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\def\RunningAuthor{Naveen Babu Kilaru et al.}
\firstPage{93}
\articleType{Original Article}
\receivedDate{14.07.2019}
\acceptedDate{23.10.2019}
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\title{\textbf{A cross-sectional observational study on drug utilisation pattern, prevalence and risk factors for the development of diabetic nephropathy among type 2 diabetic patients in a}\textbf{ south indian} \textbf{ tertiary care hospital}}
\author{Madhavi~Mannam\textsuperscript{1},  
            Lavanya~Nalluri\textsuperscript{1},  
            Dhanalakshmi~Pinnika\textsuperscript{1},  
            Mounika~Pothuraju\textsuperscript{1},  
            Ravindrababu~Pingili\textsuperscript{2},  
            Anjani~Kumar~C\textsuperscript{3},  
            Jaidev~Sudagani\textsuperscript{4}, 
            Naveen~Babu~Kilaru\textsuperscript{*}\textsuperscript{5}~\\[5pt]{\textsuperscript{1}Department of Pharmacy Practice, KVSR Siddhartha College of Pharmaceutical Sciences, Vijayawada-520010, Andhra Pradesh, India}~\\{\textsuperscript{2}Department of Pharmacology, KVSR Siddhartha College of Pharmaceutical Sciences, Vijayawada-520010, Andhra Pradesh, India}~\\{\textsuperscript{3}Department of General Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Gannavaram, Vijayawada, Andhra Pradesh, India}~\\{\textsuperscript{4}Endocrinologist, Santhi Endocrine and Diabetes Hospital, Vijayawada, Andhra Pradesh, India}~\\{\textsuperscript{5}Department of Pharmaceutics and Pharmaceutical Biotechnology, KVSR Siddhartha College of Pharmaceutical Sciences, Vijayawada-520010, Andhra Pradesh, India}}

\begin{abstract}
 Diabetic nephropathy is the leading cause of the end-stage renal disease (ESRD) worldwide, and it is estimated that {\texttildeapprox} 20\% of type 2 diabetic patients reach ESRD during their lifetime. The objective of the present study was to assess the drug utilization pattern, risk factors, and prevalence of diabetic nephropathy in patients with type 2 diabetes mellitus in a south Indian tertiary care hospital. A cross-sectional observational study was conducted on 613 subjects (254 with and 359 without diabetic nephropathy). Prevalence of diabetic nephropathy was measured, and risk factors for the development of diabetic nephropathy were determined by calculating odds ratios using graph-pad prism statistical software, and drug utilization pattern was assessed. Metformin (47.05\%), a combination of Glimepiride and Metformin (30.71\%), a combination of insulin isophane and insulin regular (29.41\%), teneligliptin (10.45\%), insulin regular (9.80\%) were the anti-diabetic medications mostly given to the T2DM patients with nephropathy. The present study revealed that the risk factors for the development of diabetic nephropathy were multiple.
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Type 2 diabetes,\newline Prevalence,\newline Risk Factors,\newline Diabetic Nephropathy,\newline Metformin,\newline Insulin
\end{keywords}
\twocolumn[ \maketitle {\printKwdAbsBox}]
\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ Naveen~Babu~Kilaru~\\ Phone:\ ~\\  Email:\ naveenbabukvsr@gmail.com
        \par}\vspace*{-11pt}\hrulefill\par{\fontsize{12}{14}\selectfont ISSN: 0975-7538}\par% 
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\section{Introduction}
 Diabetic nephropathy is one of the most common microvascular complications of type 2 diabetes mellitus (T2DM) and the leading cause of end-stage renal disease worldwide \unskip~\citep{1418139:24978851,1418139:24978850}. Diabetic kidney disease (DKD) is a thoughtful complication that takes place in 20\% to 40\% of all diabetics \unskip~\citep{1418139:24978849,1418139:24978852}. The prevalence of diabetes around the world has reached epidemic proportions. While diabetes is already estimated to affect more than 8\% of the global population (nearly more than 350 million people), this is predictable to grow to over 550 million people by the year 2035\unskip~\citep{1418139:24978855}. Many factors contribute to the development of diabetic nephropathy, including hyperglycemia, hypertension, obesity, a sedentary lifestyle, hereditary, smoking, and advancing age\unskip~\citep{1418139:24978845,1418139:24978846}. Diabetic nephropathy is characterized by morphological and ultrastructural changes in the kidney, including an expansion of the molecular matrix and loss of the charge barrier on the glomerular basement membrane.  

The progression from normal albuminuria to microalbuminuria is considered the initial step in diabetic nephropathy, which further progresses to macroalbuminuria as the renal function continues to deteriorate and glomerular filtration rate (GFR) starts to decline \unskip~\citep{1418139:24978847,1418139:24978848}. The World Health Organization (WHO) defines "drug utilization" as the marketing, distribution, prescription, and use of the drugs in a society considering its medical, social, and economic consequences\unskip~\citep{1418139:24978856}. Drug utilization studies help to assess whether the drug treatment is rational or not and to determine rational drug use, especially in poorer and rural populations \unskip~\citep{1418139:24978842}. The few studies published on the prevalence of diabetic nephropathy in India have all been clinic-based\unskip~\citep{1418139:24978848,1418139:24978854}.  Indeed, the Diabetes Atlas 2006 (2) does not list a single population-based study on diabetic nephropathy from South Asia. This article reports on the first population-based data on the prevalence of diabetic nephropathy in India. 
    
\section{Materials and Methods}
 For this purpose, a cross-sectional observational study was carried out at the outpatients department of Dr. Pinnamaneni Siddhartha Institute of Medical Sciences \& Research Foundation, Gannavaram, Andhra Pradesh, South India \unskip~\citep{1418139:24978843}. The study was initiated after approval by the Institutes Ethical Review Committee, KVSR Siddhartha College of Pharmaceutical Sciences (SCOPS), Vijayawada, India. KVSR SCOPS was recognized by All India Council of Technical Education (AICTE) and Pharmacy Council of India (PCI), New Delhi, Govt. of India. The protocol approval number was KVSRSCOPS/IEC/ PG/231/2017.

\textbf{Selection of participants}

Patients of either sex diagnosed with or without T2DM of any duration (as per ADA guidelines) and willing to participate were included in the study. A total of 613 patients (359 patients with T2DM and 254 patients with diabetic nephropathy) were enrolled in the study.

\textbf{Inclusion criteria}

Patients of either sex diagnosed with type 2 diabetes mellitus of any duration, established as per American Diabetes Association (ADA) guidelines. Patients who are visiting a public endocrine hospital in the duration of six months would be recruited.

\textbf{Exclusion criteria}

Patients with incomplete case reports. Patients having type 1 diabetes mellitus, gestational diabetes, and maturity-onset diabetes of the young were excluded from the study. 

\textbf{Data collection}

Physicians were requested to report the clinical and biochemical data not exceeding 6 months before the observation. The information regarding demographics (age, sex), socioeconomic, and lifestyle characteristics (smoking, alcohol consumption) were collected by interviewing the participant. Biochemical parameters were derived from the latest laboratory investigation reports documented in the clinical records. Socioeconomic status was assessed using the modified Kuppuswamy's scale, which considers the education qualification, occupation of the family head, and family income per month of the participant. The diagnosis of nephropathy was confirmed from the clinical records (if already documented) or if an estimated 24-h protein excretion was \ensuremath{\geq }150 mg/day. All the relevant data were collected in a predesigned paper case record form with the prior consent of the participant. Data was collected from a total of 613 patients (359 patients with T2DM and 254 patients with diabetic nephropathy).

\textbf{Statistical Analysis}

Statistical analyses were performed using SPSS version 20 (SPSS Inc., Chicago, IL, USA) and Graph Pad Prism 5.0 software (San Diego, CA). Estimates were expressed as mean \ensuremath{\pm} SD. One-way analysis of variance or Student's t-test was used to compare groups for continuous variables, and \ensuremath{\chi }\ensuremath{^{2}} test was used to compare proportions between the two groups. Univariate logistic regression analysis was used to examine the association between various exposures (age, gender, place of residence, generalized obesity, cigarette smoking, alcohol consumption, income status, and literacy level) and outcome (T2DM). P-value \textless\ 0.05 was considered significant.
    
\section{Results and Discussion}
A total of 613 subjects (359 with type 2 diabetes and 254 with diabetic nephropathy) were included in the study, and the clinical characteristics of T2DM 


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\begin{TableNotes}\footnotesize 
    
