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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 <0.05. Results: The mean age of presentation was 54.05 13.24 with
male:female ratio of 1.6:1. The prevalence of diabetic retinopathy, nephropathy, neuropathy, cardiovascular, cerebrovascular and
peripheral vascular disease was 20%, 37%, 16%, 26%, 8% and 11%, respectively; retinopathy, nephropathy and coronary artery
disease screening being significant (p < 0.05). Conclusion: There was a significant correlation between prevalence of diabetes and
increased waist circumference and body mass index. There was high prevalence of coronary artery disease, nephropathy
and retinopathy in South Indian population at diagnosis. Screening for all cases of diabetes at diagnosis for complications is
recommended.
*Senior Resident
Bangalore Medical College and Research Institute, Bangalore, Karnataka
Senior Resident
Rajarajeshwari Medical College, Bangalore, Karnataka
Professor and Head
Dept. of General Medicine
Vijayanagara Institute of Medical Sciences, Bellary, Karnataka
Address for correspondence
Dr Deepa DV
No. 82, 5th Main, Maruthi HBCS, BTM I Stage, Bangalore - 560 029, Karnataka
E-mail: drdeepa.dv@gmail.com, brkiranin@gmail.com
644
Source of Data
Newly detected patients with T2DM attending Dept. of
Medicine (outpatient/inpatient), Vijayanagara Institute
of Medical Sciences (VIMS) combined hospital, Bellary,
form the subjects.
DIABETOLOGY
Design of the Study
Duration of Study
October 2012 to June 2013 (9 months).
Inclusion Criteria
Newly diagnosed T2DM adult patients >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.*
OR
Fasting plasma glucose 126 mg/dL (7.0 mmol/L).
Fasting is defined as no caloric intake for at least
8 hours*
OR
2-hour plasma glucose 200 mg/dL (11.1 mmol/L)
during an OGTT (oral glucose tolerance test)
OR
Exclusion Criteria
Pregnancy
Sample Size
Hundred cases of newly diagnosed T2DM were
included in this study.
645
DIABETOLOGY
t-test and Chi-square test was used to calculate the
significance between the variables.
RESULTS
In this study, 62 were males and 38 were females.
The mean age was 54.05 13.24 years. The maximum
incidence of diabetics was seen between 52-62 years.
Table 1 shows various metabolic parameters in the
study population. The patients presenting with
complaints correlated with diabetic complications of
CAD, cerebrovascular disease, peripheral artery disease,
retinopathy, nephropathy and neuropathy was 15%,
7%, 7%, 2%, 9% 7%, respectively. Fundus examination
revealed that 19 cases had nonproliferative diabetic
retinopathy and one case had proliferative retinopathy.
It was statistically significant. Microalbuminuria was
seen in 30 cases, macroalbuminuria seen in four cases
was statistically significant. ECG findings were normal
in 74 cases, myocardial infarction (MI), left bundle
branch block, left ventricular hypertrophy (LVH)
in three cases each, old MI in seven cases, ischemic
heart disease in six cases and arrhythmias in two
cases. 2D-echocardiography showed regional wall
motion abnormality in 23 cases, hypertensive heart
disease in eight cases, concentric LVH and ischemic
dilated cardiomyopathy in one case each. Carotid
Doppler showed atherosclerosis in five cases and was
statistically insignificant. ABI showed limb ischemia in
19 cases among which seven cases showed critical limb
ischemia which was statistically insignificant. Twentyeight cases were detected on routine investigations,
Statistical Analysis
SPSS software package was used for the analysis.
Statistical significance was defined as a p value <0.05
(two-sided). Mean standard deviation (SD) and
confidence interval (CI) was calculated. Students
Diabetics
(n = 100)
CAD
(n = 25)
CVD
(n = 8)
PVD
(n = 11)
DR
(n = 20)
DN
(n = 34)
DNe
(n = 16)
54.05 13.24
57
61
55
55
56
59
Weight (kg)
74 13
78
79
84.36
75.8
76.94
77.33
Height (cm)
165 6.3
166
167.25
166
167
166
164
BMI
27.02 12.8
28.04
30.10
30.6
27.28
27.85
28.81
Waist circumference
90.14 9.43
93
96.25
95.54
88.75
90.6
93.73
208 73.7
220
229
277
226
232
246
FBS
PPBS
304 95
326
344
426
334
344
338
Blood urea
29.6 15.5
36.5
37.4
34.5
31.4
33.8
31.1
Serum creatinine
1.04 0.39
1.24
1.275
1.9
1.24
1.203
1.129
HbA1C
8.65 1.8
9.016
9.15
10.5
9.24
9.23
9.4
Total cholesterol
156 49.9
170
183
196
168
160
176
BMI = Body mass index; CAD = Coronary artery disease; CVD = Cerebrovascular disease; DN = Diabetic nephropathy; DNe = Diabetic
neuropathy; DR = Diabetic retinopathy; FBS = Fasting blood sugar; PPBS = Postprandial blood sugar; PVD = Peripheral vascular disease.
