PREVALENCE OF DIABETIC COMPLICATIONS AND OTHER COMORBIDITIES AMONG TYPE 2 DIABETES MELLITUS PATIENTS.

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1 WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES Simi et al. SJIF Impact Factor Volume 6, Issue 7, Research Article ISSN PREVALENCE OF DIABETIC COMPLICATIONS AND OTHER COMORBIDITIES AMONG TYPE 2 DIABETES MELLITUS PATIENTS. Simi Joju K.*, S. Thangamani and A. P. Radhakrishnan * 1 Post Graduate Student, Department of Pharmacy Practice, Grace College of Pharmacy, Palakkad, Kerala. 2 M.Pharm, Assistant Professor, Department of Pharmacy Practice, Grace College of Pharmacy, Palakkad, Kerala. 3 MBBS, MD, FID AIMS, Palakkad Diabetic Centre, Palakkad, Kerala. Article Received on 07 May 2017, Revised on 28 May 2017, Accepted on 19 June 2017 DOI: /wjpps *Corresponding Author Simi Joju K. Post Graduate Student, Department of Pharmacy Practice, Grace College of Pharmacy, Palakkad, Kerala. ABSTRACT Background: According to the ICMR INDIAB study, there are 62.4 million people living with diabetes in India. Type 2 diabetes (T2DM) is a progressive disease and hampers the quality of life of the patients due to micro and macrovascular complications. The aim of this study was to systematically identify and reporting the prevalence of diabetic vascular complications and risk factors affect on these complications among diabetic patients in Palakkad. Methods: A prospective study was conducted for study period of six months (December 2016 to May 2017) among 308 type 2 diabetes mellitus patients at Karuna Medical College and Hospital, Diabetic centre, Quality clinic-palakkad. All patients with type 2 diabetes mellitus, age range 29 to 89years, were screened for diabetic vascular complications. Results: The majority of patients 167 (54.2%) did not achieve target of HbA1c levels 7.0%. In this study most of the diabetic patients 56(18.18%) had macrovascular complications and out of those 37 (12.01%) had coronary heart disease, only 19 (6.16%) had cerebrovascular disease and 259 (84.09%) had microvascular complications. Conclusion: In conclusion, prevalence of diabetic complications was high. In this study we saw the prevalence of diabetic complications was higher in elder people, longer duration of diabetes associated obese patients. Vol 6, Issue 7,

2 KEYWORDS: T2DM-Type 2 diabetes mellitus, Prevalence, Diabetic complications, HbA1c-Glycated Haemoglobin. INTRODUCTION Type 2 diabetes mellitus (T2DM), like other chronic diseases, is considered to be a public health problem, not only in developed countries, but also in developing countries. It is estimated that by 2030, 366 million people in the world will have diabetes. [1] As of 2015, >415 million adults have diabetes mellitus, and this number is estimated to increase to 642 million by More than 95% of all adults with diabetes mellitus have T2DM. India is one of the epicentres of the global diabetes mellitus epidemic and has the second highest number of people with the disease in the world (~69 million individuals as of 2015). [2] The effects of diabetes mellitus involve complications in many organ systems in the body. [3] Individuals with diabetes are two to four times more likely to develop cardiovascular disease relative to the general population and have a two to five-fold greater risk of dying from these conditions. Diabetes is a significant cause of blindness in adults, nontraumatic lower limb amputations and end-stage renal disease resulting in transplantation and dialysis. [4] The asymptomatic phase of hyperglycemia accounts for the relatively high prevalence of complications at initial presentation. [5] Moreover, worldwide approximately 193 million diabetics remain undiagnosed predisposing them to the development of several long-term complications of untreated chronic hyperglycemia. Although intensive glycemic control lowers the incidence and progression of microvascular complications, the morbidity associated with these complications is still increasing. [6] Hyperglycemia, the primary clinical manifestation of diabetes, is strongly associated with development of the diabetic complications. Complications caused by hyperglycaemia involve damage to the small vessels such as in neuropathy, nephropathy, and retinopathy, and large blood vessels as in cardiovascular diseases. [7] The present study was to evaluate prevalence and focused on presence risk factor affecting on diabetic vascular complications among type 2 diabetic patients. MATERIALS AND METHODS A prospective study was conducted for study period of six months(december 2016 to May 2017) in order to determine the prevalence diabetic vascular complications and risk factors affect on these complications among type 2 diabetes mellitus in outpatient diabetic care hospitals at Palakkad. Vol 6, Issue 7,

