| Diabetes |
1. Evaluation of Effectiveness of Thiazolidinediones Derivatives in The Primary Management of Type-2 DM in A Teaching Hospital of Kolkata Maloy Acharyya, RL Karmakar, S Banerjee Background : Thiazolidinediones represent new class of oral anti hyperglycemic agents, which have the effects of enhancing, the certain metabolic actions of insulin. Rosiglitazone, Pioglitazone are the commonly available thiazolidinedione derivaties. Their primary mode of action is to promote glucose uptake in skeletal muscles, adipose tissue and liver. These actions are thought to be mediated via specific nuclear receptor – the peroxisome proliferators activated receptor-γ (PPAR-γ ); direct effects on intracellular glucose transporters have also been postulated. Peroxisome proliferator ’s receptors (PPAR) are members of the nuclear hormone receptor family of transcription factors, a diverse group of proteins that mediate ligand – dependent transcriptional activation and repression. Aims and Objectives : The management protocols for type 2 DM are rapidly changing in the last few years. Rosiglitazone and Pioglitazone are now being widely used both as monotherapy and co-therapy with other oral agents as well as insulin. Various studies have already been done in this regards and numerous studies are going on all over the World, to get better idea and potency. With this background the aims and objectives of present study. To evaluate the effectiveness of rosiglitazone and pioglitazone in the primary management of type 2 DM. Method : The study was undertaken in Nil Ratan Sircar Medical College and Hospital, Kolkata. One hundred patients were selected in the main study after proper exclusion. Only newly detected type -2 diabetes mellitus patients were selected. The patients were detected depending on blood glucose level recommended by American Clinical Practice recommendation, 2001. Pharmacrotherapy offered to all patients having fasting plasma glucose level more than 130 mg/dl, two hour post-prandial plasma glucose more 200 mg/dL, patients’ not attaining target plasma glucose levels with only non-pharmacological therapy following diagnosis. Result : After 6 month of therapy with Pioglitazone 15 mg and 30 mg the changes of glycosylated hemoglobin level was 7.024 ± 1.176 and 6.986 ± 0.817 respectively. The change of HbA1c level in both these group was 1.072 ± 0.214 and 0.845 ± 0.0169. Pioglitazone 15 mg and Pioglitazone 30 mg both reduces the HbA1c level which is statistically significant, although reduction of HbA1c level was more on Pioglitazone 30 mg/day therapy than Pioglitazone 15 mg/day therapy. The reduction of fasting blood glucose level in Pioglitazone 15 mg and Pioglitazone 30 mg groups were 22.833 ± 4.566 and 25.009 ± 5.001 respectively. After 8 months of therapy with Rosiglitazone HbA1c level changes to 7.004 ± 0.647% and 6.972 ± 0.793% respectively. The mean reduction of HbA1c level 0.779 ± 0.115% and 1.003 ± 0.200% respectively. The average fasting blood glucose of Rosiglitazone 1 mg and Rosiglitazone 2 mg group was 138.4 ± 4.743 mg/dl and 139.08 ± 6.027 mg/dl respectively. The reduction of fasting blood glucose after therapy was 22.698 ± 4.539 mg/dl and 26.930 ± 5.386 mg/dl respectively. The reduction of post-prandial blood glucose of Rosiglitazone 1 mg and Rosiglitazone 2 mg group was 52.501 ± 4.539 mg/dl and 49.484 ± 9.896 mg/dl respectively. Conclusion : In our present study demonstrates that, in patients with newly detected type 2 diabetes mellitus both Pioglitazone and Rosiglitazone are effective in decreasing HbA1c and FPG. Decreases in FPG began relatively quickly after receiving study medication, and by week 2, statistically significant decreases from base line both Pioglitazone 15 mg, 30 mg, and Rosiglitazone 1 mg, 2 mg groups. 2. Comparative Effects of Glipizide, Metformin and Rosiglitazone On CV Risk Factors in Type 2 DM SK Sharma, RK Gupta, HS Rehan, A Rohatgi, J Bhattacharjee,
