2. Background
Diabetes is one of
the major causes of
premature illness
and death
worldwide.*
2010 global
prevalence of
diabetes 6.4 %
2030 global
prevalence of
diabetes 7.8 %*
*Reference : World Health Organization

3. 1998 Thai
prevalence of
diabetes 4.7% *
2009 Thai
prevalence of
diabetes 6.9% *
Reference : Thai national health survey 1998
Background

4. Complication of Diabetes
Reference *http://www.medscape.org/viewarticle/449657

5. Diabetic Nephropathy
Reference *http://www.medscape.org/viewarticle/449657

6. The goal of treatment for chronic
kidney disease is to prevent or slow
further damage

7. Literature review
Impact of Glycemic control on survival of diabetic
patients on chronic regular hemodialysis
Inoue
Hemodialysis
HbA1C
* Reference:Oomichi T, Emoto M, Tabata T, Morioka T, Tsujimoto Y, Tahara H, Shoji T, Nishizawa Y. :Impact of glycemic control
on survival of diabetic patients on chronic regular hemodialysis:7 year observational study. Division of Metabolism,
Endocrinology, and Molecular medicine, Department of Internal Medicine, Osaka city university Graduate medical school,1-4-
3, Asahi-machi Osaka, Japan 545-8585

8. Literature review
Glycated protein as indices of glycemic control
in diabetic patient with chronic renal failure
HbA1c, fructosamine albumin adjusted fructosamine
mean capillary blood glucose concentration HbA1C
mean capillary blood glucose concentration
*Reference: Morgan. L, Marenah, C.B., Jeffcoate, W.J. and Morgan, A.G.,Glycated proteins as indices of Glyceamic
control in Diabetic patients with Chronic renal failure.Diabet.Med,13:514-519

9. Literature review
• The unrecognized prevalence of chronic kidney
disease in diabetes
serum creatinine albuminuria estimated
glomerular eGFR
• *Reference: [5] Wild S, Roglic G, Green A,Sicree R,King H:Global prevalence of diabetes:estimates for the year 2000
• and projections for 2030.Diabetes Care27:1047-1053,2004

10. “
*Reference : American Diabetes Association. Standards of Medical Care in
Diabetes—2013. Alexandria, VA, American Diabetes Association, 2013

12. Conceptual Framework
Diabetes
Diabetes with
nephropathy
CKD
Stage5
(ESRD)
Stage1
Stage4
Stage3
Stage2
Tertiary Prevention
-Age
-Gender
-Race
-Behavior
-Medication
-BMI
-Blood pressure
-Glycemic control
-Lipid profile

13. Objectives
–
–
–

14. Study design
• Retrospective cohort study
– 3-21 2556
–
–
Duration
Study area
Outcome measurement

15. Population
Study population )
2
- 2554
2555 2556
( Target population )
( Population )

16. Study population
–
2
2553 2556
– Creatinine 2556
– Creatinine -
2554
Inclusion criteria
Exclusion criteria

17. Sampling
Estimating population proportion and adjusted framework
•
40%
n = (NZ2
α/2 P Q ) / d2(N-1) + Z2
α/2 P Q

18. Methods
1.
2.
3.

19. Methods
4.
5.
6.
1.Gender
2. Age
3. BMI
4.U/D; HT, DLP
5.FBS
6.HbA1c
7.eGFR
8.Smorking
9.Alcohol drinking
10. Medication

20. Time schedule
3
2556
•
7
2556
•
10
2556
•
•

21. 14-20
2556
• inclusion
exclusion criteria
•
26
2556
•

22. Result
Demographic Data
Glycemic Control
Correlations

23. Demographic Data
Mean SD (Min-
Max) 58 11 (23-82)
35 22.7
119 77.3
7 4.5
138 89.6
1 0.6
8 5.2

24. 72 46.8
5 3.2
60 39.0
1 .6
2 1.3
14 9.1
Mean SD
(Min-Max)
63 14 (36-
101)
Mean SD 155 8

25. 135 87.7
11 7.1
8 5.2
134 87.0

26. 42 27.3
112 72.7
Cholesterol
≤200 mg/dl 114 74
>200 mg/dl 40 26
LDL
≤100mg/dl 79 51.3
>100mg/dl 75 48.7
HDL
≤40m
g/dl 32 20.8
>40m
g/dl 122 79.2
Triglyceride

27. Glycemic control
FBS):Mean SD (Min-Max)
137 25.5
(88-216)
FBS)
≤130mg/dl 74 48.1
>130mg/dl 80 51.9
HbA1C):Mean SD (Min-Max)
7.9 1.3(4.9
-11.2)
HbA1C)
≤6.5
% 24 15.6

28. GFR):Mean SD (Min-Max)
6.4 3.6(0.3
1-24.82)
GFR)
≤6.5
ml/min/m2/y
ear 74 48.1
>6.5
ml/min/m2/y
ear 80 51.9
2
31 20.1
3
121 78.6

29. Metfor
min
17 11.0
137 89.0
Glipizid
e
110 71.4
44 28.6
Glibenclamid
e
62 40.3
92 59.7

30. Correlation
GFR)
≤6.5 >6.5 OR
95%
Confidence
Interval
P-
VALU
E
FBS) 1.16
2
0.617-
2.189 0.642
≤130 37(50
)
37(5
0)
>130 37(46
.25)
43(5
3.75)
HbA1C) 2.48
0.993-
6.208 0.047

31. GFR)
≤6.5 >6.5 OR
95%
Confiden
ce
Interval
P-
VALU
E
Metformin 0.95
6
0.348-
2.624 0.931
8(47.06) 9(52.9
4)
66(48.18) 71(51.
82)
Glipizide
0.41
1
0.200-
0.845 0.014
46(41.82)
64(58.
18)
16(36.

32. GFR)
≤6.5 >6.5 OR
95%
Confiden
ce
Interval
P-
VALU
E
Glipizide 2.43
0.200-
0.845 0.014
28(63.64)
16(36.
36)
46(41.82)
64(58.
18)

33. Discussion
• (SD)6.4(3.6)
ml/min/m2/year
(SD) 3.8 ( 4.2) 4.0( 3.1)
ml/min/year
•
6.5%
6.5 ml/min/m2/year 2.48

34. Discussion
•
, ,
Glycemic control Is a predictor of survival
for Diabetic Patients on Hemodialysis
• Glipizide
Use of insulin and oral hypoglycemic
medications in patients with diabetes mellitus and advanced
kidney disease

35. Limitation
• HbA1c
Anemia Hemoglobinopathies
• 2
• 3. 2553
• 4.

36. Reccomentation
• 1.
• 2

37. Acknowledgement
•
•
•
•
•
•
•
•
•
•
•