PERIPHERAL VASCULAR DISEASE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Objective: To determine the frequency of peripheral vascular disease in patients with type 2 diabetes mellitus. Patients and Methods: The present study was undertaken at tertiary care hospital Hyderabad. Total fifty patients with type 2 diabetes mellitus were studied which were admitted to medical wards and all these cases fulfilled our inclusion. while the data was collected on pre-designed proforma and analyzed in SPSS 16. The inclusion criteria of the study were diagnosed patients of type 2 diabetes mellitus of ≥35 years of age, either gender and ≥ 3 years duration of diabetes mellitus. The ankle brachial index (ABI) were measured for clinical evaluation of peripheral vascular disease and calculated by using non invasive colour Doppler study to measure ankle & brachial systolic blood pressure and ABI less than 0.9 was taken as a marker of peripheral vascular disease in present study. The frequency and percentages was calculated while the numerical statistics were used to compute mean ±SD. Results: Total fifty patients with type diabetes mellitus were recruited and enrolled during six months study period, majority of the patients were males 32 (64%) and from rural population 35 (75%). The mean ±SD for age and duration of disease for whole population was 54.83+7.82 and 7.93±3.52. The peripheral vascular disease was identified in 36 (72%) patients as had low ABI while the other risk factors observed were hypertension (69.4%), dyslipidemia (61.1%), smoking (66.6%), previous history of CVA (75%), history of ischemic heart disease (69.9%) and sedentary life style (55.5%) respectively. Conclusion: the ABI is reliable, cheap and non invasive procedure to detect PVD in Type–2 DM and can be used as initial screening test for early detection of peripheral vascular diseases. Keywords: Diabetes mellitus, peripheral vascular disease, ankle brachial index, Hemoglobin A1c, Hypertension, Dyslipidemia and Smoking

The impact of type 2 diabetes and Microalbuminuria on future cardiovascular events in patients with clinically manifest vascular disease from the Second Manifestations of ARTerial Disease (SMART) study

Aims Type 2 diabetes mellitus and microalbuminuria are important risk factors for cardiovascular disease (CVD). Whether these two complications are important and independent risk factors for future CVD events in a high-risk population with clinically manifest vascular disease is unknown. The objectives of this study were to examine the impact of Type 2 diabetes and microalbuminuria on future CVD events. Methods Patients with clinically manifest vascular disease (coronary, cerebral and peripheral vascular disease) from the Second Manifestation of Arterial disease study were followed up for 4 years. Data obtained from 1996–2006 were analysed. At baseline, there were 804 patients with Type 2 diabetes mellitus (mean age 60 years) and 2983 patients without. Incident CVD (n = 458) was defined as hospital-verified myocardial infarction, stroke, vascular death and the composite of these vascular events. Results Both Type 2 diabetes [hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.16, 1.75] and microalbuminuria (HR 1.86, 95% CI 1.49, 2.33) increased the risk of new cardiovascular events in univariate analyses. From multivariable models, presence of diabetes remained significantly and independently related to incident CVD (HR 1.42, 95% CI 1.11, 1.80). Presence of microalbuminuria also remained significantly independently related to incident CVD (HR 1.38, 95% CI 1.07, 1.77). In diabetes-stratified analyses, the effect of microalbuminuria on CVD risk was observed only in patients with diabetes. In microalbuminuria-stratified analyses, the significant and independent effect of diabetes on CVD risk was shown only in the non-microalbuminuric group. Conclusions In this high-risk population, both microalbuminuria and Type 2 diabetes are important and independent risk factors for future CV

A Study to Assess the Effectiveness of Buerger Allen Exercise on Lower Extremity Perfusion among Diabetes Mellitus patients admitted in Selected Hospital at Coimbatore

OBJECTIVES: 1. To assess the lower extremity perfusion among diabetes mellitus patient in experimental group and control group. 2. To evaluate the effectiveness of Buerger’s- Allen exercise inimproving the lower extremity perfusion among the experimental group. 3. To find out the association between interventional scores of Buerger’s- Allen exercise with selected demographic variables in experimental group and control group. An interventional study was conducted to evaluate the effect of buerger-allen exercise on lower extremity perfusion in patients with type II diabetes mellitus at risk of peripheral vascular disease. A Quasi experimental one group pretest-posttest group design was adopted. A purposive sample of 60 patients with type II diabetes mellitus patients at risk of peripheral vascular disease were selected for the study. The selected patients were assessed by Pain, Edema and Capillary Refill. The data was analyzed with descriptive and inferential statistical methods. The result revealed that there was a significant improvement in lower extremity perfusion after Buerger-Allen exercise. Hence, the study concluded that Buerger-Allen exercise was effective in improving the lower extremity perfusion in patients with type II diabetes mellitus at risk of peripheral vascular disease

