Control of risk factors for nephropathy among Nigerian outpatients with Type 2 diabetes mellitus

Abstract

Background and Objectives: To determine the proportion of type 2 diabetic  outpatients with adequate control of risk factors for nephropathy in a Nigerian teaching hospital.
Methods: Between April and July 2005, 160 type 2 diabetic outpatients were  assessed for control of average fasting blood glucose and blood pressure over 3 visits, and current use of ACE inhibitors. All patients were over 30 years of age and had been followed up for at least one year with at least 6 prior clinic visits.
Results: We studied 58 male and 102 female subjects with a mean (±SD) age of 54±10 years. The majority (54.7%) had diabetes between 1 and 5 years, and 95% were on antidiabetic drugs, most commonly both a sulphonylurea and metformin (64.5%). 114 (71.2%) were being treated for hypertension. The mean fasting blood glucose (FBS) was 7.6±2.9mmol/L, and 73 (45.6%) had good glycaemic control  (mean FBS≤ 5.6mmol/L). A total of 51 (31.9%) had good blood pressure control (<140/90mmHg in non-hypertensives and <130/80mmHg in hypertensives), and 73 (45.6%) were currently receiving ACE inhibitors. Only five (3.1%) had the combination of good glycaemic control, good blood pressure control and received ACE inhibitors. Conversely, 23 (14.4%) had a combination of poor glycaemic control, poor blood pressure control, and were not receiving ACE inhibitors. Duration of diabetes (p<0.01), elevated creatinine (p<0.01), and elevated systolic blood  pressure (p<0.01) were independently associated with proteinuria.
Conclusion: Despite the availability of measures to prevent the progression of diabetic nephropathy, control of risk factors was poor. Physicians and diabetic patients in Nigeria must work together to improve their management of risk factors for nephropathy.

Key words: Diabetes mellitus, chronic kidney disease, renoprotection