LABORATORY SCREENING OF PLASMA UREA ANDCREATININE

LEVEL AMONG DIABETIC PATIENTS

A Research Thesis Submitted To The College Of Health Science In Partial

Fulfillment Of The Requirement For The Award Of Bachelor Degree Of Medical
Laboratory Technology (Bmlt)

PREPARED BY:

ABDIRASHID KALIMOW MOHAMED

NADIFO AHMED MOHAMED

SUPERVISOR’S NAME:

MR; AMIIN SAID OMAR

MARCH, 2023

MOGADISHU - SOMALIA
 DECLARATION

We hereby declare that this thesis is a true discourse of our own original
investigations and efforts and that it has not been submitted anywhere for any
award previously and is also not being concurrently submitted for any other degree.
Where other sources of supportive information derived from publishedand
unpublished articles have been acknowledged and cited

Group Name Signature:

Abdirashid Kalimow Mohamed ………..…….………...…...…...

Date: ……/………./2023

i
 APPROVAL SHEET

Approval by the Supervisor: I hereby declare that to the best of my knowledge,

this thesis has been carried out by the candidates under my supervision and
submitted with my approval.

Supervisor

Mr Amiin Said Omar

Signature: ........................Date:………./……/2023

I hereby approve the statements by the Candidates and Supervisor.

Signature: ......................... Date: ….... /. /2023

ii
 DEDICATION

We wish to dedicate this thesis which represents the hard work and outcome of our
entire stay in PLASMA UNIVERSITY in particular to our parents. Their
unwavering love, compassion and care nurtured and gave as the sense of direction
and the ability to focus in life, in as much as their sacrifices and confidence
entrusted in us strengthened and gave us the motivation to acquire as much
knowledge as we could, and also we dedicated this thesis to our dear lecturers.

iii
 ACKNOWLEDGEMENT

We are starting in the name of ALLAH, the benevolent, the compassionate who
made us Muslims and enabled us to perform this remarkable thesis and become
graduates and gave us a chance to write this thesis. We dedicate this book to our
beloved parents for the long-time energy and resources they spent in our
upbringing and for their care, sacrifice, and ultimate love that they have given us to
achieve our college level education, who we never forget for our entire lives, we
say a lot of thanks to our dear parents.
We also dedicate this book to our supervisor, MR; Amiin Said Omar, for his
excellent guidance and critical review of our thesis. He sacrificed us his time,
guidance, variable in sighted and suggestions relating to our original research plan.
We also thank him for the unforgettable helpful role in the stage of this study. We
say a lot of thank to our supervisor and we hope good life with prosperity and thank
you to all our lecturers of PLASMA UNIVERSITY particularly, our faculty.
The same gratitude also goes to the academic director, Dr. Dahir cadow. We
would like also to thank PLASMA UNIVERSITY, especially School of laboratory
and health science in provision of education to Somali community and also thank
to all our lectures who taught us different courses of this program and trained us to
be laboratory graduates for this university. Wegive special thanks to our all
classmates who were straggling with us to achieve this goal.

iv
 ABSTRACT

Background : The term diabetes describes a group of metabolic disorders

characterized and identified by the presence of hyperglycaemia in the absence of
treatment(WHO, 2019). Diabetes is a chronic disease that occurs when the pancreas
does not produce enough insulin (a hormone that regulates blood sugar) or
alternatively, when the body cannot effectively use the insulin it produces (WHO,
2010). Creatinine is formed from creatine and creatine phosphate in muscle and is
excreted into the plasma at a constant rate related to muscle mass. Plasma creatinine
is inversely related to glomerular filtration rate and, although an imperfect measure,
it is commonly used to assess renal filtration function (Bishop, 2013).
GENERAL OBJECTIVE : The main objective of the study on plasma urea and
creatinine level among diabetic patients seeking heath care in somalia.

Specific objectives focus on : To determine plasma creatinine among type2

diabetic patient seeking heath care.
To determine plasma urea level among type2 diabetic patient seeking heath care in
somalia. To compare level of creatinine among male and female type2 diabetic
patient seeking heath care in somalia.
METHODOLOGY Research design this study was used descriptive, quantitative
and cross- sectional design while the study was target diabetic patient seeking
health care in somalia. the method was used non-probability sampling particularly a
convenient
Results : - According to creatinine results
The test of biochemistry conducted for Creatinine level the majority of the sample
patient werenormal75.0% (24/32) and 25.0(8/32) were high.
The test of biochemistry conducted for urea level the majority of the sample patient
were normal75.0%(24/32) and 25.0(8/32) were high.
The researchers recommended the following in order diabetic patient

 To prevent damages caused by free radical in diabetic patients, patient

are advised to eatdiet.
 More investigation for diabetic patients must be done regularly such as
serum uric acid,Urea,microalbuminuria, creatinine, and urine analysis
Table of Contents

v
DECLARATION .............................................................................................................. i
APPROVAL SHEET ....................................................................................................... ii
DEDICATION ................................................................................................................ iii
ACKNOWLEDGEMENT .............................................................................................. iv
ABSTRACT ..................................................................................................................... v
Table of Contents ............................................................................................................. v
CHAPTER ONE .............................................................................................................. 1
INTRODUCTION ........................................................................................................... 1
1.0 Overview .............................................................................................................................. 1

1.1 Background of the study....................................................................................................... 1

1.2 Problem Statement ............................................................................................................... 3

1.3 Purpose Of The Study .......................................................................................................... 3

1.3.1 Objective of the study............................................................................................. 4

1.3.2 General objective..................................................................................................... 4
1.4 Specific objectives ................................................................................................................ 4

1.5 Research questions . ............................................................................................................. 4

1.6 Scope of the study ................................................................................................................ 4

1.7 SIGNIFICANCE OF THE STUDY ..................................................................................... 4

1.8 Conceptual Framework ........................................................................................................ 5

CHAPTER TWO ............................................................................................................. 6

