Section: Emergency Medicine

Original Research Article

CORRELATION OF HBA1C (NORMAL) IN EARLY AND

WELL CONTROLLED DIABETES WITH SERUM
CREATININE AND BLOOD UREA
Chetan Agrawal1, Bushra Khanam2, Vinita Badtiya3, Sunayna Juneja4
1
Junior Resident, Department of Emergency Medicine, Index Medical College Hospital & Research Centre, Indore, Madhya Pradesh, India.
2
Professor, Department of Emergency Medicine, Index Medical College Hospital & Research Centre, Indore, Madhya Pradesh, India.
3
Junior Resident, Department of Emergency Medicine, Index Medical College Hospital & Research Centre, Indore Madhya Pradesh, India.
4
Junior Resident, Department of Emergency Medicine, Index Medical College Hospital & Research Centre, Indore, Madhya Pradesh, India.

Received : 30/07/2024 ABSTRACT

Received in revised form : 20/09/2024
Accepted : 04/10/2024 Background: Diabetes mellitus is a prevalent metabolic disorder
characterized by chronic hyperglycemia, leading to complications affecting
Corresponding Author: various organs, particularly the kidneys. This study aims to assess the
Dr. Vinita Badtiya, correlation between glycemic control, as indicated by HbA1c levels, and renal
Junior Resident, Department of
Emergency Medicine, Index Medical
function, measured through blood urea and serum creatinine levels, in diabetic
College Hospital & Research Centre, patients with controlled diabetes compared to healthy controls.
Indore Madhya Pradesh, India. Materials and Methods: A comparative case-control study was conducted
Email: [email protected]
involving 300 patients with well-controlled diabetes and 100 healthy age-
DOI: 10.70034/ijmedph.2024.4.3 matched controls. Key biochemical parameters, including fasting blood sugar
Source of Support: Nil, (FBS), postprandial blood sugar (PPBS), HbA1c, blood urea, and serum
Conflict of Interest: None declared creatinine, were analyzed. Statistical analysis was performed using Student's t-
test to compare the two groups.
Int J Med Pub Health Results: Among the diabetic cases, 84 (28%) had elevated urea levels, 90
2024; 14 (4); 12-15 (30%) showed increased creatinine, and 126 (42%) had elevated levels of
both. Males exhibited higher creatinine values than females, likely due to
greater muscle mass. A significantly higher levels of FBS, PPBS, HbA1c,
blood urea, and serum creatinine was observed in diabetic patients as
compared to controls (p < 0.001).
Conclusion: Elevated blood urea and serum creatinine levels in diabetic
patients are indicative of renal impairment. There is a significant correlation
between poor glycemic control and kidney function deterioration. Regular
monitoring of these parameters is crucial for the early detection and
management of diabetic nephropathy, emphasizing the importance of glycemic
control in preserving renal health.
Keywords: Diabetes mellitus, blood urea, serum creatinine, HbA1c, renal
impairment, diabetic nephropathy.

INTRODUCTION 2.2% to 3% of the population, with projections

indicating an increase in the coming years.[3] In the
Diabetes mellitus is one of the most prevalent 21st century, diabetes has emerged as one of the
metabolic disorders, primarily caused by defects in most pressing health issues, affecting around 6-7%
insulin secretion or action.[1] It is characterized by of the global population. Currently, an estimated
chronic hyperglycemia, resulting from disturbances 170 million people are living with diabetes
in carbohydrate, fat, and protein metabolism. [2] This worldwide, a number expected to rise to 438 million
condition leads to damage to multiple organs, by 2030. Several factors contribute to the increased
including the eyes, kidneys, heart, nerves, and blood risk of diabetes, including dietary habits, genetic
vessels. predispositions, high blood pressure, smoking,
Globally, diabetes ranks as a leading cause of obesity, high cholesterol, and lack of physical
morbidity and mortality, affecting approximately activity.[4-6]