Cross Sectional Study to Assess the Prevalence of Peripheral Vascular Disease and Peripheral Neuropathy in Type 2 Diabetic Patients of Rural Area of Tirunelveli

BACKGROUND: Diabetes Mellitus (DM) is one of the most prevalent non communicable diseases. According to Diabetes Foundation of India, 50.9 million people suffer from diabetes and the figure is likely to go up to 80 million by 2025 making India, the diabetes capital of the world. Early screening of Peripheral Vascular Disease and Peripheral Neuropathy with improving knowledge about foot care among diabetic patient with or without complication will reduce the prevalence of foot ulcers and henceforth the prevalence of lower extremity amputation. OBJECTIVES: 1. To estimate the prevalence of Peripheral Vascular Disease (PVD) and Peripheral Neuropathy (PN) in Type 2 Diabetic patients. 2. To assess the factors influencing occurrence of Peripheral Vascular Disease (PVD) and Peripheral Neuropathy (PN) in diabetes. MATERIALS AND METHODS: A community based cross sectional study was conducted among 150 type 2 diabetic patients in Tirunelveli district, from July 2017 to August 2018 using a pre tested semi structured questionnaire which had questions related to socio demographic details, factors influencing complication of Diabetes Mellitus, signs and symptoms of Peripheral Vascular Disease and Peripheral Neuropathy and clinical examination. Data were entered in MS Excel and analysed using SPSS version 16. RESULTS: The study revealed that prevalence of Peripheral neuropathy was 40.7% and peripheral vascular disease was 6% among the study population. There was a statistically significant association between age (p <0.0001), education (p <0.002), duration of diabetes (p <0.0001), smoking (p <0.032) and peripheral neuropathy. Hypertension (p- 0.013) had a statistically significant association with Peripheral vascular disease. CONCLUSION: The study revealed that prevalence of peripheral neuropathy was higher in patients who were suffering from diabetes for more than 10 years. Since diabetics with peripheral neuropathy are more prone to foot ulcers, Behaviour change communication activities must be ensured among diabetics regarding foot care

Macrovascular Complications and their risk factors in Type 2 Diabetic Patients in Hyderabad, Pakistan.

Introduction: Diabetes mellitus (DM), is the universally occurring non-communicable disease as well as exemplary health problem affecting peo-ple worldwide.1 The number of cases of DM are rising at an enormous pace irrespective of any age, gender, economic status or ethnicity around the globe.Objective: To evaluate the macro-vascular complications and its correlation with different risk factors among type-2 diabetic patients.Methodology: This cross-sectional study was conducted at Red Crescent General Hospital Latifabad Hyderabad from October 2018 to October 2020. Type 2 diabetics of either gender, between age 20 and 70 years, on diabetic medication visited during the study duration were included in the study. Data related to socio-demographic details and clinical features was collect-ed from the participants using a written questionnaire. Collected data was analyzed using SPSS ver. 22.Results: Significant association (p&lt;0.05) was demonstrated between Coro-nary artery diseases and the risk factors like; age of patient, the duration of diabetes mellitus, diastolic as well as systolic blood pressures, body mass index and serum triglycerides levels. While the statistically significant asso-ciation (p&lt;0.05) of peripheral vascular diseases with the duration of diabe-tes mellitus, systolic blood pressure and serum triglyceride levels. Whereas, cerebrovascular disease was associated (p&lt;0.05) with age, systolic and diastolic BP.Conclusion: The coronary artery disease seems to be most frequent macro-vascular complication among the type 2 diabetic patients. Whereas the risk factors including; advancing age, duration of diabetes mellitus, hyperten-sion, BMI as well as serum triglycerides levels are the most significant fac-tors for these complications.Key Words: Coronary artery disease, Cerebrovascular Disease, Diabetes Mellitus Type 2, Peripheral vascular diseas

Diabetic foot syndrome: Immune-inflammatory features as possible cardiovascular markers in diabetes

