Capítulo 4. Resultados.
4.2. La retroalimentación o feedback estratégico
4.3.2. Factoraje a Proveedores
Stages of Chronic Kidney Disease
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TABLE 7: THE FREQUENCY OF DIABETIC NEPHROPATHY ACCORDING TO DIABETIC RETINOPATHY
Diabetic Retinopathy Total (%) Absent (%) Present (%)
Diabetic Nephropathy
Absent 75 (47.5) 116(47.9) 191(47.8)
Present 83(52.5) 126(52.1) 209(52.2)
Total 158(100.0) 242(100.0) 400(100.0)
Chi-Square = 0.008, df=1, p = 0.927
Table 7 shows the distribution of subjects according to absence or presence of diabetic retinopathy. Of the 209 diabetics with nephropathy 126 (60.29%) had diabetic retinopathy and 83(39.7%) had no retinopathy. Similarly the probability that a subject with DR had DN is 52.07%.Given the last objective of this study, the probability that a T2DM subject had concurrent DN and DR is 31.5%. Although a greater population of patients with DN had DR, there was no statistical significance (chi = 0.008, df=1 p = 0.927).
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TABLE 8: THE FREQUENCY OF DIABETIC NEPHROPATHY ACCORDING TO DYSLIPIDEMIA
Dyslipidemia Total (%)
Absent (%) Present (%) Diabetic
Nephropathy
Absent 28 (53.8) 163 (46.8) 191(47.8) Present 24 (46.2) 185 (53.2) 209 (52.2)
Total 52 (100.0) 348 (100.0) 400 (100.0)
Chi-Square=0.890, df = 1, p =0.345
Table 8 shows the distribution of subjects according to normal and abnormal serum lipids (dyslipidemia). Some 52 (13%) subjects had normal serum lipids while majority 348 (87%) had dyslipidemia. Of the 209 subjects with nephropathy 185 (88.5%) had dyslipidemia and 24 (11.5%) had normal serum lipid levels. Similarly the proportion of T2DM subjects who have DN is 53.16%. Even though the proportion of DN was higher in the former group, the difference was not statistically significant. (P = 0.345).
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FIG 6: BAR CHART SHOWING DISTRIBUTION OF SUBJECTS BY BMI
Of the study population, 3 (8%) persons were underweight, 120 (30%) had normal weight, 144(36%) over weight and 133 (26%) subjects were obese.
0 20 40 60 80 100 120 140 160
3
120
144
133
Body Mass Index
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TABLE 9: PROPORTION OF SUBJECTS WITH DIABETIC RETINOPATHY ACCORDING TO BMI
Body Mass Index
Total (%) Underweight
(%)
Normal (%)
Overweight (%)
Obese (%) Diabetic
Retinopathy
Absent
2(1.3) 46(29.1) 49(31) 61(38.6) 158(100)
Present 1(0.4) 74(30.6) 95(39.3) 72(29.8) 242(100) Total
3 (0.8) 120 (30) 144(36) 133(33.2) 400(100)
Chi-Square=0.890, df=3, p =0.168
Of the 242 subjects with retinopathy 1 (0.4%) was underweight, 74 (30.6%) had normal BMI, 95 (39.3%) subjects were overweight and 72 (29.8%) were obese (BMI> 30kg/m2) . Although a larger population in the overweight group had DR, there was no statistical significance (p > 0.05)
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TABLE 10: SHOWING PROPORTION OF SUBJECTS WITH DN ACCORDING TO BMI
Body Mass Index
Total(%) Underweight
(%)
Normal (%)
Overweight (%)
Obese (%) Diabetic
Nephropathy
Absent
0(0) 41(34.2) 69(47.9) 81(60.9) 191(47.8)
Present 3(100) 79(65.8) 75(52.1) 52(39.1) 209(52.2) Total
3(100) 120(100) 144(100) 133(100) 400(100)
Chi-Square= 20.84, df= 3, p= 0.00
Table 10 shows the distribution of subjects according to body mass index. Of the 209 subjects with nephropathy 3 (1.4%) were underweight, 79 (37.8%) had normal BMI, 75 (35.89%) subjects were overweight and 52 (24.88%) were obese (BMI> 30kg/m2).The relationship between DN and BMI was statistically significant (P = 0.00).
