HEPATIC, RENAL AND CARDIOVASCULAR BIOMARKERS VARIABILITY IN TYPE 2 DIABETES MELLITUS PATIENTS WITH POOR GLYCEMIC CONTROL ATTENDING KAKAMEGA COUNTY GENERAL HOSPITAL, KENYA.

Abstract

Type 2 diabetes mellitus (T2DM) is among the largest global health emergencies of the 21st century and one of the leading cause of death in the world. The prevalence of diabetes is high and projected to increase with 10% by 2025. Poor glycemic control continues to be a major concern with majority of the poor glycemic control cases remaining undiagnosed. Microvascular and macrovascular complications due to diabetes are the major causes of poor prognosis among diabetic patients the main ones being hepatic, cardiovascular complications and diabetic nephropathy. A high percentage of T2DM patients remain undiagnosed during the early onset of the disease hence making it difficult to establish the level of organ damage. Upon diagnosis in such cases, hepatic, renal and cardiovascular injury is already evident, and some patients have end-stage organ damage/ failure. Early determination of organ damage plays a critical role in the management of the disease thus preventing related complications and mortality. This study aimed at determining hepatic, renal and cardiovascular decline by evaluating the dynamics and variability of biomarkers in diabetes patients with poor glycemic control. In the study, 103 consenting participants were recruited at the Kakamega county general hospital comprising of (Healthy control, n=27), (T2DM good glycemic control, n=25) and (T2DM poor glycemic control, n=51). This study was an analytical crossectional study and utilized a random sampling technique in participant’s recruitment. 6 milliliters of blood sample was collected from the study participants and processed for biomarkers of hepatic, renal and cardiovascular function using colorimetric, spectrophotometric, and florescence immunodetection techniques. Data obtained was cleaned, entered into excel, coded and analyzed using the IBM SPSS 22 software. The normality test was done using the Kolmogorov Smirnov test. Chi-square test was done on categorical variables while Kruskal-Wallis test was done on the continuous variables. A Bonferroni Post-hoc test was done to determine the differences between the groups. The study revealed a significant hepatic biomarker variability in GGT (P=0.031), Total bilirubin (P<0.0001), Direct bilirubin (P<0.0001), albumin (P=0.001) and AST/ALT ratio (P<0.0001). Renal biomarkers including Urea (P=0.002), potassium (P=0.0012), sodium (P<0.0001) and chloride (0.007) showed a significant variability in poor glycemic control. Additionally, Triglycerides(P<0.0001), total cholesterol(P=0.046) and LDH (P=0.005) levels were significantly elevated in poor glycemic control. These findings suggest that poor glycemic control causes a significant variability in biomarkers due to the resultant organ damage and these biomarkers can be utilized for determination and early diagnosis of poor glycemic control related organ failure, utilization in disease monitoring and determination of clinical outcomes in T2DM