\item{T2DM, Type 2 Diabetes Mellitus; BMI, Body Mass Index; HTN, Hypertension;CVDs, Cardiovascular Diseases; HbA1C, Glycated haemoglobin; HDL, High-Density Lipoproteins; LDL, Low-Density Lipoproteins}
\end{TableNotes}\setlength\LTcapwidth{\textwidth}
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\caption{\boldmath {Biochemical and clinical characteristics of patients with type 2 diabetes mellitus (N = 359)} }
\label{tw-b2f3f5d29d01}
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\tbltoprule \rowcolor{kwdboxcolor}Variable & Patients with T2DM \mbox{}\protect\newline N (\%)\\
\tblmidrule 
Gender &
  \\
 Male \mbox{}\protect\newline  Female &
  155 (43.2) \mbox{}\protect\newline 204 (56.8)\\
Age  &
  \\
 0-20 years \mbox{}\protect\newline  21-40 years \mbox{}\protect\newline  41-60 years \mbox{}\protect\newline  Above 60 years &
  1 (0.3) \mbox{}\protect\newline 83 (23.2) \mbox{}\protect\newline 217 (60.6) \mbox{}\protect\newline 57 (15.9)\\
Marital Status &
  \\
 Unmarried  \mbox{}\protect\newline  Married  &
  16 (4.5) \mbox{}\protect\newline 343 (95.5)\\
Education  &
  \\
 Uneducated  \mbox{}\protect\newline  Educated  &
  131 (36.5) \mbox{}\protect\newline 228 (63.5)\\
BMI (Kg/m2) &
  \\
 {\textless}25 Kg/m2 \mbox{}\protect\newline  {\textgreater}25 Kg/m2 &
  114 (31.8) \mbox{}\protect\newline 245 (68.2)\\
Body Weight (Kg) &
  \\
 {\textless}50 \mbox{}\protect\newline  50-70 \mbox{}\protect\newline  {\textgreater}70 &
  5 (1.3) \mbox{}\protect\newline 161 (45) \mbox{}\protect\newline 192 (53.6)\\
Nature of Work &
  \\
 Not working any where \mbox{}\protect\newline  Private job \mbox{}\protect\newline  Govt. job \mbox{}\protect\newline  Daily labor \mbox{}\protect\newline  House wife &
  41 (11.4) \mbox{}\protect\newline 93 (25.9) \mbox{}\protect\newline 39 (10.8) \mbox{}\protect\newline 38 (10.6) \mbox{}\protect\newline 148 (41.3)\\
Locality  &
  \\
 Rural  \mbox{}\protect\newline  Urban &
  105 (29.2) \mbox{}\protect\newline 254 (70.7)\\
Monthly Income  &
  \\
 No income \mbox{}\protect\newline  Below 25000 \mbox{}\protect\newline  Above 25000  &
  170 (47.5) \mbox{}\protect\newline 115 (32.1) \mbox{}\protect\newline 73 (20.4)\\
Co-morbidities &
  \\
 No  \mbox{}\protect\newline  HTN \mbox{}\protect\newline  History of CVDs \mbox{}\protect\newline  Endocrine diseases \mbox{}\protect\newline  Other diseases &
  131 (29.4) \mbox{}\protect\newline 138 (30.8) \mbox{}\protect\newline 7 (1.56) \mbox{}\protect\newline 59 (13.2) \mbox{}\protect\newline 112 (25.1)\\
HbA1C  &
  \\
 {\textless}7 \mbox{}\protect\newline  7-9 \mbox{}\protect\newline  {\textgreater}9 &
  141 (44.2) \mbox{}\protect\newline 109 (34.2) \mbox{}\protect\newline 69 (21.6)\\
Fasting Blood Glucose (mg/dL) &
  \\
 70-80 \mbox{}\protect\newline  80-120 \mbox{}\protect\newline  121-160 \mbox{}\protect\newline  161-200 \mbox{}\protect\newline  {\textgreater}200 &
  10 (3) \mbox{}\protect\newline 92 (27.6) \mbox{}\protect\newline 107 (32) \mbox{}\protect\newline 71 (21.3) \mbox{}\protect\newline 54 (16.2)\\
\multicolumn{2}{p{\dimexpr(1\linewidth-2\tabcolsep)}}{Post prandial blood glucose levels (mg/dL)}\\
 90-110 \mbox{}\protect\newline  111-130 \mbox{}\protect\newline  131-150 \mbox{}\protect\newline  151-200 \mbox{}\protect\newline  {\textgreater}200 &
  3 (1) \mbox{}\protect\newline 9 (3) \mbox{}\protect\newline 33 (10.9) \mbox{}\protect\newline 165 (54.6) \mbox{}\protect\newline 92 (30.5)\\
\multicolumn{2}{p{\dimexpr(1\linewidth-2\tabcolsep)}}{Random Blood Glucose (mg/dL)}\\
 80-100  \mbox{}\protect\newline  101-120  \mbox{}\protect\newline  121-140  \mbox{}\protect\newline  141-160  \mbox{}\protect\newline  161-200  \mbox{}\protect\newline  {\textgreater}200 &
  0 \mbox{}\protect\newline 0 \mbox{}\protect\newline 0 \mbox{}\protect\newline 2 (13.3) \mbox{}\protect\newline 1 (6.7) \mbox{}\protect\newline 12 (80)\\
HDL (mg/dL) &
  \\
 Not available  \mbox{}\protect\newline  Normal \mbox{}\protect\newline  Low \mbox{}\protect\newline  High &
  54 (20.1) \mbox{}\protect\newline 130 (48.3) \mbox{}\protect\newline 55 (20.4) \mbox{}\protect\newline 30 (11.2)\\
Triglycerides (mg/dL) &
  \\
 Not available \mbox{}\protect\newline  Normal \mbox{}\protect\newline  Low \mbox{}\protect\newline  High  &
  54 (20.5) \mbox{}\protect\newline 109 (41.5) \mbox{}\protect\newline 8 (3) \mbox{}\protect\newline 92 (35)\\
Total Cholesterol (mg/dL) &
  \\
 Not available \mbox{}\protect\newline  Normal \mbox{}\protect\newline  Low \mbox{}\protect\newline  High &
  54 (19.6) \mbox{}\protect\newline 151 (54.7) \mbox{}\protect\newline 6 (2.2) \mbox{}\protect\newline 65 (23.6)\\
LDL (mg/dL) &
  \\
 Not available  \mbox{}\protect\newline  Normal  \mbox{}\protect\newline  Low  \mbox{}\protect\newline  High &
  57 (20.8) \mbox{}\protect\newline 163 (59.4) \mbox{}\protect\newline 9 (3.3) \mbox{}\protect\newline 45 (16.5)\\
Urea (mg/dL) &
  \\
 Not available  \mbox{}\protect\newline  Normal  \mbox{}\protect\newline  Low  \mbox{}\protect\newline  High &
  72 (36.4) \mbox{}\protect\newline 78 (39.4) \mbox{}\protect\newline 0 \mbox{}\protect\newline 48 (24.2)\\
Serum creatinine (mg/dL) &
  \\
 Not available \mbox{}\protect\newline  Normal \mbox{}\protect\newline  Low  \mbox{}\protect\newline  High  &
  45 (12.6) \mbox{}\protect\newline 305 (85.2) \mbox{}\protect\newline 5 (1.4) \mbox{}\protect\newline 3 (0.8)\\
Duration of T2DM (Years) &
  \\
 {\textless}5 \mbox{}\protect\newline  5-10 \mbox{}\protect\newline  {\textgreater}10 &
  172 (47.9) \mbox{}\protect\newline 111 (30.9) \mbox{}\protect\newline 76 (21.2)\\
Following T2DM education &
  \\
 Yes \mbox{}\protect\newline  No  &
  282 (79.2) \mbox{}\protect\newline 74 (20.8)\\
\tblbottomrule 
\end{longtable}
\endgroup
\end{ThreePartTable}

\makeatletter\@ifundefined{TwoColDocument}{}{\twocolumn}\makeatother 

\begin{ThreePartTable}

\centering 
\begingroup
\makeatletter\if@twocolumn\@ifundefined{theposttbl}{\gdef\TwoColDocument{true}\onecolumn\onecolumn}{}\fi\makeatother 
\begin{TableNotes}\footnotesize 
    
