Diabetes

Diabetes

1. INCIDENCE OF MACROVASCULAR COMPLICATIONS
IN NEWLY DIAGNOSED DIABETICS
Dr. Awadhesh Kumar sharma,SR
MEDICINE,MLB,MEDICALCOLLEGE
JHANSI

2. What is Diabetes?What is Diabetes?
Normally, blood sugar (glucose) levels are kept in the normal Normally, blood sugar (glucose) levels are kept in the normal
range by the release of insulin from the islet cells of the range by the release of insulin from the islet cells of the
pancreaspancreas
Insulin helps glucose enter the cells. Insulin helps glucose enter the cells.
Diabetes occurs when the body doesn’t produce enough Diabetes occurs when the body doesn’t produce enough
insulininsulin or the body can’t use it properly. This results in sugar or the body can’t use it properly. This results in sugar
(glucose) building up within the bloodstream(glucose) building up within the bloodstream
Diagnosed by blood test Diagnosed by blood test
Fasting glucose > 125mg/dl Fasting glucose > 125mg/dl
Random blood glucose > 200mg/dlRandom blood glucose > 200mg/dl

3. Pancreas
Cannot Produce Enough
Insulin
Body lacks insulin or is unable to Body lacks insulin or is unable to
use insulin effectivelyuse insulin effectively
DiabetesDiabetes
Muscle and
Fat Cells
Cannot Use Insulin
Effectively

4. Diagnosis CriteriaDiagnosis Criteria
One test is not enough!
The diagnosis must be done by a physician.
Normal Pre diabetesDiabetes
Fasting Blood Glucose Test
(FBG)*
Less than
100
Between
100 - 125
More than or
equal
to 126
Glucose Tolerance Test
(GTT) **
Less than
140
Equal to or more
than 140 but
less than 200
More than or
equal to 200
* FBG blood test is done after fasting 8 hours.
** GTT results are repeated after 2 hours. A person drinks a 75 mg glucose solution
before test. 100 mg for Pregnant women.

5. Epidemiology
Diabetes is an ‘iceberg” disease. According to recent
estimation the prevalence of diabetes mellitus in adult is
4% worldwide and it means that over 14.3 million
persons are affected.
At present the prevalence of DM is estimated to be
0.19% in people < 20 years old and 8.6% in people > 20
years. In individuals > 65 years old the prevalence of
DM estimated to be 20.1%. The prevalence is similar in
men and women through out most age ranges but its
slightly greater in men more than 60 years.

6. It is projected that disease prevalence will be 5.4% by
year 2025 with global diabetic population reaching 300
million. Of the close to 77% of global burden of disease
is projected to occur in developing countries.
The most recent study, National Urban Diabetes Survey
carried out in six cities found age standardized
prevalence rate of 12% for diabetes and 14% for IGT. At
present total no diabetic patient in India is about 33
million and may increase upto 80 million by 2030.

8. Risk Factors for the Development ofRisk Factors for the Development of
Type 2 DiabetesType 2 Diabetes
Family history of diabetesFamily history of diabetes
ObesityObesity
Especially centralEspecially central
HypertensionHypertension
High triglyceridesHigh triglycerides
Low HDL-CLow HDL-C
Elevated glucoseElevated glucose
Ethnicity other than Ethnicity other than
CaucasianCaucasian
Vascular diseaseVascular disease
History of gestational History of gestational
diabetesdiabetes
History of baby weighing > History of baby weighing >
9 lbs9 lbs
Sedentary lifestyleSedentary lifestyle

9. Complications of Diabetes
·Eye disease
oRetinopathy (non
proliferative /
proliferative)Macular
edema
·Nephropathy
·Neuropathy
oSensory and motor
(Mono or
polyneuropatyhy)
oAutonomic
neuropathy
The deadly triangle of
morbidity and mortality in
the diabetic population are
•Coronary artery disease
•Cerebrovascular disease
•Peripheral vascular disease
Coronary artery disease is
leading cause of mortality
followed by cerebrovascular
disease.
•Gastrointestinal (Gastro
paresis and diarrhea)
•Genitourinary (uropathy/
sexual dysfunction)
•Dermatologic
•Infectious
•Cataracts
•Glaucoma
Vascular Non-Vascular
Microvascular Macrovascular

10. Retinopathy: 25x
Complications of DiabetesComplications of Diabetes
End-Stage Kidney
Disease: 17x
Heart Disease: 2-4x
Foot/Leg
Amputations:
5x
Stroke: 2-6x

11. Macrovascular complication of diabetes
Diabetes mellitus is the most prevalent, chronic non
communicating disorder and risk of complication
increases with function of duration of
hyperglycemia. It involves various organs especially
kidney, heart, blood vessels, eye, brain. Clinical
manifestation of macrovascular disease is
atherosclerosis.

