G.J.LIM1, S.LOW1, Y.SHAO2, T.SUBRAMANIAM3, C.F.SUM3, S.C.LIM1
Nanyang Technological University1, Khoo Teck Puat Hospital2, Admiralty Medical Centre3
Singapore ranks highest in 2020 for diabetic nephropathy worldwide. Although diabetes self-care is an essential component of diabetes management, knowledge on the association between self-care and CKD remains limited. We aim to determine the association between self-care in T2D and CKD.
This was a cross-sectional study of 631 patients (age 56.8 ±11.6 years, 55.1% male, 44.6% Chinese, 33.6% Malay, 20.2% Indian) with T2D from DORIS cohort. Summary of Diabetes Self-Care Activities Measure was used to quantify self-care in diet, exercise, self-monitoring of blood glucose (SMBG) and foot care. CKD, with a prevalence of 62.3% in the cohort, was defined as estimated glomerular filtration rate <60 ml/min/1.73m2 or urinary albumin-to-creatinine ratio ≥30 mg/g from blood and urine samples collected. Logistic regression models examined the association between self-care measures and CKD in T2D patients.
Mean scores (±SD) for self-care were: general diet, 3.9±2.1; specific diet, 4.8±1.5; exercise, 2.7±2.0; SMBG, 2.1±2.1; and foot care, 3.7±2.8. Higher SMBG scores, suggestive of better self-care, were inversely associated with reduced odds of CKD (odds ratio (OR) 0.94; 95%CI 0.87-1.01; p=0.089). This association persisted after adjusting for demographics (OR 0.91; 95%CI 0.84-0.99; p=0.024) as in Model 1, and even in Model 2, after adjusting for demographics, metabolic profile, and medications (OR 0.90; 95%CI 0.81-0.99; p=0.028). The other self-care measures were not significantly associated with CKD.
SMBG was independently associated with lower odds of CKD. However, it was the most underperformed amongst patients. Heightened awareness and efforts in SMBG may prove useful in reducing CKD in T2D.