\item{T2DM, Type 2 Diabetes Mellitus; BMI, Body Mass Index; HTN, Hypertension; CVDs, Cardiovascular Diseases; HbA1C, Glycated haemoglobin; HDL, High-Density Lipoproteins; LDL, Low-Density Lipoproteins}
\end{TableNotes}\setlength\LTcapwidth{\textwidth}
\begin{longtable}{p{\dimexpr.3114\linewidth-2\tabcolsep}p{\dimexpr.22389999999999993\linewidth-2\tabcolsep}p{\dimexpr.28550000000000004\linewidth-2\tabcolsep}p{\dimexpr.17919999999999995\linewidth-2\tabcolsep}}
\caption{\boldmath {Socio-demographic characteristics of diabetic patients with (N=254) or without diabetic nephropathy (N= 359)} }
\label{tw-102609218d8a}
\def\arraystretch{1.1}\\\endfirsthead \hline \noalign{\vskip3pt} \noalign{\textit{Table \thetable\ continued}} \noalign{\vskip3pt} \hline \endhead \hline \noalign{\vskip3pt} \noalign{\textit{\hfill Continued on next page}} \noalign{\vskip3pt} \endfoot \insertTableNotes \endlastfoot 
\tbltoprule \rowcolor{kwdboxcolor}Variable & Patients with T2DM \mbox{}\protect\newline N (\%) & Patients with T2DM and nephropathy N (\%) & P-Value\\
\tblmidrule 
 &
   &
   &
  \\
Gender &
   &
   &
  \\
 Male \mbox{}\protect\newline  Female &
  155 (43.2) \mbox{}\protect\newline 204 (56.8) &
  99 (39) \mbox{}\protect\newline 155 (61) &
  Ref \mbox{}\protect\newline 0.2985\\
 &
   &
   &
  \\
Age &
   &
   &
  \\
 &
   &
   &
  \\
 0-20 years \mbox{}\protect\newline  21-40 years \mbox{}\protect\newline  41-60 years \mbox{}\protect\newline  Above 60 years &
  1 (0.3) \mbox{}\protect\newline 83 (23.2) \mbox{}\protect\newline 217 (60.6) \mbox{}\protect\newline 57 (15.9) &
  ------ \mbox{}\protect\newline 20 (7.9) \mbox{}\protect\newline 152 (59.8) \mbox{}\protect\newline 82 (32.3) &
  Ref \mbox{}\protect\newline 0.6239 \mbox{}\protect\newline 0.4031 \mbox{}\protect\newline 0.2328\\
 &
   &
   &
  \\
Marital Status &
   &
   &
  \\
 &
   &
   &
  \\
 Unmarried  \mbox{}\protect\newline  Married  &
  16 (4.5) \mbox{}\protect\newline 343 (95.5) &
  3 (1.2) \mbox{}\protect\newline 251 (98.8) &
  Ref \mbox{}\protect\newline 0.0211*\\
 &
   &
   &
  \\
Education  &
   &
   &
  \\
 &
   &
   &
  \\
 Uneducated  \mbox{}\protect\newline  Educated  &
  131 (36.5) \mbox{}\protect\newline 228 (63.5) &
  155 (61) \mbox{}\protect\newline 99 (39) &
  Ref \mbox{}\protect\newline {\textless}0.0001***\\
 &
   &
   &
  \\
BMI (Kg/m\ensuremath{^{2}}) &
   &
   &
  \\
 &
   &
   &
  \\
 {\textless}25 Kg/m\ensuremath{^{2}} \mbox{}\protect\newline  {\textgreater}/=25 Kg/m\ensuremath{^{2}} &
  114 (31.8) \mbox{}\protect\newline 245 (68.2) &
  62 (24.5) \mbox{}\protect\newline 191 (75.5) &
  Ref \mbox{}\protect\newline 0.0511\\
 &
   &
   &
  \\
Body Weight (Kg) &
   &
   &
  \\
 &
   &
   &
  \\
 {\textless}50 \mbox{}\protect\newline  50-70 \mbox{}\protect\newline  {\textgreater}70 &
  5 (1.3) \mbox{}\protect\newline 161 (45) \mbox{}\protect\newline 192 (53.7) &
  5 (2) \mbox{}\protect\newline 112 (44.3) \mbox{}\protect\newline 136 (53.7) &
  Ref \mbox{}\protect\newline 0.5714 \mbox{}\protect\newline 0.5897\\
 &
   &
   &
  \\
Nature of Work &
   &
   &
  \\
 &
   &
   &
  \\
 Not working any where \mbox{}\protect\newline  Private job \mbox{}\protect\newline  Govt. job \mbox{}\protect\newline  Daily labour \mbox{}\protect\newline  House wife &
  41 (11.4) \mbox{}\protect\newline 93 (25.9) \mbox{}\protect\newline 39 (10.8) \mbox{}\protect\newline 38 (10.6) \mbox{}\protect\newline 148 (41.2) &
  57 (22.5) \mbox{}\protect\newline 45 (17.7) \mbox{}\protect\newline 14 (5.5) \mbox{}\protect\newline 25 (9.8) \mbox{}\protect\newline 113 (44.4) &
  Ref \mbox{}\protect\newline {\textless}0.0001*** \mbox{}\protect\newline 0.0002*** \mbox{}\protect\newline 0.0221* \mbox{}\protect\newline 0.0120*\\
 &
   &
   &
  \\
Locality  &
   &
   &
  \\
 &
   &
   &
  \\
 Rural  \mbox{}\protect\newline  Urban &
  105 (29.2) \mbox{}\protect\newline 254 (70.8) &
  130 (51.2) \mbox{}\protect\newline 124 (48.8) &
  Ref \mbox{}\protect\newline {\textless}0.0001***\\
 &
   &
   &
  \\
Monthly Income &
   &
   &
  \\
 &
   &
   &
  \\
 No income \mbox{}\protect\newline  Below 25000 \mbox{}\protect\newline  Above 25000  &
  170 (47.5) \mbox{}\protect\newline 115 (32.1) \mbox{}\protect\newline 73 (20.4) &
  148 (58.3) \mbox{}\protect\newline 87 (34.2) \mbox{}\protect\newline 19 (7.4) &
  Ref \mbox{}\protect\newline 0.4382 \mbox{}\protect\newline {\textless}0.0001***\\
 &
   &
   &
  \\
Co-morbidities &
   &
   &
  \\
 &
   &
   &
  \\
 No  \mbox{}\protect\newline  HTN \mbox{}\protect\newline  History of CVDs \mbox{}\protect\newline  Endocrine diseases \mbox{}\protect\newline  Other diseases &
  131 (29.4) \mbox{}\protect\newline 138 (30.8) \mbox{}\protect\newline 7 (1.56) \mbox{}\protect\newline 59 (13.2) \mbox{}\protect\newline 112 (25.1) &
  37 (8.6) \mbox{}\protect\newline 161 (37.44) \mbox{}\protect\newline 34 (7.90) \mbox{}\protect\newline 41 (9.53) \mbox{}\protect\newline 157 (36.51) &
  Ref \mbox{}\protect\newline {\textless}0.0001*** \mbox{}\protect\newline {\textless}0.0001*** \mbox{}\protect\newline 0.0009*** \mbox{}\protect\newline {\textless}0.0001***\\
 &
   &
   &
  \\
\multicolumn{2}{p{\dimexpr(.53529999999999994\linewidth-2\tabcolsep)}}{Systolic Blood Pressure} &
   &
  \\
 &
   &
   &
  \\
 {\textless}140 mmHg \mbox{}\protect\newline  {\textgreater}/=140 mmHg &
  259 (72.1) \mbox{}\protect\newline 100 (27.9) &
  160 (63) \mbox{}\protect\newline 94 (37) &
  Ref \mbox{}\protect\newline 0.0164*\\
 &
   &
   &
  \\
\multicolumn{2}{p{\dimexpr(.53529999999999994\linewidth-2\tabcolsep)}}{Diastolic Blood Pressure} &
   &
  \\
 &
   &
   &
  \\
 {\textless}90 mmHg \mbox{}\protect\newline  {\textgreater}/=90 mmHg &
  281 (78.3) \mbox{}\protect\newline 78 (21.7) &
  203 (79.9) \mbox{}\protect\newline 51 (20) &
  Ref \mbox{}\protect\newline 0.6219\\
 &
   &
   &
  \\
HbA1C  &
   &
   &
  \\
 &
   &
   &
  \\
 {\textless}7 \mbox{}\protect\newline  7-9 \mbox{}\protect\newline  {\textgreater}9 &
  141 (44.2) \mbox{}\protect\newline 109 (34.2) \mbox{}\protect\newline 69 (21.6) &
  52 (21.8) \mbox{}\protect\newline 100 (42) \mbox{}\protect\newline 86 (36.1) &
  Ref \mbox{}\protect\newline {\textless}0.0001*** \mbox{}\protect\newline {\textless}0.0001***\\
 &
   &
   &
  \\
\multicolumn{4}{p{\dimexpr(1\linewidth-2\tabcolsep)}}{Fasting Blood Glucose (mg/dL)}\\
 &
   &
   &
  \\
 70-80 \mbox{}\protect\newline  80-120 \mbox{}\protect\newline  121-160 \mbox{}\protect\newline  161-200 \mbox{}\protect\newline  {\textgreater}200 &
  10 (3) \mbox{}\protect\newline 92 (27.6) \mbox{}\protect\newline 107 (32) \mbox{}\protect\newline 71 (21.3) \mbox{}\protect\newline 54 (16.2) &
  2 (0.9) \mbox{}\protect\newline 54 (24) \mbox{}\protect\newline 62 (27.6) \mbox{}\protect\newline 41 (18.2) \mbox{}\protect\newline 66 (29.3) &
  Ref \mbox{}\protect\newline 0.1572 \mbox{}\protect\newline 0.1610 \mbox{}\protect\newline 0.1678 \mbox{}\protect\newline 0.0113*\\
 &
   &
   &
  \\
\multicolumn{4}{p{\dimexpr(1\linewidth-2\tabcolsep)}}{Post prandial blood glucose levels (mg/dL)}\\
 &
   &
   &
  \\
 90-110 \mbox{}\protect\newline  111-130 \mbox{}\protect\newline  131-150 \mbox{}\protect\newline  151-200 \mbox{}\protect\newline  {\textgreater}200 &
  3 (1) \mbox{}\protect\newline 9 (3) \mbox{}\protect\newline 33 (10.9) \mbox{}\protect\newline 165 (54.6) \mbox{}\protect\newline 92 (30.5) &
  1 (0.5) \mbox{}\protect\newline 5 (2.3) \mbox{}\protect\newline 12 (5.6) \mbox{}\protect\newline 98 (45.4) \mbox{}\protect\newline 100 (46.3) &
  0.6885 \mbox{}\protect\newline 0.9423 \mbox{}\protect\newline 0.6143 \mbox{}\protect\newline 0.2834 \mbox{}\protect\newline Ref\\
 &
   &
   &
  \\
\multicolumn{4}{p{\dimexpr(1\linewidth-2\tabcolsep)}}{Random Blood Glucose (mg/dL)}\\
 &
   &
   &
  \\
 80-100  \mbox{}\protect\newline  101-120  \mbox{}\protect\newline  121-140 \mbox{}\protect\newline  141-160 \mbox{}\protect\newline  161-200 \mbox{}\protect\newline  {\textgreater}200 &
  0 \mbox{}\protect\newline 0 \mbox{}\protect\newline 0 \mbox{}\protect\newline 2 (13.3) \mbox{}\protect\newline 1 (6.7) \mbox{}\protect\newline 12 (80) &
  4 (5.2) \mbox{}\protect\newline 5 (6.5) \mbox{}\protect\newline 2 (2.6) \mbox{}\protect\newline 8 (10.4) \mbox{}\protect\newline 9 (11.7) \mbox{}\protect\newline 49 (63.6) &
  0.3259 \mbox{}\protect\newline 0.2729 \mbox{}\protect\newline 0.4857 \mbox{}\protect\newline 0.9807 \mbox{}\protect\newline 0.4635 \mbox{}\protect\newline Ref\\
 &
   &
   &
  \\
HDL (mg/dL) &
   &
   &
  \\
 &
   &
   &
  \\
 Not available  \mbox{}\protect\newline  Normal \mbox{}\protect\newline  Low \mbox{}\protect\newline  High &
  54 (20.1) \mbox{}\protect\newline 130 (48.3) \mbox{}\protect\newline 55 (20.4) \mbox{}\protect\newline 30 (11.2) &
  84 (37.8) \mbox{}\protect\newline 73 (32.9) \mbox{}\protect\newline 51 (23) \mbox{}\protect\newline 14 (6.4) &
  Ref \mbox{}\protect\newline {\textless}0.0001*** \mbox{}\protect\newline 0.0470* \mbox{}\protect\newline 0.0008***\\
 &
   &
   &
  \\
\multicolumn{4}{p{\dimexpr(1\linewidth-2\tabcolsep)}}{Triglycerides (mg/dL)}\\
 Not available  \mbox{}\protect\newline  Normal \mbox{}\protect\newline  Low  \mbox{}\protect\newline  High  &
  54 (20.5) \mbox{}\protect\newline 109 (41.5) \mbox{}\protect\newline 8 (3) \mbox{}\protect\newline 92 (35) &
  85 (38.5) \mbox{}\protect\newline 46 (20.8) \mbox{}\protect\newline 2 (0.9) \mbox{}\protect\newline 88 (39.8) &
  Ref \mbox{}\protect\newline {\textless}0.0001*** \mbox{}\protect\newline 0.0108* \mbox{}\protect\newline 0.0293*\\
 &
   &
   &
  \\
\multicolumn{4}{p{\dimexpr(1\linewidth-2\tabcolsep)}}{Total Cholesterol (mg/dL)}\\
 Not available  \mbox{}\protect\newline  Normal \mbox{}\protect\newline  Low \mbox{}\protect\newline  High &
  54 (19.6) \mbox{}\protect\newline 151 (54.7) \mbox{}\protect\newline 6 (2.2) \mbox{}\protect\newline 65 (23.6) &
  82 (36.8) \mbox{}\protect\newline 78 (35) \mbox{}\protect\newline 1 (0.4) \mbox{}\protect\newline 62 (27.8) &
  Ref \mbox{}\protect\newline {\textless}0.0001*** \mbox{}\protect\newline 0.0161* \mbox{}\protect\newline 0.0617\\
 &
   &
   &
  \\
LDL (mg/dL) &
   &
   &
  \\
 &
   &
   &
  \\
 Not available  \mbox{}\protect\newline  Normal \mbox{}\protect\newline  Low \mbox{}\protect\newline  High &
  57 (20.8) \mbox{}\protect\newline 163 (59.4) \mbox{}\protect\newline 9 (3.3) \mbox{}\protect\newline 45 (16.5) &
  82 (37.1) \mbox{}\protect\newline 71 (32.2) \mbox{}\protect\newline 4 (1.8) \mbox{}\protect\newline 64 (28.9) &
  Ref \mbox{}\protect\newline {\textless}0.0001*** \mbox{}\protect\newline 0.0496* \mbox{}\protect\newline 0.9649\\
 &
   &
   &
  \\
Urea (mg/dL)  &
   &
   &
  \\
 &
   &
   &
  \\
 Not available  \mbox{}\protect\newline  Normal \mbox{}\protect\newline  Low  \mbox{}\protect\newline  High &
  72 (36.4) \mbox{}\protect\newline 78 (39.4) \mbox{}\protect\newline 0 \mbox{}\protect\newline 48 (24.2) &
  120 (59.1) \mbox{}\protect\newline 22 (10.8) \mbox{}\protect\newline 0 \mbox{}\protect\newline 61 (30.1) &
  Ref \mbox{}\protect\newline {\textless}0.0001*** \mbox{}\protect\newline ----- \mbox{}\protect\newline 0.2656\\
 &
   &
   &
  \\
\multicolumn{4}{p{\dimexpr(1\linewidth-2\tabcolsep)}}{Serum creatinine (mg/dL)}\\
 &
   &
   &
  \\
 Not available \mbox{}\protect\newline  Normal \mbox{}\protect\newline  Low \mbox{}\protect\newline  High  &
  45 (12.6) \mbox{}\protect\newline 305 (85.2) \mbox{}\protect\newline 5 (1.4) \mbox{}\protect\newline 3 (0.8) &
  7 (2.8) \mbox{}\protect\newline 175 (68.9) \mbox{}\protect\newline 0 \mbox{}\protect\newline 72 (28.3) &
  Ref \mbox{}\protect\newline 0.0009*** \mbox{}\protect\newline 0.3811 \mbox{}\protect\newline {\textless}0.0001***\\
 &
   &
   &
  \\
\multicolumn{4}{p{\dimexpr(1\linewidth-2\tabcolsep)}}{Duration of T2DM (Years)}\\
 &
   &
   &
  \\
 {\textless}5 \mbox{}\protect\newline  5-10 \mbox{}\protect\newline  {\textgreater}10 &
  172 (47.9) \mbox{}\protect\newline 111 (30.9) \mbox{}\protect\newline 76 (21.2) &
  59 (23.2) \mbox{}\protect\newline 101 (39.8) \mbox{}\protect\newline 94 (37) &
  Ref \mbox{}\protect\newline {\textless}0.0001*** \mbox{}\protect\newline {\textless}0.0001***\\
 &
   &
   &
  \\
\multicolumn{4}{p{\dimexpr(1\linewidth-2\tabcolsep)}}{Following T2DM education }\\
 &
   &
   &
  \\
 Yes  \mbox{}\protect\newline  No &
  282 (79.2) \mbox{}\protect\newline 74 (20.8) &
  180 (70.9) \mbox{}\protect\newline 74 (29.1) &
  Ref \mbox{}\protect\newline 0.0177*\\
\tblbottomrule 
\end{longtable}
\endgroup
\end{ThreePartTable}