646
DIABETOLOGY
28 were incidentally detected when they attended the
hospital for other illnesses and rest of the 44 cases
presented with multiple complications due to diabetes.
The metabolic parameters are described in Table 1.
Common complications which they presented were
CAD (15%), infection (12%), stroke (6%), ulcers (4%),
neuropathy (4%) and diabetic ketoacidosis (1%). The
prevalence of macrovascular complications CAD,
Percentage (%)
P value
CAD
26
0.011*
CVD
08
0.334
PVD
11
0.477
DR
20
0.018*
DN
34
0.003*
DN
16
0.368
DISCUSSION
This is a study done over a period of 24 months in
cases of newly detected T2DM attending the inpatient
and outpatient department of VIMS combined
*Significant p <0.05.
Mean SD
CAD
CVD
PVD
DR
DN
DNe
P value
<6.5
02
5.95 0.77
P-01
A-01
P-01
A-01
P-00
A-02
P-00
A-02
P-01
A-01
P-00
A-02
0.8602*
6.51-7.5
37
7.16 0.22
P-08
A-29
P-02
A-35
P-01
A-36
P-05
A-32
P-06
A-31
P-03
A-34
0.0301**
7.51-8.5
20
7.94 0.31
P-03
A-17
P-01
A-19
P-02
A-18
P-04
A-16
P-07
A-13
P-04
A-16
0.0021**
8.51-9.5
13
9.16 1.9
P-04
A-09
P-00
A-13
P-00
A-13
P-03
A-10
P-08
A-05
P-02
A-11
0.0040**
>9.51
38
11.16 1.23
P-10
A-28
P-04
A-34
P-08
A-30
P-08
A-30
P-12
A-26
P-06
A-32
0.0026**
P-26
A-74
P-08
A-92
P-11
A-89
P-20
A-80
P-34
A-66
P-15
A-85
Pool
*Nonsignificant; **Significant p <0.05.
A = Absent; N = Number; P = Present.
CAD
Mohan et al13
(n = 4,471)
Hoorn study12
(n = 255)
7.9
CVD
PVD
2.3
DR
34.2
Weerasuriya et al9
(n = 597)
Drivsholm et al8
(n = 1,137)
Our study
(n = 100)
26.9
28.4
27.9
26
5.1
3.4
2.4
08
4.6
16.1
17.5
11
1.9
15.2
5.4
20
DN
26.7
29
48.1
37.4
34
DN
48.3
25.2
19.1
19.1
16
647
DIABETOLOGY
hospital. In our study, 28 cases were detected on
routine investigations out which 18 had symptoms of
polydipsia, polyuria. Twenty-eight were incidentally
detected when they attended the hospital for other
illnesses and rest of the 44 cases presented with
multiple complications due to diabetes.
REFERENCES
3. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL,
Loscalzo J. Harrisons Principles of Internal Medicine.
18th edition, Vol. 2. McGraw-Hill: USA 2012;344:
p. 2968-3002.
648
Nocturnal Cough
Productive Cough
Dry Cough
Nocturnal Cough
Dry Cough
Productive Cough
Nocturnal Cough
Cough
Dry Cough
Nocturnal
Productive
Dry Cough
Nocturnal Cough
Cough
Productive
Dry
Dry
Nocturnal Cough
Cough
Nocturnal Cough
Productive
In Dry Cough
Grilinctus
(Dextromethorphan HBr 5mg, Chlorpheniramine Maleate 2.5 mg,
Guaifenesin 50 mg and NH,CI 60 m!V'5 ml)
Syrup
In Productive Cough
Grilinctus-BM
(Terbutaline Sulphate 2.5 mg + Bromhexine HCI 8mg/5ml) Syrup I Tablets
In Nocturnal Cough
GRILINCTus:co
(Codeine Phosphate 10 mg+ Chlorpheniramine Maleate 4mg/5ml)
[YJ
PRANCO - ltmlAN
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