12. Insulin resistance diabetes mellitusInsulin resistance diabetes mellitus
HypertensionHypertension
ObesityObesity
HyperinsulinemiaHyperinsulinemia
DiabetesDiabetes
DyslipidemiaDyslipidemia
Small, dense LDLSmall, dense LDL
InflammationInflammation
HypercoagulabilityHypercoagulability
InsulinInsulin
ResistanceResistance
AtherosclerosisAtherosclerosis

14. Aims and objectives
To study the incidence of macrovascular
complications in DM in newly diagnosed
patient (diagnosed within 6 months)

15. Material & Methods
The study will include diabetes mellitus patients new
cases which is diagnosed within 6 months.
Sources of cases
•OPDs in MLB Medical College
•Patient admitted in wards
•Patients admitted in ICCU.
Criteria of selection
Any volunteer who fulfils the criteria of diagnosis of DM
new cases (diagnosed within 6 months) will be included
in study.

16. Method of study
Name
Age and sex
Residence
History
-H/o present illness
-Past history
-Personal history
-Family history
-H/O risk factors
Anthropometry
-Height
-Weight
-BMI
-Waist circumference

17. General examinations
-Pulse
i.Radial
ii.Dorsalis pedis
-BP
•Brachial BP
•Ankle BP
•Ankle brachial index
Systemic examinations
-Detailed CVS examination
-Detailed CNS examination
-Detailed peripheral vascular systemic examination

18. INVESTIGATION
General investigation
-Hemoglobin
-S. creatinine
-Micral test
-24 hr urinary protein
Lipid profile
-Total cholesterol
-HDL cholesterol
-LDL cholesterol
-VL/DL cholesterol
-HDL/LDL ratio

19. Specific investigations for macrovascular disorders
·ECG
oRoutine ECG
oWith long lead II & V1
oDouble speed ECG
oTread Mill Test (TMT)
·X-ray chest PAV
·Echo cardiography
·Duplex imaging of carotids
oCarotid intimal medial thickness
·NCCT

20. Distribution of cases according to sex
Male
87%
Female
13%

21. 0
20
40
60
80
100
120
140
160
180
No. of cases
20-29 30-39 40-49 50-59 60-69
Age group (in years)
Distribution of cases according to age

22. 0
30
60
90
120
150
No. of cases
40-49 50-59 60-69 70-79 80-89
Weight (in kg)
Distribution of cases according to weight

23. 0
30
60
90
120
150
No. of cases
130-139140-149150-159160-169170-179
Height (in cm)
Distribution of cases according to Height

24. Distribution of cases according to risk
factors (Hypertension)
27%
73%
HypertensiveNon Hypertensive

25. 0
20
40
60
80
100
No. of cases
Cholesterol LDL TriglycerideHDL
Types of dyslipidemia
Distribution of cases according to type
of dyslipidemia

26. Distribution of cases according to BM I
(Obesity)
12%
8%
5% 3%
72%
PreobeseClass I ObeseClass II ObeseClass III ObeseOthers

27. Distribution of cases according to risk
factors (Family H/o diabetes)
15%
85%
Family H/o DiabetesNo family H/o diabetes
Distribution of cases according to risk
factors (Smoking)
60%
40%
SmokerNon smoker

28. Distribution of cases according to risk factors
(Central obesity)
28%
13%
59%
Central Obesity (MaleCentral Obesity (Female)Others

29. Macrovascular complications at the time
of presentation (Cardiovascular)
8%
33%
59%
MIAnginaOthers

30. Macrovascular complications at the time of
presentation (Peripheral vascular disease)
3%
5%
92%
Diabetic gangreneClaudicationOthers
Macrovascular complications at the time
of presentation
44%
11%
9%
36%
Cardiovascular Cerebrovascular
Peripheral vascular Without complications

31. Diabetes control starts knowing patient’s A1c levels. Diabetes control starts knowing patient’s A1c levels.
Good diabetes control avoids or delays complications.Good diabetes control avoids or delays complications.
 A1c test every 3 months.A1c test every 3 months.
 A1c < 7% is the goalA1c < 7% is the goal
Diabetes ControlDiabetes Control

32. meal plan meal plan
(always eating (always eating
healthy)healthy)
exercise exercise
moderately (eg. moderately (eg.
walking 30 walking 30
minutes a day)minutes a day)
Diabetes Diabetes Self-managementSelf-management
what a person with diabetes should do by her/what a person with diabetes should do by her/
himself to maintain controlhimself to maintain control

33. DiabetesDiabetes Self-managementSelf-management
monitor glucose monitor glucose
levels frequentlylevels frequently
take medications take medications
properlyproperly
take care of eyes, take care of eyes,
feet, teeth and feet, teeth and
skin skin

34. Remember the values of good Remember the values of good
controlcontrol
A1c test < 7 %
Blood Pressure< 130/80
LDL cholesterol< 100
If a person with diabetes keeps these values
between medical check ups, means a good
diabetes control

35. Conclusion
The following conclusions can be drawn from the present study :-
•The average age of newly diagnosed type-2 diabetes mellitus
patients was 40-60 years.
•Incidence of cardiovascular disease in newly diagnosed type-2 DM
found to be 40%.
•Incidence of cerebrovascular complications were found to be 10%
in newly diagnosed type-2 DM.
•Incidence of peripheral vascular disease was found to be 8% in
newly diagnosed type-2 DM.
•Incidence of macrovascular complications were more in those
having risk factors like hypertension, dyslipidemia, obesity,
smoking and family history of diabetes.