Background

Diabetes is one of the major causes of premature illness

and death worldwide.*

2010 global prevalence of

diabetes 6.4 %

2030 global prevalence of

diabetes 7.8 %*

*Reference : World Health Organization

1998 Thai prevalence of

diabetes 4.7% *

2009 Thai prevalence of

diabetes 6.9% *

Reference : Thai national health survey 1998

Background

Complication of Diabetes

Reference *http://www.medscape.org/viewarticle/449657

Diabetic Nephropathy

Reference *http://www.medscape.org/viewarticle/449657

The goal of treatment for chronic

kidney disease is to prevent or slow

further damage

Literature review

Impact of Glycemic control on survival of diabetic

patients on chronic regular hemodialysis

Inoue

Hemodialysis

HbA1C

* Reference:Oomichi T, Emoto M, Tabata T, Morioka T, Tsujimoto Y, Tahara H, Shoji T, Nishizawa Y. :Impact of glycemic control

on survival of diabetic patients on chronic regular hemodialysis:7 year observational study. Division of Metabolism,

Endocrinology, and Molecular medicine, Department of Internal Medicine, Osaka city university Graduate medical school,1-4-

3, Asahi-machi Osaka, Japan 545-8585

Literature review

Glycated protein as indices of glycemic control

in diabetic patient with chronic renal failure

HbA1c, fructosamine albumin adjusted fructosamine

mean capillary blood glucose concentration HbA1C

mean capillary blood glucose concentration

*Reference: Morgan. L, Marenah, C.B., Jeffcoate, W.J. and Morgan, A.G.,Glycated proteins as indices of Glyceamic

control in Diabetic patients with Chronic renal failure.Diabet.Med,13:514-519

Literature review

• The unrecognized prevalence of chronic kidney

disease in diabetes

serum creatinine albuminuria estimated

glomerular eGFR

• *Reference: [5] Wild S, Roglic G, Green A,Sicree R,King H:Global prevalence of diabetes:estimates for the year 2000

• and projections for 2030.Diabetes Care27:1047-1053,2004

“

*Reference : American Diabetes Association. Standards of Medical Care in Diabetes—2013. Alexandria, VA, American Diabetes Association, 2013

Conceptual Framework

DiabetesDiabetes with

nephropathyCKD

Stage5

(ESRD)

Stage1

Stage4

Stage3

Stage2

Tertiary Prevention

-Age

-Gender

-Race

-Behavior

-Medication

-BMI

-Blood pressure

-Glycemic control

-Lipid profile

Objectives

–

–

–

Study design

• Retrospective cohort study

– 3-21 2556

–

–

Duration

Study area

Outcome measurement

Population

Study population )

2- 25542555 2556

( Target population )

( Population )

Study population

–

2

2553 2556

– Creatinine 2556

– Creatinine -

2554

Inclusion criteria

Exclusion criteria

Sampling

Estimating population proportion and adjusted framework

•

40%

n = (NZ2α/2 P Q ) / d2(N-1) + Z2

α/2 P Q

Methods

1.

2.

3.

Methods

4.

5.

6.

1.Gender

2. Age

3. BMI

4.U/D; HT, DLP

5.FBS

6.HbA1c

7.eGFR

8.Smorking

9.Alcohol drinking

10. Medication

Time schedule

3 2556

•

72556

•

10 2556

•

•

14-20 2556

• inclusion exclusion criteria

•

262556

•

Result

Demographic Data

Glycemic Control

Correlations

Demographic Data

Mean SD (Min-

Max) 58 11 (23-82)

35 22.7

119 77.3

7 4.5

138 89.6

1 0.6

8 5.2

4 2.6

72 46.8

5 3.2

60 39.0

1 .6

2 1.3

14 9.1

Mean SD

(Min-Max)

63 14 (36-

101)

Mean SD

(Min-Max)

155 8

(135-175)

135 87.7

11 7.1

8 5.2

134 87.0

42 27.3

112 72.7

Cholesterol

≤200 mg/dl 114 74

>200 mg/dl 40 26

LDL

≤100mg/dl 79 51.3

>100mg/dl 75 48.7

HDL

≤40m

g/dl 32 20.8

>40m

g/dl 122 79.2

Triglyceride

≤150mg/dl 101 65.6

Glycemic control

FBS):Mean SD (Min-Max)

137 25.5

(88-216)

FBS)

≤130mg/dl 74 48.1

>130mg/dl 80 51.9

HbA1C):Mean SD (Min-Max)

7.9 1.3(4.9

-11.2)

HbA1C)

≤6.5

% 24 15.6

>6.5

GFR):Mean SD (Min-Max)

6.4 3.6(0.3

1-24.82)

GFR)

≤6.5

ml/min/m2/y

ear 74 48.1

>6.5

ml/min/m2/y

ear 80 51.9

2

31 20.1

3

121 78.6

1 .6

Metfor

min

17 11.0

137 89.0

Glipizid

e

110 71.4

44 28.6

Glibenclamid

e

62 40.3

92 59.7

Insulin

Correlation

GFR)

≤6.5 >6.5 OR

95%

Confidence

Interval

P-

VALU

E

FBS) 1.16

2

0.617-

2.189 0.642

≤130 37(50

)

37(5

0)

>130 37(46

.25)

43(5

3.75)

HbA1C) 2.48

0.993-

6.208 0.047

16(66 8(33.

GFR)

≤6.5 >6.5 OR

95%

Confiden

ce

Interval

P-

VALU

E

Metformin 0.95

6

0.348-

2.624 0.931

8(47.06) 9(52.9

4)

66(48.18) 71(51.

82)

Glipizide

0.41

1

0.200-

0.845 0.014

46(41.82)

64(58.

18)

16(36.

GFR)

≤6.5 >6.5 OR

95%

Confiden

ce

Interval

P-

VALU

E

Glipizide 2.43

0.200-

0.845 0.014

28(63.64)

16(36.

36)

46(41.82)

64(58.

18)

Discussion

• (SD)6.4(3.6)

ml/min/m2/year

(SD) 3.8 ( 4.2) 4.0( 3.1)

ml/min/year

•

6.5%

6.5 ml/min/m2/year 2.48

Discussion

•

, ,

Glycemic control Is a predictor of survival

for Diabetic Patients on Hemodialysis

• Glipizide

Use of insulin and oral hypoglycemic

medications in patients with diabetes mellitus and advanced

kidney disease

Limitation• HbA1c

Anemia Hemoglobinopathies

• 2

• 3. 2553

• 4.

Reccomentation

• 1.

• 2

Acknowledgement

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