Comparison of Ureum Plasma Level between Controlled Type 2

Diabetes Mellitus and Uncontrolled Type 2 Diabetes Mellitus

Maya Savira

, Rusdiana

, Sry Suryani Widjaja

, M. Syahputra

Departement of Physiology,Medical Faculty, Universitas Sumatera Utara, Jl. dr. Mansur no.5, Medan, Indonesia

Departement of Biochemistry, Medical Faculty, Universitas Sumatera Utara, Jl. dr. Mansur no.5, Medan, Indonesia

Keywords Diabetes Mellitus, Type 2 Diabetes Mellitus, Ureum, Ureum Plasma

Abstract Diabetes mellitus is characterized by chronic hyperglycemia, Diabetes mellitus is associated with absolute or

relative deficiencies in insulin secretion, insulin action or both. Diabetic nephropathy occur in approximately

in one third type 2 diabetic patients which are uncontrolled. In diabetic nephropathy, bio-markers such as

serum urea and creatinine are known to be raised with hyperglycemia and usually correlate with severity of

kidney damage. Urea and creatinine are good indicators of a normal functioning kidney and increase in the

serum are indications of kidney dysfunction. Objective of this study is to compare ureum plasma level between

controlled type 2 diabetes mellitus (CT2DM) and uncontrolled type 2 diabetes mellitus (UCT2DM). This

study is descriptive analytic research method with across-sectional design. It involved 40 patients, sample

population is all of type 2 diabetic patients in the Primary Health Care in Binjai city of North Sumatera

Indonesia in accordance with the inclusion criteria. Subjects devided into two groups each group consisted of

20subjects the two groups are UCT2DM patients and CT2DM. Estimation of ureum level was done by the

modified Berthelot’s method with spectrophotometry. t-test was used to compare the ureum level. The

average ureum level of the UCT2DM patients is 28.05 mg/dl, the CT2DM patients is 27.58 mg/dl. This study

showed that there was significant difference between CT2DM and UCT2DM (p<0.005). This findings

showed that good control of blood glucose level is absolute requirement to prevent progressive renal

impairment.

1 INTRODUCTION

Diabetes mellitus (DM) is classified based on chronic

hyperglycemia the increasing of blood glucose level

that is caused by missarrengement in metabolism of

fat, carbohydrate, and protein. DM is connected

relatively or absolutely with decreasing in insulin

secretion or/ and insulin action (Kanwar et al., 2015).

DM affects above 170 million people in the world and

keep increasing up to 370 million in 2030 according

to the World Health Organization (WHO) (Wild et

al.,2004., Mehta , 2006). At the present time, around

217 million people live with DM, above 350 million

people will live in that condition by 2030 (Smyth and

Heron, 2006., Yach et al.,2006). The data from

regional International Diabetes Federation (IDF)

demontrates that Southeast Asia ranked second in the

world 3 and the number of diabetics in Indonesia was

ranked seventh in the world in 2013 (Riskesdas ,

2013).

Type 1 diabetes mellitus (T1DM)and type 2

diabetes mellitus (T2DM) are clear diseases due to

either disfunction of pancreatic to synthesize insulin

or ineffectiveness of insulin maintaining blood

glucose level that is still in the physiologic range

(Karla , 2012).

The risk factors for T2DM are obesity,

poor diet, sedentary lifestyle, increased age, family

history and metabolic syndrome (Kasper et al., 2005).

Diabetic nephropathy occur on the order of one third

T2DM patients which are uncontrolled (Rehman et

al., 2005). Diabetic nephropathy is classified based on

albuminuria above 300 mg/24-hour urine collection

and disfunction of renal as shown by the increasing of

creatinine serum level and urea serum level. Diabetic

nephropathy Clinically, is diagnosed based on

proteinuria and, decresing of glomerular function rate

(GFR), (Melmed, 2016).

In diabetic nephropathy,

bio-markers like serum urea and creatinine are known

to be increased with hyperglycemia and usually

associate with severity of kidney damage (Melmed,

2016., Zimmet et al., 2001).The good indicators to

determine weather kidney is in normal function are

urea serum level and creatinine serum level. The

Savira, M., Rusdiana, ., Widjaja, S. and Syahputra, M.

Comparison of Ureum Plasma Level between Controlled Type 2 Diabetes Mellitus and Uncontrolled Type 2 Diabetes Mellitus.

DOI: 10.5220/0010077105250527

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

525-527

ISBN: 978-989-758-449-7

525

increasing of these serum indicates dysfunction of the

kidney (Kamal, 2014).

Blood tests for Blood Urea

Nitrogen (BUN) which is a major nitrogenous end

product of protein and amino acid catabolism and

creatinine which is a breakdown product of creatine

phosphate in muscle are excreted by kidneys are used

routinely instead of urine analysis whish is

discomforting for patients (Kamal, 2014., Gowda et

al, 2010). The aim of this study is to compare ureum

plasma level between controlled type 2 diabetes

mellitus (CT2DM) and uncontrolled type 2 diabetes

mellitus (UCT2DM).

