Microvascular In DM

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Received First Prize at the ASCICON 2009 on competitive Platform Presentation.

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Microvascular In DM

  1. 1. A STUDY ON PREVALENCE OF MICROVASCULAR COMPLICATIONS IN PATIENTS WITH NEWLY DETECTED DIABETES MELLITUS<br />Dr. Tanoy Bose<br />Laskar B, Bora w rejaMd, Dutta a<br />Assam Medical College <br />Dibrugarh<br />
  2. 2. Introduction:<br />The Devastating Trio: <br />◙ Neuropathy ◙ Nephropathy ◙ Retinopathy<br />↑ Glucose + ↓ Insulin: The driving forces<br />Htn, Obesity, Dyslipidemia, Smoking: Accelerators<br />Despite good long-term glycemic and BP control, diabetes remains a major cause of blindness, renal failure and amputations, all of which result in significant health care expenditure.<br />
  3. 3. Objective:<br /> Determine the prevalence of microvascular complications in patients with newly diagnosed Diabetes Mellitus.<br />
  4. 4. Inclusion Criteria:<br />Age ≥ 12 years<br />Newly detected DM diagnosed within preceding 6 mnths attending the Diabetic clinic<br />Exclusion Criteria:<br /><ul><li>Pregnancy
  5. 5. Hepatic disorders, CKD, Acute infections, Trauma, Burns, AMI, Malignancy, Leprosy, Diphtheria, B1B6B12 deficiency
  6. 6. Conditions altering urinary albumin excretion e.g UTI, CHF, Drugs
  7. 7. Drugs altering OGTT e.g Steroids, Quinine, OCP, Salicylates etc.
  8. 8. Drugs causing Neuropathy, Nephropathy or Retinopathy.</li></li></ul><li>Methodology:<br />Diabetic clinic of Assam Medical College<br />One year study period (Aug ‘07 – July ‘08)<br />Serial Sampling ( Total 90 cases )<br />Diagnosis of DM by ADA 2006 criteria<br />Screened for microvascular complications with direct ophthalmoscopy, Urinalysis, Micral test, Bioaesthesiometry for vibration & Semmes-Weinstein monofilament (10g) for pressure.<br />
  9. 9. Summary of Results: [n=90]<br />95.56% cases = Type 2 DM<br />Mean age of detection of DM = 45.21y<br />MC complication: Distal Sym Sensory Per Neuropathy ( 56.66%) f/b Nephropathy (36.66%) & Retinopathy (20%)<br />MC isolated complication: Neuropathy (23.33%)<br />Prevalence of Triopathy : 15.55%<br />90.9% were asymptomatic for nephropathy as were 70.58% for neuropathy.<br />
  10. 10. Summary of Results continued:[n=90]<br />Aged ≥ 50 years<br />78.12% of neuropathy cases<br />50% of nephropathy cases<br />37.5 % of retinopathy cases<br />Comorbidities: [Out of 54 Htnsives ( 60%) ]<br />61.11% had neuropathy (vs 47.22% in normo)<br />38.88% had retinopathy (vs 11.11% in normo)<br />37.03% had nephropathy (vs 11.11% in normo)<br />Comorbidities: [BMI]<br />84.6% had neuropathy among cases with BMI≥25 vs 43.47% among those with BMI ≤24.9.<br />
  11. 11. Conclusions:<br />Prevalence of microvascular complications in newly detected DM is significantly alarming.<br />Distal symmetrical sensory neuropathy is the most prevalent complication both in combination as well as in isolation.<br />Increasing age, Hypertension and higher BMI contributes to the prevalence of microvascular complications significantly.<br />
  12. 12. Take home message:<br />Almost half of the battle is lost to the microvascular complications when Type 2 DM is diagnosed for the first time.<br />Early detection, risk stratification and addressing the co morbidities remain the mainstay of controlling diabetic microvasculopathy and related morbidities.<br />
  13. 13. Thank you<br />

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