ASSOCIATION BETWEEN PRESENCE OF PROTEINURIA AND DIABETIC RETINOPATHY AS WELL AS THEIR RELATION WITH SERUM 25(OH) VITD LEVEL DEFICIENCY AMONG TYPE 2 DIABETIC PATIENTS: A CROSS-SECTIONAL STUDY IN EASTERN INDIA
Main Article Content
Keywords
Diabetic Retinopathy(DR), Non Proliferative DiabeticRetinopathy(NPDR), ProliferativeDiabeticRetinopathy(PDR), Proteinuria,Renin-Angiotensin-Aldosterone System(RAAS)
Abstract
Background:Diabetes Mellitus(DM) is a severe and growing public health problem with substantial economic burden worldwide. Uncontrolled Diabetes leads to dreaded micro-vascular complications like diabetic retinopathy and nephropathy etc. In parallel to increase in prevalence of DM and its complications, several reports of serum 25(OH) VitD deficiency have been documented in India.Objective:To establish the association between proteinuria and presence as well as severity of Diabetic retinopathy& their relation with VitD deficiency.Materials & Methods: The present study was carried out in a tertiary care teaching hospital in Kolkata, approved by the institutional Research & Ethics Committee. In this present study,107 Type2 diabetic patients of 40 yrs of age & above were selected.Direct Ophthalmoscopy(Heine β - 200) was used for detection of Diabetic Retinopthy(DR) and grading of DR.Venous blood for FBS,PPBS, HbA1C and 25(OH)VitD level estimation, was taken aseptically. Urinary protein was tested by Dip stick method.Results & Conclusion:Results were analysed by using SPSS version 20. Chi square test, Fischer Exact test,Man Whitney U & Kruscal Wallis test were used in statistical analysis where they were appropriate. Most of the patients are VitD deficient. Proteinuria was present in highest percentage of total patients.There was statistically significant association between proteinuria and presence as well as severity of Diabetic retinopathy. In our study, the presence of proteinuria is significantly associated with deficient VitD status in diabetics without retinopathy group, patients with ‘Severe NPDR’ & total patients.Deficient Vit D status is significantly associated with severity of Diabetic Retinopathy in presence of proteinuria.
References
2.Klein BEK.Overview of epidemiological studies of diabetic retinopathy.OphthalmicEpidemiol.2007 July-Aug;14(4):179-183[CrossRef][PubMed]
3.Kanski JJ.Retinal Vascular Disease, Clinical Ophthalmology,A Systematic Approach,Fifth Edition.ELSIVIER SCIENCE;2003,p.439
4.Andy KhLim.Diabeticnephropathy-complication and treatment.Int J Nephrol Renovasc Dis.2014 October 15;7:361-381.Published online 2014 Oct 18
5.Rani P K,Raman R, et al.Albuminuriaand Diabetic Retinopthy in Type2 Diabetes Mellitus Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular genetic study(SN-DREAMS, report 12).Diabetol Metab Syndr.2011 May;3(1):9.doi:10.1186/1758-5996-3-9.
6.Neil A,Hawkins M,Protok M, et al. A prospective population based study of microalbuminuria as a predictor of mortality in NIDDM. Diabetes Care.1993 July,16(7):996-1003.
7.Asegaonkar SB, et al. VitaminD and Type2 Diabetes Mellitus:Indian Perspective. Journal of Diabetic Complications & Medicine.2016 July.doi:10.4172/2475-3211.1000110
8.Alcubierre N,Valls J, et al.VitaminD deficiency is associated with the Presence and Severity of Diabetic Retinopathy in type 2 Diabetes Mellitus. Journal of Diabetes.Research.2015:2015:374178.doi:10.1155/2015/374178.
9.Mani K,Rose DC,et al.Prevalence of Diabetic Retinopathy inType2 Diabetes Mellitus patients attending medicine OPD of a tertiary care hospital in Alappuzha,Kerala,India.InternationalJournal ofResearch inMedical Sciences.2017April;5(4):1532-1536.
