Morbidity in relation to stage of diabetic nephropathy in type-2 diabetic patients

Type-2 diabetic patients have excessive cardiovascular mortality, primarily related to diabetic nephropathy. The extent of the morbidity due to nephropathy in type-2 diabetes mellitus has not been fully quantified in Nigeria. This study aims to quantify the prevalence of micro- and macrovascular complications in hospitalized type-2 diabetic patients with nephropathy.

Over a three-year period, 465 type-2 diabetic patients were examined for nephropathy and diabetic associated diseases while on hospital admission.

One-hundred-ninety-one patients (41.1%) had signs of different stages of diabetic nephropathy. There is a predominance of the male sex in the nephropathic groups. Disease duration is lowest in the non-nephropathic group (6.5+/-7.1 years) but varies between 9.4+/-4.1 years and 11.7+/-3.5 years in the nephropathic groups. Hypertension, left ventricular hypertrophy, stroke, and myocardial infarction were less common in the non-nephropathic group, p<0.05, but showed an upward trend with progression of nephropathy. Although foot amputation was uncommon, the total percentage of patients with diabetic foot increased with progression of nephropathy (17% in non-nephropathic group versus 67% in patients with chronic renal insufficiency). The overall prevalence of diabetic retinopathy increased with progression of nephropathy, especially the occurrence of proliferative retinopathy.

A high morbidity was already present even in patients without nephropathy that increased in the course of the development of nephropathy. The study identifies patients with diabetic nephropathy as a high-risk group for excess cardiovascular morbidity in Nigeria. Thus, it is imperative to aggressively prevent or slow down progression of diabetic nephropathy.