International Journal of Medical Laboratory Research (IJMLR)

ASSESSMENT OF ERYTHROPOIETIN AND RENAL BIOMARKERS OF DIABETICS WITH COMPLICATIONS IN BENIN CITY, EDO STATE

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UI Abdulkadir, BIG Adejumo, FO Oyakhire, RO Omoregie, EO Akhaumere, WP Udoh, AJP Kamdem, IMM Otutu, GE Obasuyi, AO Ogbebor, FO Aiyesoro, E Samson, EOA Egwuakhide 

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ABSTRACT: Chronic diabetes mellitus is a metabolic disorder characterized by persistent hyperglycaemia and associated complications. Assessing erythropoietin (EPO) levels and glycated haemoglobin (HbA1c) levels in diabetic patients can provide valuable insights into the management and progression of the disease. This study aimed to assess the levels of erythropoietin and renal parameters in patients with complications of diabetes mellitus and evaluate the clinical implications of these assessments. A total of eighty-one consenting participants including 21 patients presenting complications of diabetes mellitus, 30 diabetic patients without any complications, and 30 heathy control persons without history of diabetes mellitus. Erythropoietin level was measured using enzyme-linked immunosorbent assay (ELISA), and HbA1c levels were also determined through modified enzymatic reaction, packed cell volume, haemoglobin, urea and creatinine values were determined using standard methods. Demographic and clinical data, including age, gender, diabetes duration, and medication history, were collected via questionnaires. Statistical analysis was performed to determine the correlation between EPO levels and HbA1c levels. Values obtained in this study was presented as mean ± standard deviation (levels of significance were accepted at p<0.001). In this study, high HbA1c levels among diabetic patients with complications were associated with a diet rich in protein and carbohydrates. Additionally, the increased erythropoietin levels were attributed to the absence of nephropathy, a condition typically linked to lower erythropoietin levels, in these patients.  Further research is warranted to explore the clinical implications of these assessments in predicting diabetes complications and guiding therapeutic interventions.

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KEYWORDS: DWOC, diabetics without complications; DWC, diabetics with complications

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REFERENCES:​​

1. [1]. Lebovitz HE. Diagnosis classification and pathogenesis of diabetes mellitus. Journal of Clinical Psychiatry. 2000;27:5-9.

2. [2]. Ogbera AO, Ekpebegh C. Diabetes mellitus in Nigeria: The past present and future. World Journal of Diabetes. 2014;5:905-911.

3. [3]. Chobanian AV, Bakris GL, Black HR. The seventh report of the joint national committee on prevention detection evaluation and treatment of high blood pressure: The JNC 7 report. Journal of the American Medical Association. 2003;289:2560-2572.

4. [4]. International Diabetes Federation. IDF Diabetes Atlas. 8th ed. Brussels: International Diabetes Federation; 2017.

5. [5]. Brutsaert EF. Complications of diabetes mellitus - endocrine and metabolic disorders. MSD Manual Professional Edition. 2023.

6. [6]. Thomas MC, MacIsaac RJ, Tsalamandris C, Molyneaux L, Goubina I, Fulcher G, Yue D, Jerums G. The burden of anaemia in type 2 diabetes and the role of nephropathy: A cross-sectional audit. Nephrology Dialysis Transplantation. 2004;19:1792-1797.

7. [7]. Anjaly VP, Sanghamithra P, Mathew LK. Anemia in patients with type 2 diabetes mellitus and its association with the microvascular complications. International Journal of Health Sciences. 2022;6(S9):4030–4043.

8. [8]. McGill JB, Bell DS. Anemia and the role of erythropoietin in diabetes. Journal of diabetes and its complications. 2006;20(4):262-272.

9. [9]. Craig KJ, Williams JD, Riley SG, Smith H, Owens DR, Worthing D, Cavill I, Phillips AO. Anemia and diabetes in the absence of nephropathy. Diabetes Care. 2005;28:1118-1123.

10. [10]. Singh DK, Winocour P, Farrington K. Erythropoietic stress and anemia in diabetes mellitus. Nature Reviews Endocrinology. 2009;5(4):204-210.