\makeatletter\@ifundefined{TwoColDocument}{}{\twocolumn}\makeatother 

\begingroup
\makeatletter\if@twocolumn\@ifundefined{theposttbl}{\gdef\TwoColDocument{true}\onecolumn\onecolumn}{}\fi\makeatother \setlength\LTcapwidth{\textwidth}
\begin{longtable}{p{\dimexpr.3256\linewidth-2\tabcolsep}p{\dimexpr.233\linewidth-2\tabcolsep}p{\dimexpr.28970000000000002\linewidth-2\tabcolsep}p{\dimexpr.1517\linewidth-2\tabcolsep}}
\caption{\boldmath {Food and lifestyle characteristics of diabetic patients with (N=254) or without diabetic nephropathy (N=359)} }
\label{tw-ea6d534dd9bc}
\def\arraystretch{1.1}\\\endfirsthead \hline \noalign{\vskip3pt} \noalign{\textit{Table \thetable\ continued}} \noalign{\vskip3pt} \hline \endhead \hline \noalign{\vskip3pt} \noalign{\textit{\hfill Continued on next page}} \noalign{\vskip3pt} \endfoot \endlastfoot 
\tbltoprule \rowcolor{kwdboxcolor}Variable & Patients with T2DM N (\%) & Patients with T2DM and nephropathy N (\%) & P-value\\
\tblmidrule 
Food habits &
   &
   &
  \\
 Vegetarian \mbox{}\protect\newline  Mixed &
  60 (16.7) \mbox{}\protect\newline 299 (83.3) &
  37 (14.6) \mbox{}\protect\newline 217 (85.4) &
  Ref \mbox{}\protect\newline 0.4732\\
Physical activity &
   &
   &
  \\
 No physical activity \mbox{}\protect\newline  Regular exercise &
  176 (49) \mbox{}\protect\newline 183 (50.9) &
  165 (64.9) \mbox{}\protect\newline 89 (35) &
  Ref \mbox{}\protect\newline {\textless}0.0001***\\
Habit of smoking &
   &
   &
  \\
 No \mbox{}\protect\newline  Yes \mbox{}\protect\newline  Past smoker &
  320 (89.1) \mbox{}\protect\newline 22 (6.1) \mbox{}\protect\newline 17 (4.7) &
  218 (85.8) \mbox{}\protect\newline 18 (7.1) \mbox{}\protect\newline 18 (7.1) &
  Ref \mbox{}\protect\newline 0.5781 \mbox{}\protect\newline 0.2039\\
\multicolumn{2}{p{\dimexpr(.5586\linewidth-2\tabcolsep)}}{A habit of drinking alcohol } &
   &
  \\
 No \mbox{}\protect\newline  Yes \mbox{}\protect\newline  Past alcoholic &
  304 (85.1) \mbox{}\protect\newline 44 (12.3) \mbox{}\protect\newline 9 (2.5) &
  221 (87) \mbox{}\protect\newline 25 (9.9) \mbox{}\protect\newline 8 (3.2) &
  Ref \mbox{}\protect\newline 0.3526 \mbox{}\protect\newline 0.6834\\
\multicolumn{2}{p{\dimexpr(.5586\linewidth-2\tabcolsep)}}{A habit of taking junk foods} &
   &
  \\
 No \mbox{}\protect\newline  Weekly once \mbox{}\protect\newline  Weekly twice \mbox{}\protect\newline  Weekly thrice and more \mbox{}\protect\newline  Occasionally &
  180 (50.3) \mbox{}\protect\newline 31 (8.7) \mbox{}\protect\newline 23 (6.4) \mbox{}\protect\newline 28 (7.8) \mbox{}\protect\newline 96 (26.8) &
  123 (48.6) \mbox{}\protect\newline 16 (6.3) \mbox{}\protect\newline 18 (7.1) \mbox{}\protect\newline 23 (9.1) \mbox{}\protect\newline 73 (28.9) &
  Ref \mbox{}\protect\newline 0.3931 \mbox{}\protect\newline 0.6860 \mbox{}\protect\newline 0.5455 \mbox{}\protect\newline 0.5824\\
\multicolumn{3}{p{\dimexpr(.8483\linewidth-2\tabcolsep)}}{A habit of taking fruits /fruit juices} &
  \\
 No \mbox{}\protect\newline  Weekly once \mbox{}\protect\newline  Weekly twice \mbox{}\protect\newline  Weekly thrice \& more \mbox{}\protect\newline  Occasionally &
  66 (18.5) \mbox{}\protect\newline 27 (7.5) \mbox{}\protect\newline 35 (9.8) \mbox{}\protect\newline 125 (34.9) \mbox{}\protect\newline 105 (29.3) &
  62 (24.5) \mbox{}\protect\newline 17 (6.7) \mbox{}\protect\newline 22 (8.7) \mbox{}\protect\newline 57 (22.4) \mbox{}\protect\newline 96 (37.8) &
  Ref \mbox{}\protect\newline 0.2604 \mbox{}\protect\newline 0.2145 \mbox{}\protect\newline 0.0023** \mbox{}\protect\newline 0.9047\\
\multicolumn{2}{p{\dimexpr(.5586\linewidth-2\tabcolsep)}}{A habit of taking soft drinks } &
   &
  \\
 No \mbox{}\protect\newline  Weekly once \mbox{}\protect\newline  Weekly twice \mbox{}\protect\newline  Weekly thrice \& more \mbox{}\protect\newline  Occasionally &
  272 (76.2) \mbox{}\protect\newline 6 (1.7) \mbox{}\protect\newline 5 (1.4) \mbox{}\protect\newline 14 (4) \mbox{}\protect\newline 60 (16.8) &
  163 (64.1) \mbox{}\protect\newline 6 (2.4) \mbox{}\protect\newline 2 (0.8) \mbox{}\protect\newline 2 (0.8) \mbox{}\protect\newline 81 (31.9) &
  Ref \mbox{}\protect\newline 0.3773 \mbox{}\protect\newline 0.6291 \mbox{}\protect\newline 0.0417* \mbox{}\protect\newline {\textless}0.0001***\\
\multicolumn{2}{p{\dimexpr(.5586\linewidth-2\tabcolsep)}}{A habit of taking tea/coffee } &
   &
  \\
 No \mbox{}\protect\newline  Daily once without sugar \mbox{}\protect\newline  Daily twice without sugar \mbox{}\protect\newline  Daily thrice without sugar \mbox{}\protect\newline  Daily once with sugar \mbox{}\protect\newline  Daily twice with sugar \mbox{}\protect\newline  Daily thrice with sugar &
  55 (15.3) \mbox{}\protect\newline 54 (15) \mbox{}\protect\newline 110 (30.6) \mbox{}\protect\newline 58 (16.2) \mbox{}\protect\newline 25 (6.9) \mbox{}\protect\newline 37 (10.3) \mbox{}\protect\newline 20 (5.6) &
  29 (11.5) \mbox{}\protect\newline 32 (12.6) \mbox{}\protect\newline 107 (42.3) \mbox{}\protect\newline 35 (13.9) \mbox{}\protect\newline 16 (6.3) \mbox{}\protect\newline 24 (9.5) \mbox{}\protect\newline 10 (4) &
  Ref \mbox{}\protect\newline 0.7151 \mbox{}\protect\newline 0.0208* \mbox{}\protect\newline 0.6671 \mbox{}\protect\newline 0.6226 \mbox{}\protect\newline 0.5518 \mbox{}\protect\newline 0.9061\\
\multicolumn{2}{p{\dimexpr(.5586\linewidth-2\tabcolsep)}}{Situations at working places} &
   &
  \\
 No stress \mbox{}\protect\newline  Stress &
  181 (50.4) \mbox{}\protect\newline 178 (49.6) &
  127 (50) \mbox{}\protect\newline 127 (50) &
  Ref \mbox{}\protect\newline 0.9188\\
\tblbottomrule 
\end{longtable}
\endgroup
\makeatletter\@ifundefined{TwoColDocument}{}{\twocolumn}\makeatother 

