Abstract              Background: According to the World Health Organization, approximately 180 million people worldwide currently have type 2 DM (formerly called adult-onset diabetes); over 95% of people with diabetes have this form Aims and Objectives: To Study association of increased level of HbA1C with development of complications of Diabetes mellitus at tertiary health care centre. Methodology: This prospective study was undertaken at Krishna Hospital and Medial research Centre, Karad. One hundered patients of Diabetes Mellitus admitted to hospital during an eighteen month period from 1^st July 1977 to 31^st December 1998 were included in the study. The statistical analysis done by Chi –square test analyzed by SPSS 19 version software. Result: the majority of the patients were in the age group of 51-60 were 34%, 61-70 were 27%, followed by 41-50 were 18%, 31-40 were 7%, 71-80% were 6%, 21-30 were 4%, >80 and <20 were 2%. The IDDM patients were 28% and NIDDM were 72%. The majority of the patients were with HbA1C% >11 (Bad) were 41%, 9.1-11.0 (Poor)-19%, 8.1-9.0 (Fair)-16%, <8 (Good)-24%. The majority of the patients with Macro-vascular complications were present in the patients with HbA1C% >11 i.e. 22% as compared to 4% HbA1C<11 this observed difference is statistically significant. (χ² = 27.63,df=1,p<0.0001) The majority of the patients with Micro-vascular complications were present in the patients with HbA1C% >11 i.e. 32% as compared to 8% HbA1C<11 this observed difference is statistically significant. (χ² = 41.92,df=1,p<0.0001). Conclusion: It can be concluded from our study that the micro-vascular and macro-vascular complications were significantly associated with HbA1C% >11.

Key Words: Glycosylated hemoglobin (HbA1C), IDDM (Insulin Dependant Diabetes Mellitus), NIDDM (Non-insulin

Dependent Diabetes Mellitus).

 

INTRODUCTION

Diabetes mellitus (DM) is a global health issue affecting children, adolescents, and adults. According to the World Health Organization, approximately 180 million people worldwide currently have type 2 DM (formerly called adult-onset diabetes); over 95% of people with diabetes have this form. The number of people with type 2 DM is estimated to double by 2030.¹ In the year 2000, death from diabetes-associated complications accounted for approximately 6% of worldwide mortality.² Additionally, the economic burden of diabetes in the United States in 2002 was estimated to be $132 billion.³ Diabetes is a disease that is strongly associated with both microvascular and macrovascular complications, including retinopathy, nephropathy, and neuropathy (microvascular) and ischemic heart disease, peripheral vascular disease, and cerebrovascular disease (macrovascular), resulting in organ and tissue damage in approximately one third to one half of people with diabetes.⁴ Because of the progressive nature of the disease, physical therapists will increasingly encounter patients with prediabetes (ie, impaired glucose tolerance or insulin resistance), early type 2 DM without or with only a few vascular complications, and more advanced disease with several vascular complications. For additional information describing the epidemiology of these problems in people with DM, see the perspective article by Deshpande et al⁵ in this issue. Diabetes-associated vascular alterations include anatomic, structural, and functional changes or also known as Micro vascular and Macro vascular complications.

 

MATERIAL AND METHODS

This prospective study was undertaken at Krishna Hospital and Medial research Centre, Karad. One hundered patients of Diabetes Mellitus admitted to hospital during an eighteen month period from 1^st July 1977 to 31^st December 1998 were included in the study. The national diabetes data group of the national Institute of health in 1979 revised the criteria for the diagnosis of Diabetes Mellitus (39) was used for the diagnosis of diabetic patients. The glycosylated hemoglobin was estimated by kit available in our hospital. We considered HbA1C (%) less than 8 –Good, 8.1-9.0-Fair, 9.1-11-Poor, >11-Bad. The patients with hemolytic anemia, pregnancy, acute or chronic blood lost and those with abnormal hemoglobin’s as their HbA1C concentrations may not be accurately estimated. The statistical analysis done by Chi –square test analyzed by SPSS 19 version software.