M Agarwal Cardiovascular complications are responsible for up to 75% deaths among people who have type 2 diabetes. Despite several large studies, it remains unclear whether hypoglycaemic agents are effective method to reduce the incidence or progression of macrovascular diseases. This study investigated the effects of Glipzide. Metformin and Rosiglitazone on cardiovascular disease markers – lipid profile, Lp, V-CAM, Homocysteine, MDA (Malonyldialdehyde) and NO. Design – An open label, randomized parallel, comparative study was conducted in LHMC and SSKH Hospital. Patients with newly diagnosed Type 2 DM were divided into three treatment groups – Glipzide, Metformin and Rosiglitazones groups. Investigations for cardiovascular risk factors were done before starting treatment and at 12 weeks. Results : Rosiglitazone and Glipzide treatment resulted in weight gain whereas metformin resulted in weight loss. All groups displayed increase in HDL-C level with significant increase in rosiglitazone and Metformin group. Glipzide and Motorman decreased LDL-C levels significantly while an increase in level was observed in Rosiglitazone group. Total cholesterol levels increased in Rosiglitazone group but decreased in Glipzide and Metformin group. Only Metformin therapy significantly decreased triglyceride and VLDL levels. Lp (a) levels remain unchanged in all the three groups. Rosiglitazone significantly decreased V-CAM levels. Metformin significantly increased homocysteine levels. MDA levels decreased in Metformin and Rosiglitazone group and remained unchanged in Glipzide group. 3. Association of Thyroid Disorders and The Antibodies Profile in Patients with Type 2 Diabetes Mellitus A Varma, KJBS Gaur Aim of the Study : To study the association of thyroid disorders in Type 2 Diabetes in Uttarkhand. Methodology : The study was conducted at Himalayan Institute of Medical Sciences, Swami Rama Nagar, Dehradun and included patients suffering from Type II Diabetes mellitus who attend the out and in-patient department. Patients with Type 1, secondary diabetes and gestational diabetes were excluded from the study. These patients were also evaluated for the thyroid function tests (T3, T4 and TSH). The thyroid disorders were categorized as hyperthyroidism and hypothyroidism. Hypothyroidism was further sub-divided into clinical and subclinical hypothyroidism. Those patients with abnormal thyroid function test were subjected to serum anti-TPO and TSH-R antibodies. The association of the thyroid disorders in diabetics was analyzed and evaluated. Summary : 684 patients of Type 2 Diabetes Mellitus who attend the out patient and in patient department of Himalayan Institute of Medical Sciences were evaluated. 85 patients (12.4%) were found to be suffering from thyroid disorders. 71 (83.5%) were hypothyroid. {Clinical = 55 (77.4%); sub-clinical = 16 (22.6%)}. In clinical hypothyroid group, anti-TPO was positive in 17 (30.9%), anti- TSHR in 12 (21.8%) and both the antibodies were present in 28 (50.9%). In the sub clinical group, anti-TPO was present in 5 (31.2%), anti TSHR in 3 (18.7%) and both in 7 (43.7%). Amongst hyperthyroid patients (14; 16.4%), anti-TPO was present in 8 (57.1%), anti-TSHR in 4 (28.5%) and both the anti-bodies were present in 9 patients (64.2%). Conclusion : Association of thyroid antibodies may represent an autoimmune basis in type 2 diabetic patients and may have a bearing in the management of the disease. 4. Anti-Inflammatory Effect of Insulin in Patients of Coronary Artery Disease with Diabetes VA Kothiwale, MB Prabhu, VS Patil This study was aimed at evaluating the role of insulin in inflammation in patients with coronary artery disease (CAD), to explore the influence of admission sugars and duration of disease on inflammation in the presence of insulin and oral hypoglycemics (OHA). We studied 83 patients coming to the hospital with CAD with diabetes mellitus. Patients history was elicited at admission and they were divided into those on insulin and those on OHAs. Admission RBS and HsCRP values were determined and statistical analysis was done using appropriate statistical methods for correlation of admission RBS, duration of diabetes and type of therapy with HsCRP. Of the 83 patients 27 had unstable angina 17 stable angina and 39 had myocardial infarction, 39 patients were on insulin and 44 on OHA. HsCRP was consistently high in patients with higher RBS (p=.000). HsCRP was lower in patients on insulin when compared with OHA despite high RBS (p=.000). HsCRP was lower in patients on insulin irrespective of the duration of the disease (p=.000). Admission RBS has a direct correlation with the inflammatory burden in patients with CAD. Insulin exerts marked antiinflammatory effect on patients with CAD irrespective of the admission sugars or the duration of the disease. 