10.Wilkinson CP,Ferris FL,etal.Proposed International Clinical Diabetic Retinopathy and
Diabetic Macular Edema Disease Severity Scales.Ophthalmol.2012;130:756-760.(AmericanAcademyofOphthalmology)[TheEye M.D.Association]
11. The Centers for Disease Control and Prevention.Fat-Soluble Vitamins & Micro-nutrients:VitaminD.https://www.cdc.gov/nutritionreport/99-02/pdf/nr_ch2b.pdf
12. Lima VC,Cavalieri GC,etal.Risk factors for diabetic retinopathy:Acase-control study.International Journal of Retina and Vitreous.2016;2:21
13.Garg P, Misra S,et al .Correlative Study of Diabetic Retinopathy with HbA1C and Microalbuminuria. International Journal of OphthalmicResearch.2018 January;4(2):282-286
14.Khatoon AS, Faheem R, et al. Effect Of Proteinuria in Diabetes Mellitus.Journal of Evidence Based Medicine and Healthcare.2016December;3(98):5404-5412
15.Cho A,Park HC, et al. Progression of Diabetic Retinopathy and Declining Renal Function in patients with Type 2 Diabetes.Journal of Diabetes Research.2020 July;2020:8784139.doi:10.1155/2020/8784139
16.Sanyal D, Chatterjee S. Advanced Diabetic Nephropathy with “Clean” Eyes:An Extreme Phenotype.Indian Journal of Endocrinology and Metabolism.2018 March- April;22(2):274-276
17.Mandal GK, Jyothrimayi D. COMPARATIVE STUDY OF MICROALBUMINURIA AND GLYCATED HEMOGLOBIN LEVELSIN TYPE 2 DIABETIC COMPLICATIONS. Asian Journal of Pharmaceutical and Clinical Research
18.TrevisanR,Vedovato M, et al.Concomitance of Diabetic Retinopathy and Proteinuria accelerates the rate of decline of Kidney Function in Type 2 Diabetic Patients.Diabetes Care.2002;25(11):2026-2031.doi:10.2337/diacare.25.11.2026
19.Yamamoto M,Fujihara K, et al.Overt Proteinuria, Moderately Reduced eGFR and Their Combination are Predictive of Severe Diabetic Retinopathy or Diabetic Macular Edema in Diabetes.Investigative Ophthalmology &Visual Science. June 2019;Vol 60:2685-2689.doi:https://doi.org/10.1167/iovs.19-26749
20.Dash S, Chougule A, et al.Correlation of Albuminuria and Diabetic Retinopathy in Type-II Diabetes Mellitus Patients.Cureus.2022 February;14(2):e21927.doi:10.7759/cureus.21927
21.Ahmadi N,Mortazavi M, et al.Whether vitaminD3 is effective in reducing proteinuria in type 2 dibeticpatients?J Res Med Sci.2013 May;18(5):374-377
22.O’Reilly D St,Grey R H B, Morris A, et al.Proteinuria and retinopathy in patients with diabetes mellitus: a survey ofan entire clinic.Practical Diabetes International.January/February 1987;4(1):35-38.https://doi.org/10.1002/pdi.1960040111
23.Kaiser N, Sasson S, et al.Differential regulation of glucose transport and transporters by glucose in vascular endothelial and smooth muscle cells.Diabetes.1993 January;42(1):80- 89
24.Mizutani M,Kern TS, et al.Accelerated death of retinal microvascular cells in human and experimental diabetic retinopathy.Journal of Clinical Investigation.1996 June 15;97(12):2883-2890
25.Szymczak-PazorI,Sliwinska A, et al.Analysis of Association between VitaminD deficiency & Insulin Resistance.Nutrients.2019April;11(4):794.doi:10.3390/nu11040794.
26.Berridge MJ, et al.VitaminD deficiency &diabetes.Biochem J.2017 March 24;474(8):1321-1332.https://doi:10.1042/BCJ20170042
27.Ben-ShoshanM,Amir S, et al.1 alpha,25-dihydroxy VitaminD3(Calcitriol) inhibits hypoxia-inducible factor-1/vascular endothelial growth factor pathway in human cancer cells.Mol CancerTher.2007 April;6(4):1433-9.
28.Roscioni Sara S,Heerspink H J L, et al.Correction:The effect of RAAS blockade on the progression of diabetic nephropathy.Nat Rev Nephrol.2014 February;10(2):77-87.doi:10.1038/nrneph.2013.251
29.Campbell Kirk N,RaijL,etal..Role of AngiotensinII in the development of nephropathy and podocytopathy of diabetes.Curr Diabetes Rev.2011 January;7(1):3-7.doi:10.2174/157339911794273973
30.Koroshi A, Idrizi A. Renoprotective effects of VitaminD and renin-angiotensin system.Hippokratia.2011 October-December;15(4):308
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Rajarshi As
Assistant Medical Superintendent, E.S.I. Hospital; Gourhati; Angus; Hooghly; E.S.I.(MB) Scheme; Labour Department; Govt. of West Bengal
Dr.Srila Ghosh Chowdhury
Associate Professor, Department of Physiology; Midnapore Medical College & Hospital; Midnapore
Dr.Pinaki Sengupta
Associate Professor, Regional Institute of Ophthalmology(RIO); Medical College & Hospital; Kolkata
Dr. Mrityunjay Sinha
Clinical Tutor, Department of General Medicine; M.J.N. Medical College & Hospital;
Coochbehar