Loscalzo J. Harrison's Principles of Internal Medicine. 18th edition, Vol. 2. McGraw-Hill: USA 2012;344: p. 2968-3002. 4. American Diabetes Association ...
DIABETOLOGY
Macrovascular and Microvascular Complications in Newly Diagnosed Type 2 Diabetes Mellitus DEEPA DV*, KIRAN BR†, GADWALKAR SRIKANT R‡
ABSTRACT Objectives: To study the prevalence and clinical profile of microvascular and macrovascular complications in newly diagnosed type 2 diabetes mellitus patients in and around Bellary, Karnataka. Study design: The study was an observational cross-sectional study of 100 newly detected type 2 diabetics attending Dept. of Medicine (outpatient/inpatient), VIMS combined hospitals, Bellary, from October 2012 to June 2013 (9 months) who matched the inclusion criteria. Material and methods: Cases were screened for vascular complications as per ADA criteria, data tabulated and analyzed. Statistical analysis: SPSS software package was used for analysis. Statistical significance was defined as a p value 20 years of age were included in the study. (Laboratory diagnosis of diabetes mellitus was confirmed by latest criteria laid by the American Diabetes Association (ADA). Blood glucose levels were checked on two separate occasions before the diagnosis of diabetes mellitus was made.) According to ADA,1 criteria for diagnosis are: Glycosylated hemoglobin (HbA1C) ≥6.5%. The test should be performed in a laboratory using a method that is NGSP (National Glycohemoglobin Standardization Program) certified and standardized to the DCCT (Diabetes Control and Complications Trial) assay.*
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Detailed history such as age and sex, family history of diabetes was recorded. Symptoms suggestive of diabetes or of related complications were noted. Past history of hypertension and complications of diabetes was documented. Any previous treatment for these complications taken was recorded. Smoking or alcohol history was noted. General physical examination, vital parameters such as pulse, blood pressure (in sitting and standing position) temperature and respiratory rate were recorded. Anthropometric measurements: ÂÂ
Weight (in kilograms) and height (in centimeters) was recorded.
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The body mass index (BMI) was determined by dividing the weight (in kilograms) by height (in meters2).
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Measurement of waist circumference (cm): It was measured just above the uppermost lateral border of the right iliac crest, a horizontal mark was drawn, and then crossed with a vertical mark on the midaxillary line. The measuring tape was placed in a horizontal plane around the abdomen at the level of this marked point on the right side of the trunk.
OR Fasting plasma glucose ≥126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 hours*
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OR 2-hour plasma glucose ≥200 mg/dL (11.1 mmol/L) during an OGTT (oral glucose tolerance test)†
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OR ÂÂ
In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dL (11.1 mmol/L).
*In the absence of unequivocal hyperglycemia, criteria 1-3 should be confirmed by repeat testing. †The
test should be performed as described by the World Health Organization, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water.
Exclusion Criteria ÂÂ
Type 1 diabetes mellitus
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Any other severe illness
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Patients already diagnosed of diabetes mellitus and on treatment
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Refusal to be a part of the study
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Pregnancy
Sample Size Hundred cases of newly diagnosed T2DM were included in this study.
Presence of skin infections, gangrene and ulcers was noted. Systemic examination was carried out in all patients. Presence of sensory neuropathy was defined4 by symptoms of tingling and numbness over the extremities (bilaterally symmetrical) with or without impaired touch, vibration sense or joint position sense. Presence of motor neuropathy was noted. Autonomic dysfunction in the form of resting tachycardia, orthostatic hypotension, gastroparesis/diarrhea or abnormal sweating was noted. Ten gram monofilament was used to note any reduced sensation due to neuropathy. Dilated pupil fundoscopy was carried out in all patients by an ophthalmologist and retinopathy was defined and graded as nonproliferative diabetic retinopathy and proliferative retinopathy.5 Proliferative retinopathy was described by the presence of any retinal or optic disc neovascularization, or the presence of preretinal or vitreous hemorrhage, whereas the presence of microaneurysms, exudates (lipid exudates or ‘cotton-wool spots’) and/or retinal hemorrhages only
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DIABETOLOGY t-test and Chi-square test was used to calculate the significance between the variables.
was defined as nonproliferative retinopathy. Fasting and postprandial blood sugars (venous blood samples drawn) on two separate occasions were determined using glucose oxidase-peroxidase method. Renal function tests included blood urea, serum creatinine and urine analysis. Urine was analyzed for glucose, ketone bodies and protein. Microalbuminuria was estimated by nephelometry. Microalbuminuria is defined as the mean urine albumin concentration of 30-300 mg/mL detected by nephelometry on three consecutive days. Macroalbuminuria is defined as urine albumin >300 mg/dL.6 Fasting lipid profile included serum cholesterol, serum triglycerides, serum high-density lipoprotein (HDL) and serum low-density lipoprotein (LDL). Patient was termed to have dyslipidemia if LDL was >100 mg/dL, serum cholesterol >200 mg/dL, serum HDL 150 mg/dL. A 12-lead electrocardiogram (ECG) and 2Dechocardiography was done to note the presence of ischemia or infarction to indicate coronary artery disease (CAD).6 Carotid Doppler was done to note for presence of stenosis. Ankle-brachial index (ABI) was determined using arterial Doppler. A value