5. Cardiovascular Profile in Type 2 Diabetes Mellitus Patients with Normal Resting ECG with Special Reference to Echocardiography and Treadmill Test JC Abraham, MK Jain, M Indurkar Aim : To evaluate the extent of cardiac dysfunction by echocardiographic assessment and TMT performance in Type 2 Diabetes Mellitus patients with normal resting ECG. Material and Methods : A total of 30 Type 2 Diabetic patients with normal resting ECG were included in the study. All subjects underwent detailed clinical evaluation, glycaemic, lipid, haematological and biochemical parameter evaluation. Results : There were 21 male (70%) and 9 female (30%) patients. Echocardiographic study revealed that out of the 30 patients 13 patients (43%) had diastolic dysfunction. The incidence of diastolic dysfunction in females was 44% (4 out of 9) and that in males was 42% (9 out of 21). Out of the 19 patients with ≤ 5 yrs of diabetic duration 5 patients (26%) while out of the 7 patients with 6-10 yrs of diabetic duration 5 patients (71%) and out of the 4 patients with > 10 yrs duration of diabetes 3 patients (75%) had diastolic dysfunction. Among the 19 patients without diabetic complications 6 patients (31%) had diastolic dysfunction while out of the 11 patients with diabetic complications 7 patients (63%) had diastolic dysfunction. Diastolic dysfunction was seen in 66% (2 out of 3) with nephropathy, in 75% (3 out of 4)with peripheral neuropathy and in 75% (6 out of 8) with retinopathy. LVH was seen in 8 patients (26%) and of them 4 patients (50%) had associated hypertension. EF was less than normal in 7 patients (23%-7 out of 30) while diastolic dysfunction was found in 13 patients (43% - 11 out of 30). Out of the 13 patients with diastolic dysfunction only 2 patients had reduced EF. TMT was done in all patients and was positive in only 2 patients (6%). Conclusion : Incidence of diastolic dysfunction increases as the duration of diabetes increases. Diastolic dysfunction was more in patients with diabetic complications. Incidence of diastolic dysfunction was more as compared to systolic dysfunction in asymptomatic diabetic patients. The TMT findings in the present study were not significant. 6. Correlation of Common Carotid Artery Intima Media Thickness (CCA-IMT) with Cardiovascular Complications in Type 2 Diabetes N Bhalla, G Mohan, M Chandey, M Arora Introduction : Diabetes mellitus is a panmetabolic disorder invariably associated with alteration in lipid metabolism, atherosclerosis and Ischaemic Heart Disease. IHD occurs three times more commonly in diabetics. How ever limited studies have been conducted to study the markers of atherosclerosis. CCA-IMT measured by high resolution B-Mode sonography is one of the marker for evaluating the progress of atherosclerosis. The study was undertaken to determine CCA-IMT in type 2 Diabetics and to asses its correlation with cardiovascular risk factors. Material and Methods : 50 patients of type – 2 DM between 40-70 years age were assessed for CCA-IMT using high resolution B. Mode ultrasonography with 50 age and sex matched controls. Diabetic patients were divided into 2 equal groups. Group 1 – Normotensive. Group 2 – hypertensive. Detailed history and clinical examination with special referene to duration of DM, waist hip ratio NYHA class symptoms of dyspnoea / chest pain was done. Relevant biochemical investigation included FBS/PPB. Sugar, lipidogram, glycosylated Hb, ECG/Chest X-ray for heart size. TMT was also done in all the cases. Results : The maximum CCA-IMT thickness of normal control group was 0.78 ± 0.04 mm while those of Gp 1 (normotensive diabetic) was 0.96 ± 0.14 mm and GII (hypertensive diabetics) was 1.10 ± 0.29 mm respectively.