2 METHODS

This is a descriptive analytic research study with

cross-sectional design. 40 patients included,in this

research consecutive sampling method used to enroll

the subjects, population of the sample is all of the

patients in the Primary Health Care in Binjai city of

North Sumatera Indonesia that is diagnosed as type 2

diabetes mellitus then the subjects divided in to two

groups the first one is the group of UCT2DM 20

subjects and the second one is the group of CT2DM

included 20 subjects, it separated based on clinincal

laboratory test of Hba1c. the value of Hba1c 6.5-8%

was classified as CT2DM and the value of Hba1c >

8% was classified as UCT2DM. The inclusion criteria

were, aged > 40 years old, have a will to join this

research and cooperative and exclusion criteria were,

in the middle of cancer and diuretic therapy.The

approval of this research was obtained from Health

Research Ethical Committee, Medical Faculty of

University Sumatera Utara /H.Adam Malik General

Hospital number 591/TGL/KEPK FK USU-RSUP

HAM 2018. We examined each sample by their

weight, height, abdominal circumstance, blood

pressure,and we did the clinical laboratory tests such

as fasting blood sugar levels and Hba1c and ureum

plasma levels as well by using secondary data, we

estimated the ureum levels by Berthelot’s method

that is modified. We collected plasma using standart

protocol with EDTA then we add urease and

incubated for 20 minutes in 37

C then we add reagen

1 and 2, incubated for next 20 minutes in 37

C and

we did the spectrophotometry with wavelength

546±548 nm. The measurement of Hba1c was done

in Thamrin clinical laboratory. The informed consent

were given to all subjects. The data were analyzed

using T-Test and p value<0.005 was considered as

significant.

3 RESULT AND DISCUSSION

Table 1. Baseline characteristic of 40 subjects.

UCT2DM CT2DM

)

56.2±9.2 60.6±7.3

BMI (kg/m2) 26.5±3.5 25.7±4.1

waist size

(

)

92.4±5.2 93.1±9.0

FBS

(

/dl

)

219.1±92.4 155.6±45.2

Hba1C (%) 9.7±1.0 8.0±1.8

Ureum

(

/dl

)

28.05±7.45 27.58±7.20

stole

(

mmH

124.9±18.2 144±30.6

Diatole(mmHg) 77.6±7.3 89.1±17.3

Between 40 patients of T2DM, the male were 30.4%

and the female were 69.6%. Baseline characteristic of

the samples are shown in table 1. In this research the

average age of the uncontrolled T2DM patients is

56.2 years old, the controlled T2DM patients is 60.6

years old. The average BMI of the uncontrolled

T2DM patients is 26.5 kg/m

, the controlled T2DM

patients is 25.7 kg/m

. The average waist size of the

uncontrolled T2DM patients is 92.4 cm, the

controlled T2DM patients is 93.1cm. The average

FBS of the uncontrolled T2DM patients is 291.1

mg/dl, the controlled T2DM patients is 155.6 mg/dl.

The average Hba1C of the uncontrolled T2DM

patients is 9.7%, the controlled T2DM patients is

8.0%. The average ureum level of the uncontrolled

T2DM patients is 28.05 mg/dl, the controlled T2DM

patients is 27.58 mg/dl. The average systole of the

uncontrolled T2DM patients is 124.9 mmHg, the

controlled T2DM patients is 144mmHg. The average

diastole of the uncontrolled T2DM patients is 77.6

mmHg, the controlled T2DM patients is 89.1 mmHg.

All of the group samples showed the above normal of

ureum levels, which the normal value is 7-20mg/dl.

We have already known that the ureum plasma value

demonstrated the function of the renal. The aim of

this study is to compare ureum plasma level between

CT2DM and UCT2DM. So we used the T-test

statistical analysis to analyze the value of both groups

sample. This study showed that there was significant

difference between CT2DM and UCT2DM

(p<0.005). When there is a damage in kidney or it

does not work properly an increase in urea level will

be seen. Increasing of blood sugar level followed by

increasing blood urea level clearly indicates that there

is a damage in the kidney. Research conducted by

Anjaneyulu et al., 2004 had found that increase urea

and serum creatinine in diabetic rats indicates

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

526

progressive renal damage (Anjaneyulu et al., 2004).

In our study, the increasing in serum urea levels

associated with the severity of diabetes, this finding

is in accordance with the fact that serum creatinine

and urea are used as important markers of Glomerular

Filtration Rate (GFR) (Deepa et al., 2011). Our study

is inline as well with the study that was conducted by

Sugam S et al that found that diabetic patients have

higher serum urea in compare to non-diabetic

patients. They reported that 18 out of 103 diabetes

samples have high urea level. An another study also

showed that the increase in mean values of serum urea

136.03 ± SD 74.6 mg/dl in kidney disease patients

with Diabetes mellitus (Mittal et al, 2010). The

increasing levels of serum urea is one of the

important measures of a damage in glomerular which

can, in no way be reversed by intensive treatment plan

of lowering glucose level in diabetic patients. The

only way to control the progressiveness of glomerular

damage and thereby increasing levels of serum urea

is the early detection and intervention.

4 CONCLUSION

The major cause of renal morbidity and mortalityis

DM, and diabetic nephropathy is one of the major

cause of chronic kidney failure. One of the indicator

that is widely used to examine the renal function

failure is blood urea and creatinine levels, it is simple

and useful biomarkers that can be a predictor test to

examine kidney functions (nephropathy) in DM

patients. Blood glucose levels that is in good control

helps to preventthe progressiveness of renal

impairment and one of major cause of chronic renal

failure which is diabetic nephropathy. The good

control of blood glucose level is the most important

requirement in preventing the progressiveness of

renal impairment. In order to monitor the control of

blood glucose level along with blood sugar blood urea

can also be important parameter as we found that

there is strong correlation of blood sugar and urea

level.

ACKNOWLEDGEMENT

The authors gratefully acknowledge that the present

research is supported by Ministry of Research and

Technology and Higher Education Republic

Indonesia, under research grant TALENTA USU of

Year 2018.

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