\begin{ThreePartTable}

\centering 
\begingroup
\makeatletter\if@twocolumn\@ifundefined{theposttbl}{\gdef\TwoColDocument{true}\onecolumn\onecolumn}{}\fi\makeatother 
\begin{TableNotes}\footnotesize 
    
\item{T2DM, Type 2 Diabetes Mellitus; BMI, Body Mass Index; HTN, Hypertension; CVDs, Cardiovascular Diseases; HbA1C, Glycated haemoglobin; HDL, High-Density Lipoproteins; LDL, Low-Density Lipoproteins}
\end{TableNotes}\setlength\LTcapwidth{\textwidth}
\begin{longtable}{p{\dimexpr.33269999999999996\linewidth-2\tabcolsep}p{\dimexpr.4103\linewidth-2\tabcolsep}p{\dimexpr.257\linewidth-2\tabcolsep}}
\caption{\boldmath {Univariate regression analysis of modifiable and non-modifiable risk factors for the development of nephropathy in patients with type 2 diabetes mellitus.} }
\label{tw-814da6f9e77b}
\def\arraystretch{1.1}\\\endfirsthead \hline \noalign{\vskip3pt} \noalign{\textit{Table \thetable\ continued}} \noalign{\vskip3pt} \hline \endhead \hline \noalign{\vskip3pt} \noalign{\textit{\hfill Continued on next page}} \noalign{\vskip3pt} \endfoot \insertTableNotes \endlastfoot 
\tbltoprule \rowcolor{kwdboxcolor}Variable & OR (95\% CI) & P-value\\
\tblmidrule 
Gender &
   &
  \\
 Male \mbox{}\protect\newline  Female &
  1 \mbox{}\protect\newline 1.190 (0.8574 to 1.651) &
  Ref \mbox{}\protect\newline 0.2985\\
Age  &
   &
  \\
 0-20 years  \mbox{}\protect\newline  21-40 years \mbox{}\protect\newline  41-60 years \mbox{}\protect\newline  Above 60 years &
  1 \mbox{}\protect\newline 0.7365 (0.02891 to 18.76) \mbox{}\protect\newline 2.103 (0.08505 to 52.02) \mbox{}\protect\newline 4.304 (0.1721 to 107.6) &
  Ref \mbox{}\protect\newline 0.6239 \mbox{}\protect\newline 0.4031 \mbox{}\protect\newline 0.2328\\
Marital Status &
   &
  \\
 Unmarried  \mbox{}\protect\newline  Married  &
  1 \mbox{}\protect\newline 3.903 (1.125 to 13.54) &
  Ref \mbox{}\protect\newline 0.0211*\\
Education  &
   &
  \\
 Uneducated  \mbox{}\protect\newline  Educated  &
  1 \mbox{}\protect\newline 0.3670 (0.2635 to 0.5112) &
  Ref \mbox{}\protect\newline {\textless}0.0001***\\
BMI (Kg/m\ensuremath{^{2}}) &
   &
  \\
 {\textless}25 Kg/m\ensuremath{^{2}} \mbox{}\protect\newline  {\textgreater}/=25 Kg/m\ensuremath{^{2}} &
  1 \mbox{}\protect\newline 1.433 (0.9974 to 2.060) &
  Ref \mbox{}\protect\newline 0.0511\\
Body Weight (Kg) &
   &
  \\
 {\textless}50 \mbox{}\protect\newline  50-70 \mbox{}\protect\newline  {\textgreater}70 &
  1 \mbox{}\protect\newline 0.6957 (0.1967 to 2.460) \mbox{}\protect\newline 0.7083 (0.2011 to 2.495) &
  Ref \mbox{}\protect\newline 0.5714 \mbox{}\protect\newline 0.5897\\
Nature of Work &
   &
  \\
 Not working any where \mbox{}\protect\newline  Private job \mbox{}\protect\newline  Govt. job \mbox{}\protect\newline  Daily labour \mbox{}\protect\newline  House wife &
  1 \mbox{}\protect\newline 0.3480 (0.2035 to 0.5952) \mbox{}\protect\newline 0.2582 (0.1243 to 0.5363) \mbox{}\protect\newline 0.4732 (0.2483 to 0.9020) \mbox{}\protect\newline 0.5492 (0.3432 to 0.8789) &
  Ref \mbox{}\protect\newline {\textless}0.0001*** \mbox{}\protect\newline 0.0002*** \mbox{}\protect\newline 0.0221* \mbox{}\protect\newline 0.0120*\\
Locality  &
   &
  \\
 Rural  \mbox{}\protect\newline  Urban &
  1 \mbox{}\protect\newline 0.3943 (0.2820 to 0.5513) &
  Ref \mbox{}\protect\newline {\textless}0.0001***\\
Monthly Income  &
   &
  \\
 No income \mbox{}\protect\newline  Below 25000 \mbox{}\protect\newline  Above 25000 &
  1 \mbox{}\protect\newline 0.8690 (0.6092 to 1.240) \mbox{}\protect\newline 0.2990 (0.1723 to 0.5187) &
  Ref \mbox{}\protect\newline 0.4382 \mbox{}\protect\newline {\textless}0.0001***\\
Co-morbidities &
   &
  \\
 No  \mbox{}\protect\newline  HTN \mbox{}\protect\newline  History of CVDs \mbox{}\protect\newline  Endocrine diseases \mbox{}\protect\newline  Other diseases &
  1 \mbox{}\protect\newline 4.131 (2.687 to 6.350) \mbox{}\protect\newline 17.20 (7.049 to 41.95) \mbox{}\protect\newline 2.460 (1.433 to 4.224) \mbox{}\protect\newline 4.963 (3.202 to 7.692) &
  Ref \mbox{}\protect\newline {\textless}0.0001*** \mbox{}\protect\newline {\textless}0.0001*** \mbox{}\protect\newline 0.0009*** \mbox{}\protect\newline {\textless}0.0001***\\
\multicolumn{3}{p{\dimexpr(1\linewidth-2\tabcolsep)}}{Systolic Blood Pressure}\\
 {\textless}140 mmHg \mbox{}\protect\newline  {\textgreater}140 mmHg &
  1 \mbox{}\protect\newline 1.522 (1.079 to 2.146) &
  Ref \mbox{}\protect\newline 0.0164*\\
\multicolumn{3}{p{\dimexpr(1\linewidth-2\tabcolsep)}}{Diastolic Blood Pressure}\\
 {\textless}90mmHg \mbox{}\protect\newline  {\textgreater}90mmHg &
  1 \mbox{}\protect\newline 0.9051 (0.6088 to 1.346) &
  Ref \mbox{}\protect\newline 0.6219\\
HbA1C &
   &
  \\
 {\textless}7 \mbox{}\protect\newline  7-9 \mbox{}\protect\newline  {\textgreater}9 &
  1 \mbox{}\protect\newline 2.488 (1.638 to 3.779) \mbox{}\protect\newline 3.380 (2.157 to 5.295) &
  Ref \mbox{}\protect\newline {\textless}0.0001*** \mbox{}\protect\newline {\textless}0.0001***\\
\multicolumn{3}{p{\dimexpr(1\linewidth-2\tabcolsep)}}{Fasting Blood Glucose (mg/dL)}\\
 70-80 \mbox{}\protect\newline  81-120 \mbox{}\protect\newline  121-160 \mbox{}\protect\newline  161-200 \mbox{}\protect\newline  {\textgreater}200 &
  1 \mbox{}\protect\newline 2.935 (0.6196 to 13.90) \mbox{}\protect\newline 2.897 (0.6146 to 13.66) \mbox{}\protect\newline 2.887 (0.6028 to 13.83) \mbox{}\protect\newline 6.111 (1.283 to 29.10) &
  Ref \mbox{}\protect\newline 0.1572 \mbox{}\protect\newline 0.1610 \mbox{}\protect\newline 0.1678 \mbox{}\protect\newline 0.0113*\\
\multicolumn{3}{p{\dimexpr(1\linewidth-2\tabcolsep)}}{Post prandial blood glucose levels (mg/dL)}\\
 90-110 \mbox{}\protect\newline  111-130 \mbox{}\protect\newline  131-150 \mbox{}\protect\newline  151-200 \mbox{}\protect\newline  {\textgreater}200 &
  1 \mbox{}\protect\newline 1.667 (0.1349 to 20.59) \mbox{}\protect\newline 1.091 (0.1032 to 11.53) \mbox{}\protect\newline 1.782 (0.1827 to 17.38) \mbox{}\protect\newline 3.261 (0.3331 to 31.92) &
  Ref \mbox{}\protect\newline 0.6885 \mbox{}\protect\newline 0.9423 \mbox{}\protect\newline 0.6143 \mbox{}\protect\newline 0.2834\\
Random Blood Glucose (mg/dL) &
   &
  \\
 80-100  \mbox{}\protect\newline  101-120  \mbox{}\protect\newline  121-140 \mbox{}\protect\newline  141-160 \mbox{}\protect\newline  161-200 \mbox{}\protect\newline  {\textgreater}200 &
  2.273 (0.1146 to 45.09) \mbox{}\protect\newline 2.778 (0.1437 to 53.69) \mbox{}\protect\newline 1.263 (0.05689 to 28.02) \mbox{}\protect\newline 0.9796 (0.1837 to 5.222) \mbox{}\protect\newline 2.204 (0.2540 to 19.13) \mbox{}\protect\newline 1 &
  0.3259 \mbox{}\protect\newline 0.2729 \mbox{}\protect\newline 0.4857 \mbox{}\protect\newline 0.9807 \mbox{}\protect\newline 0.4635 \mbox{}\protect\newline Ref\\
HDL (mg/dL) &
   &
  \\
 Not available  \mbox{}\protect\newline  Normal \mbox{}\protect\newline  Low \mbox{}\protect\newline  High &
