PREVALENCE OF MICROVASCULAR COMPLICATIONS AMONG INDOOR DIABETIC PATIENTS

Abstract

Uncontrolled diabetes mellitus with a longer duration leads to the development and progression of mi crovascular complications such as retinopathy, nephropathy and neuropathy. The present study was undertaken to estimate the number and proportion of diabetic patients having these complications and to understand the role of ri sk factors including age. BMI nnd diabetes duration respons ible for the development <lnd progressIOn of these microvascular complications. Two hundred diabetic patients with different cl inical problems, admitted to Endocrinology un it of H.lyatabad Medical Complex, Peshawar were included in the study. Age, sex, type of diabetes, past medical history (includ ing heart attacks, strokes, smoking, foot ulcers nod gan grenes), ramily history, dumti on since diagnosis of diabetes, treatment modal ity. and cause of admiss ion of each pat ient were recorded. Weight and height were measured to (h.:tl:rll1tI1C the body mass index.. Each patient was examined for the measuremen t of blood pressure and presence or absence of nrtet lal pu lses in the feel. Casual plasma glucose on the day of admission and subsequent days was also measured. Ophthnltntc examination to detect retinopathy was performed with the help of direct ophthalmoscope. Neuropmhy was diagnosed by the assessment of ankle reflexes, vibration, pain and touch sensations in the feet lIsing appropriate instruments (tendon hammer. tllning fork, small so ft bnlsh and common.pin respecti ve ly). Nephropathy was diagnosed by the estimation ortotal proteins in a 24 hourly-collected urina ry specimen taking 200mg/24 hours as the cut-ofT point. Renal function tests constituting rneasurements of serum urea and creatinine were also performed. Renal ultrasonography was performed, where appropriate. The results showed considerably high prevalence of retinopathy (51 %), nephropathy (56.5%) and neuropathy (68.5%) occurring singly or in combination of :Illy two or all1 he three complications Of 200 patients, only 35 patients were rree from any complication . Most or these uncomplicated patients had a shorter diAbetes dumlion (3 3±2. I vs 96±5.J ycrlT';j, lesser body mass index (24.3±3,3 vs 26.9:i3.9 kg/m 2 ) and younger age (371±7 4 vs ~ O (1±12.8 years). Each complication showed positive correlat ion with increas ing age, diabetes durat ion and body mass index. The differences between various groups o/' age, duration and body mass index were s tatist ically significant. Mean va lues for age, BMI and diabetes duration were found higher in patients, with retinop;lthy. nephropathy or neuropathy than those not haVing th em. Hypertens ion was found in 107 (53 ,5%) cases, and its relation with the occurrence of reti nopathy, nephropa thy and neuropathy was evident. Mean casual plasma glucose level on the dfly of adm iss ion was 331±lll . Family histo ries demonstrated that 46% patients were positive for diabetes. The results necess itate thallbe dHtbetic patients shou ld have awareness of tile problems associated with diabetes Moreover, there is a critical need for conducting programs for the primary and secondary prevention of not on ly the re lated compli cations but also the dl.'ieast!. llself