LITERATURE REVIEW ................................................................................................ 6
2.0 INTRODUCTION ..................................................................................................... 6
2.1 Theoretical review ...................................................................................................... 6
2.2 Types of diabetes mellitus .......................................................................................... 7
2.3 Plasma creatinine among type2 diabetic patients ....................................................... 8
2.4 Plasma urea level among type2 diabetic patients ..................................................... 10
2.5 Compare level of creatinine among male and female type2 diabetic patient ........... 12
CHAPTER THREE........................................................................................................ 13
RESEARCH METHODOLOGY .................................................................................. 13
3.0 INTRODUCTION: .................................................................................................. 13

vi
3.1 STUDY DESIGN ..................................................................................................... 13
3.2 Study Area ................................................................................................................ 13
3.3 Target population ..................................................................................................... 13
3.4 Sampling size ........................................................................................................... 13
3.5 SAMPLING FRAME ............................................................................................... 14
3.5.1 Inclusion Criteria ................................................................................................... 14
3.5.2 Exclusion Criteria.................................................................................................. 14
3.6 Sampling technique .................................................................................................. 14
3.7 Type of Research ...................................................................................................... 14
3.8 Data Collection Tools .............................................................................................. 14
3.9 Sample collection ..................................................................................................... 15
3.10 ANALYSIS OF SAMPLE ..................................................................................... 15
3.10.1 TEST PROCEDURE........................................................................................... 15
Urea test procedure .................................................................................................................. 15

PROCEDURE:............................................................................................................... 15
Reference range: ............................................................................................................ 15
PROCEDURE:............................................................................................................... 16
3.11 Ethical Considerations ........................................................................................... 16
3.12 Limitation of the study ........................................................................................... 17
CHAPTER FOUR .......................................................................................................... 18
RESULTS AND INTERPRETATION.......................................................................... 18
4.0 INTRODUCTION ............................................................................................................. 18

CHAPTER FIVE ........................................................................................................... 28

FINDINGS, CONCLUSION AND RECOMMENDATIONS ...................................... 28
5.0 INTRODUCTION ............................................................................................................ 28

5.1 Findings ............................................................................................................................. 28

5.2 CONCLUSION .................................................................................................................. 28

5.3 Recommendation ............................................................................................................... 29

Reference ....................................................................................................................... 30
Appendix IV Map of hodan district ............................................................................... 37

vii
 LIST OF TABLES
Table 4. 1 Gender of study participants. ................................................................................... 18

Table 4. 2 Age Distribution of study participants. .................................................................... 19

Table 4. 3 Marital status of study participants .......................................................................... 20

Table 4. 4 Education Levels of Study Participants ................................................................... 21

Table 4. 5 Occupation of study participants ............................................................................. 22

Table 4. 6 Do you think that diabetic nephropathy is a disorder that........................................ 23

Table 4. 7 According of the respondents Who take diabetic drugs regularly. .......................... 24

Table 4. 8 Do you believe that diabetes induces retinopathy? .................................................. 25

Table 4. 9 According to Creatinine results ............................................................................... 26

Table 4. 10 According to urea results. ...................................................................................... 27

viii
 LIST OF FIGURES
Table 4. 1 Gender of study participants. ................................................................................... 18

Table 4. 2 Age Distribution of study participants. .................................................................... 19

Table 4. 3 Marital status of study participants .......................................................................... 20

Table 4. 4 Education Levels of Study Participants ................................................................... 21

Table 4. 5 Occupation of study participants ............................................................................. 22

Table 4. 6 Do you think that diabetic nephropathy is a disorder that........................................ 23

Table 4. 7 According of the respondents Who take diabetic drugs regularly. .......................... 24

Table 4. 8 Do you believe that diabetes induces retinopathy? .................................................. 25

Table 4. 9 According to Creatinine results ............................................................................... 26

Table 4. 10 According to urea results. ...................................................................................... 27

ix
 CHAPTER ONE
INTRODUCTION

1.0 Overview
This chapter consists of the background of the study, problem statement, objectives
of the study, research questions, significance of the study, scope of the study, and
conceptual framework.
1.1 Background of the study
The term diabetes describes a group of metabolic disorders characterized and
identified by the presence of hyperglycaemia in the absence of treatment
(WHO, 2019). Diabetes is a chronic disease that occurs when the pancreas does
not produce enough insulin (a hormone that regulates blood sugar) or alternatively,
when the body cannot effectively use the insulin it produces (WHO, 2010).
Creatinine is formed from creatine and creatine phosphate in muscle and is
excreted into the plasma at a constant rate related to musclemass. Plasma creatinine
is inversely related to glomerular filtration rate and, although animperfect measure,
it is commonly used to assess renal filtration function (Bishop, 2013). Urea is the
major excretory product of protein metabolism. It is formed in the liver from amino
groups and free ammonia generated during protein catabolism. This enzymatically
catalyzed process is termed the urea cycle. Since historic assays for urea were based
on the measurement of nitrogen,the term blood urea nitrogen (BUN) has been used
to refer to urea determination (Bishop, 2013). BUN is most frequently measured
using enzymatic methods. The first step involves the enzyme urease to hydrolyze
urea, thereby producing ammonium. The second step involves thequantitative
measurement of ammonium using a variety of methods to determine the amount
ofurea in the sample.
IN Globally: WHO estimates that, 422 million adults aged over 18 years were
living with diabetes in 2014. The largest numbers of people with diabetes were
estimated for the WHO South-East Asia and western pacific regions, accounting for
approximately half the Diabetes cases in the world. The number of people with
diabetes (defined in surveys as those having a fasting plasma glucose value of