3 Signed informed consent was obtained from all patients before starting the study. All patients with type 2 diabetes mellitus, age range 29 to 89years, were screened for diabetic vascular complications. The information obtained from the interview included the patient s identification data such as age, sex, alcohol-smoking history and family history. They were classified alcohol-smoking history to never, previous, current smoker or drinker. Glycaemic control based on measurement (poor glycaemic control if HbA1c >7%) and blood pressure (BP hypertension if systolic BP> 130 mm Hg or diastolic BP> 80 mm Hg. Diagnosis of retinopathy is based on finding the diagnostic signs of retinopathy on eye exams by fundoscopy at hospital. Patients were considered to have neuropathy if symptoms of pain anesthesia, paresthesia, muscular weakness, loss of tendon reflexes and impaired vibration sense. Patients were considered to have nephropathy if they have microalbuminuria or proteinuria. Coronary artery disease was diagnosed by documented angina symptoms and confirmed by performed an ECG, or from results of percutaneous transcoronary angiography (PTCA) in patients record. Cerebrovascular disease was defined by present of transient ischemic attack or stroke in past medical history. RESULT A total of 308 Type 2 diabetic patients were involved in this study. About 184 were males and 124 were females. The majority of patients 167 (54.2%) did not achieve target of HbA1c levels 7.0%. Positive family history of DM was 141(45.77%) patients while a total of 167(54.22%) patients had no known family history of diabetes. Type of vascular complications among type 2 dm patients Most of the patients, 203 (65.10%) had microvascular complications alone and 56 (18.18%) had combination of microvascular and macro vascular complications (Figure1). complications In this study most of the diabetic patients 252 (81.81%) had no macrovascular complications, 56(18.18%) had macrovascular complications and out of those 37 (12.01%) had coronary heart disease, only 19 (6.16%) had Cerebrovascular disease see (figure 2). Microvascular complications Out of 308 type 2 diabetic patients 259 (84.09%) had microvascular complications. (Table-1 and Table-2) showed type of microvascular complications. Vol 6, Issue 7,

4 complications Figure 1: Type of complications % 80.00% 60.00% 40.00% 20.00% 0.00% N (%) None CVA IHD Figure 2: Type of Macro vascular complication Table-1 Sociodemographic characteristics of Type-2 diabetic patients Variable Number of patients (%) Gender Male Female Age (years) 35 years >35-50 years >50-65 years >65 years Smoking history Current smoker Previous smoker Never smoked Alcohol history Current drinker Previous drinker Never drink Family history of diabetes Yes No 184(59.74) 124(40.25) 5(1.62) 41(13.31) 146(47.40) 116(37.66) 13(4.22) 55(17.85) 240(77.92) 29(9.41) 57(18.50) 222(72.07) 141(45.77) 167(54.22) Vol 6, Issue 7,

