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Table of Content - Volume 8 Issue 3 - December 2017



A study of complications in patients with newly detected type 2 DM

 

Dilip Krishna Godavarthi1*, P Chandrasekhara2

 

1PG Final Year, 2Retd. Professor, Department of General Medicine, MVJ Medical College and Research Hospital, Dandupalya, National Highway 4, 30th Km Milestone, Kolathur P.O, Hoskote, Bengaluru, Karnataka, INDIA.

Email: gdilipkrishna@gmail.com

 

Abstract              Background: Chronic complications of diabetes, the major cause of morbidity and mortality, are often present at the time of diagnosis. The problem is further worsened as the diagnosis of diabetes is often delayed from months to years due to lack of symptoms, lack of awareness and the fear of unknown in spite of awareness. The asymptomatic phase of hyperglycemia accounts for the relatively high prevalence of complications at initial presentation. A high prevalence of such complications, if documented, will help convince the physicians the importance of screening for these complications in all type 2 diabetics (T2DM) at presentation for appropriate implementation of treatment without delay. Methods: The study was conducted on 100 newly diagnosed type 2 diabetes mellitus patients. Each patient was screened for diabetic complications, hypertension and dyslipidemia. Standard protocols were used to make the diagnosis of retinopathy, neuropathy, nephropathy, IHD, peripheral artery disease and autonomic complications. Results: There were 55 males and 45females. Majority were less than 60 years of age.22% of patients had neuropathy, 14% retinopathy and 7%, nephropathy. IHD and PAD were observed in 12% and 8%. Autonomic complications noticed in 5% patients. Co morbid conditions such as hypertension and dyslipidemia were observed in 24%, and 35% of patients respectively. Conclusion: All cases of Type 2 DM must be investigated for early detection of chronic complications so that further progression of the disease can be prevented.

Key Word: type 2 DM.

 

INTRODUCTION

Chronic complications of diabetes, the major cause of morbidity and mortality, are often present at the time of diagnosis. The problem is further worsened as the diagnosis of diabetes is often delayed from months to years due to lack of symptoms, lack of awareness and the fear of unknown in spite of awareness. The asymptomatic phase of hyperglycemia accounts for the relatively high prevalence of complications at initial presentation. A high prevalence of such complications, if documented, will help convince the physicians, the importance of screening for these complications in all type 2 diabetics (T2DM) at presentation, for appropriate treatment without delay.

 

MATERIAL AND METHODS

  • Source of Data: Newly detected patients with T2DM attending Dept. of Medicine (outpatient/inpatient), MVJMC&RH form the subjects.
  • Design of the Study: Cross-sectional observational study.
  • Duration of Study: September 2016 to June 2017 (10 months).

Inclusion Criteria

Newly diagnosed T2DM adult patients >40 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).

Exclusion Criteria

 Type 1 Diabetes mellitus, patients who have been diagnosed with diabetes for more than one month, patients already on drug therapy, gestational diabetes, secondary diabetes and patients with severe infections.

  • Sample Size: Hundred cases of newly diagnosed T2DM were included in this study.

Study design: Detailed history - age and sex, family history of diabetes were recorded.  General physical examination, vital parameters such as pulse, blood pressure (in sitting and standing position) temperature and respiratory rate were recorded. Presence of skin infections, gangrene and ulcers were noted. Standard protocols were used to make the diagnosis of Microvascular - Retinopathy, Neuropathy, Nephropathy, autonomic disturbances and Macrovascular - IHD , CVA, Peripheral artery disease.

 

RESULTS

Males 55, Females –45, <60yrs -62 >60yrs – 38 Comorbid conditions such as hypertension 24% and dyslipidemia  35%, Obesity – 20%, and Smokers – 19%. 30% had family history of diabetes. Infection was the presenting feature in 14 cases & DKA in one case Distal symmetry sensory motor neuropathy was most common variety of neuropathy. Non proliferative retinopathy was most common variety of retinopathy. Microalbuminuria was seen in 19 cases and macroalbuminuria in 7 cases. ECG findings were normal in 88 cases. LBBB -4, old myocardial infarction -3, IHD -9 2 D ECHO showed regional wall motion abnormalities in 3 cases, HHD in 5 cases. ABI showed PAD with limb ischemia in 8 cases. No patient had stroke. Among lipid abnormalities triglycerides were > 150mg/dl in 22 patients, total cholesterol >200mg/dl in 18 patients, 10 patients had LDL >130mg/dl.

 

Hba1c %

Neuropathy

Nephropathy

Retinopathy

Pad

Autonomic

ndysfuction

6.5 - 7.5

3

1

7.51-8.5

4

3

1

8.51-9.5

5

2

4

2

1

>9.51

10

5

6

6

3

Total

22

7

14

8

5

 

DISCUSSION

TYPE 2 DM is progressive illness with a long preclinical asymptomatic phase during which patients may be exposed to the ill effects of hyperglycemia for many years before they are diagnosed. The present study reconfirms this and shows that a substantial proportion of patients with TYPE 2 DM have evidence of diabetic tissue damage at the time of diagnosis of diabetes. In our study 22% of cases had microvascular complication as neuropathy, which was due to severe hyperglycemia, among which 5% were associated with autonomic neuropathy. It is comparable to the study conducted by Shukla et al in which 23% had neuropathy in newly detected diabetics. In study done by Sosale et al percentage of peripheral neuropathy was 13.15%.  Karmakar et al have shown 9% of neuropathy at diagnosis and Rani et al have also reported 13% in established cases of retinopathy having neuropathy. In our study 14% of cases had retinopathy. In comparision with a study by Shukla et al 15% had evidence of Retinopathy. Where as study done by Sosale et al in which 6% had retinopathy. Percentage of nephropathy was 7% in our study which is higher than various earlier studies in India, Sosale et al showed 1.03% overt of nephropathy while by Unnikrishnan et al observed 0.8% of nephropathy. Hypertension (24%) in our study was lower than other studies in India. Shukla et al reported 30% of hypertension in diabetic patients. Our study was comparable with Sosale et al in which 23% of cases had hypertension.  Dyslipidemia 35% was again higher in comparison to other studies, In study conducted by Shukla et al 30% patients had dyslipidemia, Sosale et al reported lipid abnormalities in 23% of newly detected type 2 diabetes patient.

 

CONCLUSION

All cases of Type 2 DM must be investigated for early detection of chronic complications so that further progression of the disease can be prevented. Lack of awareness can also be a contributing factor in developing country like India. Once complications develop, treating hyperglycemia alone usually does not suffice and complications from diabetes can be prevented only up to a certain point, beyond, which these will progress. This underlines for the high importance of screening of all newly diagnosed T2DM patients not only for early detection of micro vascular and macro vascular complications, but also to prevent or retard the progression of complications by aggressive management. Beyond screening, education of high risk population regarding diabetes related complications must be started to encourage earlier medical consultation.

 

REFERENCES

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