Conclusion : CCA-IMT which is a marker of atherosclerosis was significantly higher in diabetics compared to non-diabetics. It is significantly increasing with age, WHR, duration of DM, HT and smoking. Diabetics with higher LDL levels and positive TMT had significantly higher CCA-IMT as compared to non diabetics. So the cardiac risk in type 2 DM can well be evaluated by measuring CCA-IMT. Hence CCA-IMT should be a regular tool of investigation in diabetic patients. Carotid Intimo Medical Thickness and Insulin Resistance Status Study in Diabetic and Non Diabetic Strokes D Misra, S Majumder, AC Roy, US Ghosh Background : Increased carotid intimo medial thickness (CIMT) ratios, marker of macrovasculopathy are associated with diabetic (DM) strokes and is related to insulin resistance (IR) status. Aims : To study the relation of CIMT in DM and non DM strokes and find its associations with incident lipid and IR status. Methods : Consecutive 17 cases of stroke with first time detection of DM were studied for the parameters of lipid profile, CIMT (left and right) and IR(HOMA) and were compared with an age (p=0.38), BMI (p=0.37) and sex (p=0.052) matched non DM strokes of 13 patients. The patients were also segregated according to sex and CT scan reports (hemorrhage or infarct) for further comparison. Results : The lipid parameters hardly varied between the two broad groups and most of the subgroups, the CIMT also varied little (p=0.052, 0.203). However, the IR status was significantly higher in DM (p=0.0147). IR was significantly higher in male DMs and DMs with infarcts but there was no difference for females (0.497) or hemorrhagic strokes (0.304). Conclusion : In a matched population of DM and non DM strokes, only CIMT measurement may not be always reflective of the vascular status. Probably, for stroke in females and hemorrhagic stroke in diabetics factors other than CIMT status and IR are more important. Whether South Indians Need Straingent Criteria for Screening of Diabetes than Advocated P Alagianambi, K Selvakumary, AG Kulasekarraj,
M Ramprasad, P Nazni Background :Though obesity is more prevalent in affluent
countries than India, Indians are more prone for diabetes which
ethnicity is blamed; more worrying is that Indians develop diabetes
at an earlier age and unpreceeded by metabolic syndrome (clinical
identification of metabolic syndrome needs any of the 3 of the Aim : Hence we analysed to define whether more stringent criteria are needed to detect Type 2 diabetes in South Indians. Material and Methods : From the rural district of Salem. (The
study was done at Sri Gokulam Hospitals, Salem, Tamil Nadu)
we screened 851 Type 2 diabetics or either sex between the age
group of 20-83 years, gender ratio M:F = 1:1.25. Irrespective of
their socio economic status had their anthropometric
measurements like height, weight and all had their blood glucose
fasting, postprandial, HbA1c and Lipid profile estimated. They
were classified as hypertensives when their blood pressure crosses
over 130/86 mmHg in two different occasions in lying posture.