5 Table-2 Frequency and distribution of microvascular complications among Type2 DM patients. Type of Microvascular complications N (%) No Microvascular complications 49(15.9) Retinopathy 5(1.6) Neuropathy 7(2.27) Nephropathy 8(2.5) Retinopathy, Neuropathy 48(15.58) Retinopathy, Nephropathy 35(11.36) Neuropathy, Nephropathy 45(14.61) Retinopathy, Neuropathy and Nephropathy 111(36.03) Total 308(100) Table-3 Frequency of diabetic complications according to gender Complication Male n (%) Female n (%) None 37(20.10) 12(9.67) Microvascular 111(60.32) 92(74.19) Microvascular and 36(19.56) 20(16.12) Total Table-4 Frequency of diabetic complications according to age Complication Age <35 n (%) n (%) >50-65 n (%) >65 n (%) None 18(90) 20(36.36) 11(7.69) 0 Microvascular 2(10) 30(54.54) 95(66.43) 76(84.4) Microvascular and 0 5(9.09) 37(25.8) 14(15.5) Total Table-5 Frequency of diabetic complications according to body mass index (BMI) Complication BMI<23 kg/m 2 n (%) BMI 23 kg/m 2 n (%) None 0 49(23.90) Microvascular 82(79.6) 121(59.02) Microvascular and 21(20.3) 35(17.07) Total Table-6 Frequency of diabetic complications according to diabetic duration Complication <10 years n (%) 10 years n (%) None 37(28.90) 12(6.66) Microvascular 75(58.59) 128(71.11) Microvascular and 16(12.5) 40(22.22) Total Vol 6, Issue 7,

6 Table-7 Frequency of diabetic complications according to HbA1c control Complication Control n (%) Uncontrolled n (%) None 11(10.6) 38(18.5) Microvascular 73(70.8) 130(63.41) Microvascular and 19(18.4) 37(18.04) Total Table-8 Frequency of diabetic complications according to Hypertension DISCUSSION Complication Normotensive BP<130/80 n (%) Hypertensive BP 130/80 n (%) None 32(19.8) 17(11.5) Microvascular 100(62.11) 103(70.06) Microvascular and 29(18.01) 27(18.36) Total The frequency of microvascular diabetic complications is clearly correlated to the duration of diabetes, quality of metabolic control (HbA1c) and systolic blood pressure. [8] Only a few investigations have focused on the role of obesity in the development or progression of microvascular complications. Several studies considered that poor glycaemic control, disease duration, hypertension and dyslipidaemia are to be important risk factors for microvascular complications. [9] This study has shown a prevalence of macrovascular disease of 18.18% among diabetics and percentage of macrovascular disease lower than in study in UAE by Al-Maskari et al. [10] they found prevalence of macrovascular disease in 29.5% of diabetics. The differences in our rates of macrovascular complications among Type 2 DM patients as compared with others could be attributed to differences in study design, and population characteristics of various studies. Morgan et al. [11] found evidence to show that multiple complications occur in almost one fifth of diabetic patients. In addition, the incidence of individual and multiple complications increases with both age and duration of diabetes. The present study shows that the prevalence rate of retinopathy were 64.61% alone or in combination with other microvascular complications. The prevalence of retinopathy demonstrates wide variations between countries; in Type 2 DM it ranges from 17% in Switzerland to 52% in United Kingdom. [12] Vol 6, Issue 7,