  1 \mbox{}\protect\newline 0.3610 (0.2310 to 0.5640) \mbox{}\protect\newline 0.5961 (0.3572 to 0.9947) \mbox{}\protect\newline 0.3000 (0.1459 to 0.6168) &
  Ref \mbox{}\protect\newline {\textless}0.0001*** \mbox{}\protect\newline 0.0470* \mbox{}\protect\newline 0.0008***\\
\multicolumn{2}{p{\dimexpr(.743\linewidth-2\tabcolsep)}}{Triglycerides (mg/dL)} &
  \\
 Not available \mbox{}\protect\newline  Normal \mbox{}\protect\newline  Low \mbox{}\protect\newline  High  &
  1 \mbox{}\protect\newline 0.2681 (0.1651 to 0.4354) \mbox{}\protect\newline 0.1588 (0.03249 to0.7765) \mbox{}\protect\newline 0.6077 (0.3878 to 0.9523) &
  Ref \mbox{}\protect\newline {\textless}0.0001*** \mbox{}\protect\newline 0.0108* \mbox{}\protect\newline 0.0293*\\
\multicolumn{2}{p{\dimexpr(.743\linewidth-2\tabcolsep)}}{Total Cholesterol (mg/dL)} &
  \\
 Not available  \mbox{}\protect\newline  Normal \mbox{}\protect\newline  Low \mbox{}\protect\newline  High &
  1 \mbox{}\protect\newline 0.3402 (0.2193 to 0.5277) \mbox{}\protect\newline 0.1098 (0.01285 to0.9377) \mbox{}\protect\newline 0.6281 (0.3852 to 1.024) &
  Ref \mbox{}\protect\newline {\textless}0.0001*** \mbox{}\protect\newline 0.0161* \mbox{}\protect\newline 0.0617\\
LDL (mg/dL) &
   &
  \\
 Not available \mbox{}\protect\newline  Normal \mbox{}\protect\newline  Low \mbox{}\protect\newline  High  &
  1 \mbox{}\protect\newline 0.3028 (0.1954 to 0.4693) \mbox{}\protect\newline 0.3089 (0.09070 to 1.052) \mbox{}\protect\newline 0.9886 (0.5939 to 1.646) &
  Ref \mbox{}\protect\newline {\textless}0.0001*** \mbox{}\protect\newline 0.0496* \mbox{}\protect\newline 0.9649\\
Urea (mg/dL) &
   &
  \\
 Not available  \mbox{}\protect\newline  Normal \mbox{}\protect\newline  Low \mbox{}\protect\newline  High  &
  1 \mbox{}\protect\newline 0.1692 (0.09703 to 0.2951) \mbox{}\protect\newline 0.7625 (0.4728 to 1.230) &
  Ref \mbox{}\protect\newline {\textless}0.0001*** \mbox{}\protect\newline 0.2656\\
\multicolumn{2}{p{\dimexpr(.743\linewidth-2\tabcolsep)}}{ Serum creatinine (mg/dL)} &
  \\
 Not available \mbox{}\protect\newline  Normal \mbox{}\protect\newline  Low \mbox{}\protect\newline  High  &
  1 \mbox{}\protect\newline 3.689 (1.628 to 8.358) \mbox{}\protect\newline 0.5515 (0.02754 to 11.05) \mbox{}\protect\newline 154.3 (37.92 to 627.7) &
  Ref \mbox{}\protect\newline 0.0009*** \mbox{}\protect\newline 0.3811 \mbox{}\protect\newline {\textless}0.0001***\\
\multicolumn{2}{p{\dimexpr(.743\linewidth-2\tabcolsep)}}{Duration of T2DM (Years)} &
  \\
 {\textless}5 \mbox{}\protect\newline  5-10 \mbox{}\protect\newline  {\textgreater}10 &
  1 \mbox{}\protect\newline 2.653 (1.778 to 3.958) \mbox{}\protect\newline 3.606 (2.362 to 5.504) &
  Ref \mbox{}\protect\newline {\textless}0.0001*** \mbox{}\protect\newline {\textless}0.0001***\\
\multicolumn{2}{p{\dimexpr(.743\linewidth-2\tabcolsep)}}{Following T2DM education} &
  \\
 Yes \mbox{}\protect\newline  No  &
  1 \mbox{}\protect\newline 1.567 (1.079 to 2.274) &
  Ref \mbox{}\protect\newline 0.0177*\\
Food habits &
   &
  \\
 Vegetarian \mbox{}\protect\newline  Mixed &
  1 \mbox{}\protect\newline 1.177 (0.7538 to 1.838) &
  Ref \mbox{}\protect\newline 0.4732\\
Physical activity &
   &
  \\
 No physical activity \mbox{}\protect\newline  Regular exercise &
  1 \mbox{}\protect\newline 0.5188 (0.3727 to 0.7220) &
  Ref \mbox{}\protect\newline {\textless}0.0001***\\
Habit of smoking &
   &
  \\
 No \mbox{}\protect\newline  Yes \mbox{}\protect\newline  Past smoker &
  1 \mbox{}\protect\newline 1.201 (0.6292 to 2.292) \mbox{}\protect\newline 1.554 (0.7835 to 3.083) &
  Ref \mbox{}\protect\newline 0.5781 \mbox{}\protect\newline 0.2039\\
\multicolumn{2}{p{\dimexpr(.743\linewidth-2\tabcolsep)}}{A habit of drinking alcohol } &
  \\
 No \mbox{}\protect\newline  Yes \mbox{}\protect\newline  Past alcoholic &
  1 \mbox{}\protect\newline 0.7816 (0.4643 to 1.316) \mbox{}\protect\newline 1.223 (0.4643 to 3.220) &
  Ref \mbox{}\protect\newline 0.3526 \mbox{}\protect\newline 0.6834\\
\multicolumn{2}{p{\dimexpr(.743\linewidth-2\tabcolsep)}}{A habit of taking junk foods } &
  \\
 No \mbox{}\protect\newline  Weekly once \mbox{}\protect\newline  Weekly twice \mbox{}\protect\newline  Weekly thrice and more \mbox{}\protect\newline  Occasionally &
  1 \mbox{}\protect\newline 0.7553 (0.3960 to 1.440) \mbox{}\protect\newline 1.145 (0.5930 to 2.212) \mbox{}\protect\newline 1.202 (0.6614 to 2.185) \mbox{}\protect\newline 1.113 (0.7601 to 1.629) &
  Ref \mbox{}\protect\newline 0.3931 \mbox{}\protect\newline 0.6860 \mbox{}\protect\newline 0.5455 \mbox{}\protect\newline 0.5824\\
\multicolumn{2}{p{\dimexpr(.743\linewidth-2\tabcolsep)}}{A habit of taking fruits /fruit juices} &
  \\
 No \mbox{}\protect\newline  Weekly once \mbox{}\protect\newline  Weekly twice \mbox{}\protect\newline  Weekly thrice \& more \mbox{}\protect\newline  Occasionally &
  1 \mbox{}\protect\newline 0.6703 (0.3332 to 1.348) \mbox{}\protect\newline 0.6691 (0.3542 to 1.264) \mbox{}\protect\newline 0.4854 (0.3042 to 0.7746) \mbox{}\protect\newline 0.9733 (0.6245 to 1.517) &
  Ref \mbox{}\protect\newline 0.2604 \mbox{}\protect\newline 0.2145 \mbox{}\protect\newline 0.0023** \mbox{}\protect\newline 0.9047\\
\multicolumn{2}{p{\dimexpr(.743\linewidth-2\tabcolsep)}}{A habit of taking soft drinks } &
  \\
 No \mbox{}\protect\newline  Weekly once \mbox{}\protect\newline  Weekly twice \mbox{}\protect\newline  Weekly thrice \& more \mbox{}\protect\newline  Occasionally &
  1 \mbox{}\protect\newline 1.669 (0.5292 to 5.262) \mbox{}\protect\newline 0.6675 (0.1280 to 3.481) \mbox{}\protect\newline 0.2384 (0.05348 to 1.063) \mbox{}\protect\newline 2.253 (1.531 to 3.315) &
  Ref \mbox{}\protect\newline 0.3773 \mbox{}\protect\newline 0.6291 \mbox{}\protect\newline 0.0417* \mbox{}\protect\newline {\textless}0.0001***\\
\multicolumn{2}{p{\dimexpr(.743\linewidth-2\tabcolsep)}}{A habit of taking tea/coffee } &
  \\
 No \mbox{}\protect\newline  Daily once without sugar \mbox{}\protect\newline  Daily twice without sugar \mbox{}\protect\newline  Daily thrice without sugar \mbox{}\protect\newline  Daily once with sugar \mbox{}\protect\newline  Daily twice with sugar \mbox{}\protect\newline  Daily thrice with sugar &
  1 \mbox{}\protect\newline 1.124 (0.6001 to 2.105) \mbox{}\protect\newline 1.845 (1.094 to 3.112) \mbox{}\protect\newline 1.144 (0.6186 to 2.117) \mbox{}\protect\newline 1.214 (0.5607 to 2.627) \mbox{}\protect\newline 1.230 (0.6214 to 2.435) \mbox{}\protect\newline 0.9483 (0.3923 to 2.292) &
  Ref \mbox{}\protect\newline 0.7151 \mbox{}\protect\newline 0.0208* \mbox{}\protect\newline 0.6671 \mbox{}\protect\newline 0.6226 \mbox{}\protect\newline 0.5518 \mbox{}\protect\newline 0.9061\\
\multicolumn{2}{p{\dimexpr(.743\linewidth-2\tabcolsep)}}{Situations at working places} &
  \\
 No stress \mbox{}\protect\newline  Stress &
  1 \mbox{}\protect\newline 1.017 (0.7373 to 1.402) &
  Ref \mbox{}\protect\newline 0.9188\\
\tblbottomrule 
\end{longtable}
\endgroup
\end{ThreePartTable}