1
greater than or equal to 7.0 mmol/l or on medication for diabetes/raised blood
glucose), due to population growth, the increase in the average age of the

population, and the rise in prevalence of diabetes at each age. Worldwide, the
number of people with diabetes has substantially increased between 1980 and 2014,
risingfrom 108 million to current numbers that are around four times higher. Forty
per cent of this increase is estimated to result from population growth and ageing,
28% from a rise in agespecific prevalence’s, and 32% from the interaction of the
two. In the past 3 decades the prevalence 1 (age-standardized) of diabetes has risen
substantially in countries at all income levels, mirroring the global increase in the
number of people who are overweight or obese. The global prevalence of diabetes
has grown from 4.7% in 1980 to 8.5% in 2014, during which time prevalence has
increased or at best remained unchanged in every country. Over the past decade,
diabetes prevalence has risen faster in low- and middle-income countries than in
high-income countries. The WHO eastern mediterranean region has experienced the
greatest rise in diabetes prevalence, and is now the WHO region with the highest
prevalence 13.7%, (WHO, 2016).
IN Africa an estimated 14.2 million adults aged 20-79 have diabetes in the africa
region, representinga regional prevalence of 2.1-6.7%. The AFRICA region has the
highest proportion of undiagnosed diabetes; over two thirds (66.7%) of people with
diabetes are unaware they have the disease. The majority (58.8%) of people With
diabetes live in cities, even though the population in the region is predominantly
(61.3%) rural (IDF diabetes, 2015). Although diabetic is a significant problem in
Somalia, however, there are no sufficient studies related to the problem under
investigation. Therefore, this study is aimed to determine the study on plasma urea
and creatinine level among diabetic patients seeking heath care in Somali Sudanese
specialist hospital.
IN Somalia: Diabetes prevalence (% of population ages 20 to 79) in Somalia was
reported at 5.1% in 2019, according to the World Bank collection of development
indicators, compiled from officially recognized sources.
Somalia Diabetes Mellitus Type 2 (DMT2) is a type that has the highest percentage
(90–95%). 80% of DMT2 patients are in low-income countries or medium with an

2
age range of 40–59 The prevalence of DMT2 in several countries developing due to
increased prosperity in the country. According to the data released there are known
to be 415 million people in the world suffering from Diabetes Mellitus Based on the
2019 International Diabetes Federation (IDF), 10,7 million people are living with
Diabetes Mellitus Data from the World Health Organization (WHO)
1.2 Problem Statement
When diabetes is not well-controlled, the sugar level in our blood goes up. This is
called hyperglycemia. Uncontrolled hyperglycemia can cause damage to many parts
of our body, especially: in kidneys, heart, blood vessels, eyes, feet, nerves diabetes
can also cause high blood pressure and hardening of the arteries (called
arteriosclerosis). These can lead to heart and blood vessel disease. (National kidney
foundation, 2007). Uncontrolled diabetic effects the function of our kidney. Our
kidney like a filter for our body. They keep some things in our body that we need,
and they get rid of the wastes and things that we don’t need. The filters in our
kidneys are full of tiny blood vessels (called glomeruli). High blood sugar can hurt
These tiny blood vessels. When this happens, it is called diabetic kidney disease (or
diabetic nephropathy). Once the kidneys are hurt like this, they can’t be fixed. If
diabetic kidney diseaseis not treated early, it can lead to kidney failure. Kidney
failure means that the kidneys don’t work well enough to clean our blood. There is
no cure for kidney failure (American kidney fund, 2008). The kidneys are essential
organs with a wide range of functions: they form urine and route it through the
urinary tract. Excess water and toxins from metabolic processes are also removed
along with this urine. The kidneys also regulate the body’s acid-base balance to
preventexcess acidity in the blood. Diabetes is often the cause of kidney disease
(Fresenius medical care, 2009). In Somalia there is no previous published articles or
studies conducted which address the function of the renal in diabetic patient. Thus
there is a gab which exist in the group of the diabetic patient.
1.3 Purpose Of The Study
Purpose Of This Assessment Of Thyroid Stimulating Hormon Level In Women Of
Childbearing Age In Mogadishu

3
1.3.1 Objective of the study
1.3.2 General objective
To investigate on plasma urea and creatinine level among diabetic patients seeking heath
care.
1.4 Specific objectives
To determine plasma creatinine among type2 diabetic patient seeking
heath care in Somali.

To determine plasma urea level among type2 diabetic patient seeking

heath care in Somali.
To compare level of creatinine among male and female type2 diabetic patient
seeking heathcare inSomali.
1.5 Research questions .
What is the determine plasma urea level among type2 diabetic patient seeking
heath care inSomali?

What is the determine plasma creatinine level among type2 diabetic patient
seeking heathcare in Somali?
How compare relationship between the level of creatinine among male and
female type2diabeticpatient?
1.6 Scope of the study
This study should be done on the topic of plasma urea and creatinine level among
diabetic patients seeking heath care in Somali. The study covered a period of four
months from March2022 to July 2022.
1.7 SIGNIFICANCE OF THE STUDY
The study was To investigate on plasma urea and creatinine level among diabetic patients
seeking heath care. This study was significant to select the students in one.

4
 1.8 Conceptual Framework

IV DV

High plasma urea level

Lifestyle factors
Poor diet
Chronic stress
Family history

Diabetic patient

High plasma creatinine level

Lack insulin
Reduce the ability to clean waste
Chronic illness
Increase Age.

5
 CHAPTER TWO

LITERATURE REVIEW
2.0 INTRODUCTION

Diabetes is a chronic disease which lasts lifelong. It is characterized by very high levels

Of sugar in the blood. Diabetes is caused by too little insulin, resistance to insulin,
or both. Insulin is a hormone, which is produced by the pancreas to control blood
sugar. When the food we eat is digested a sugar called glucose enters the
bloodstream. It is the source of fuel for the body. It is the pancreas makes insulin.
Insulin moves glucose from the bloodstream into muscle, fat, and liver cells, where
it can be used as fuel. Diabetic people have high blood sugar as their body is not
able to move sugar into fat, liver, and muscle cells to be stored for energy (gee
Varghese, 2006).
2.1 Theoretical review

Diabetes mellitus is a metabolic disease characterized by an increase in blood

glucose levels exceeding the normal. The cause is impaired insulin secretion or
insulin action; therefore, it happens to result in metabolic disorders of fats, and
protein failure of various microvascular organs, especially that eyes, Ina J Med Lab
Data from the World Health Organization (WHO) stated that from various types of
Diabetes Mellitus. Diabetes Mellitus Type 2 (DMT2) is a type that has the highest
percentage (90– 95%). 80% of DMT2 patients are in low-income countries
ormedium with an age range of 40–59 . The prevalence of DMT2 in several
countries developing due to increased prosperity in the country. According to the
data released there are known to be
415 million people in the world suffering from Diabetes Mellitus Based on the 2019
International Diabetes Federation (IDF), 10,7 million people are living with
Diabetes Mellitus in Indonesia. Henceforth, the predicted prevalence of diabetes
mellitus in Indonesia during the year 2030 and 2045 was reach 13.7 and 16,6
million.