BMI were calculated by the formula Weight in Kgs/height in m2 =
Kg/m2, BMI : < 18.5 – under weight, 18.5-24.9 – Ideal body
weight, 25-29.9 over weight, 30-34.9 – Obese Grade I; 35-39.9-
Grade II, > 40 Grade III (Morbid). WHO does not use waist
circumference as one of the criteria diagnosis of metabolic
syndrome, it depends only on the body mass. Lipid profile was
estimated for all of them with 10 hours over night fasting state by
enzymatic colorimeter method. (spectrophotometer). According
to ATP III guidelines, Total cholesterol < 200 mg/dl, Triglycerides < 150 mg/dl, LDL < 130 mg/dl, HDL > 40 mg/dl is considered
to be normal. LDL is calculated by the formula : (Friendwald’s
formula), Total cholesterol = (VLDL+HDL);
VLDL=Triglycerides/5. When it is crosses the value they are
considered to be dyslipidemic. Subjects were classified as diabetics
as per ADA guidelines (2004). Fasting plasma glucose > 126
mg/dl (8 hours over nigh fasting), 2 hours post prandial plasma
glucose > 200 mg/dl (after a glucose challenge i.e. 75 grams of Exclusion Criteria : Type 2 diabetics with hypo lipidemic drugs, Usasge of Oral contraceptive pills, Thyroid disorder, Nephrotic syndrome, Cirrhosis of liver, Gestational diabetes, Type I, Malnutrition Modulated Diabetes Mellitus and Latent Auto Immune Diabetes in Adutls were excluded from the study. Results : We analyzed 851 diabetic patients who showed mean fasting blood glucose of about 181 mg/dl and Glcosylated hemoglobin of about 10.2%, 499 (58.73%) had –ve family history, 255 (29.22%) had their onset of diabetes between 20-34 years of age. From the selected diabetics 357 (41.95%) patients had their BMI < 25 kg/m2, 228 (26.86%) were normotensives, dyslipidemia is not a feature in 488 (57.39%) of the selected diabetic subjects. Statistical analysis : After executing normal test for difference of the two ratios we find the differencies of the ratio to be statistically significant. Conclusion : The analysis emphasizes the fact that the Type 2 diabetics of south India have their onset at an very early age unpreceeded by metabolic syndrome; hence it implies more stringent criteria are needed for south Indian for screening of diabetes; such as screening should begin even at the age of the 25 years of age irrespective of BMI, family history and status of metabolic syndrome. Study of Role of Insulin Aspart (Subcutaneous Route) in Management of Diabetic Ketoacidosis in Comparison with Regular Insulin (Intravenous Route) Rajneesh*, A Mishra, CG Agarwal, RC Ahuja
*Junior Resident, Objective : To compare the role of Insulin Aspart SC. In comparison with Regular Insulin IV route. Method : 40 patient admitted to our Indoor Ward with Random Blood Sugar > 250 mg/dl and urinary sugar/ketone ++++/large and Arterial Blood Gas analysis and divided the patient in two groups. One group on Insulin Aspart (S.C.) and other group on regular Insulin (IV) and exclusion of patient of myocardial infarction, end Stage Renal Disease, Hepatic Failure and Pregnant Mother. Result : There were no statistical difference in mean duration of treatment of hyperglycemia or until resolution of ketoacidosis among patient treated with Insulin Aspart SC 1 hour/SC. 2 hours or with Intravenous Regular Insulin. There was no mortality and no difference in length of hospital stay and total amount of Insulin Administration until resolution of hyperglycemia and ketoacidosis. A Comparative Study of Etiological, Clinical Profile and Radiological Features of Bacterial Pneumonias in Type 2 Diabetics and Non diabetics Prabhakar, BC Chandra Mouli, M Bangera Study : 30 patients with pneumonia in diabetics and 30 patients with pneumonia in non diabetics each were studied. Pts with diabetes were significantly older. 