Assessment of Renal Disease in Patients with Type 1 Diabetes Mellitus Attended at a Tertiary Endocrinology Outpatient Clinic

Abstract

Purpose: To classify Type 1 Diabetes Mellitus (DM1) patients according to Diabetes Kidney Disease (DKD) stage and compare them with those with normal kidney function in relation to metabolic control and time of disease, quality of life (QoL) and prevalence of Common Mental Disorders (CMD), such as anxiety and depression. Methods: Metabolic data was collected, after approval of the Ethics Committee, directly from the medical records. The investigation of QoL and CMD's, was obtained through the Diabetes Quality of Life Measure (DQOL-Brasil) and Hospital Anxiety and Depression Scale (HADS) questionnaires, respectively. Results: 97 patients were assessed (61 females and 36 males), 38 of them were diagnosed with DKD. The patients had average metabolic control levels of Fasting Blood Glucose (FG) 213 mg/dL and Glycated Hemoglobin (Hb1Ac) 9%. There was a significant relationship between the time of DM1 diagnosis and the occurrence of DKD, which was higher in the second group, and patients with longer DM1 history had better metabolic control and Glomerular Filtration Rate (GFR). The distribution of patients according to renal risk by Kidney Disease Improve Global Outcomes (KDIGO) shows low risk of loss of renal function (68% low risk/intermediate risk) in the stratified group (n=31). When comparing patients with and without DKD, there were significant correlations related to creatinine control, Microalbuminuria (MAI), average Hb1Ac and GFR. When analyzing the stages of DKD, significant differences were found in: creatinine, MAI after drug treatment, FG and GFR. In regard to QoL, patients aged between 18 and 25 years old showed a significantly lower QoL related to social and vocational concerns when compared to the 25 to 55 age group, while there were no relevant differences when it comes to gender, presence of DKD or stages of it to the different aspects of QoL. As for CMD, there were no statistical differences in the data analyzed, including gender, presence of DKD or stages of it. Conclusion: Our patients demonstrate laboratory control above the recommended targets, and those with DKD have longer DM1 duration and worse metabolic and renal control. In the advanced stages, it has been found that there is a greater predisposition to end-stage renal failure. We did not observe a higher prevalence of anxiety and depression in our sample, but the quality-of-life analysis highlights the negative impact on mental health, especially in the 18-25 age group, emphasizing the importance of multidisciplinary approaches.