 

RESULT

 

Table 1: Age wise distribution of patients of Diabetes Mellitus

The majority of the patients were in the age group of 51-60 were 34%, 61-70 were 27%, followed by 41-50 were 18%, 31-40 were 7%, 71-80% were 6%, 21-30 were 4%, >80 and <20 were 2%.

 

Table 2: Pathological classification of diabetes mellitus

The IDDM patients were 28% and NIDDM were 72%

 

Table 3: Distribution of the patients as per the Glycosylated Hemoglobin Levels

The majority of the patients were with HbA1C% >11 (Bad) were 41%, 9.1-11.0 (Poor)-19%, 8.1-9.0 (Fair)-16%, <8 (Good)-24%.

 

Table 4: Distribution of the patients as per the macro-vascular complications

(χ² = 27.63,df=1,p<0.0001)

The majority of the patients with Macro-vascular complications were present in the patients with HbA1C% >11 i.e. 22% as compared to 4% HbA1C<11 this observed difference is statistically significant. (χ² = 27.63,df=1,p<0.0001)

 

Table 5: Distribution of the patients as per the micro-vascular complications

(χ² = 41.92, df=1,p<0.0001)

The majority of the patients with Micro-vascular complications were present in the patients with HbA1C% >11 i.e. 32% as compared to 8% HbA1C<11 this observed difference is statistically significant. (χ² = 41.92, df=1,p<0.0001).

 

DISCUSSION

leading to multiorgan dysfunction.⁶ As physical therapists increasingly become first-line providers of treatment for musculoskeletal and movement disorders in people with diabetes, it will be important for clinicians to be keenly aware of the underlying vascular deficits in conditions such as diabetic neuropathy, retinopathy, nephropathy, and cardiovascular and peripheral vascular diseases in their treatment programs, even if these conditions are not the reasons for referral. Additionally, physical therapists will play an important role in the care of people with diabetes because numerous interventions provided by physical therapists (such as therapeutic exercise) can assist in alleviating symptoms, slow the metabolic progression to overt type 2 DM, and reduce morbidity and mortality associated with these complications.^7–10 Diabetic microvascular (involving small vessels, such as capillaries) and macrovascular (involving large vessels, such as arteries and veins) complications have similar etiologic characteristics. Chronic hyperglycemia plays a major role in the initiation of diabetic vascular complications through many metabolic and structural derangements, including the production of advanced glycation end products (AGE), abnormal activation of signaling cascades (such as protein kinase C [PKC]), elevated production of reactive oxygen species (ROS, oxygen-containing molecules that can interact with other biomolecules and result in damage), and abnormal stimulation of hemodynamic regulation systems (such as the renin-angiotensin system [RAS])¹¹. Good glycemic control is essential in preventing diabetic complications ^{12, 13}. The level of glycosylated hemoglobin (HbA1c) provides a measure of the glycemic control of diabetes patients during the previous 2–3 months ¹⁴. Besides the average level of HbA1c, certain changes in HbA1c levels and HbA1c at different points in time can possibly have different implications for the clinician and in studies of the relation between HbA1c and diabetic complications. The term HbA1c-variable is used to describe how different combinations and weighting of HbA1c-values relate to diabetic complications¹⁵. In our study we have seen that the majority of the patients were in the age group of 51-60 were 34%, 61-70 were 27%, followed by 41-50 were 18%, 31-40 were 7%, 71-80% were 6%, 21-30 were 4%, >80 and <20 were 2%. The IDDM patients were 28% and NIDDM were 72%. The majority of the patients were with HbA1C% >11 (Bad) were 41%, 9.1-11.0 (Poor)-19%, 8.1-9.0 (Fair)-16%, <8 (Good)-24%. The majority of the patients with Macro-vascular complications were present in the patients with HbA1C% >11 i.e. 22% as compared to 4% HbA1C<11 this observed difference is statistically significant. (χ² = 27.63, df=1,p<0.0001) The majority of the patients with Micro-vascular complications were present in the patients with HbA1C% >11 i.e. 32% as compared to 8% HbA1C<11 this observed difference is statistically significant. (χ² = 41.92, df=1,p<0.0001).

 

CONCLUSION

It can be concluded from our study that the micro-vascular and macro-vascular complications were significantly associated with HbA1C% >11.

 

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