Significance of proteinuria in type 2 diabetic patients treated at a primary health care center in Abha city, Saudi Arabia

The aim of the present study is to describe the prevalence of proteinuria in a series of type 2 diabetic patients registered and followed up in the diabetes clinic of a primary health care center (PHCC) in Abha city, southern Saudi Arabia and to relate the proteinuria to some clinical manifestations. The study involved the files of 208 diabetic patients (118 females and 90 males). They were chosen from 475 files of diabetic patients receiving care in the PHC center of Shamasan in Abha City. The selection for this study was based on the fulfillment of certain criteria: type 2 diabetic patients, registered for at least 12 months and visited the clinic for at least once during that period. For each patient the age, sex, family history, diabetes duration, body mass index, the last readings of fasting blood sugar, total cholesterol level, systolic and diastolic blood pressure were used. Proteinuria was considered whenever the last and any of the preceding 3 urine analysis revealed it by the dipstick test provided the patient was not suffering on the day of the test from fever, urinary tract infections, other renal diseases or congestive heart failure. Further, the last recorded subjective evaluation of the treating physician concerning diet, drug and appointment compliance as poor or good was used. The mean age is 56.2+/-8.8 years. The mean duration of diabetes was 9.6+/-4.7 years, while the fasting blood sugar shows a considerably high mean of 218.0+/-72.0 mg/dl. The total cholesterol level on the other hand showed a slight high average of 233.7+/-55.2 mg/dl. The mean systolic and diastolic blood pressure were within normal ranges (136.4+/-18.9mmHg and 87.5+/-10.8mmHg) respectively. The results of the three different types of compliance as scored by the treating physician. The poor scores dominate with 74%, 82.7% and 78.4% of patients' diet, drug and appointment compliances. Proteinuria is present in more than half of the patients (54.3%). The outcome of the logistic regression model for proteinuria showed that the significant factors were the poor glycemic control with an odds ratio (OR) of 3.13, diabetes duration (OR= 1.08 for every year) and diastolic blood pressure (OR= 6.11). The overall model prediction was 72.12%. Diabetic patients treated in the PHC level should be regularly monitored for microalbuminuria and not gross proteinuria to prevent progression to overt nephropathy which will eventually lead to ESRD. The risk increases with poorly controlled and hypertensive patients.