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TABLE 11: SHOWING PROPORTION OF SUBJECTS WITH DN ACCORDING TO WAIST-HIP RATIO
Waist-Hip Ratio Total (%) Increased(%) Normal (%)
Diabetic nephropathy
Absent
108 (56.5) 83 (43.5) 191 (100) Present
117 (56) 92 (44) 209 (100) Total
225(56.2) 175 (43.8) 400 (100.0)
Chi-Square = 0.13, df = 1, p = 0.910
175(43.8%) of the study subjects had normal WHR and 225(56.2%) had > 0.9.Of the 209 diabetics with nephropathy 117 (56%) had abnormal WHR and 92 (44%) had normal WHR.
Even though more persons in the group with increased WHR had DN, statistical significance could not be established (p = 0.910).
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TABLE12: RELATIONSHIP BETWEEN WAIST-HIP RATIO AND DIABETIC RETINOPATHY
Diabetic Retinopathy Total (%) Absent (%) Present (%)
Waist-Hip Ratio Increased
71 (44.9) 154 (63.6) 225 (56.2) Normal
87 (55.1) 88 (36.4) 175 (43.8) Total
158 (100.0) 242 (100.0) 400 (100.0)
Chi-Square = 13.582, df = 1, p = 0.000
Above table shows that a total of 225 (56.2%) study subjects had increased WHR and 175 normal waist-hip ratio. Of the 242 subjects with DR 154 (63.6%) had increased WHR while 88 (36.4%) had WHR < 0.9.A larger proportion of subjects with increased WHR had DR and this was found to be statistically significant (p = 0.000).
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TABLE 13: SHOWING PROPORTION OF SUBJECTS WITH DN ACCORDING TO WAIST CIRCUMFERENCE
Waist Circumference Total(%) Increased (%) Normal (%)
Diabetic Nephropathy
Absent
97 (54.5) 94(42.3) 191 (47.8) Present
81(45.5) 128 (57.7) 209 (52.2) Total
178 (100.0) 222 (100.0) 400 (100.0)
Chi-Square = 5.84, df =1, p=0.16
Table 14 shows the distribution of subjects according to normal and abnormal waist circumferenc.222 (55.5%) subjects had normal WC while 178 (44.5%) had WC >94cm. Of the 209 subjects with nephropathy 128 (61.2%) had normal WC and 81 (38.8%) had increased WC. Although the proportion of DN was higher in the former group, the difference was not statistically significant. (P = 0.16).
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TABLE 14: ASSOCIATION BETWEEN WAIST CIRCUMFERENCE AND DIABETIC RETINOPATHY
Waist-hip ratio
Total (%) Increased (%) Normal (%)
Diabetic Retinopathy Absent
71 (44.9) 87 (55.1) 158 (100) Present
154 (63.6) 88(36.4) 242 (100) Total
225(56.2) 175 (43.8) 400 (100.0)
Chi-Square= 4.502, df=1, p=0.034
Table 14 shows the association between waist circumference (WC) and diabetic retinopathy .Of the 242 diabetics with DR 154 (63.6%) had increased WHR while 88 (36.4%) had normal WC. This difference was found to be statistically significant. (P = 0.034).
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TABLE 15: SHOWING PROPORTION OF SUBJECTS WITH DN ACCORDING TO BLOOD PRESSURE
Blood pressure
Total (%) Controlled(%) Uncontrolled
Diabetic Nephropathy
Absent 112(56.8) 79(41.4) 191(100)
Present 126(60.3) 83(39.7) 209(100)
Total 238(59.5) 162(40.5) 400(100.0)
Chi-Square=0.113, df =1, p = 0.737
Table 15 shows the distribution of study population according to blood pressure levels.238 patients had controlled blood pressure and 162 had blood pressure
>140/90mmHg.Of the subjects with DN 126 (60.3%) had controlled blood pressure while 83 (39.7%) had uncontrolled BP. Even though a higher proportion of patients with controlled blood pressure had DN compared with those with uncontrolled BP, the difference was not statistically significant (p = 0.737).
