Rate of Decline in Kidney Function after Apply an Estimate HbA1c Formula for day-to-day Individual Capillary Blood Sugar Control in Hemoglobin E Homozygote Diabetes Patients and Control Group.
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Abstract
Background: This research aims to observe the rate of decline in kidney function after apply an estimate HbA1c formula for day-to-day individual capillary blood sugar control in hemoglobin E homozygote diabetes patients and control group.
Objective: To reduce rate of decline in kidney function in hemoglobin E homozygote diabetes patients
Methods: Clinical intervention research was conducted from 2009. Patient’s clinical information were collected from the first visit of year 2009, retrospective to year at diagnosis and once time per year until 2021 or loss follow up or dead and eGFR were collected and stratified into 2 groups, hemoglobin E homozygote and negative DCIP group. Target of diabetic control follow standard treatment and try to intensive control in hemoglobin EE by apply an estimate HbA1c formula for day-to-day individual capillary blood sugar control. The endpoint was rate of decline of eGFR per year. The hypothesis was that after apply an individual goal for diabetes control, the rate of decline in kidney function between 2 groups was not different.
Results: Of all the 566 patients enrolled in this study, 182 (32.2%) were male and 117 (20.7%) patients had HbEE. Multivariable analysis found a faster rate of decline eGFR in HbEE group, before 2009, -3.41 ml/min/1.73m^²/year (95% confidence interval (-4.67) - (-2.14), p-value <0.001) and significant slower in control group, -1.88 ml/min/1.73m^²/year (95% confidence interval (-3.28) - (-0.48), p-value =0.009). After apply an individual targets by formular Y=2.5+0.015Dtx+0.06Hct, the rate of decline in eGFR were no significant difference between 2 groups, 1.35 ml/min/1.73m^²/year (95% confidence interval (-0.58) – 3.29, p-value <0.169) in HbEE group and 0.097 ml/min/1.73m^²/year (95% confidence interval (-0.66) – 0.44, p-value <0.737).
Conclusions: In endemic area of hemoglobinopathy is associated with high clinical variability HbA1c level are associated with Hct. level. HbEE diabetes patients should be used individual goal following the level of Hct. compare with blood test every 4 mouth.
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