6
2.2 Types of diabetes mellitus

In 1979, the national diabetes data group developed a classification and diagnosis
scheme for diabetes mellitus. This scheme included dividing diabetes into two
broad categories: Type1 insulin dependent diabetes mellitus (IDDM) and type2
Non-insulin dependent diabetes mellitus (NIDDM). Therefore, the WHO
guideline recommends the following categories of diabetes:

type1 diabetes, type 2 diabetes, other specific type and Gestational diabetes
mellitus (GDM) (Bishop et al., 2013).
Type1 diabetes
Type1 diabetes is characterized by inappropriate hyperglycemia primarily a result
of pancreatic islet Beta-cell destruction and a tendency to ketoacidosis. Type 1
diabetes mellitus is a result of cellular- mediated autoimmune destruction of the
Beta-cells of the pancreas, causing an absolute deficiency of insulin secretion.
Upper limit of 110 mg/dL on the fasting plasma glucose is designated as the upper
limit of normal blood glucose ((Bishop et al., 2013).
Type 1 constitutes only 10% to 20% of all cases of diabetes and commonly occurs
in childhood and adolescence. This disease is usually initiated by an environmental
factor or infection in individuals with a genetic predisposition and causes the
immune destruction of the b-cells of the pancreas and, therefore, a decreased
production of insulin. Characteristics of type1 diabetes include abrupt onset, insulin
dependence, and ketosis tendency. This diabetic type is genetically related. One or
more of the following markers are found in 85% to 90% of individuals with fasting
hyperglycemia: islet cell autoantibodies, insulin autoantibodies, glutamic acid
decarboxylase autoantibodies, and tyrosine phosphatase IA-2 and IA-2B
autoantibodies (Bishop et al., 2013).
Signs and symptoms include polydipsia polyphagia (increase food intake), polyuria
(excessive urine production), rapid weight loss, hyperventilation, mental confusion,
and possible loss of consciousness (due to increase glucose to brain). Complications
include microvascular problems such asnephropathy, neuropathy, and retinopathy.
Increased heart disease is also found in patients with diabetes (Bishop et al., 2013).

7
 Type2 diabetes
Type2 diabetes mellitus is characterized by hyperglycemia as a result of an
individual’s resistance to insulin with an insulin secretary defect. This resistance
result in relative, not an absolute insulin deficiency. Type2 constitutes the majority
of the diabetes cases. Most patients inthis type are obese or have an increased
percentage of body fat distribution in the abnormal region. This type of diabetes
often goes undiagnosed for many years and is associated with a strong genetic
predisposition, with patients at increased risk with an increase in age, obesity, and
lack of physical exercise. Characteristic usually include adult onset of the disease
and milder

symptoms than in type1, with ketoacidosis seldom occurring. However, these

patients are more likely to go into a hyperosmolar coma and are at an increased risk
of developing macro vascular and micro vascular complications (Bishop et al.,
2013).
Gestational Diabetes Mellitus (GDM)
GDM is any degree of glucose intolerance with onset or first recognition during
pregnancy. Causes of GDM include metabolic and hormonal changes. Patients with
GDM frequently return to normal post- partum. However, this disease is associated
with increased prenatal complicationsand an increased risk for development of
diabetes in later years. Infants born to mothers with diabetes are at increased risk for
respiratory distress syndrome, hypocalcaemia, and hyperbilirubinemia. Fetal insulin
secretion is stimulated in the neonate of mother with diabetes. However, when the
infant is born and the umbilical cord is severed, the infant’s over supply of glucose
is abruptly terminated, causing sever hypoglycemia (Bishop et al., 2013).
2.3 Plasma creatinine among type2 diabetic patients

Diabetes mellitus is characterized by chronic hyperglycemia due to derangement in

carbohydrate, fat, and protein metabolism. Diabetes mellitus is associated with
absolute orrelative deficiencies in insulin secretion, insulin action or both. Diabetes
is fast gaining the statusof a potential epidemic in India with more than 62 million
diabetic individuals currently diagnosed with the disease. Creatinine is formed from
creatine. Muscle contains 98% of total body creatinine. Creatinine leaves muscle

8
and enters blood, from where it is removed by kidneys. If the kidneys are failing
serum creatinine levels increase. The use of serum(SR)creatinine, as a marker of
GFR originated from the work of Rehberg, in 1926. Creatinine fulfills most of the
requirements for a perfect filtration marker.
There is no single normal value for SR creatinine. But often said normal values are

for males 0.8 to 1.3 mg/dl and for females 0.6 to 1.0 mg/dl.3 diabetes mellitus is
a group of metabolic disorders of carbohydrate metabolism in which glucose is
underused producing. kidney disease at an early stage and can limit the
progression to end stage renal disease (ESRD).Creatinine is the breakdown
product of creatinine phosphate is released from skeletal muscle at asteady rate.
Serum creatinine correlates quite well with the percent of the body that is
skeletalmuscle. It is filtered by the glomerulus, and a small amount is also
secreted into the glomerularfiltrate by the proximal tubule (hence at low GFR's,
the usual reciprocal relationship breaksdown and creatinine tends to underestimate
how low the GFR has gotten). . Patients with early

onset diabetes mellitus have higher GFR levels thus making them a suitable
population for study of progressive loss of renal function.
Hyperglycaemia. Diabetes mellitus (DM) type2 comprises about 90% of total
diabetics (Tejal j wagle,2010).
Epidemiological data shows that, increasing incidence of DM has made it a health
problem. Diabetic patients are at an increased risk of developing specific
complications including: nephropathy, retinopathy, neuropathy and atherosclerosis.
Diabetic nephropathy occurs in approximately one third of type2 diabetics. A quick
and simple way to check renal function in diabetics is to draw blood sample for
serum creatinine and blood urea nitrogen (bun) tests. Although SR creatinine and
bun tests can reveal the patients renal function, SR creatinine is a more sensitive
indicator, as many extra renal conditions such as dehydration, can elevate bun
levels but SR creatinine levels change little except in renal disease.