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TABLE16: ASSOCIATION BETWEEN BLOOD PRESSURE AND DIABETIC RETINOPATHY
Diabetic Retinopathy
Total (%) Absent (%) Present (%)
Blood Pressure Control
Controlled
116(73.4) 122(50.4) 238(59.5) Uncontrolled
42(26.6) 120(49.6) 162(40.5)
Total 158(100.0) 242(100.0) 400(100.0)
Chi-Square=20.993, df=1, p=.000
Table 17 shows the proportion of study subjects with DR according to blood pressure. A total of 238 (59.5%) subjects had controlled blood pressure and 162 (40.5%) had BP≥ 140/90mmHg.Of the 242 diabetics with retinopathy, 122 (50.4%) had controlled BP while 120 (49.6%) had uncontrolled blood pressure. This difference was found to be very statistically significant. (P = 0.000).
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TABLE 17: THE RELATIONSHIP BETWEEN GLYCEMIA AND DIABETIC NEPHROPATHY
Diabetic Nephropathy
Glycemic control Absent Present Total
Poor Control 121 (63.4%) 139 (66.5%) 260 (65.0%)
Good Control 70 (36.6%) 70 (33.5%) 140 (35.0%)
Total 191 (100.0%) 209 (100.0%) 400 (100.0%)
Chi-Square =0.437, df=1, p=0.509
Table 18 shows the proportion of subjects with DN according to glycemic control.260 (65%) of the study population had poor glycemic control and 140 (35%) had HBA1c< 7%.
Of the 209 respondents with DN 139 (66.5%) had poor glycemic control while 70 (33.5%) subjects had good glycemic control. Although a larger number of the former group had DN, the difference was not statistically significant (p > 0.05).
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TABLE 18: THE ASSOCIATION BETWEEN GLYCEMIA AND DIABETIC RETINOPATHY
Chi-Square =0.501, df = 1, p=0.004
260 study subjects had poor glycemic control while 140 (35%) had good glycemic control.
Of the diabetics with retinopathy 88 (36.4%) had good glycemic control and 154 (63.6%) had glycated hemoglobin values > 7%. The difference between these groups was found to be statistically significant (p <0.05).
Diabetic Retinopathy
Absent (%) Present (%) Total (%) Poor Control 106 (67.1) 154 (63.6) 260 (65.0)
Good Control 52 (32.9) 88 (36.4) 140 (35.0)
Total 158 (100.0) 242 (100.0) 400 (100.0)
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TABLE 19: PROPORTION OF SUBJECTS WITH DR ACCORDING TO CHRONIC KIDNEY DISEASE.
Diabetic Retinopathy
Total (%) Absent (%) Present (%)
Chronic Kidney Disease
No CKD
137(86.7) 176(72.7) 313(78.2) Presence of CKD
21(13.3) 66(27.3) 87(21.8)
Total 158(100.0) 242(100.0) 400(100.0)
Chi-Square=10.979,df = 1, p = 0.001
Table 19 shows the proportion of subjects with DR according to CKD.242 of the study subjects had DR and 158 had no evidence of DR. Of the subjects with DR 66(27.3%) had CKD while 176 (72.7%) had no CKD. Although a larger proportion of the former group had DR there was a significant statistical difference between the two groups (p = 0.001).
