Prevalence and risk factors for diabetic microvascular complications in newly diagnosed type II diabetes mellitus. Sankara Nethralaya Diabetic Retinopathy Epidemiology And Molecular Genetic Study (SN-DREAMS, report 27)

https://doi.org/10.1016/j.jdiacomp.2012.02.001Get rights and content

Abstract

Purpose

The aims of this study were to report the prevalence of various microvascular complications and to identify the various clinical and biochemical characteristics related to these complications in subjects with newly diagnosed type II diabetes.

Methods

Of the 5999 subjects enumerated, 1414 subjects with diabetes (both known and newly diagnosed) were analyzed for the study. Among the diabetic subjects, 248 (17.5%) were newly diagnosed with diabetes and the remaining had history of diabetes. All subjects underwent a detailed standard evaluation to detect diabetic retinopathy (fundus photography), neuropathy (vibration pressure threshold), and nephropathy (microalbuminuria).

Results

The prevalence of any form of microvascular complication was 30.2% (95% confidence interval [CI] = 24.5–35.9). The prevalence of diabetic retinopathy was 4.8%, and that of diabetic nephropathy and neuropathy was 10.5%. The risk factors for developing any form of microvascular complication were increasing age (odds ratio [OR] = 1.07, 95% CI = 1.04–1.11, P < .0001), increasing systolic blood pressure (OR = 1.03, 95% CI = 1.01–1.06, P = .001), and increasing hemoglobin (OR = 1.39, 95% CI = 1.09–1.79, P = .011). The risk factors for diabetic retinopathy and diabetic nephropathy were increasing systolic blood pressure (OR = 1.06 [P = .001] for retinopathy and OR = 1.04 [P = .012] for nephropathy) and increasing hemoglobin (OR = 2.20 [P = .007] for retinopathy and OR = 1.57 [P = .023] for nephropathy). The risk factor for diabetic neuropathy was increasing age (OR = 1.12, P < .0001).

Conclusions

Nearly one third of the newly diagnosed type II diabetes subjects had some form of microvascular complication; nephropathy, and neuropathy being commoner than retinopathy.

Introduction

The prevalence of type II diabetes mellitus, particularly in urban India, is increasing; we observed it to be around 28% in subjects older than 40 years (Raman et al., 2009). Type II diabetes has a significant association with comorbidities, already present at the time of diagnosis (American Diabetes Association, 2011, Di Pietro et al., 2007, Son et al., 2011). It is recommended that all patients, once diagnosed with type II diabetes, undergo a complete evaluation including a dilated fundus examination (American Diabetes Association, 2011, UK Prospective Diabetes Study Group, 1998). In the United Kingdom Proliferative Diabetic Retinopathy Study (UKPDS), around half of the subjects showed the presence of microvascular complications, at diagnosis (Harris et al., 1992, UK Prospective Diabetes Study Group, 1998). The prevalence of microvascular complications, in patients with newly diagnosed diabetes, has been reported in various populations varying from 5% to 35% (Al-Zuabi et al., 2005, Bała et al., 2009, de Fine Olivarius et al., 2001, Di Pietro et al., 2007, Harzallah et al., 2006, Kohner et al., 1998, Nguyen et al., 1996, Owens et al., 1988, Rema et al., 2000, Tălu et al., 2002, Tapp et al., 2003, Tzeng et al., 2001, Van Leiden et al., 2002, Wahab et al., 2008). Such high prevalence may suggest the presence of a delay between the onset of diabetes and the time of its diagnosis. The same can also occur secondary to the presence of additional risk factors in such patients. The risk factors associated with the presence of microvascular complications, at the time of diagnosing diabetes, have been identified in few studies (Kohner et al., 1998, Nguyen et al., 1996, Owens et al., 1988, Van Leiden et al., 2002). However, data are limited regarding population-based assessment of prevalence of various microvascular complications in the Indian population, particularly in those with newly diagnosed type II diabetes. The present study aims to report the prevalence rates of various microvascular complications of type II diabetes in isolation and in combination and identify various clinical and biochemical characteristics related to these complications.