11. [11].  Antwi-Bafour S, Hammond S, Adlei JK, Kyeremeh R, Martin-Odoom A, Ekem I. A case-control study of prevalence of anemia among patients with type 2 diabetes. Journal of Medical Case Reports. 2016;10(1):110.

12. [12]. Baisakhiya S, Garg P, Singh S. Anemia in patients with type II diabetes mellitus with and without diabetic retinopathy. International Journal of Medical Science and Public Health. 2017;6(2):303-306.

13. [13]. Holland DC, Lam M. Predictors of hospitalization and death among pre‐dialysis patients: A retrospective cohort study. Nephrology Dialysis Transplantation. 2000;15(5):650-658.

14. [14]. Periasamy S, Xavier AA, Gowtham R. Incidence of anemia in type 2 diabetic mellitus and its prognostic index. Journal of Medical Research and Review. 2016;4(7):1239-1242.

15. [15]. AlDallal SM, Jena N. Prevalence of anemia in type 2 diabetic patients. Journal of hematology. 2018;7(2):57.

16. [16]. Samuel TR, Tejaswi N, Kumar P, Prudhvi K, Sravan NS, Govardhin B. Clinical significance of screening for anaemia in diabetic patients. International Journal of Pharmaceutical Sciences Review and Research. 2018;48(2):20-24.

17. [17]. Okoye OCA, Oviasu E, Ojogwu L. Prevalence of chronic kidney disease and its risk factors amongst adults in a rural population in Edo State Nigeria. Journal of US-China Medical Science. 2011;8(8):471-481.

18. [18]. Kumar V, Gill KD. Estimation of blood glucose levels by glucose oxidase method. In: Basic concepts in clinical biochemistry: A practical guide. Springer; 2018. p. 6-13.

19. [19].  International Expert Committee. Report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009;32(7):1327-1334.

20. [20].  Farooq U, Idris M, Sajjad N, Lashari MH, Ahmad S, Rehman ZU, Rashid H, Makmood A, Hameed S. Investigating the potential of packed cell volume for deducing hemoglobin: Cholistani camels in perspective. PLoS One. 2023;18(5):e0280659.

21. [21]. Nkrumah B, Nguah SB, Sarpomg N, Dekker D, Idriss A, May J, Adu-Sarkordie Y. Hemoglobin estimation by the Hemocue portable hemoglobin photometer in a resource-poor setting. BMC Clinical Pathology. 2011;11:5.

22. [22]. Langenfeld NJ, Payne LE, Bugbee B. Colorimetric determination of urea using diacetyl monoxime with strong acids. PLoS One. 2021;16(11):e0259760. doi:10.1371/journal.pone.0259760. PMID: 34748601; PMCID: PMC8575183.

23. [23]. Toora BD, Rajagopal G. Measurement of creatinine by Jaffe’s reaction-determination of concentration of sodium hydroxide required for maximum colour development in standard, urine and protein-free filtrate of serum. Indian Journal of Experimental Biology. 2002;40(3):352-354.

24. [24]. Prabhakar SP, Ganesan M. Development of a high-sensitive sandwich ELISA for measuring erythropoietin in human serum. Applied Biological Research. 2015;17:105-112.

25. [25]. Young EE, Okafor CN, Okwara CC. Diabetes mellitus, associated co-morbidities, and complications: A review. Journal of Medical Sciences. 2016;7:047-055.

26. [26]. World Health Organization. Peer support programs in diabetes: A report of World Health Organization consultation. 2008;5-7.

27. [27]. Bai A, Tao J, Tao L, Liu J. Prevalence and risk factors of diabetes among adults aged 45 years or older in China: A national cross-sectional study. Endocrinology Diabetes and Metabolism. 2021;4(3):e00265.

28. [28]. Adogu PO, Chineke HN, Ewuzie MU, Enwere OO, Egenti NB. The prevalence and presentation pattern of diabetes mellitus in patients at Imo State University Teaching Hospital (IMSUTH) Orlu and Imo State Specialist Hospital (IMSSH) Umuguma Owerri. Journal of Diabetes Mellitus. 2015;5:49-57.

29. [29]. Aguocha BU, Ukpabi JO, Onyeonoro UU, Njoku P, Ukegbu AU. Pattern of diabetic mortality in a tertiary health facility in Southeastern Nigeria. African Journal of Diabetes Medicine. 2013;21:1-3.