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International Journal of Medicine and Public Health, Vol 14, Issue 4, October- December, 2024 (www.ijmedph.org)
Dyslipidemia, hypertension, and visceral adiposity • Patients who consented to participate in the
are associated with Diabetes and these are the study
comorbid risk factors for developing chronic disease Exclusion Criteria
and cardiovascular disease.[7] End stage renal • Smokers, individuals with hypertension,
disease and diabetic nephropathy are mainly hyperlipidemia, pregnant women, and those
associated with renal disorders in diabetic patients. with other chronic disorders were excluded
8.25-45% of diabetic patients clinically develop from our study; and
diabetic nephropathy in their lifetime.[8] • Patients who didn’t consented for the study.
Glycosylation of tissue proteins causes deterioration Methodology
of the structure and function of kidney which finally A detailed medical and personal history was
leads to Diabetic nephropathy (DN). In many obtained, along with a systemic examination. The
countries, DN affects 30% of all diabetics which is variables collected included age, gender, fasting and
the leading cause of end stage renal disease postprandial blood glucose levels, HbA1C, blood
(ESRD).[9–12] Abnormal renal functions like urea, and serum creatinine for all subjects.
abnormal blood urea, serum creatinine and macro Blood samples were collected from both the case
albuminuria are some of the characteristic features and control groups to assess key biochemical
of Diabetic Nephropathy. In uncontrolled diabetes, parameters such as blood urea, serum creatinine,
there may be hyperglycemia associated abnormal fasting blood sugar (FBS), postprandial blood sugar
increase of blood urea and serum creatinine. So, (PPBS), and HbA1C. These parameters were
urea and creatinine are the two important factors to analyzed in a clinical biochemistry laboratory using
find any abnormality in the kidney. commercial kits adapted to an auto-analyzer. Serum
Serum creatinine when it alters, there will be more was separated through centrifugation at 4,000 rpm
reliable reflection in GFR whereas urea formation for 10 minutes. Plasma glucose levels were
depends on factors like liver function, protein measured using the glucose oxidase and peroxidase
intake, and rate of degradation of proteins. So, (GOD-POD) endpoint assay method. Blood urea
measurement of blood urea and serum creatinine was assessed via the enzymatic urease method,
helps in the early detection and prevention of while serum creatinine was measured using the
diabetic kidney diseases and prevents the alkaline Jaffe’s method. HbA1C levels were
progression of end stage renal disease.[13,14] As renal determined through the ion exchange resin method
complications are more common in diabetic using a diagnostic kit. The results were expressed as
patients, we aimed to measure the blood urea and mean ± SD.
serum creatinine levels in diabetic patients and Normal ranges were established as follows: fasting
correlate these parameters in non-diabetic patients. plasma glucose (70-110 mg/dl), postprandial
In advent of same the present study was undertaken glucose (<140 mg/dl), urea (15-40 mg/dl), and
with an aim to assess the correlation of HbA1c creatinine (0.6-1.4 mg/dl for males, 0.5-1.2 mg/dl
(normal) in early and well controlled diabetes with for females), with HbA1C values of ≥6%. The
serum creatinine and blood urea. WHO criteria were used to classify diabetes mellitus
cases.
MATERIALS AND METHODS Statistical Analysis
The raw data was recorded on a Microsoft Excel
After receiving approval from the institutional ethics spreadsheet and analyzed using IBM Statistical
committee, this comparative case-control study was Package for Social Sciences (SPSS), version 22.0.
conducted in the Department of General Medicine at The mean and standard deviation were used to
Index Medical College Hospital and Research compare continuous parametric data while meaning
Centre, Indore. The study included 300 male and and interquartile range was used for continuous non-
female patients over the age of 18 with well- parametric data and percentages for categorical data.
controlled diabetes as the case group, and they were The data collected was analyzed using the Student's
compared with 100 healthy, age-matched t-test to compare the significance between the
individuals without a history of diabetes, who diabetic and non-diabetic control groups. A p-value
served as the control group. Written informed of less than 0.05 was considered statistically
consent was obtained from all patients after significant.
explaining the study protocol, prior to their
enrolment in the study. RESULTS
Inclusion Criteria
• All patients of both genders aged more than 18 The demographic distribution of our study included
years; a total of 300 subjects in the study group, consisting
• Study Group: Patients with well controlled of 216 (72%) males and 84 (28%) females, with
diabetes mellitus were taken as cases. ages ranging from 20 to 60 years and a mean age of
• Control Group: Patients with normal blood approximately 55.2 + 10.1 years. 100 Age-matched
glucose and normal renal functions tests are controls were also included.
taken as controls; and

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International Journal of Medicine and Public Health, Vol 14, Issue 4, October- December, 2024 (www.ijmedph.org)
Among the 300 diabetic cases, 84 (28%) exhibited In our study, the mean fasting and post-prandial
elevated urea levels, 90 (30%) showed increased blood sugar levels were found to be significantly
creatinine levels, and 126 (42%) had elevated levels higher in diabetic subjects compared to non-diabetic
of both urea and creatinine compared to the controls. individuals. The HbA1C levels were also higher in
Notably, males demonstrated higher creatinine diabetic patients, with blood sugar and serum
values than females, likely due to greater muscle creatinine levels showing significant increases in
mass. Overall, increased blood urea and serum cases compared to controls. Both blood urea and
creatinine levels were found in diabetic patients serum creatinine exhibited statistically significant
compared to the controls, who showed no elevation differences, with p-value <0.001. [Table 2]
in these parameters. [Table 1]

Table 1: Presents the number of samples exhibiting elevated levels of blood urea and serum creatinine in both
diabetic and non-diabetic groups
Parameters Cases (N=50) Control (N=50)
Increased Blood urea 84 (28%) 0 (0%)
Serum Creatinine increased 90 (30%) 0 (0%)
Both urea and creatinine increased 126 (42%) 0 (0%)
Total 50 (100%) 0 (0%)