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TABLE 20: UNIVARIATE REGRESSION ANALYSIS SHOWING VARIABLES ASSOCIATED WITH DIABETIC NEPHROPATHY
DM Nephropathy Present (%)
DM Nephropathy
Absent (%)
OR (C.I) P
History of Hypertension
104(57.5) 77(42.5) 1.466 (0.987 - 2.180) 0.058
History of Smoking
17(44.7) 21(55.3) 1.395 (0.713 - 2.732)
0.330 History of
Alcohol use
36(48.0) 39(52.0) 1.233 (0.746 - 2.037)
0.414
Elevated WC 81(45.5) 97(54.5)
1.631 (1.093-2.426) 0.016
Elevated WHR 92(52.6) 83(47.4)
1.023 (0.689 - 1.520) 0.91
Obesity 51(38.6) 81(61.4) 2.283 (1.488 - 3.497)
0.000 Uncontrolled
BP
83(51.2) 79(48.8) 1.071 (0.718 - 3.067)
0.003 Diabetic
Retinopathy
126(52.1) 116(47.9) 1.018 (0.682 - 1.522)
0.927 Poor
Glycaemic Control
139(53.5) 121(46.5)
0.871 (0.577- 1.313) 0.509
High TC 75(51.0) 72(49.0)
1.081 (0.719 – 1.623) 0.707
High LDL 150(51.9) 139(48.1) 1.052 (0.678 - 1.629)
0.823
Low HDL 57(55.9) 45(44.1) 1.217 (0.773 - 1.912)
0.394
High TG 42(64.6) 23(35.4) 1.837 (1.058 - 3.189) 0.029
A univariate regression analysis of the variables associated with diabetic nephropathy is shown in table 20.The variables that were found to be associated with DN include uncontrolled hypertension >140/90mmHg (p=0.003), increased waist circumference > 94 cm (p = 0.016), obesity; (BMI > 30kg/m2), (p=0.000) and high serum triglyceride level >
150mg/dl (p= 0.029).
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TABLE 21: MULTIPLE LOGISTIC REGRESSION TABLE SHOWING
INDEPENDENT PREDICTORS OF DIABETIC NEPHROPATHY IN STUDY SUBJECTS
B p Odds Ratio
95.0% Confidence Interval
Variable Lower Upper
Elevated
TG 0.658 0.022 1.931 1.099 3.390
Obesity 0.848 0.000 2.335 1.518 3.593
Constant 0.076 0.798 1.079
Table 22 shows a multiple regression analysis of diabetic nephropathy-related variables which were found to be statistically significantly associated with DN in univariate analysis. Even though all the variables tested were significantly correlated with DN in univariate analysis, the independent predictors of DN in multivariate analysis were elevated serum triglyceride level > 150mg/dl (p = 0.022) and obesity (BMI) > 30kg/m2 (p = 0.000);
the latter being the stronger independent predictor of diabetic nephropathy.
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TABLE 22: UNIVARIATE REGRESSION ANALYSIS SHOWING VARIABLES ASSOCIATED WITH DIABETIC RETINOPATHY
DM
Retinopathy Present (%)
DM
Retinopathy Absent (%)
OR (C.I) P
History of Hypertension
137(69.3) 44(30.7) 3.381 (2.197 - 5.201) 0.000 History of
Smoking
28(73.7) 10(46.3) 1.936 (0.913- 4.107) 0.081 History of
Alcohol use
52(69.3) 23(30.7) 1.606 (0.938 – 2.751) 0.083 Elevated WC 118(66.3) 60(33.7) 1.555 (1.033 - 2.336) 0.034 Elevated WHR 154 (68.4) 71(31.6) 2.146 (1.425 - 3.226) 0.000
Obesity 72(45.5) 60(54.5) 1.445 (0.947 - 2.212) 0.088
Uncontrolled BP
140 (74.1) 42 (25.9) 2.717 (1.761 - 4.192) 0.000 Poor
Glycaemic Control
154 (59.2) 106 (40.8) 1.165 (0.763 - 1.778) 0.002
High TC 93(63.3) 54(36.7) 1.202 (0.791 - 1.827) 0.388
High LDL 178(61.6) 111(38.4) 1.178 (0.755 - 1.838) 0.472
Low HDL 57(55.9) 45(44.1) 1.293 (0.820 - 2.038) 0.269
High TG 44(67.7) 21 (32.3) 1.450(0.825-2.547) 0.195
DN 116(60.7) 75 (39.3) 0.982(0.657-1.466) 0.927
CKD 66(75.9 21 (24.1) 2.44 (1.426-4.196) 0.001
Table 22 shows a univariate regression analysis of the variables associated with diabetic retinopathy. The variables that were found to be associated with DR include history of hypertension (p = 0.000), increased waist circumference > 94 cm (p = 0.034), increased WHR > 0.9 and uncontrolled hypertension (p= 0.000) poor glycemic control (p=0.002) and chronic kidney disease (p<0.001).
