| Summary, etc. |
ABSTRACT: The prevalence of diabetes is increasing throughout the world and heart disease accounts for 75% of all deaths among the people of European origin with diabetes2. Diabetes is a heterogenous metabolic disorder, and it is unlikely that control of hyperglycemia alone will eliminate the excess ofcardiac disease found in diabetic patients. Measures to control hyperglycemia, hypertension, and hyperlipidemia are important in the management of type 2 diabetes and prevention of tits long-term complications. Numerous studies in patients with type 2 diabetes have shown the benefits of aggressive treatment of blood pressure and lipids. because of the growing number of diabetic patients. Because of lack of study regarding coronary risk factors early aggressively in our type 2 diabetic patients, this study has been carried out with a hope to identify the risk factors and treat them early and aggressively. Objectives: • To study prevalence of coronary risk factors in type 2 diabetes mellitus. • To compare coronary risk factors in different age groups. • To compare coronary risk factors in male and female sex. • To correlate coronary risk factors among each other. • To evaluate various ECG abnormalities. Design: Cross-sectional study of fifty consecutive patients of type 2 diabetes mellitus from July 1999 to March 2001. Setting: Bir Hospital and Tribhuvan University Teaching Hospital. Method: This study included 50 consecutive type 2 diabetic patients (26 males and 24 females) attending Bir Hospital and Tribhuvan University Teaching Hospital for their routine checkup in the Outpatient Department. Type 2 diabetes mellitus patients without ketosis, congestive heart failure, myocardial infarction, pregnancy and any other serious medical illness were included. Patients were either already diagnosed by a physician or included in the study if they had fasting glucose concentration above 7 mmol/1 (>-126mg/dl) or 2hr glucose tolerance concentrations greater than 11.1 mmol/1 (>-200mg/dI ) after a 75g oral glucose tolerance test. Coronary risk factors comprising of age, gender, duration for diabetes, current smoking habit, sedentary physical activity, past and /or present hypertension, generalized and abdominal obesity, serum total cholesterol, LDL cholesterol, HDL cholesterol, Triglycerides, Ischemic electrocardiographic (ECG) abnormalities and gross Albuminuria have been ascertained. Data were tabulated and entered in Excel programme of computer. Analysis of the data was done with the help of SPSS and EPI-info 6, developed by WHO. Descriptive statistics of the variables was carried out. The groups have been compared. Statistical tools used for comparison were correlation coefficient, X2 tests with Fischer exact test and students t-test. Results: The mean age of the patients was 60.74 year and mean duration of diabetes was 6.86 year. 72% of cases were hypertensive; out of which 64% of the patients had previous history of hypertension. Among the patients with previous history of hypertension 65.62% of patients were taking antihypertensive drugs. ACE inhibitor, enalapril was the commonly prescribed drug in the treatment group. The blood pressure goal of <130/85 mmHg was achieved by only 9.52% of patients who were taking antihypertensive medication. 8% of patients were newly detected hypertensives during this study period. More female were hypertensive than male (75% vs. 69.23%). Abdominal obesity was found in 54%, more so in female compared to male (66.67% vs. 42.30%). Generalized obesity was more common in female than male (33.33% vs. 19.23%). High total cholesterol was found in 40% of the patients, this was the commonest lipid abnormality present in males. High LDL cholesterol was found in 30% of cases and was next common lipid abnormality of males. Hypertriglyceridemia was found in 30% of the patients, this was the commonest lipid abnormality present in females. 42.30% of our diabetic males were found to be currently somking cigarettes. 79.17% of our diabetic female had sedentary life style . 16% of the diabetic patients had ischemic ECG abnormalities. Hypertension in the patients was almost significantly related with the various rang of ECG changes (p=0.07827). Range of ECG changes were dependent upon average age of the patient (P=0.01282) but not with the duration of diabetes (p=0.33418). Correlation of systolic and diastolic blood pressure with total cholesterol, HDL cholesterol, triglycerides, LDL cholesterol, WHR, BMI and duration of hypertension was not significant. The systolic blood pressure, diastolic blood pressure and mean duration of diabetes was not significantly correlated with different stages of albuminuria. Conclusion: Although our type 2 diabetic patients share similar coronary risk factors as compared to diabetic patients form other different countries, our type 2 diabetic patients have got high prevalence of hypertension. This study also showed that large populations of our diabetic patient have inadequately controlled blood pressure. Male diabetics have got high prevalence of smoking habits. Our male and female type 2 diabetic patients also differ in coronary risk factors. |