Section snippets

Materials and methods

The study population was recruited from the SN-DREAMS 1 study, which was a population-based cross sectional study. The methodology has been described elsewhere (Agarwal et al., 2005). The study was approved by the institutional review board, and a written informed consent was obtained from the subjects as per the Helsinki Declaration (Touitou, Portaluppi, Smolensky, & Rensing, 2004).

The study population was selected by multistage systematic random sampling. The sampling was stratified based on

Results

Table 1 shows the prevalence of microvascular complications among subjects with newly diagnosed type II diabetes mellitus. The prevalence of any form of microvascular complication was 30.2% (95% CI = 24.5–35.9). The prevalence of individual microvascular complication was as follows: DR 4.8% (95% CI = 2.2–7.5), diabetic nephropathy 10.5% (95% CI = 6.7–14.3), and neuropathy 10.5% (95% CI = 6.7–14.3). The prevalence of combination of any two microvascular complications was found to be 4.4% (95% CI = 

Discussion

We found a high prevalence of diabetic microvascular complications among subjects with newly diagnosed type II diabetes. Nearly one third of the subjects had some form of microvascular complication when they were diagnosed with diabetes. Table 5 shows the prevalence of microvascular complications in various populations. Similar to our study, the prevalence of diabetic nephropathy and neuropathy was higher than that of retinopathy in most of the studies. The variation in the prevalence, among

References (53)

  • S.R. Shorb

    Anemia and diabetic retinopathy

    American Journal of Ophthalmology

    (1985)
  • J.W. Son et al.

    Diabetic retinopathy is associated with subclinical atherosclerosis in newly diagnosed type 2 diabetes mellitus

    Diabetes Research and Clinical Practice

    (2011)
  • W.Q. Wang et al.

    Changing prevalence of retinopathy in newly diagnosed non-insulin dependent diabetes mellitus patients in Hong Kong

    Diabetes Research and Clinical Practice

    (1998)
  • [No authors listed]

    Diabetic neuropathy

    Lancet

    (1989)
  • S. Agarwal et al.

    Sankara Nethralaya-Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN-DREAMS 1): study design and research methodology

    Ophthalmic Epidemiology

    (2005)
  • F. Al-Mahroos et al.

    Diabetic neuropathy, foot ulceration, peripheral vascular disease and potential risk factors among patients with diabetes in Bahrain: a nationwide primary care diabetes clinic-based study

    Annals of Saudi Medicine

    (2007)
  • H. Al-Zuabi et al.

    Retinopathy in newly diagnosed type 2 diabetes mellitus

    Medical Principles and Practice

    (2005)
  • American Diabetes Association

    Standards of medical care in diabetes–2011

    Diabetes Care

    (2011)
  • M.M. Bała et al.

    Characteristics of patients with type 2 diabetes of short duration in Poland: Rationale, design and preliminary results of the ARETAEUS1 study

    Polskie Archiwum Medycyny Wewnętrznej

    (2009)
  • A.P. Barbosa et al.

    Prevalence and risk factors of clinical diabetic polyneuropathy in a Portuguese primary health care population

    Diabetes & Metabolism

    (2001)
  • J. Belmin et al.

    Diabetic neuropathy in elderly patients. What can be done?

    Drugs & Aging

    (1996)
  • B.N. Conway et al.

    Prediction of proliferative diabetic retinopathy with hemoglobin level

    Archives of Ophthalmology

    (2009)
  • M.D. Davis et al.

    Risk factors for high-risk proliferative diabetic retinopathy and severe visual loss: Early Treatment Diabetic Retinopathy Study Report #18

    Investigative Ophthalmology and Visual Science

    (1998)
  • N. de Fine Olivarius et al.

    Diabetic retinopathy in newly diagnosed middle-aged and elderly diabetic patients: prevalence and interrelationship with microalbuminuria and triglycerides

    Graefes Archives of Clinical and Experimental Ophthalmology

    (2001)
  • N. de Fine Olivarius et al.

    Prevalence and progression of visual impairment in patients newly diagnosed with clinical type 2 diabetes: a 6-year follow up study

    BMC Public Health

    (2011)
  • D.E. Goldstein et al.

    Tests of glycemia in diabetes

    Diabetes Care

    (2003)
  • Cited by (75)

    View all citing articles on Scopus
    View full text