reported as vascular complications of diabetes mellitus associated with a high degree of morbidity and mortality. Diabetic foot syndrome (DFS), as defined by the World Health Organization, is an “ulceration of the foot (distally from the ankle and including the ankle) associated with neuropathy and different grades of ischemia and infection”. Pathogenic events able to cause diabetic foot ulcers are multifactorial. Among the commonest causes of this pathogenic pathway it’s possible to consider peripheral neuropathy, foot deformity, abnormal foot pressures, abnormal joint mobility, trauma, peripheral artery disease. Several studies reported how diabetic patients show a higher mortality rate compared to patients without diabetes and in particular these studies under filled how cardiovascular mortality and morbidity is 2-4 times higher among patients affected by type 2 diabetes mellitus. This higher degree of cardiovascular morbidity has been explained as due to the observed higher prevalence of major cardiovascular risk factor, of asymptomatic findings of cardiovascular diseases, and of prevalence and incidence of cardiovascular and cerebrovascular events in diabetic patients with foot complications. In diabetes a fundamental pathogenic pathway of most of vascular complications has been reported as linked to a complex interplay of inflammatory, metabolic and procoagulant variables. These pathogenetic aspects have a direct interplay with an insulin resistance, subsequent obesity, diabetes, hypertension, prothrombotic state and blood lipid disorder. Involvement of inflammatory markers such as IL-6 plasma levels and resistin in diabetic subjects as reported by Tuttolomondo et al confirmed the pathogenetic issue of the a “adipo-vascular” axis that may contribute to cardiovascular risk in patients with type 2 diabetes. This “adipo-vascular axis” in patients with type 2 diabetes has been reported as characterized by lower plasma levels of adiponectin and higher plasma levels of interleukin-6 thus linking foot ulcers pathogenesis to microvascular and inflammatory events. The purpose of this review is to highlight the immune inflammatory features of DFS and its possible role as a marker of cardiovascular risk in diabetes patients and to focus the management of major complications related to diabetes such as infections and peripheral arteriopathy

Current clinical status and vascular complications among patients with type 2 diabetes mellitus at tertiary hospitals in Malaysia

Objective: To assess the prevalence of diabetic vascular complications and cardiovascular risk factors control in type 2 diabetic patients at tertiary settings. Methods: This cross-sectional study was conducted among 313 patients diagnosed with type 2 diabetes mellitus (T2DM) at two tertiary referral hospitals in Malaysia. Data regarding socio-demographics, macro- and microvascular complications, family health history, blood pressure, anthropometric indices, glycaemic control, and lipid profile were obtained from medical records, face-to-face interview and physical examination. Results: The mean age of patients was 55.7±9.2 years, mean diabetes duration was 10.1±8.1 years, and 52.1% were females. Approximately 36.1% patients had cardiovascular disease (CVD). There were high prevalence of established coronary artery disease (30.7%), cerebrovascular disease (10.2%), and peripheral vascular disease (5.1%). Peripheral neuropathy, diabetic nephropathy and retinopathy were present in 41.5%, 17.6% and 15.0% patients respectively. Only 14.1% of the patients reached optimal HbA1c level and 21.1% patients achieved target fasting plasma glucose. The overall prevalence of dyslipidemia was 89.1%, hypertension was 80.2%, and obesity was 35.9% (BMI) and 86.5% (waist-to-hip ratio). Conclusions: Diabetic vascular complications were highly prevalent among the type 2 diabetic patients. Cardiovascular risk factors control was suboptimal. Both awareness and application of recommended guidelines need to be reinforced

Correlation of Ankle Brachial Index with Peripheral Vascular Disease in Type 2 Diabetes Mellitus

Objective: The aim of this study was to correlate ankle brachial index (ABI) with peripheral vascular disease (PVD) in type 2 diabetes mellitus. Material and methods: This was a hospital based interdisciplinary prospective study. A total of 100 patients in the age group of 30 to 80 years having peripheral vascular disease with predefined inclusion criteria were included in the study. Patients with other causes of raised blood sugar or peripheral vascular disease were excluded by relevant investigations. Ankle Brachial Index (ABI) was calculated using sphygmomanometer, and Colour Doppler Ultrasound (CDU) was used to diagnose PVD. Both the ABI method and the CDU method were compared for detecting PVD. Results: In our study, mean age was 60.04 ± 5.03 years, mean body mass index was 27.10 ± 2.67 kg/m2 and mean duration of diabetes was 7.75 ± 1.50 years. Among the 68 diagnosed cases of PVD on CDU, 70.6% cases were detected to have PVD by the ABI method (true positive) whereas 20 (29.4%) cases remained undiagnosed when ABI alone was used for the diagnosis (false negative). Conversely, among 51 diagnosed cases of PVD by ABI method 5.9% cases were found to be normal on CDU (false positive). The ABI method was found to have specificity of 88.5% but the sensitivity was only 70.6%. Conclusion: ABI has a very high specificity but the sensitivity is low compared to colour Doppler ultrasound. Therefore, if ABI is abnormal, the diagnosis of PVD is almost certain but in symptomatic cases with normal ABI; colour Doppler should be performed to exclude the PVD. Keywords: Ankle Brachial Index, peripheral vascular disease, Colour Doppler Ultrasound, type 2 diabetes mellitus. DOI: 10.7176/JMPB/57-02 Publication date: July 31st 201

