Diabetes Mellitus Type 2: Evaluation of Microvascular and Macrovascular Complications

INTRODUCTION: Diabetes Mellitus comprises a group of common metabolic disorder that shares the phenotype of hyperglycemia. Several distinct type of DM exists and is caused by complex interaction of genetic, environmental factors and lifestyle choices. The two broad categories of DM are designated as Type 1 and Type 2 Diabetes. Type 1 Diabetes occurs due to auto-immune Beta cell destruction. Type 2 DM is a heterogeneous group of disorders characterized by variable degrees of insulin resistance, impaired insulin secretion and increased glucose production. The chronic complication of DM affects many organ systems and is responsible for the majority of morbidity and mortality associated with the disease. The vascular complication of DM are further subdivided into Micro-vascular (Retinopathy, neuropathy, nephropathy) and Macro-vascular (coronary artery disease, peripheral arterial disease and cerebro-vascular disease). The micro-vascular complications of both Type 1 and Type 2 DM result from chronic hyperglycemia. Since type 2 DM often has a long asymptomatic period of hyperglycemia, many individuals with Type 2 DM have complications at the time of diagnosis. The evidence implicating a causative role of chronic hyperglycemia in macrovascular complications is less conclusive. Moreover coronary heart disease events and mortality are two to four times greater in patients with Type 2 DM. Other factors like dyslipidaemia and Hypertension play an important role in macro vascular complications. AIM OF THE STUDY: 1. To evaluate the microvascular and macrovascular complications of Type 2 Diabetes Mellitus, attending the Diabetology Out-Patient Department at Government Stanley Hospital, Chennai. The Patients were categorised according to the duration of diabetes for the purpose of study into (a) Newly diagnosed DM. (b) DM of < 5 years. (c) DM for 5 – 10 years. (d) DM > 10 years. 2. To evaluate the Risk factors such as hypertension, obesity, hypercholesterolemia and smoking. METHODOLOGY: Selection of Cases: Patients with type 2 DM aged more than 35 years attending the Diabetology Out-Patient Department, Government Stanley Hospital were evaluated for (A) Risk factors - Hypertension, Obesity, Smoking & Hypercholesterolemia. (B) Microvascular Complications – Retinopathy, Nephropathy & Neuropathy. (C) Macrovascular Complications – CAD, Cerebrovascular Disease, Peripheral Vascular Disease. (D) For evaluation of complications they were categorised according to the duration of diabetes: 1. Newly Diagnosed, 2. DM < 5 Years, 3. DM 5 – 10 Years, 4. DM > 10 Years. A detailed history was recorded in respect of all the subject patients, particularly the duration of DM, Smoking, Complications, Family History of DM, etc. The following criteria was taken (1) Diagnosis of Diabetes, Fasting Plasma Glucose > 126mg%, 2 Hrs Plasma glucose > 200mg%. CONCLUSION: 1. In this study 53% of patients were males and 47% were females, all of them being above 35 years of age. The mean age of the Patients was 54 years. 2. The highest number of patients with diabetes was in the age group of 41 – 60 years. 3. 85% of Patients had duration of diabetes < 5 years. 4. Hypertension was found in 62% of patients. 5. Obesity was found in 57% of patients. 6. Smoking was found in 20% of patients. 7. Hypercholestrolemia was found in 74% of patients. 8. The highest risk factor was Hypercholestrolemia followed by Hypertension. 9. Retinopathy was found in 34% of the Patients. 10. Neuropathy was found in 20% of the Patients. 11. Nephropathy was found in 32% of the DM patients. 12. The most common Microvascular Complication was Retinopathy. 13. Newly diagnosed DM patients presented with Retinopathy in 34%, Neuropathy in 24% and Nephropathy in 24%. 14. Coronary artery disease was found in 36% of Patients. 15. Peripheral Vascular Disease was found in 6% of patients. 16. Cerebrovascular Disease was found in 10% of patients. 17. The most common Macrovascular Complication is coronary artery disease. 18. Significant number of patients with coronary artery disease presented by patients with < 5 Years duration of DM