Table 2: Presents the mean ± standard deviation (SD) of blood urea and serum creatinine levels, along with their
correlation to fasting blood sugar (FBS), postprandial blood sugar (PPBS), and HbA1C values in both the diabetic
cases and the control group
Parameters Cases (N=300) Control (N=100) P value
FBS 181.20 ± 32.25 92.51 ± 9.25 0.000*
PPBS 271.10 ± 41.11 123.28 ± 6.43 0.000*
HbA1c 6.52 ± 0.03 5.16 ± 0.42 0.000*
Blood Urea 65.80 ± 12.22 27.64 ± 5.43 0.000*
Serum Creatinine 1.85 ± 0.79 0.83 ± 0.10 0.000*

DISCUSSION kidneys, impairing their primary function of

maintaining fluid and electrolyte balance. The
Diabetes mellitus is a major global cause of increase in serum creatinine and blood urea is
mortality, and renal function impairment associated attributed to a decrease in glomerular filtration rate
with diabetes can be evaluated by measuring blood (GFR), as creatinine serves as an indirect measure of
urea and serum creatinine levels. Monitoring these GFR, reflecting the reduced filtration capacity of the
parameters is crucial for the early detection of any kidneys.[2]
kidney dysfunction.[15] Intensive treatment can effectively lower elevated
In our study, the presence of elevated blood sugar levels of HbA1c; however, increased levels of blood
levels indicates poor glycemic control, which is a urea and serum creatinine are often irreversible due
sign of renal nephropathy (RN). Glycemic control is to permanent kidney damage associated with
closely associated with the risk of nephropathy and diabetes mellitus (DM).[7] This study suggests that
other complications related to diabetes. An increase blood urea and serum creatinine serve as prognostic
in blood urea levels suggests kidney impairment or markers and predictors of renal damage in diabetic
damage, while creatinine levels act as a marker for patients. This was in concurrence with findings of
glomerular filtration rate (GFR). The concurrent rise study done by Aldler AI et al.[17]
in both creatinine and urea, along with elevated The study's limitations include a relatively small
blood sugar levels, clearly indicates kidney sample size, which may affect the generalizability of
damage.[7] the findings, and the cross-sectional design, which
Our study demonstrates a significant increase in limits the ability to establish causal relationships
blood urea and serum creatinine levels in diabetic between glycemic control and renal impairment.
patients, suggesting potential pre-renal damage. This Additionally, potential confounding factors such as
finding aligns with the research of Rao M et al., who diet, medication adherence, and duration of diabetes
highlighted the correlation between prolonged were not controlled for, which may influence the
plasma glucose levels and blood urea levels.[2] results.
Similarly, the study by Anjaneyulu M and Chopra R
et al. reported elevated urea and creatinine levels in CONCLUSION
diabetic rats, indicating progressive renal
damage.[16] In conclusion, our study demonstrates that elevated
Our study indicates that elevated levels of blood levels of blood urea and serum creatinine in patients
urea and serum creatinine are clear signs of with diabetes mellitus are indicative of renal
prolonged hyperglycemia, which leads to impairment and highlight the significant relationship
irreversible damage to the kidney's nephrons. High between poor glycemic control, as reflected by
blood sugar levels harm the tiny filtering units of the HbA1c levels, and kidney function deterioration.

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Regular monitoring of these parameters is essential 6. Adeghate E, Schattner P, Dunn E. An Update on the Etiology
and Epidemiology of Diabetes Mellitus. Ann N Y Acad Sci.
for early detection and management of diabetic 2006; 1084:1– 29.
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progression of renal damage and reduce the risk of with glycemic index and duration of diabetes in Type 1 and
Type 2 diabetes mellitus: A comparative study. Natl J Physiol
long-term complications associated with diabetes. Pharm Pharmacol. 2017;7(9):914–9.
Thus, blood urea and serum creatinine serve as 8. Whaley-Connell A, Sowers JR, Mccullough PA, Roberts T,
effective biomarkers for assessing renal health in Mcfarlane SI, Chen SC. Diabetes mellitus and CKD awareness:
the Kidney Early Evaluation Program (KEEP) and National
diabetic patients, reinforcing the importance of Health and Nutrition Examination Survey (NHANES). Am J
glycemic control in preserving kidney function. Kidney Dis. 2009;53(4):S11– 21.
Acknowledgement 9. Atkins RC. The epidemiology of chronic kidney disease.
Kidney Int. 2005;67(suppl 94):S14–8.
Source of Funding: Nil 10. Stewart JH, Mccredie MR, Williams SM, Jager KJ, Trpeski L,
Conflict of Interest: The authors declare no conflict Mcdonald SP. ESRD Incidence Study Group. Trends in
of interest. incidence of treated end-stage renal disease, overall and by
primary renal disease, in persons aged 20- 64 years in Europe,
Ethical Considerations: Approval was taken from Canada and the Asia-Pacific region. Nephrology (Carlton).
institutional ethical committee. Written informed 1998; 12:520–7.
consent was obtained from all patients after 11. Boddana P, Caskey F, Casula A, Ansell D. UK Renal Registry
11th Annual Report (December 2008): Chapter 14 UK Renal
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12. US Renal Data System – USRDS 2010 Annual Data Report.
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