\makeatletter\@ifundefined{TwoColDocument}{}{\twocolumn}\makeatother 

\begin{table*}[!htbp]
\caption{\boldmath {Medication given for the patients with diabetic nephropathy} }
\label{tw-993cf44ce220}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.1414\linewidth-2\tabcolsep}p{\dimexpr.6207\linewidth-2\tabcolsep}p{\dimexpr.2379\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}S. No & Generic Name of Drugs & N (\%)\\
\tblmidrule 
1 &
  Metformin  &
  72 (47.05)\\
2 &
  Glimepiride + Metformin &
  47 (30.71)\\
3 &
  Insulin Isophane + Regular Insulin &
  45 (29.41)\\
4 &
  Teneligliptin  &
  16 (10.45)\\
5 &
  Insulin Regular &
  15 (9.80)\\
6 &
  Glimepiride &
  10 (6.53)\\
7 &
  Pioglitazone  &
  10 (6.53)\\
8 &
  Gliclazide + Metformin  &
  8 (5.22)\\
9 &
  Insulin Glargine &
  7 (4.57)\\
10 &
  Gliclazide &
  6 (3.92)\\
11 &
  Sitagliptin + Metformin  &
  4 (2.61)\\
12 &
  Teneligliptin + Metformin  &
  4 (2.61)\\
13 &
  Metformin + Voglibose &
  4 (2.61)\\
14 &
  Insulin Aspart &
  4 (2.61)\\
15 &
  Glipizide + Metformin &
  3 (1.96)\\
16 &
  Glibenclamide + Metformin &
  3 (1.96)\\
17 &
  Metformin + Vildagliptin &
  3 (1.96)\\
18 &
  Lantus Insulin  &
  2 (1.30)\\
19 &
  Glimepiride + Metformin + Voglibose &
  2 (1.30)\\
20 &
  Glimepiride + Metformin + Pioglitazone  &
  2 (1.30)\\
21 &
  Sitagliptin &
  2 (1.30)\\
22 &
  Acarbose &
  1 (0.65)\\
23 &
  Linagliptin &
  1 (0.65)\\
24 &
  Voglibose &
  1 (0.65)\\
25 &
  Dapagliflozin &
  1 (0.65)\\
26 &
  Empagliflozin &
  1 (0.65)\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}
were presented in Tables~\ref{tw-b2f3f5d29d01} and~\ref{tw-102609218d8a} and Table~\ref{tw-ea6d534dd9bc} show the socio-demographic and lifestyle characteristics of subjects with and without diabetic nephropathy, respectively. 

The prevalence of diabetic nephropathy was significantly higher in subjects who are married(98.8\%,P=0.0211), uneducated(61\%, p{\textless}0.0001), nature of work (house wives 44.4\%,P=0.0120), rural residents(51.2\%) and risk factors were co-morbidities(HTN 37.44\%, P{\textless}0.0001, other diseases 36.51\%, P{\textless}0.0001, endocrine diseases 9.53\%, P=0.009, history of CVDs 7.90\%, P\textless\ 0.0001), no physical activity (64.9\%, P{\textless}0.0001), soft drinks (taking occasionally 31.9\%, P{\textless}0.0001), habit of taking tea /coffee (twice without sugar 42.3\%, p=0.0208), HbA1C(7-9\% 42\%, P{\textless}0.0001), FBS ({\textgreater}200 29.3\%, P=0.0113), low HDL(23\%, P=0.0470), high triglyceride levels (39.8\%,P=0.0293), high serum creatinine (28.3\%, P{\textless}0.0001), duration of T2DM(5-10years 39.8\% \& {\textgreater}10 years 37\% , p{\textless}0.0001). Gender, age, BMI, body weight, monthly income, food habits, the habit of smoking, alcohol, stress levels, blood glucose levels are not significantly associated with the development of diabetic nephropathy. 

Univariate regression analysis was performed to determine the odds ratios for the modifiable and non modifiable risk factors for T2DM (Table~\ref{tw-814da6f9e77b}). 

The analysis showed that married (OR, 3.903; 95\% CI, 1.125-13.54, P=0.0211), poorly educated (OR, 0.3670;95\%CI, 0.2635-0.5112, P{\textless}0.0001), house wives (OR, 0.5492; 95\% CI, 0.3432 - 0.8789, P=0.0120), rural residents (OR, 0.3943; 95\% CI, 0.2820-0.5513, P{\textless}0.0001), hypertension (OR, 4.131; 95\% CI, 2.687-6.350, P{\textless}0.0001), other diseases (OR, 4.963; 95\% CI, 3.202 -7.692, P{\textless}0.0001), Endocrine diseases (OR, 2.460; 95\% CI, 1.433- 4.224, P=0.0009), history of CVD (OR, 17.20; 95\% CI, 7.049- 41.95, P{\textless}0.0001), HbA1c (OR, 3.380; 95\% CI,2.157- 5.295, P{\textless}0.0001), low HDL  (OR, 0.5961; 95\% CI, 0.3572 - 0.9947 , P=0.0470), high FBS levels (OR, 6.111; 95\%CI, 1.283 -29.10, P=0.0113), high triglyceride levels (OR, 0.6077; 95\%CI, 0.3878 -0.9523, P=0.0293), high serum creatinine  (OR, 154.3; 95\% CI,  37.92- 627.7, P{\textless}0.0001), duration of T2DM (5-10years OR, 2.653;95\% CI 1.778 - 3.958, \& {\textgreater}10 years , OR, 3.606 ; 95\% CI, 2.362-5.504, P{\textless}0.0001). physical inactivity(OR, 0.5188;95\% CI,  0.3727-0.7220 , P{\textless}0.0001),  soft drinks occasionally (OR, 2.253; 95\% CI,1.531-3.315, P{\textless}0.0001), habit of taking tea /coffee twice without sugar(OR, 1.845; 95\% CI, 1.094 to 3.112, P=0.0208). 

Drug utilization pattern was assessed and presented the results in Table~\ref{tw-993cf44ce220}. Metformin, combination of Glimepiride and Metformin, combination of insulin isophane and insulin regular, Teneligliptin, insulin regular were the anti-diabetic medications mostly given to the T2DM patients with nephropathy. 

The present study's results suggested that  subjects who are married, uneducated, nature of work (housewives), rural residents and risk factors were co-morbidities(HTN, other diseases, endocrine diseases, history of CVDs), no physical activity, soft drinks (taking occasionally), habit of taking tea /coffee (twice without sugar),poor glycemic control, FBS ({\textgreater}200), low HDL, high triglyceride levels, high serum creatinine, duration of T2DM are major risk factors for the development of nephropathy complications.