83% of them had uncontrolled sugar levels. The common etiological organisms in non diabetics were streptococcus (40% vs 23%), staphylococcus (20% vs 6%) and in diabetics were klebsiella (16% vs 6%), acinectobacter (10% vs 0%), polymicrobials (20% vs 6%). In diabetics bilateral lobe involvement (26% vs 16%) and multiple lobe involvement (50% vs 33%) were common. ICU admissions (23% vs 13%) and mortality (23% vs 10%) were common in diabetics. Mortality was common in pts with polymicrobial etiology and multilobe involvement. Complications like lung abscess, empyema, septic shock, ARF, arrhythmias were common in diabetics. In contrast there was no significant difference in gender, concomitant comorbidities, clinical symptoms and signs in both groups except for short duration of symptoms in diabetics. Conclusions : In diabetic pts with pneumonia, diabetes is associated with polymicrobial etiology, multilobe involvement, poor prognosis, increased complications and mortality. So diabetes acts as independent risk factor in pneumonias. Clinical Profile of Mucormycosis in Type 2 Diabetes Mellitus from Rural Karnataka – Case Series Report K Prabakar, S Rao, A Raveesha, MK Bangera Study : A study was conducted to know the clinical profile of mucormycosis in type 2 diabetes mellitus in rural Karnataka (Kolar) who were admitted to RL Jalappa Hospital with varied complaints. A total of 7 cases of type 2 DM were admitted who were later diagnosed to have mucormycosis. 4 out of 7, were diagnosed as freshly detected DM who presented with DKA. All the 7 had mucor debris in nasal cavity diagnosed by nasal endoscopy, biopsy and microscopy. All of them had received medical (Amphotericin) as well as surgical (debridement) treatment. 2 out of 7 had developed multiple cranial nerve palsy (2nd, 3rd, 4th, 5th , 6th, 7th), 2 out of 7 died (one because of aspiration pneumonia due to involvement of 9th, 10th cranial nerve and another because of aspiration toxicity), 2 out of 7 didn’t come for follow up. Conclusion : Mucormycosis is a grave disease in diabetics which has to be diagnosed early with initiation of early treatment which carried prognosis. Mucormycosis has to be ruled out in all cases of uncontrolled type 2 diabetes mellitus. Prevalence of Depression in Type 2 Diabetes Mellitus and Its Association with Glycemic Control AR Bankar, PP Joshi Background : Diabetic patients have more depression which may lead to the loss of glycemic control due to glucocorticoid dysregulation and increased sympathetic activity. Objective : To assess the prevalence of depression in Type 2 diabetes patients and its association with glycemic control. Methodology : Study design : Cross-sectional. Setting : Diabetes
Clinic, GMCH, Nagpur. Type 2 Diabetes patients, compliant with
antidiabetic treatment were included. Patients with recent (< 6
weeks). Myocardial Infarct, Stroke, acute infections were excluded.
A structured validated depression scale-DSM-IV (also used in Results : Depression was found in 24 out of 102 patients
(24%) and was significantly associated with poor glycemic control
(p < 0.05). 31% patients had Diabetic retinopathy, 24% had
Peripheral neuropathy, 28% had Diaebtic nephropathy. These
microvascular complications had a significant correlation with
poor glycemic control (p < 0.05). 8% patients had cerebrovascular
disease, 22% had Peripheral vascular disease and Coronary artery Conclusion : Prevalence of depression in Type 2 Diabetics was high and was associated with poor glycemic control. Implications : Type 2 Diabetics with poor glycemic control should be assessed and treated for depression. Role of C-Peptide Assay in The Classification of Diabetes Mellitus Occurring in Patients ≤ 30 years Meenkashi V Sundaram, G Prakash, M Pazhanivel, P Senthilnathan, K Sathyamoorthy, R Anbalagan, V Dhandapani Department of Medicine, Govt., Mohan Kumaramangalam Medical College, Salem, Tamil Nadu. Background : C-peptide has been widely used as a test of beta cell function. We evaluated the role of C-Peptide assay in the classification of Diabetes Mellitus. Methods : The study population consisted of 50 diabetic patients below 30 yrs of age from our outpatient Diabetic Clinic. The details regarding the age of onset, duration, month of detection and family history were recorded. The serum samples for fasting blood sugar and c-peptide assay were analyzed. Results : Of the study group, 40 had Type 1 while 10 had Type 2 Diabetes Mellitus. The prevalence of Type 1 was similar in both sexes, while a female preponderance was noted in Type 2 patients. The mean age of onset was 19.3 yrs for Type 1 and 29.3 yrs for Type 2 Diabetes. 