7 The results of the present study showed that the overall prevalence of neuropathy was 68.50%, alone or in combination with the other complications. Percentage of neuropathy in this study is higher than in a study by Tres GS et al. [13] The results of this study also showed that the overall prevalence of nephropathy was 64.61%. It is considered a high percentage in comparison with other studies on diabetic nephropathy which occurs in 40% in diabetic patients [14] and ADA [15] reported that diabetic nephropathy occurs in 20-40% of patients with diabetes and is the single leading cause of end-stage renal disease (ESRD). Only % of patients had optimal controlled, but glycaemic control in the current study insignificant factor affect the development of diabetic complications. In this study, it did not find any relation between diabetic glycaemic control and the presence of macrovascular, similar as in these studies. [16] The major risk factors in this study were gender, age, BMI, duration of diabetes and hypertension. Therefore the rate of diabetic complications may reduce by weight loss and controlled of hypertension. CONCLUSION In conclusion, prevalence of diabetic complications was high. Identifying factors associated with the development of microvascular and macrovascular complications would to be able to prevent the complications. In this study we saw the prevalence of diabetic complications was higher in elder people, longer duration of diabetes associated obese patients. We recommend screening of high risk type 2 diabetes for diabetic complication and highlight importance of early diagnosis of diabetes and detection diabetic complications so that appropriate treatment initiated at the earliest. It need to focus on the treatment of hypertension and advised the diabetic patients to reduced weight to prevent or decreased the complications of diabetes. BIBLIOGRAPHY 1. Santos Ade L, Cecílio HP, Teston EF, de Arruda G1, Peternella FM, Marcon SS. Microvascular complications in type 2 diabetes and associated factors: a telephone survey of self-reported morbidity. Cien Saude Colet Mar; 20(3): Ranjit Unnikrishnan, Ranjit Mohan Anjana and Viswanathan Mohan. Diabetes mellitus and its complications in India. 12: June 2016: Vol 6, Issue 7,

8 3. Young E. E, 2Okafor C.N, 3Okwara C.C. Diabetes mellitus, associated co-morbidities and complications - A review. J. Med. Med. Sci: May 2016; 7(3): Tracey ML, Gilmartin M, O'Neill K, Fitzgerald AP, McHugh SM, Buckley CM, Canavan R, Kearney PM. Epidemiology of diabetes and complications among adults in the Republic of Ireland : a systematic review and meta-analysis. BMC Public Health Feb 9; 16: Deepa DV, Kiran B, Gadwalkar srikant R. and Microvascular in newly diagnosed type 2 Diabetes mellitus ijcp Vol. 25, No. 7, December Aastha Chawla, Rajeev Chawla, Shalini Jaggi. Microvasular and macrovascular complications in diabetes mellitus: Distinct or continuum? Ijem jun , IP: Khaled A. Ahmed 1,2, *, Sekaran Muniandy 1, and Ikram S. Ismail Type 2 Diabetes and Vascular complications: A pathophysiologic view.bio med research 2010; 21(2): Salwa Selim Ibrahim Abougalambou1*, Mohamed Azmi Hassali2, Syed Azhar Syed Sulaiman. Prevalence of Vascular Complications among Type 2 Diabetes Mellitus Outpatients at Teaching Hospital in Malaysia J DiabetesMetab 2011; 2: 1, / Stratton I, Kohner E, Aldington S,Turner RC, Holman RR, et.al UKPDS50:risk factors for incidence &progression of retinopathy in Type 2 diabetes over 6 years from diagnosis. Diabetologia 2001; 44: Al-Maskari F, EI-Sadig M Prevalence of diabetic retinopathy in United Arab Emirates: A crosssectional survey. BMC opthalmol 2007; 16: Morgan C, Currie C, Stott N, Smithers M, Butlert C et al. The prevalence of multiple diabetes-related complications. Diabetic Medicine 2000; 17: Amos A, Mccarty D, Zimmet P (1997) The rising global burden of diabetes and its complications: estimates and projections to the year Diabet Med, 14: S Tres GS, Lisboa HR, Syllos R,Canani LH,Gross JL,et al. Prevalence and characteristics of diabetic poly neuropathy in Passo Fundo,South of Brazil.Arq Bras Endocrinol Metabol 2007; 51: Parving H Benefits of and cost of anti-hypertensive treatment in incipient and overt diabetic nephropathy. Journal Hyperten, 1998; 16: Standards of medical care in diabetes. American Diabetes Association. Diabetes Care 2007; 30: S4-S41. Vol 6, Issue 7,

9 16. Park K (2002) Park s textbook of Preventive and Social Medicine. 17 th edition. Kirkman MS, McCarren M, Shah J, Duckworth W, Abraira C The association between metabolic control and prevalent macrovascular disease in Type-2 diabetes. J Diabetes Complications, 2006; 20: Vol 6, Issue 7,