1. By Miss Jitjira Chaiyarit ID: 567110015-4 The association between eGFR and Hyperosmolar Non-Ketotic Hyperglycemia Syndrome in Diabetes type 2 Doctoral Seminar 1 / 2013

2. Outline Introduction Materials and Methods Results Discussion Doctoral Seminar 1 / 2013

3. Introduction Hyperosmolar Non-Ketotic Hyperglycemia Syndrome (HNHS) is a life-threatening complication of uncontrolled diabetes mellitus and often found in patients with type 2 diabetes, is a serious condition most frequently seen in older persons. Complications associated with HHNS include severe metabolic disturbances, renal impairment etc. The testing of kidney working is an uncommon complication of HNHS but probably subclinical and thus underestimated. Doctoral Seminar 1 / 2013

4. Materials and Methods  The design was Cross-sectional analytical.  The information for analysis was part of DM&HT dataset.  The sampling method was stratified cluster sampling with probability proportional to size hospitals  The exclusion criteria were: i)under age of 18 ii)not been examined serum creatinine iii)were diagnosed with HT or both DM & HT Doctoral Seminar 1 / 2013

5. Materials and Methods (Cont.)  The main outcome was HNHS (yes, no)  The factor of interest was eGFR that was recalculated by CKD-EPI formulas  Covariate were gender, age, receiving ACEI or ARB and HbA1C Doctoral Seminar 1 / 2013 Stages of kidney diseaseeGFR Stage 1-2 ≥ 60 Stage 3 30-59 Stage 4-5 ≤ 29

6. Materials and Methods (Cont.)  Statistical analysis: i)The continuous variables were presented as mean and standard deviation. ii) The categorical variables were presented as frequency and percentage. iii) Logistic regression models were used to examine association and OR. Doctoral Seminar 1 / 2013

7. Materials and Methods (Cont.) Ethical Consideration The permission to study was granted by each of sampled hospitals. Obtaining written informed consent of all participating patients was done prior to access to their medical records. Data collection was done by participating hospital’s authorized skilled personnel who had been trained to protect and deliberately engaged in the study. Doctoral Seminar 1 / 2013

8. Materials and Methods (Cont.) Doctoral Seminar 1 / 2013 Research frame

9. Results Baseline Characteristics eGFR (n=24,133) Doctoral Seminar 1 / 2013 Mean(SD) = 84.22 (24.44) (mL/minute/1.73m 2 )

10. Results (Cont.) Baseline Characteristics (Cont.) Doctoral Seminar 1 / 2013 Gender (n= 24,263) Age (n= 24,245) Mean(SD) = 56.09 (10.90) (year)

11. Results (Cont.) Baseline Characteristics (Cont.) Doctoral Seminar 1 / 2013 Receiving ACEI or ARB (n= 19,162) HbA1C (n= 17,653)

12. Results (Cont.) Factors associated with HNHS Doctoral Seminar 1 / 2013

13. Results (Cont.) Factors associated with HNHS adjusted for all other factors Doctoral Seminar 1 / 2013

14. Discussion The study found statistically significant association between eGFR and HNHS. The present result found the patients with low eGFR had risk effect (adj.OR=2.89) for having HNHS. This is consistent with a previous finding that if renal function declined, it was cause of glucosuria that was a risk factor for HNHS. Doctoral Seminar 1 / 2013

15. Discussion (Cont.) From result, age was protective effect ( adj. OR=0.80 ) that contrasts with research in the past which found the average age of patients with HNHS is 60 years. In the other hand, the previous research has demonstrated that HNHS may also occur in younger people. Doctoral Seminar 1 / 2013

16. Discussion (Cont.) The patients who had poor glycemic control (HbA1c ≥ 7%) were at greater risk ( adj.OR=2.01 ). This finding suggests that in those who have not been able to control their diabetes, HNHS will occur. This result supports past studies show that the patients were poor management if blood sugar levels rise and left untreated, this can result in diabetic coma and death. Doctoral Seminar 1 / 2013

17. Thank you for your attention. for your attention.