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TABLE 23: MULTIPLE LOGISTIC REGRESSION TABLE SHOWING INDEPENDENT PREDICTORS OF DIABETIC RETINOPATHY IN THE STUDY POPULATION
B p
Odds Ratio
95.0% Confidence Interval
Lower Upper History of
Hypertension 0.855 0.001 2.350 1.475 4.371
Elevated Waist-Hip
Ratio 0.791 0.001 0.454 0.292 0.705
Uncontrolled Blood
Pressure 0.915 0.002 2.497 1.392 4.479
CKD Constant
0.915
0.319 0.181 1.375
Table 23 shows a multiple regression analysis of diabetic retinopathy-related variables which were found to be statistically significantly associated with DR in univariate analysis.
Even though all the variables tested were significantly correlated with DR in univariate analysis, the only independent predictors of DR in multivariate analysis were history of hypertension (p=0.000), WHR > 0.9 (p=0.001), uncontrolled hypertension (p=0.001) and chronic kidney disease (P < 0.002). History of hypertension and uncontrolled hypertension were the strongest predictors of DR in the study subjects.
0.002 2.497 1.392 4.479
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TABLE 24 PROPORTION OF SUBJECCTS WITH BOTH DN AND DR Both Complications Frequency Percent
Absent 274 68.5
Present 126 31.5
Total 400 100.0
126 (31.5%) of the study population had co-occurrence of both diabetic nephropathy and retinopathy.
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TABLE 25: UNIVARIATE REGRESSION ANALYSIS SHOWING VARIABLES ASSOCIATED WITH BOTH DN AND DR
ABSENT (%) PRESENT(%) OR (C.I) P History of
Hypertension
108(59.7) 73(40.3) 2.117 (1.379 - 3.250) 0.000 History of
Smoking
23(60.5) 15(39.5) 1.475 (0.741- 2.934) 0.266 Alcohol use 51(68.0) 24(32.0) 1.029 (0.600 – 1.763) 0.918 Elevated WC 126(70.8) 52(29.2) 1.212 (0.791 - 1.857) 0.378 Elevated WHR 141 (62.7) 84(37.3) 1.56 (1.137 - 2.13) 0.004
Obesity 100(75.8) 32(24.2) 1.447 (1.027 - 2.028) 0.028
Uncontrolled BP
62(38.3) 100 (61.7) 1.666 (1.100 - 2.584) 0.016 Poor
Glycaemic Control
178 (68.5) 82(31.5) 0.995 (0.639 - 1.549) 0.982
Low HDL 72(70.6) 30(29.4) 1.41(0.70 - 1.83) 0.599
High LDL 198(68.5) 81(31.5) 0.10 (0.62 - 1.60) 0.99
High TC 99(67.3) 48(32.7) 1.09 (0.70 - 1.68) 0.71
High TG 37(56.9) 28 (43.1) 1.83(1.06-3.15) 0.028
Dyslipidemia 111(31.9) 237 (68.1) 1.16(0.61-2.20) 0.66
Table 25 shows a univariate regression analysis of the variables associated with co-occurrence of diabetic nephropathy and retinopathy. The variables that were found to be associated with both conditions include history of hypertension (p = 0.000), obesity (p=0.028), increased WHR > 0.9 (p=0.004,) uncontrolled hypertension (p= 0.016) and elevated TG> 150mg/dl (p=0.028).
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TABLE 26: MULTIPLE LOGISTIC REGRESSION TABLE SHOWING INDEPENDENT PREDICTORS OF DIABETIC NEPHROPATHY AND RETINOPATHY IN THE STUDY POPULATION
B p
Odds Ratio
95.0% Confidence Interval
Lower Upper History of
Hypertension 0.69 0.002 1.99 1.29 3.07
Elevated WHR 0.64 0.006 1.89 1.21 2.97
Obesity 0.51 0.038 1.67 1.03 2.71
Constant
0.319 0.181 1.375
Table 26 shows a multiple regression analysis of diabetic nephropathy and retinopathy-related variables which were found to be statistically significantly associated with DN and DR in univariate analysis. Even though all the variables tested were significantly correlated with DN and DR in univariate analysis, the independent predictors of DN and DR in multivariate analysis were history of hypertension (p=0.002), WHR > 0.9 (p=0.006), and obesity (p=0.038).
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