 93 patients who had UmA, 58.06 % (54/93) showed UmA in the range of 20 mg/L; 22.58 % (21/93) had 50 mg/L of UmAand 19.36 % (18/93) showed 100 mg/L of UmA. It is recommended that until UmA is detected, all diabetes patients should undergo the test once a year and more often upon detection. Considering that there were 2884 HbA1c requisitions, there should have been at least that many requests for UmA. The all cause UmA was 17.86 % (515/2884) and that which was most definitely due to diabetes was a meager 8.88 % (256/2884). The cause of such a low turnout could be attributed to a combined effect of ‘Clinical inertia’ (15),(26) among the practitioners and lack of understanding of the disease implications among the patients. Microalbuminuria reflects diffuse vasculopathy and endothelial dysfunction, thus leading to atherosclerosis in large arterial beds. Prospective and epidemiological studies have demonstrated UmA as an independent risk factor of cardiovascular mortality (27). A recent report from south India (28) put the occurrence of overt diabetic nephropathy at 2.2 % and microalbuminuria at 26.9 %. It is alarming that in our area it is 33 %, although we are limited by the nature of the study (laboratory based) and by the absence of details relating to patient characteristics and clinical history.

Conclusion

In the absence of economical means for SMBG and CGMS, HbA1c is a good measure of long term glycaemic control, particularly in the treatment of type 2 diabetes. In patients with very infrequent HbA1c estimations, RPG best predicts their HbA1c. It would be a better practice for laboratories to mention the MGV with HbA1c. This allows the patient a better translation of the HbA1c values in terms of average glucose concentration and better adherence to treatment. Based on the laboratory data, the prevalence of microalbuminuria is found to be much higher in the present study. Hence, requests for UmA must be an adjunct to HbA1c requests. Data from regional areas have a better impact on the seriousness of the problem. Despite the costs involved, awareness regarding the complications and the importance of their early diagnosis should be reinforced to the patients so as to improve the quality of life and expectancy.

Key Message

1. Random Plasma Glucose or Casual Plasma Glucose closely reflects HbA1c levels.
2. In diabetic patients, more frequent urinary Microalbumin check is mandatory.
3. Mean Glucose Values seem to be more meaningful than HbA1c to the patients.

References

1.
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