9
2.4 Plasma urea level among type2 diabetic patients

Diabetic nephropathy (microvascular complications) is a disorder that occurs in the

kidneycaused by diabetes mellitus This kidney function disorder characterized by
decreased Glomerolus Filtrate Rate (GFR) followed with an increase in urea and
creatinine. Diabetic nephropathy is a condition kidney that not only experiences
disposal failure but lost large amounts of protein, specifically albumin. Albumin is
the resulting Metabolism of proteins stored in the blood. Laboratory tests related to
diabetes mellitus as a diagnostic examination is when blood sugar, fasting blood
sugar, blood sugar postprandial, blood sugar tolerance test and HbA1C. Fasting
blood sugar, i.e. examination of sugar levels when the patient is fasting 12 hours
before examination HbA1c is the specific glycated haemoglobin as a result addition
of glucose tothe Nterminal valine in the Beta chain haemoglobin (B- N [1-deoxy]
fructosyl-Hb).
The concentration of HbA1c depends on blood glucose concentrations and
erythrocyte life span. HbA1C describes the average patient’s long-term blood
glucose for 2–3 months with good control value (HbA1C level 8%). The most
HbA1C examination widely used and is a gold standard for glycemic monitoring as
well as inhibits inflammation that often occurs HbA1C is checking with using blood
ingredients, to obtain information on blood sugar levels in Ina 85-92 Muhammad
Rizki Kurniawan, Eni Kusrini 87 fact, because the patient cannot control the test
results, in a period time 2–3 months. This test is useful for measuring the level of
sugar bonds in haemoglobin A (A1C) throughout the life of red blood cells (120
days) The laboratory test to

know and prevent complications in the kidneys is urea and creatinine. Urea is the
result of protein metabolism. It came from the amino acids that the ammonia has
transferred in the liver and reach the kidneys, and excreted an average of 30 grams a
day. Normal blood urea level is 20–40 mg per 100 mL of blood, but this depends on
the amount of normal protein that is eaten and liver function in urea formation.
Creatinine is a waste product from the creatine phosphate repairment that occurs
in muscle, excreted through the kidneys. According to medical recorddata of
outpatients, 9600 patients are with diabetes mellitus. Outpatients are mostly patients

10
fromthe Social Security Administrator for Health (Badan Penyelenggaraan Jaminan
Sosial Kesehatan/BPJS Kesehatan) and they do not do kidney examination since
the beginning because of the limited examination fees provided by the BPJS
Kesehatan. Based on the background above, the researcher is interested in
determining the description of Ureum and Creatinine in Patients with Diabetes
Mellitus.
The NPN compound present in highest concentration in the blood is urea (demir,2005).

Urea is the major excretory product of protein metabolism. It is formed in the liver
from amino groups and free ammonia generated during protein catabolism Michael
l. (bishop et al, 2013).
Diabetes is also one of the major causes of kidney failure. Diabetic nephropathy
(DN) is the most common clinical condition of the diabetic patients with
progressive deterioration of renal function and structure during their life time. DN
affects 30% of all diabetics and it is the major leading cause of end stage renal
disease (ESRD) in many countries (Madhusudan Sadhvimani, 2017).
DN is characterized by abnormal levels (more than 300 mg/day) of albumin in the
urine, referred as macro albuminuria and abnormal renal function as represented by
an abnormality in bloodurea and serum creatinine. Blood urea and serum creatinine
are known to be raised with hyperglycemia in uncontrolled diabetics, usually
correlating with kidney damage severity. Measurements of blood urea and serum
creatinine are easily available tests which can assist in detection and prevention of
diabetic kidney diseases at an early stage thereby, limit the progression to end stage
renal disease. Blood urea and serum creatinine are the simplest way to assess the
kidney functional status. These substances accumulate in the body in cases of renal
dysfunction thus raising their levels in the blood (Madhusudan sadhvimani, 2017).
Biochemical markers play an important role in accurate diagnosis and in assessing
risk and adopting therapy to improve clinical outcome. Blood urea and serum
creatinine are good

indicators of a normal functioning of the kidney and increased serum levels of

these parameters are indication of kidney dysfunction (Madhusudan sadhvimani,
2017).

11
2.5 Compare level of creatinine among male and female type2 diabetic patient

Creatinine is formed from creatine. Muscle contains 98% of total body creatinine.1
Creatinine leaves muscle and enters blood, from where it is removed by kidneys. If
the kidneys are failing serum creatinine levels increase. The use of serum (Sr.)
creatinine, as a marker of GFR originated from the work of Rehberg, in 1926.4
Creatinine fulfills most of the requirements for a perfect filtration marker.5 There is
no single normal value for Sr. creatinine. But often said normal values are:- for
males 0.8 to
1.3 mg/dl and for females 0.6 to 1.0 mg/dl.3 Diabetes Mellitus is a group of
metabolic disorders of carbohydrate metabolism in which glucose is underused
producing hyperglycaemia.6 Diabetes Mellitus (DM) Type2 comprises about 90%
of total Diabetics.
Epidemiological data shows that, increasing incidence of DM has made it a health
problem. Diabetic patients are at a increased risk of developing specific
complications including: nephropathy, retinopathy, neuropathy and atherosclerosis.
Diabetic nephropathy occurs in approximately one third of type2 diabetics.8 A
quick and simple way to check renal function in diabetics is to draw blood sample
for serum creatinine and blood urea nitrogen (BUN) tests. Although Sr. creatinine
and BUN tests can reveal the patients renal function, Sr.creatinine is a more
sensitive indicator, as many extra renal conditions such as dehydration, can elevate
BUN levels but Sr.creatinine levels change Comparison of Serum Creatinine and
Blood Sugar Levels in Type-2 Diabetic
Men tend to have higher concentrations of creatinine than women because, in
general, they havea greater mass of skeletal muscle increased dietary intake of
creatine or eating a lot of protein (like meat) can increase daily creatinine excretion
(Nail creatinine measurement, 2017).

