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(15) CORELATION OF RETINAL CHANGES AND CAROTID INTIMAL THICKNESS IN TYPE 2 DIABETES MELLITUS


Authors:

Shrikant Sharma, MD – Associate Professor Internal medicine, SMS Medical College Jaipur Rajasthan India

Prakash Keswani, DNB ( endocrinologist) – Senior professor, Sms medical college

Puneet Shah, Sr. – Senior Resident, SMS Hospital Jaipur

Shrikant Sharma, MD – Associate Professor Internal medicine, SMS Medical College Jaipur Rajasthan India

Abstract:

Objective :

Diabetes mellitus(DM) complications include microvascular manifestation such as retinopathy and macrovascular affection like coronary artery disease. DM with retinopathy may have unidentified macrovascular disease. Common pathophysiologic mechanism like advance glycation end products, oxidative stress, low grade inflammation and neovascularization of vasa vasorum are proposed for both micro and macroangiopathy. Carotid intimal medial thickness (CIMT) is a sensitive marker of early carotid atherosclerosis whereas DR is an early and reliable marker of microvascular disease. We have endeavored to correlate severity of DR with CIMT in type 2 diabetic patients. Correlation of dyslipidemia to DR in diabetic patients was also studied

Methods :

Consecutive 25 diabetic patients of proliferative diabetic retinopathy (PDR) (Gr A1), non-proliferative diabetic retinopathy (NPDR) (Gr A2) and without DR (Gr A3) were taken in 3 groups taking treatment in department of medicine and 25 healthy controls (Gr B) were included in the study. Thus, total 75 diabetic and 25 healthy controls were included in the study. All were subjected for fundus photography. Diabetic patients were subjected for fluorescein angiography also. Carotid intima media thickness was measured in all.. Fasting blood sugar, HbA1c, lipid profile and other routine investigations were also done

Results :

CIMT was significantly greater in patients with PDR compared  with NPDR.Mean CIMT of group A1,A2 and A3 was compared with control group B individually i.e. group A1 vs B, group A2 vs B, group A3 vs B ; all three P values were found significant (<0.001).CIMT also showed positive correlation with diabetes duration, fasting blood sugar, HbA1c, total cholesterol, triglycerides, LDL in PDR and NPDR patients while HDL is inversely correlated to it. Multiple regression analysis revealed that the determinants of CIMT in the studied group were duration of diabetes, TGs and DR all with (P<0.001)

Discussion : Diabetes exposes the vasculature to the onslaught of several factors, mainly hyperglycemia, hypertension, dyslipidemia, hemostatic changes and inflammation. Epidemiologic studies reveals an increase in 0.1 mm in maximum CIMT is associated with an 11% increase in the risk of myocardial infarction. By comparing various groups the mean CIMT in group A1 was 0.89 + 0.06 mm; in group A2 was 0.77 + 0.06 mm ; in group A3 was 0.68 + 0.01 mm and group B was 0.53 + 0.03 mm  with mean CIMT significant P value

Conclusion :

Patients with severe diabetic retinopathy were having associated increased CIMT.Retinopathy,a multifactorial microvascular complication, which, apart from hyperglycemia, is associated with dyslipidemia and duration of diabetes

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