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)
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.
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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
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