FREQUENCY OF EARLY DIABETIC NEPHROPATHY AND ITS CLINICAL PREDICTORS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS PRESENTING TO A TERTIARY CARE HOSPITAL IN ISLAMABAD

Abstract

Objective: To determine the prevalence of diabetic nephropathy (microalbuminuria) in early phase of type 2 diabetes mellitus (DM)  presenting to a tertiary care hospital in Islamabad. Study Design: A prospective cross sectional study. Place and Duration of Study: Department of Endocrinology, Capital Hospital, Islamabad, Pakistan, from June 5, 2025 to December 5, 2025. Methodology: The methodology involved the random sampling of 250 patients with type 2 diabetes mellitus with a non-probability (consecutive) sampling technique. Baseline demographics, anthropometric measurements, clinical and laboratory evaluations, such as estimated glomerular filtration rate (eGFR), serum creatinine, fasting blood glucose, and lipid profile were recorded. Spot urinary albumin to urinary creatinine ratio (UACR) was used for the diagnosis of early diabetic nephropathy with a spot urinary albumin of 30-300 mg/g defined as microalbuminuria (early diabetic nephropathy). Independent clinical factors that could predict the onset of early diabetic nephropathy were determined by logistic regression analysis using SPSS v.25.0 software. Results: Among our cohort there was an overall prevalence of early diabetic nephropathy (microalbuminuria) of 36.8% (n = 92). Patients with early nephropathy exhibited a significantly higher mean age (58.4 ±7.2 years vs. 51.2 ±8.5 years; P < 0.001), longer median duration of diabetes (11.4 ±4.1 years vs. 6.2 ±3.3 years; P < 0.001), and poorer glycemic control with a higher mean HbA1c (8.6% ±1.4% vs. 7.1% ± 0.9%; P = 0.002) compared to those without nephropathy. Multivariate logistic regression analysis identified a prolonged duration of diabetes (OR = 1.42, 95% CI: 1.15 to 1.76; P = 0.001), elevated systolic blood pressure (OR = 1.08, 95% CI: 1.03 to 1.13; P = 0.004), elevated HbA1c levels (OR = 2.11, 95% CI: 1.45 to 3.08; P < 0.001), and presence of dyslipidemia (OR = 1.84, 95% CI: 1.12 to 3.02; P = 0.015) as strong, statistically significant independent clinical predictors of early diabetic nephropathy. Conclusion: In our area, high prevalence of early diabetic nephropathy was found among T2DM patients. Long-term diabetes, a lack of glycemic control, systemic hypertension and the presence of dyslipidemia are key clinical risk factors associated with renal microvascular alterations. A common approach to screening for renal disease, using urinary Albumin to Creatinine Ratios, should be aggressively used to enable multi-factor interventions to commence at an early stage in the disease.