Thailand Diabetes Registry Project: Prevalence, Characteristics and Treatment of Patients with Diabetic Nephropathy
Chardpraorn Ngarmukos MD*, Pongamorn Bunnag MD*, Natapong Kosachunhanun MD**, Sirinate Krittiyawong MD***, Rattana Leelawatana MD****, Thongchai Prathipanawatr MD*****, Nattachet Plengvidhya MD******, Yupin Benjasuratwong MD*******, Sompongse Suwanwalaikorn MD********, Chaicharn Deerochanawong MD*********, Thanya Chetthakul MD**********, Sirima Mongkolsomlit BS***********, Petch Rawdaree MD************
Affiliation : * Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University ** Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, *** Theptarin General Hospital **** Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla ***** Deptpartment of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen ****** Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University ******* Department of Internal Medicine, Phramongkutklao Hospital ******** Department of Medicine, Faculty of Medicine, Chulalongkorn University, ********* Rajavithi Hospital ********** Department of Medicine, Maharat Nakhon Ratchasima Hospital, NakhornRatchasima *********** TDR research coordinator, ************ BMA Medical Collage and Vajira Hospital
Objectives : To identify the prevalence and characteristics of patients with Diabetic Nephropathy (DN) and to
,
evaluate adequacy of glycemic and blood pressure control of these patients in the authors
registry.
Materials and Methods : A cross-sectional, multicenter, hospital-based diabetic registry was carried out in
diabetes clinics of 11 tertiary centers in Thailand. DN was defined as the presence of at least two out of three
of these symptoms; positive microalbuminuria, positive dipstick proteinuria or creatinine levels equal to or
greater than 2 mg/dl. One center that did not perform urine microalbumin measurement was excluded from the
analysis. Overt nephropathy was defined as the presence of gross proteinuria or renal insufficiency.
Results : The study included 4,875 patients (females 63.8%) with a mean (SD) duration of diabetes of 12.8(8.2)
years. The prevalence of DN was 42.9% (microalbuminuria 19.7% and overt nephropathy 23.2%). There were
373 (7.7%) patients with renal insufficiency and 24 (0.47%) with end-stage renal disease. By multivariate
analysis, factors associated with DN were age, duration of diabetes, male sex, smoking, blood pressure,
HbA1c, dyslipidemia and presence of diabetic retinopathy. Prevalence of ischemic heart disease and cere-
brovascular disease in patients with DN was 11.5% and 6.6% respectively. Mean (SD) HbA1c in patients with
nephropathy was 8.2 (2.6)%. Only 25% of subject had HbA1c of less than 7%, 46% had blood pressure of more
than 140/90 mmHg and 84% received at least one antihypertensive drug. However, the target blood pressure
of less than 130/80 mmHg could be achieved in only 18% of these patients. The mean (SD) number of antihy-
pertensive drugs was 1.7 (1.1). Nearly 60% of patients received either ACE inhibitors or ARBs.
Conclusion : DN was very common. The overall picture of DN in the present survey suggests the seriousness of
the problem and prompts more aggressive intervention.
Keywords : Diabetes registry, Nephropathy, Prevalence, Thailand, Glycemic control, Blood pressure