\textbf{Marital status}

The present study's results revealed that marital status (98.8\%, P=0.0211) was significantly associated and was the major risk factor for diabetic nephropathy (OR, 3.903; 95\% CI, 1.125-13.54). Therefore, further studies are needed to evaluate the exact impact of marital status on risk for diabetic nephropathy.

\textbf{Education}

Education is one of the risk factors for the development of diabetic nephropathy. Abdulhakeemhamood et al. conducted a study on Prevalence and Risk Factors of Diabetic Nephropathy in Omani Type 2 Diabetics in Al-Dakhiliyah Region and concluded that decreased literacy was significantly related to the presence of diabetic nephropathy \unskip~\citep{1418139:24978857}.

 The present study's results suggested that educational status was significantly associated with (61\%, P{\textless}0.0001), and a risk factor for the development of diabetic nephropathy.

\textbf{Nature of work }

The present study's results revealed that housewives (44.4\%, p=0.0120) were significantly associated and was the major risk factor for diabetic nephropathy (OR, 0.5492; 95\% CI, 0.3432 - 0.8789). Therefore, further studies are needed to evaluate the exact impact of the nature of work on  risk for diabetic nephropathy.

\textbf{Rural residence}

The present study's results revealed that rural residents (51.2\%, P{\textless}0.0001) were significantly associated and was the major risk factor for diabetic nephropathy. Therefore, further studies are needed to evaluate the exact impact of rural residence on risk for diabetic nephropathy.

\textbf{Co-morbidities}

Hypertension (P \textless\ 0.0001) was positively associated with diabetic nephropathy. Khalid Al-Rubeaan et al., conducted a study on ``Diabetic Nephropathy and Its Risk Factors in a Society with a Type 2 Diabetes Epidemic: A Saudi National Diabetes Registry-Based Study'' and concluded that the hypertension was the most significant risk factor for diabetic nephropathy in Saudi type 2 diabetic population \unskip~\citep{1418139:24978844}. 

The present study's results are also supported that hypertension (37.44\%, P \textless\ 0.0001) was a risk factor for diabetic nephropathy (OR, 4.131; 95\% CI, 2.687-6.350). 

\textbf{Physical inactivity }

The present study's results revealed that physical inactivity (64.9\%, P{\textless}0.0001) was significantly associated and was the major risk factor for diabetic nephropathy.Therefore, further studies are needed to evaluate the exact impact of physical inactivity on risk for diabetic nephropathy.

\textbf{Soft drinks}

The present study's results revealed that habit of taking soft drinks occasionally (31.9\%, P{\textless}0.0001) was significantly associated and was the major risk factor for diabetic nephropathy (OR, 2.253; 95\% CI, 1.531-3.315). Therefore, further studies are needed to evaluate the exact impact of the habit of taking soft drinks on risk for diabetic nephropathy.

\textbf{A habit of taking tea/coffee }

The present study's results revealed that the habit of taking tea/coffee twice without sugar (42.3\%, P =0.0208) was significantly associated and was the major risk factor for diabetic nephropathy (OR, 1.845; 95\% CI, 1.094-3.112). Therefore, further studies are needed to evaluate the exact impact of the habit of taking tea/coffee on risk for diabetic nephropathy.

\textbf{HbA1c}

Poor glycemic control was significantly associated with the development of diabetic nephropathy. \unskip~\citep{1418139:24978857} conducted a study on Prevalence and Risk Factors of Diabetic Nephropathy in Omani Type 2 Diabetics in Al-Dakhiliyah Region and concluded that poor glycemic control was a significant risk factor for the development of nephropathy \unskip~\citep{1418139:24978857}. 

Another study conducted by Feng \textit{et al.,} (2008) on the prevalence and risk factors of diabetic nephropathy in taiwanese Type 2 diabetes{\textendash}A hospital-based study and concluded that risk factors associated with diabetic nephropathy included the poor glycemic control. Other relevant studies conducted by \unskip~\citep{1418139:24978844} concluded that poor glycemic control is the most significant risk factor. In the present study, it was significant that poor glycemic control (42\%, P{\textless}0.0001) was a major risk factor (OR, 2.488; 95\% CI, 1.638-3.779).

\textbf{Fasting blood glucose}

The present study's results revealed that FBS levels (29.3\%, P=0.0113) was significantly associated and was the major risk factor for diabetic nephropathy (OR, 6.111; 95\%CI, 1.283-29.10). Therefore, further studies are needed to evaluate the exact impact of FBS levels on risk for diabetic nephropathy.

\textbf{HDL}

Feng \textit{et al.} (2008) conducted a study on the prevalence and risk factors of diabetic nephropathy in taiwanese Type 2 diabetes{\textendash}A hospital-based study and concluded that risk factors associated with diabetic nephropathy include HDL- cholesterol. The present study's results are also supported that HDL (23\%,  P=0.0470) was a significant risk factor for diabetic nephropathy  (OR, 0.5961; 95\% CI, 0.3572-0.9947).

\textbf{Triglycerides}

Serum triglycerides levels are significantly associated with the development of diabetic nephropathy. Feng \textit{et al.} (2008) conducted a study on the prevalence and risk factors of diabetic nephropathy in taiwanese Type 2 diabetes{\textendash}A hospital-based study and concluded that triglyceride levels were the most significant risk factor associated with the development of diabetic nephropathy. 

Another study conducted by \unskip~\citep{1418139:24978844} on ``Diabetic Nephropathy and Its Risk Factors in a Society with a Type 2 Diabetes Epidemic: A Saudi National Diabetes Registry-Based Study'' and concluded that the most significant risk factors for diabetic nephropathy in Saudi type 2 diabetic population was hyperlipidemia. In the present study, it was also significant that high serum triglyceride levels (39.8\%, P=0.0293) were a major risk factor (OR, 0.6077; 95\% CI, 0.3878-0.9523) for the development of diabetic nephropathy.

\textbf{Serum creatinine}

Feng \textit{et al.} (2008) conducted a study on the prevalence and risk factors of diabetic nephropathy in taiwanese Type 2 diabetes{\textendash}A hospital-based study and concluded that serum creatinine levels was a significant risk factor associated with the development of diabetic nephropathy. The present study's results are also supported that serum creatinine levels (28.3\%,  P{\textless}0.0001) were the most significant risk factor for diabetic nephropathy  (OR, 154.3; 95\% CI, 37.92-627.7).

\textbf{Duration of T2DM}

\unskip~\citet{1418139:24978857} conducted a study on Prevalence and Risk Factors of Diabetic Nephropathy in Omani Type 2 Diabetics in Al-Dakhiliyah Region and concluded that long-standing diabetes was one of the significant risk factors for diabetic nephropathy. Other relevant studies conducted by Feng \textit{et al.} (2008) also conclude that long-standing diabetes was the most significant risk factor for the development of diabetic nephropathy. The present study's results are also supported that long-standing diabetes  (39.8\%, P{\textless}0.0001) was the significant risk factor  (OR, 2.653; 95\% CI, 1.778 -3.958).
    
\section{Conclusions}
Subjects who are married, uneducated, nature of work (housewives), rural residents and risk factors were co-morbidities(HTN, other diseases, endocrine diseases, history of CVDs), no physical activity, soft drinks (taking occasionally), habit of taking tea /coffee (twice without sugar), HbA1C(7-9\%), FBS ({\textgreater}200), low HDL, high triglyceride levels, high serum creatinine, duration of T2DM(5-10years \& 10 years) were significant risk factors for development of nephropathy. Metformin, a combination of Glimepiride and Metformin, a combination of Insulin Isophane and Insulin Regular, Teneligliptin, Insulin Regular, were the anti-diabetic medications mostly given to the T2DM patients with nephropathy.

\textbf{Key findings}


  
  \begin{enumerate}
  \item \relax The prevalence of nephropathy was found to be 20.58\%.
  \item \relax Nephropathy prevalence was higher in females compared to males (P=0.2985).
  \item \relax  The prevalence of nephropathy was significantly higher in subjects who are married (98.8\%, P=0.0211) when compared to unmarried.
  \item \relax  The prevalence of nephropathy was significantly higher in subjects who are poorly educated (61\%, p{\textless}0.0001) when compared to educated.
  \item \relax The prevalence of nephropathy was significantly higher in subjects who are not doing any work when compared to others.
  \item \relax The major comorbidities for the development of nephropathy complications include Hypertension (P{\textless}0.0001), other diseases (P{\textless}0.0001), endocrine diseases (P=0.009), history of CVDs (P\textless\ 0.0001).
  \item \relax Locality, physical inactivity, soft drinks, a habit of taking tea /coffee are significantly associated with the development of diabetic nephropathy. 
  \item \relax Poor glycemic control, blood glucose levels, HDL, Triglycerides, serum creatinine levels are significantly associated with the development of diabetic nephropathy.
  \item \relax Duration of T2DM (5-10years 39.8 \%, P{\textless}0.0001, {\textgreater}10 years 37\%, P{\textless}0.0001) was significantly associated with the development of diabetic nephropathy. 
  \item \relax  Metformin, a combination of Glimepiride and Metformin, a combination of Insulin Isophane and Insulin Regular, Teneligliptin, Insulin Regular, were the anti-diabetic medications mostly given to the T2DM patients with nephropathy. 
  \end{enumerate}
  
\section*{Acknowledgement}This study was supported by the Siddhartha Academy of General and Technical Education (SAGTE). The authors are grateful to the physicians of Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, Andhra Pradesh, for providing the necessary information. The authors thank Dr. Jaidev Sudagani, consultant endocrinologist and diabetologist, Santhi Endocrine, and Diabetes hospital for providing the necessary facilities.

 \textbf{Source of funding}

The authors did not receive funds from any other funding sources/agencies for this work.

 \textbf{Conflict of interest}

The authors declare that they have no conflict of interest.
    

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