12
 CHAPTER THREE

RESEARCH METHODOLOGY
3.0 INTRODUCTION:
This chapter represents the research methodology that the researchers have been
used. The purpose of this chapter is to provide insight into the research design of
the study and study area. Also, this chapter describes study population, sampling
method and sample size, process of data collection and data analysis as well. And
also ethical considerations included in this chapter.
3.1 STUDY DESIGN
The design of the study was a cross sectional. This means that the sample size has been
taken from thetarget population and the information was obtained at the same time on a
particular point in time.
3.2 Study Area
Hospital that is located in center of the Mogadishu.
3.3 Target population
The target populations for this study would be 35 from Somali Sudanese Hospital
Those are diabetic patient who are living in the districts Banadir region.
3.4 Sampling size
The sample size of the study was be consisting of 32 respondents selected from the
diabetic patient women in Somali Sudanese Hospital by using convenient sample
procedure. The number of respondents depends on the researcher’s capacity.
according to the Slovene's formula

n= 𝑁 , where :
1+(𝑒2)

N = Total Population

n = Sample size

e = is the confidence level at 0.05

n= ( )
= ( )
= = =32

13
3.5 Sampling Frame

3.5.1 Inclusion Criteria

Diabetes mellitus patients, those are attending health care at the Somali Sudanese
Hospital were participate for the study. Additionally diabetes mellitus patients were
included in the study upon signing the consent form for the study.
Patients with type 1 and Type 2 diabetes mellitus was be enrolled in this study.
3.5.2 Exclusion Criteria
1-Non diabetes mellitus patients those are refused to participate in this study are
excluded.

2.-diabetes mellitus patients who failed to sign the consent form was excluded from the
study.
3.6 Sampling technique
The sample method, which has been used for this study, was the non-random
sample particularlypurposive sampling method. Purposive sampling is a
nonprobability sampling technique.
The subjects were selected because they are small group or limited group of accessibility.

3.7 Type of Research

Data Quantitative data collection was used, by obtaining laboratory test results.
3.8 Data Collection Tools
In order to get better the reliability of the findings, questionnaire and
laboratory analysis wasused for the data collection. The choices of these methods
were guided by the data requirements and the objectives of the study. The
researchers decided to determine gathering a reliable and valid data, by using
structured questionnaire and laboratory analysis. The researchers distributed 32
copies of questionnaire, containing questions of research and laboratory materials
such as reagent, alcohol, cotton, pipette, needle, syringe, gloves and centrifuge to
make possible comparing the results in a validity analysis of bringing helpful
findings.

14
 3.9 Sample collection
The sample blood was selected from each blood into plasma separator tubes. Then
centrifuged at1500 rpm for 10 minutes and blood into labeled tubes and stored at -
20 until use.
3.10 Analysis Of Sample

3.10.1 Test Procedure

Urea test procedure

SAMPLE PREPARATION

Make sure the reagents and samples are at room temperature. Then, pipette into a test
tube:

Blank Sample Standard1

Standard1 10 (μl) 10 μl
Sample 10 (μl) 10 μl
Working solution (R1+R3) 1.0 ml 1.0 ml 1.0 ml

WAKING REAGENT PREPARATION: transfer the content of reagent A2 vial

into reagent A1, mix thoroughly other volume can be prepared: 1ml reagent A2 +
24ml reagent A1 The. Working reagent is stable for 10 days at 15-25°C.

PROCEDURE:
Pipette 1ml of reagent A and add 10ml of the sample.

Mix through and incubate the tube for 10 minute at room temperature.Add 1ml of
reagent B and mixthrough and incubate 10minute.
Read the absorbance.
Reference range:

Urea: 15 – 45 mg/dl.

15
 Creatinine test procedure SAMPLE PREPARATION

Make sure the reagents and samples are at room temperature. Then, pipette into a test
tube:

Blank2 Sample Standard1

Standard1 100 (μl) - - 100 μl

Sample 100 (μl) - 100 μl

Working reagent (R1 + R2) 1.0 ml 1.0 ml

1.0 ml

WAKING REAGENT PREPARATION: Mix equal volume of reagent A

and reagent B. Theworking reagent is stable for 10 days at 15-25°C.
PROCEDURE:

Bring reagent at room temperature.

Pipette 1000µl of reagent and add 100µl of the sample.Read the absorbance at 30s and
after 90s.

Reference range Female: 0.6 – 1.1 mg/dl.

Male: 0.7 – 1.3 mg/dl

3.11 Ethical Considerations
An introductory paragraph in the samples of clarified the role and background of
the laboratory researcher. Relevant information was verbally provided to the
participants before blood collection. The necessary precautions were taken to ensure
that potential ethical dilemma had anticipated and addressed. The respondents
assured that their identity had protected and their personal particulars were not
disclosed to any third part. Also, to ensure confidentiality, participants were
informed that their names was not be recorded anywhere and that all the
information gathered and subsequent reports would not refer to individual
participants. All the respondents required signing a consent form to indicate that
their participation was a voluntary. Integrity and respect for the participants of the
study was a primary prerequisite. However, this study has been only commenced

16
once ethical approval had achieved from the research ethics committee. Finally, no
incentives provided to the respondents as a way of motivating them to participate
the study.
3.12 Limitation of the study
Our sample size not enough according to our problem size

There were a problem about language barrier of respondents , it was difficult to

fulfill the questionnaire of the study .

17
 CHAPTER FOUR
RESULTS AND INTERPRETATION
4.0 INTRODUCTION
This chapter presents and analysis data obtained from the questioner and laboratory
results, thus
results are presented in tables and figures with their text as following:
Table 4. 1 Gender of study participants.
Gender Frequency Percent

Male 16 50.0

Female 16 50.0

Total 32 100.0

4.1 Gender of study participants.

This study same males participants and female. accounted for the study participants are
50% (16/32) were male, while female accounted 50% (16/32).

Figure 4.1: Gender of the respondents.

18
Table 4. 2 Age Distribution of study participants.
Age Frequency Percent

15-25 12 37.5

26-35 10 31.3

36-45 5 15.6
Above 45 5 15.6

Total 32 100.0

4.2 Age Distribution of study participants

According to age group distribution from ones who were collected from the sample of
plasma urea and creatinine level among diabetic patients, the highest number 37.5%
(12/32) were aged between 15 and 25years, followed by 31.3% (10/32) were aged
between 26 and 35 years, and while 15.6% (5/32) were aged between 36 and 45 year and
the rest group 15.6% (5/32) were aged above 45.