Maggot Therapy for Treating Diabetic Foot Ulcers

Diabetes mellitus, Type 1 and Type 2, are associated with numerous debilitating consequences. One of the most common and serious complication is diabetic foot ulcers (DFU) (Baltzis, Elftheriadou, and Veves, 2014, p.817). DFUs are “caused by loss of glycemic control, peripheral neuropathy, peripheral vascular disease, and immunosuppression” and account for greater than 80,000 amputations per year in the United States (Aumiller & Dollahite, 2015, p.28). Approximately 15% of people with diabetes have diabetic foot ulcers (Aumiller & Dollahite, 2015, p.28) and studies demonstrate that 45% to 55% of patients presenting with neuropathic and ischemic diabetic foot ulcers will die within 5 years (Snyder, 2010, p.191)

Diabetes Mellitus Type 2: Evaluation of Microvascular and Macrovascular Complications

INTRODUCTION: Diabetes Mellitus comprises a group of common metabolic disorder that shares the phenotype of hyperglycemia. Several distinct type of DM exists and is caused by complex interaction of genetic, environmental factors and lifestyle choices. The two broad categories of DM are designated as Type 1 and Type 2 Diabetes. Type 1 Diabetes occurs due to auto-immune Beta cell destruction. Type 2 DM is a heterogeneous group of disorders characterized by variable degrees of insulin resistance, impaired insulin secretion and increased glucose production. The chronic complication of DM affects many organ systems and is responsible for the majority of morbidity and mortality associated with the disease. The vascular complication of DM are further subdivided into Micro-vascular (Retinopathy, neuropathy, nephropathy) and Macro-vascular (coronary artery disease, peripheral arterial disease and cerebro-vascular disease). The micro-vascular complications of both Type 1 and Type 2 DM result from chronic hyperglycemia. Since type 2 DM often has a long asymptomatic period of hyperglycemia, many individuals with Type 2 DM have complications at the time of diagnosis. The evidence implicating a causative role of chronic hyperglycemia in macrovascular complications is less conclusive. Moreover coronary heart disease events and mortality are two to four times greater in patients with Type 2 DM. Other factors like dyslipidaemia and Hypertension play an important role in macro vascular complications. AIM OF THE STUDY: 1. To evaluate the microvascular and macrovascular complications of Type 2 Diabetes Mellitus, attending the Diabetology Out-Patient Department at Government Stanley Hospital, Chennai. The Patients were categorised according to the duration of diabetes for the purpose of study into (a) Newly diagnosed DM. (b) DM of < 5 years. (c) DM for 5 – 10 years. (d) DM > 10 years. 2. To evaluate the Risk factors such as hypertension, obesity, hypercholesterolemia and smoking. METHODOLOGY: Selection of Cases: Patients with type 2 DM aged more than 35 years attending the Diabetology Out-Patient Department, Government Stanley Hospital were evaluated for (A) Risk factors - Hypertension, Obesity, Smoking & Hypercholesterolemia. (B) Microvascular Complications – Retinopathy, Nephropathy & Neuropathy. (C) Macrovascular Complications – CAD, Cerebrovascular Disease, Peripheral Vascular Disease. (D) For evaluation of complications they were categorised according to the duration of diabetes: 1. Newly Diagnosed, 2. DM < 5 Years, 3. DM 5 – 10 Years, 4. DM > 10 Years. A detailed history was recorded in respect of all the subject patients, particularly the duration of DM, Smoking, Complications, Family History of DM, etc. The following criteria was taken (1) Diagnosis of Diabetes, Fasting Plasma Glucose > 126mg%, 2 Hrs Plasma glucose > 200mg%. CONCLUSION: 1. In this study 53% of patients were males and 47% were females, all of them being above 35 years of age. The mean age of the Patients was 54 years. 2. The highest number of patients with diabetes was in the age group of 41 – 60 years. 3. 85% of Patients had duration of diabetes < 5 years. 4. Hypertension was found in 62% of patients. 5. Obesity was found in 57% of patients. 6. Smoking was found in 20% of patients. 7. Hypercholestrolemia was found in 74% of patients. 8. The highest risk factor was Hypercholestrolemia followed by Hypertension. 9. Retinopathy was found in 34% of the Patients. 10. Neuropathy was found in 20% of the Patients. 11. Nephropathy was found in 32% of the DM patients. 12. The most common Microvascular Complication was Retinopathy. 13. Newly diagnosed DM patients presented with Retinopathy in 34%, Neuropathy in 24% and Nephropathy in 24%. 14. Coronary artery disease was found in 36% of Patients. 15. Peripheral Vascular Disease was found in 6% of patients. 16. Cerebrovascular Disease was found in 10% of patients. 17. The most common Macrovascular Complication is coronary artery disease. 18. Significant number of patients with coronary artery disease presented by patients with < 5 Years duration of DM