30. [30]. Chijioke A, Adamu AN, Makusidi AM. Mortality patterns among type 2 diabetes mellitus patients in Ilorin, Nigeria. JEMDSA. 2010;15:79-82.

31. [31]. Ojobi JE, Onuh JA, Odoh GU, Gomerep SS, Ogiator MO. Pattern of medical admissions in a tertiary health centre in Makurdi, North-Central Nigeria: A one-year review. Highland Medical Research Journal. 2014;14:67-70.

32. [32]. Unadike BC, Essien I, Akpan NA, Peters EJ, Essien OE. Profile and outcome of diabetic admissions at the University of Uyo Teaching Hospital, Uyo. International Journal of  Medical Sciences. 2013;5:286-289.

33. [33]. Khan MAB, Hashim MJ, King JK, Govender RD, Mustafa H, Kaabi JA. Epidemiology of type 2 diabetes: Global burden of disease and forecasted trends. Journal Epidemiology Global Health. 2020;10(1):107-111.

34. [34]. Erasmus RT, Blanco Blanco E, Okesina AB, Mesa Arana J, Gqweta Z, Matsha T. Importance of family history in type 2 black South African diabetic patients. Postgraduate Medical Journal. 2001;77:323-325.

35. [35]. Lee SC, Pu YB, Chow CC, Yeung VT, Ko GT, So WY, Li JK, Chan WB, Ma RC, Critchley JA, et al. Diabetes in Hong Kong Chinese: Evidence for familial clustering and parental effects. Diabetes Care. 2000;23:1365-1368.

36. [36]. Harrison TA, Hindorff LA, Kim H, Wines RC, Bowen DJ, McGrath BB, Edwards KL. Family history of diabetes as a potential public health tool. American Journal of Preventive Medicine. 2003;24:152-159.

37. [37]. ADAM. Diabetes: Type 2. 2004. Available from: http://adam.about.net/reports/000060_2.htm.

38. [38]. Uloko AE, Musa BM, Ramalan MA, Gezawa ID, Puepet FH, Uloko AT, Borodo MM, Sada KB. Prevalence and risk factors for diabetes mellitus in Nigeria: A systematic review and meta-analysis. Diabetes Therapy. 2018;9(3):1307-1316.

39. [39]. Pham TM, Carpenter JR, Morris TP, Sharma M, Petersen I. Ethnic differences in the prevalence of type 2 diabetes diagnoses in the UK: Cross-sectional analysis of the Health Improvement Network primary care database. Clinical Epidemiology. 2019;11:1081-1088.

40. [40]. Brutsaert EF. Complications of diabetes mellitus. New York Medical College. Reviewed/Revised Oct 2023. Modified Nov 2023.

41. [41]. Agofure O, Okandeji-Barry OR, Ogbon P. Pattern of diabetes mellitus complications and co-morbidities in Ughelli North Local Government Area, Delta State, Nigeria. Nigerian Journal of Basic and Clinical Sciences. 2020;17(2):123-127. doi:10.4103/njbcs.njbcs_37_18.

42. [42]. Tracey ML, Gilmartin M, O’Neill K, Fitzgerald AP, McHugh SM, Buckley CM, Canavan RJ, Kearney PM. Epidemiology of diabetes and complications among adults in the Republic of Ireland 1998-2015: A systematic review and meta-analysis. BMC Public Health. 2016;16:132.

43. [43]. Sherwani SI, Khan HA, Ekhzaimy A, Masood A, Sakharkar MK. Significance of HbA1c test in diagnosis and prognosis of diabetic patients. Biomark Insights. 2016;11:95-104.

44. [44]. Gluba-Brzózka A, Franczyk B, Olszewski R, Rysz J. The influence of inflammation on anemia in CKD patients. International Journal of Molecular Sciences. 2020;21(3):725.

45. [45]. Harita N, Hayashi T, Sato KK, Nakamura Y, Yoneda T, Endo G, Kambe H. Lower serum creatinine is a new risk factor of type 2 diabetes: The Kansai healthcare study. Diabetes Care. 2009;32(3):424-426.