Figure 4.2: Age Distribution of study participants

19
Table 4. 3 Marital status of study participants
Marital status Frequency Percent

Single 11 34.4

Married 15 46.9

Divorced 3 9.4

Widowed 3 9.4

Total 32 100.0

4.3 Marital status of study participants

Most of the participants 46.9% (15/32) are married and have families, followed by
34.4% (11/32) were Single and followed by the participants 9.4 % (3/32) were Divorced
and 9.4 % (3/32) were Widowed.

Figure 4.3 Marital status of study participants

20
Table 4. 4 Education Levels of Study Participants
Education Levels Frequency Percent

Informal 17 53.1

Secondary 6 18.8

Bachelor degree 9 28.1

Total 32 100.0

4.4 Education Levels of Study Participants

According to the level of education distribution from ones who were collected from the
sample of plasma urea and creatinine level among diabetic patients,the highest number
53.1% (17/32) were no formal education, followed by 28.1% (9/32) were have Bachelor
degree of education, while 18.8% (6/32) have secondary school educational levels .

Figure 4.4 Education Levels of Study Participants

21
Table 4. 5 Occupation of study participants
Occupation of study participants Frequency Percent

Employee 12 37.5

self-employee 10 31.3

Housewife 7 21.9

Non-employee 3 9.4

Total 32 100.0
4.5 Occupation of study participants
According to the occupation distribution from ones who were collected the sample of
plasma urea and creatinine level among diabetic patients,the majority number 37.5%
(12/32)were Employee followed by 31.3% (10/32) were Self-employee while 21.9%
(7/32) were Housewife ,were remains 9.4%(3/32) Non-employee.

Figure 4.5 Occupation of study participants

22
Table 4. 6 Do you think that diabetic nephropathy is a disorder that caused by
diabetic mellitus?

Diabetic mellitus Frequency Percent

Yes 23 71.9

No 9 28.1

Total 32 100.0

4.6 Do you think that diabetic nephropathy is a disorder that caused by diabetic
mellitus?
The study showed that 71.9% (23/32) of the respondents said, “Yes” while 28.1 (9/32) of
the respondents replied, “No”.

Figure 4.6 Do you think that diabetic nephropathy

23
Table 4. 7 According of the respondents Who take diabetic drugs regularly.
The majority of the respondents 68.75% (22/32 ) were taking diabetic drugs regularly
and 31.25% (10/32 ) were taking diabetic drugs no regularly.
Do you take DM drugs regularly?
DM drugs Frequency Percent
Yes 22 68.75
No 10 31.25

Total 32 100.0

Figure 4.7 diabetic drugs regularly.

24
Table 4. 8 Do you believe that diabetes induces retinopathy?

Diabetes induces retinopathy Frequency Percent

Yes 14 43.8
No 18 56.3

Total 32 100.0

4.8 Do you believe that diabetes induces retinopathy

The majority of the respondents shows that 56.3% (18/32) of the respondents said, “No”
while, 43.8% (14/32) of the respondents said,” Yes

Figure 4.8 Do you believe that diabetes induces retinopathy.

25
Table 4. 9 According to Creatinine results
Results of Creatinine Frequency Percent

Normal 24 75.0

High 8 25.0

Total 32 100.0

4.9 According to creatinine results

The test of biochemistry conducted for Creatinine level the majority of the sample patient
were normal 75.0% (24/32) and 25.0(8/32) were high.

Figure : 4.9 According to creatinine results.

26
Table 4. 10 According to urea results.
Results of urea Frequency Percent

Normal 24 75.0

High 8 25.0

Total 32 100.0

The test of biochemistry conducted for urea level the majority of the sample patient were
normal 75.0% (24/32) and 25.0(8/32) were high.

Figure : 4.10 According to urea results.

27
 CHAPTER FIVE
FINDINGS, CONCLUSION AND RECOMMENDATIONS
5.0 INTRODUCTION
This chapter presents the findings of the study. The chapter also concluded the study as a
whole and suggested some recommendations for further action.
5.1 Findings
This study same males participants and female. accounted for the study participants are
50% (16/32) were male, while female accounted 50% (16/32).
According to age group distribution from ones who were collected from the sample of
plasma urea and creatinine level among diabetic patients, the highest number 37.5%
(12/32) were aged between 15 and 25years, followed by 31.3% (10/32) were aged
between 26 and 35 years, and while 15.6% (5/32) were aged between 36 and 45 year and
the rest group 15.6% (5/32) were aged above 45.
Most of the participants 46.9% (15/32) are married and have families, followed by 34.4%
(11/32) were Single and followed by the participants 9.4 % (3/32) were Divorced and 9.4
% (3/32) were Widowed.
According to the level of education distribution from ones who were collected from the
sample of plasma urea and creatinine level among diabetic patients,the highest number
53.1% (17/32) were no formal education, followed by 28.1% (9/32) were have Bachelor
degree of education, while 18.8% (6/32) have secondary school educational levels .
According to the occupation distribution from ones who were collected the sample of
plasma urea and creatinine level among diabetic patients,the majority number 37.5%
(12/32)were Employee followed by 31.3% (10/32) were Self-employee while 21.9%
(7/32) were Housewife ,were remains 9.4%(3/32) Non-employee.
The study showed that 71.9% (23/32) of the respondents said, “Yes” while 28.1 (9/32) of
the respondents replied, “No”.
The majority of the respondents 68.75% (22/32 ) were taking diabetic drugs regularly and
31.25% (10/32 ) were taking diabetic drugs no regularly
The majority of the respondents shows that 56.3% (18/32) of the respondents said, “No”
while, 43.8% (14/32) of the respondents said,” Yes
The test of biochemistry conducted for Creatinine level the majority of the sample patient
were normal 75.0% (24/32) and 25.0(8/32) were high.