80% of Type 2 patients had a family history of Diabetes. The mean fasting C-peptide assay in Type 1 and Type 2 Diabetes was 0.61 ng and 1.73 ng respectively which had a statistical significance in the classification of Diabetes Mellitus (p = 0.001). Conclusion : C-peptide assay is thus a valuable tool in the classification of Diabetes in patients younger than 30 yrs. of age. An Epidemiological Study of Diabetes Mellitus in Urban Health Post Area, Dharavi ND Moulick, V Singh, Daksha Pandit, K Sanjaykumar,
Namita Padwal, Ashwini Dharavi, largest urban slum of Asia, is main drain area to LTMGH, Sion. Diabetes mellitus is one of main threat to human health, considered to be major in epidemic 21st century. India will become capital of diabetes. We have conducted a study comprosing of epidemiological characteristics of diabetes mellitus among individuals aged 20 years and above during March-December 2006. Objectives were to study prevalence of diabetes mellitus and its association with some socio-demographic characteristics. Study design was cross sectional study and 457 subjects were included residing in slum near LTMGH, LTMMC, Sion. Oral glucose tolerance test was performed on all subjects after 8 hrs of fasting and results were interpreted as subjects having diabetes mellitus impaired glucose tolerance (IGT) and normal glucose tolerance. Diabetes mellitus was found in 11.9% subjects and IGT in 13.7% subjects. Parameters studied such as Age, Sex, Education, type of work, family history of diabetes, alcohol intake, high body mass index, waist-hip ratio and hypertension were statistically significant; socio-economic class parameter was not statistically significant which was surprising. Conclusion of study was that large number of diabetes are hidden and impaired glucose tolerance are more than diabetes so life style modification programmes will be very helpful. Microalbuminuria, Retinopathy, Glycosylated Haemglobin Levels and Diabetic Nephropathy J Saurabh, P Sharma, BB Maheshwari, AK Gupta, A Gupta,
HK Bist, Himanshu Objective : The study was carried out to see the association of diabetic retinopathy in cases of diabetic microalbuminuria and overt nephropathy and correlation of diabetic nephropathy and retinopathy with glycosylated haemoglobin levels. Methods : The study included one hundred and twenty nine diabetic patients and cases were divided into 3 groups Group 1 diabetic patient with microalbuminuria (MAU) (29 pt) Group – 2 with overt protenuria (OP) (58 pt) Group 3 without potenuria (WP) (42 pt) cases were distributed according to duration of diabetes among the groups. (maximum number of patients in the study known to have diabetes mellitus from < 5 yrs with average duration of diabetes = 3.19 yrs and assessed the association of retinopathy with nephropathy and association of retinopathy and nephropathy with glycosylated Hb level). Result : It was found that prevalence of retinopathy in Group 1 (MAU) was 34.4% in group 2 (OP) was 12.4% is higher a compared to group 3 (25.5) the difference was statistically significant (p < 0.05) showing that diabetic retinopathy is associated with microalbuminuria and overt nephropathy. As duration increases prevalence diabetic retinopathy also increases. It was 8.9% in < 5 yr duration and 89.0% in 11-15 yrs and 100% in cases with > 15 yrs of diabetes. There were also statistically significant (p < 0.05). Patient having HbA1c 8% the retinopathy was present in 15.78% while with HbA1c > 10.0 the prevalence raises to 60% result were statistically significant (p < 0.05). In patient having HbA1c 8% the nephropathy was present in 10.5% while with HbA1c > 10.0 the prevalence raises to 86% the result were statistically significant (p < 0.05). |