MICROVASCULAR AND MACROVASCULAR COMPLICATIONS IN DIABETIC NEPHROPATHY CASES IN LOK MANYA GROUP OF HOSPITALS

Abstract

INTRODUCTION: Diabetes is a global health problem which affects all age group including children, adolescents, and adults. According to the World Health Organization (WHO), worldwide approximately 180 million people currently have type 2 DM (T2DM) and more than 95% of people with diabetes have this form. Also the number of people with type 2 DM is estimated to double by 20. According to the first WHO Global report on diabetes shown that the number of adults living with diabetes has quadrupled since 1980 to 422 million adults. This dramatic rise is largely due to the rise in type 2 diabetes and major factors driving it include overweight and obesity. In 2012 diabetes caused 1.5 million deaths and its complications can lead to heart attack, stroke, blindness, kidney failure and lower limb amputation[i]. In India, there are about 69.2 million people living with diabetes and are expected to cross 123.5 million by 2040. Intensive glycemic control lowers the incidence and progression of microvascular complications, the morbidity associated with these complications is still increasing. Diabetic microvascular which involves small vessels, such as capillaries and macrovascular complications involving large vessels, such as arteries and veins have similar etiologic characteristics. Chronic hyperglycemia plays a major role in the initiation of diabetic vascular complications through metabolic and structural derangements. Diabetic nephropathy (DN) is a progressive complication of both type1 DM and type2 DM. The first manifestation of DN is microalbuminuria, which progresses to overt albuminuria.

RESULTS: Mean age of the patients with DN was 62.54 ± 12.47. Male were 36 (72%) and female were 14 (28%) included in the study. The mean duration of nephro­pathy was 7.2 ± 2.9 years. Family history of DN was shown in 5 (10%). In DN Complications retinopathy was seen in 22 (44%), Stroke in 4 (8%), coronary artery disease in 29(58%), angina in (26 (52%), hypertension in 44 (88%), diabetic foot in 3 (6%) end stage renal disease in13 (26%) and death in 3 (6%) during study period. The mean proteinuria in our DN patients (gm/24 hrs) was 2.01 ± 1.99 gm/L at baseline. Protein excretion < 0.5 was found in 16 (32%) patients, mean HbA1C was 9.2 ± 1.8 % (Range 5.4-15.9) at base line and 8.93 ± 2.08 % (6.5­12.5) at the last visit.

CONCLUSION: Frequent screenings in addition to tight glycaemic, lipid, and blood pressure control may be helpful. In our study are at a higher risk of having retinopathy, CAD, angina, hypertension was observed. These complications should be studied further in future. Continuous monitoring of Blood pressure, BMI, Hypertension, HbA1C should be screened on regular basis to prevent.

KEYWORDS: Dm, DN, Glycemic, CAD, BP, BMI and HbA1