28
 The test of biochemistry conducted for urea level the majority of the sample patient were
normal 75.0% (24/32) and 25.0(8/32) were high.
5.2 CONCLUSION
The term diabetes describes a group of metabolic disorders characterized and identified
by the presence of hyperglycaemia in the absence of treatment
(WHO, 2019). Diabetes is a chronic disease that occurs when the pancreas does not
produce enough insulin (a hormone that regulates blood sugar) or alternatively, when the
body cannot effectively use the insulin it produces (WHO, 2010). Creatinine is formed
from creatine and creatine phosphate in muscle and is excreted into the plasma at a
constant rate related to muscle mass. Plasma creatinine is inversely related to glomerular
filtration rate and, although an imperfect measure, it is commonly used to assess renal
filtration function (Bishop, 2013). Urea is the major excretory product of protein
metabolism. It is formed in the liver from amino groups and free ammonia generated
during protein catabolism. This enzymatically catalyzed process is termed the urea cycle.
Since historic assays for urea were based on the measurement of nitrogen, the term blood
urea nitrogen (BUN) has been used to refer to urea determination (Bishop, 2013).
BUN is most frequently measured using enzymatic methods. The first step involves the
enzyme urease to hydrolyze urea, thereby producing ammonium. The second step
involves the quantitative measurement of ammonium using a variety of methods to
determine the amount of urea in the sample.
5.3 Recommendation
 Recommendation the study recommends the biochemistry machine is well by detect
diabetic patient test Creatinine and Urea level.
 The research recommends training the community members and community leaders to
Understand important of knowing the disease
 To prevent damages caused by free radical in diabetic patients, patient are advised to eat
diet.
 More investigation for diabetic patients must be done regularly such as serum uric acid,
Urea, microalbuminuria, creatinine, and urine analysis.
 further study should be done to measure plasma Creatinine and Urea level and glucose
level to assess relationship between them.

29
 Reference
Who. (2019). Classification of diabetes mellitus 2019. P.8.
File:///c:/users/hp/downloads/9789241515702-eng.pdf
World,health,organization (2010). Diabetes. P.1.
Https://www.who.int/nmh/publications/fact_sheet_diabetes_en.pdf.
Bishop, M.L. Fody, E.P. Schoeff, L.E.( 2013), Clinical Chemistry, Techniques, Principles
and Correlation 7th Edition: 270-316. Urea and creatinine p.247.
World health organization (2016). Global report on diabetes. P.26.
https://apps.who.int/iris/bitstream/handle/10665/204871/9789241565257_eng.pdf?sequen
ce=1.
IDF diabetes atlas · seventh edition (2015). P.70.
Https://www.oedg.at/pdf/1606_idf_atlas_2015_uk.pdf.
National kidney foundation (2007). How does diabetes affect my body?.p.5.
Https://www.kidney.org/sites/default/files/docs/diabckd_stg5.pdf.
American kidney fund (2008). How can diabetes hurt my kidneys? P.3.
Http://www2.kidneyfund.org/site/docserver/diabetes_and_your_kidn
eys.pdf?docid=222.
Fresenius medical care n.d). The functions of the kidneys. P.4.
Https://www.fresenius.com/media/understanding_the_kidneys.pdf.
medline plus encyclopedia: serum creatinine. Ww.nlm.nih.gov/medlineplus/ency/article.
Bonsnes rw, taussky ha. On the colorimetric determination of creatinine by jaffe reaction.
J biol chem; 158 : 581-91.
Serum creatinine. Serum creatinine and kidney disease. Kidney
diseases.about.com/od/diagnostic test/a/article0052.htm18k.Rehberg pb. Studies
on kidney function i. The rate of filtration and reabsorption in human
Kidney. Biochem j 20 : 447-60.
Perrone ronald d, madias nicolaos e, levey andrew s. Serum creatinine as index of
renalFunction. Clin chem 1992; 38 (10) : 1932-51.Teitz textbook of clinical chemistry
and molecular diagnosis. Fourth edition. Pgs 853-863.
American diabetes association. Report of the expert committee on the diagnosis
andClassification of dm. Diabetes care 1997; 20 : 1183-97.

30
Rehman g, khan sa, hamayun m. Studies on diabetic nephropathy and secondary diseases
in type-2 diabetes. Int j diab dev ctries 2005; 25 : 25-9.Serum creatinine and bun
test diabetes. Www.diabetescurehelp.org/diabetes-
Michael l. Bishop Edward p. Fody larry e. Schoeff ,2013 chemistry principles,
techniques, and correlations Clinical.
International journal of medical and health research issn: 2454-9142.
Impact factor: rjif 5.54 www.medicalsciencejournal.com volume 3; issue 12; December
2017; page no. 132-136.
Nail,Creatinine,Measurement(2017).
Https://www.ijcmr.com/uploads/7/7/4/6/77464738/ijcmr_1765_v1.pdf.

31
 Appendix I questionnaire
QUESTIONNAIRE OF ACADEMIC RESEARCH
Dear respondents
We are students at Plasma university University faculty of health science, preparing
Thesis of bachelor degree of medical laboratory department, who are doing questionnaire
involves
in the collection of valuable information about Study On Plasma Urea and Creatinine
Level Among Diabetic Patients Seeking Heath Care Please give correct short answer

All information was be kept in confidential

These researches are only for academic purpose and not money .
Section A demographic questions
1. Age of the respondents

A) 15-25 years B) 26-35 years C) 36-45 years D)>45

2. Gender of the respondents

A) Male B) Female
3. Marital status of the respondents

A) Single B) Married C) Divorced D)Widowed

4. Educational level of the respondents

A) Informal B) Secondary C) Bachelor degree

5. Occupational level of the respondents

A) Employee B) self-employee C) Housewife D)Non-

employee

Section B Plasma creatinine & urea level among type2 diabetic patients
6. Do you think that diabetic nephropathy is a disorder that caused by diabetes
mellitus?

32
A) Yes B) No
7.According of the respondents Who take diabetic drugs regularly.

A) Yes B) No
8..Do you believe that diabetes induces retinopathy

A) Yes B) No
9.According to Creatinine results
A) Normal B) High

10.According to urea results.

A) Normal B) High

33
 APPENDIX II: RESEARCH BUDGET

Item Cost ($ USD)

Three research assistants $ 45

Plain papers $ 10

Pens, pencils, ruler, erasers $ 10

Photocopying $ 20

Printing $ 10

Transport $ 50

Airtime for cell phone $ 20

Other costs $ 40

Total $165

34
Appendix III Map of Somali

35
Appendix IV Map of Mogadisho

36
 Appendix V Map of Hodan district

37