Association of proteinuria with retinopathy, hypertension and ischaemic ECG changes in type 2 diabetes mellitus.
ABSTRACT: Objective: To study the association of proteinuria with retinopathy, hypertension, and ischaemic ECG changes in patients with type 2 diabetes mellitus. The secondary objective is to study the prevalence of hypertension, retinopathy, ischaemic ECG changes, lipid abnormalities, and obesity...
Saved in:
| Main Author: | |
|---|---|
| Format: | Unknown |
| Language: | English |
| Published: |
c2003.
|
| Subjects: | |
| Online Access: | Visit NHRC Library |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | ABSTRACT: Objective: To study the association of proteinuria with retinopathy, hypertension, and ischaemic ECG changes in patients with type 2 diabetes mellitus. The secondary objective is to study the prevalence of hypertension, retinopathy, ischaemic ECG changes, lipid abnormalities, and obesity in the same group of patients. Research design and methods:This is a cross-sectional study, carried out in Bir Hospital and Tribhuvan University Teaching Hospital (TUTH) during the year 2002 and 2003. A total of 101 consecutive patients with type 2 diabetes mellitus presented to medical outpatient departments for their routine check-up were enrolled in this study. All the 101 old and new cases of type 2 diabetes were screened which included a through history and physical examination as per the proforma. Height, weight, and waist and hip circumference were measured. Blood pressure was measured for two times and mean was calculated. Clinical hypertension was defined as systolic blood pressure 140 mm Hg and / or diastolic blood pressure (phase V) 90 mm Hg. Subjects already diagnosed to have hypertensive and/or on antihypertensive medication were also considered to be hypertensive regardless of their current blood pressure. The diabetic retinopathy was documented by means of direct and indirect opthalmoscopy after full mydriasis. Hypertensive retinopathy was also evaluated at the same sitting. Laboratory investigations included fasting and postpranial blood surgar, urea and creatinine, lipid profile and urine protein assessment by dipstick method in the early morning sample of urine. Resting 12-lead ECG was analyzed in all subjects. Chi-square test and multiple logistic regression models were used to calculate the statistic. Results:A total of 101 patients were enrolled, of which 50 were with and 51 were without overt proteinuria. There were 56 males and 45 females. The male female ratio was 1.24:1, Age of the patients in this study ranged from 40 to 87 years and mean age was 58.89 years. The prevalence of hypertension among patients with type 2 diabetes mellitus was found to be 55% (59% among males and females 51% among females). Sixty nine percent of patients with proteinuria in comparison to 42% of patients without urinary protein were hypertension (p <0.01). Among the hypertensive patients, 91% were on antihypertensive medication. Of those who were on drug treatment, only in one-third the blood pressure was adequately controlled when the cut-off value is 140/ 90. This number would have been even more if the currently recommended blood pressure goal of 130/ 80 were used as a measure of blood pressure control in patients with diabetes mellitus. Prevalence of diabetic retinopathy in this study was 65% in total. 76% in proteinuric group and d54% in nonproteinuric group (p=,0.02). Among total, non-proliferative retinopathy was seen in 74% and proliferative in 26%. Prevalence of diabetic retinopathy went on increasing with the duration of diabetes. In patients with disease duration of less than 5 years diabetic retinopathy was present in 40%, whereas it increased to 71% and 97% in patients with diabetes duration of 5 to 10 years and more than 10 years respectively (p<0.001). On the basis electrocardiographic changes. the prevalence of myocardial ischaemia/ infarction was 36% among the patients with type 3 diabetes. The prevalence among proteinuric patients was 43% and that among nonproteinuric patients was 28% (p value no significant). In this study, the maximum number of patients with positive urinary protein had >10 years disease duration of < 5 years. The duration of diabetes mellitus was significantly associated with diabetic retinopathy (p<0.001), hypertension (p<0.001), urine protein excretion (p<0.001). and ischaemic ECG changes (p<0.01). The present study showed that the prevalence of proteinuria was higher in smokers (29.7%) than in nonsmokers (20.8%), But there was no significant association between smoking and other variables like urine protein excretion, diabetic retinopathy, ischaemic ECG changes, and lipid profile. Ninety seven percent of the patients under the study were on treatment for diabetic mellitus. Among them 64% were on oral hypoglycaemic agent and 35% were on insulin. Among those who were on oral hypoglycaemic drugs, 43.5% were taking sulfonylurea alone, 42% were on combination of sulfonylurea and metformin, and 11% were taking metformin alone. According to WHO criteria grade I, grade II, and grade III overweight was present in 29% ,5% and 0% of cases respectively. According to recently recommended classification of obesity for Asinans, the prevalence of overweight (BMI 23.0 -24.9), obese (BMI 25.0 -29.9), and severely obese (BMI >- 30.0) individuals were 16%, 30% and 5% respectively. Overweight (BMI ->25.0) was significantly associated with elevated total and LDL, cholesterol (p <0.01 for both variables), and hypertension (p<0.05) but not with sex,,microvascular complications lik diabetic reinopathy and proteinuria, and other components of lipid profile. Though abnormalities of lipid profile were more common in diabetic patients with proteinuria than those without, it could not reach the level of significance. Conclusion and Recommendation:This study showed that proteinuria in patients with type 2 diabetes millitus is significantly associated with hypertension and retinopathy. Though not significant, the prevalence of ischaemic ECG changes was one and half times more common in patients having proteinuria were also closely related with abdominal obesity, smoking, and alterations in lipid profile. If newly, detected patients were found to have high blood pressure. Of these, more than 90% were on antihypertensive pills and about one-fourth of hypertension patients were using more than two drugs to control their blood pressure.Even among those who were on treatment, blood pressure was adequately controlled (< 140/90) only in one third of patients. The duration of diabetes mellitus was significantly associated with both microvascular (proteinuria and retinopathy) and macrovascular (ischaemic ECG changes and hypertension) complications. Though glycosylated haemoglobin was not tested in this study, the blood sugar was not under control (fasting plasma glucose <110 mg/dL and/ or 2-hour postprandial glucose <140 mg/ dL) in >90% of cases at the point of examination. Thirty-five percent of the patients were on insulin and among those who were on oral hypoglycaemic drugs, 52% were taking metformin alone or in combination with sulfonylurea. Since hypertension can accelerate the onset and progression of both small and large vessel disease in diabetes mellitus, earl identification by regular check-up and treatment is mandatory in all diabetic patients. Patients should be made aware that blood pressure control is equally, if not more important, than control of blood sugar. Early screening of proteinuria (microalbuminuria, if possible) in diabetes mellitus is a rational approach. Being a marker of generalized vascular damage, it can guide the physician to look for other vascular involvements and to institute treatment and preventive modalities. |
|---|---|
| Item Description: | Thesis Report. |
| Physical Description: | iv, 92p. : |