Authors: Sueyanyongsiri P, Tangbundit P, Sueyanyongsiri S, Bunmee S, Khansri P.
Background: Diabetes is now the common cause of end-stage renal disease (ESRD). This research aims to study the rate of decline in estimated glomerular filtration rate (eGFR) in hemoglobin E disorder diabetic patients in Surin hospital.
Methods: This case control cohort study was conducted from 2009 to 2018. Patient’s general clinical information, fasting plasma glucose (FPG), HbA1c levels, hematocrit (Hct) and eGFR were collected and divided into two groups, anemic hemoglobin E homozygote group (anemic group) and clinical silent hemoglobin E homozygote group (control group).Subjects were confirmed diabetics who already had been treated either with insulin, oral hypoglycemic drugs or a physician-prescribed diet. Target of diabetic control follow standard treatment, not try to intensive control. The endpoint was rate of decline of eGFR per year. The hypothesis was that the cumulative average duration of disease was equally, the renal complication between two groups was not different.
Results: From 2009 to 2018, 195 diabetic patients with hemoglobin E homozygote, 72 anemic hemoglobin E homozygote group (anemic group) and 123 clinical silent hemoglobin E homozygote group (control group). There were no significant differences in regard to fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), triglyceride (TG) and low-density lipoprotein (LDL) among the groups. The hematocrit (Hct), diastolic blood pressure (DBP), high-density lipoprotein (HDL), eGFR was significantly lower in anemic group. The age, cholesterol (CHO), systolic blood pressure (SBP), serum creatinine (Cr) and duration of disease was significant high in anemic group. The rate of decline in eGFR were significant much slower in control group 0.74 ml/min/year and 1.41 ml/min/year in anemic group (P<0.001), after adjusted confounding factors.
Conclusion: With long term cohort study, anemic hemoglobin E homozygote group have artificial lower HbA1c. Diabetic patients with clinical silent hemoglobin E homozygote group should be monitored using HbA1c level as an indicator for long-term glycemic control. But in anemic hemoglobin E homozygote group should be use self-monitoring blood sugar level.
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