ABSTRACT
Introduction: Peripheral vascular disease (PVD) is one of the significant Macro vascular complications of type 2 diabetes mellitus. Peripheral vascular disease assumes importance, for prevention of morbidity and mortality related to diabetic foot. PVD is the single most important factor which raises the incidence of leg amputation risk in type 2 DM patients. While peripheral neuropathy alone leads to, trophic ulcer which has a chronic indolent course provided super added infection is prevented and controlled, the presence of PVD leads to the ischemic foot which leads to rapid spread of infection. The aim of the study: To investigate the prevalence of PVD among type 2 diabetes patients, to assess the risk factors associated with the development of pvd.to correlate the prevalence of cardiovascular risk factors and vascular complications of type 2 diabetes patients. Materials and Methods: Cross sectional observational analytical study was conducted. Patients were interviewed with a special note on elicitation of history regarding symptoms of PVD, in the form of intermittent claudication, Ischemic rest pain, history of foot ulcers in the past and present. Smoking was recorded in pack-years of cigarettes smoked. Duration of diabetes since diagnosis was recorded and they were grouped accordingly. The anthropometric measurements were recorded and the body- M. Arivumani. A study of the prevalence and risk factors associated with peripheral vascular disease in type 2 diabetes mellitus patients in Government Dharmapuri Medical College Hospital, Dharmapuri. IAIM, 2017; 4(9): 12-18. Page 13 mass index was calculated. Waist-hip ratio was also recorded. The blood pressure was recorded in both the upper limbs and both the lower legs using the standard B.P cuff. An comprehensive physical examination was done and findings recorded. Special importance was given to foot examination. Peripheral neuropathy assessment was done using Simmel-Weiss monofilament testing and timed vibration sense perception recordings. Symptoms of peripheral neuropathy were also noted. Results: The duration of diabetes ranged from newly detected to 28 years, with a mean duration of 8.2 years + 6.24 S.D. For patients affected with PVD, the duration of diabetes was found to be longer than others. The mean FPG for the PVD sub group is 173.6mg % + 34.9 SD, while for the other subjects the mean FPG is 151.8 mg % + 36.3 SD and the difference was statistically significant. (P = 0.006). Among the hypertensive diabetic subjects (n=57), 26.3% had peripheral vascular disease and the prevalence of PVD among normotensive diabetes subjects (n = 55) was 9.1% (P = 0.0329). Smokers among Hypertensive Diabetic males had 58.3% prevalence of PVD (ABI < 1) compared to 14.3% among non – smoking Hypertensive Diabetic males. Difference in the lipid parameters above was all statistically significant. This shows that individuals with a triad of increased LDL – cholesterol, lower HDL – cholesterol (Higher LDL / HDL ratio) and increased triglycerides were more at higher risk for peripheral vascular disease. Conclusion: As the duration of diabetes increased, the risk of PVD increased. There was relatively poor glycemic control in the PVD sub-set. Hypertension, when associated with Type2 Diabetes raised the risk of PVD nearly threefold. The duration of Hypertension also significantly correlated with the risk of PVD.
ABSTRACT
Introduction: Rising incidence of Diabetes mellitus, Systemic hypertension and Dyslipidemia, the well-known risk factor for cardiovascular disease is the leading cause for increased incidence of cardiovascular diseases1. Till today, body mass index and waist circumference are the two popular parameters used to assess the cardiovascular risk factors. Though Asian people are not overtly obese, they are still at an increased risk of cardiovascular disease and this may be due to presence of visceral obesity, but the cut off value for waist circumference. Aim of the Study: To assess the effectiveness of the newer anthropometric index, Waist/Height ratio in identifying cardiovascular risk factors. To compare the effectiveness of various anthropometric indices Body mass index, Waist Circumference and Waist/Height ratio in identifying Cardiovascular risk factors. Materials and Methods: 135 patients were included in our study. Careful history taking was first taken in these patients regarding pre-existing diabetes mellitus, systemic hypertension and dyslipidemia and about the treatment for these illnesses. In all these patients the following anthropometric measurements are done: Height, weight, waist Circumference were measured using standard methods. Results: In our study, 135 patients was selected randomly. The cut off values of anthropometric indices which was taken as abnormal were Body mass index > 25kg/m2 , Waist Circumference Males > 90 cm Females > 85 cm, Waist/Height ratio > 0.5. Conclusion: Waist/Height ratio with cut off > 0.5 was found to be an effective, newer and cheaper anthropometric index in identifying cardiovascular disease.