Morbidity Profile and Causes of Mortality in Type 2 Diabetes Patients: Data from a Tertiary Teaching Hospital from Eastern India — Oak Academic Publishing
Research ArticleOpen AccessGoogle Scholar indexed
Morbidity Profile and Causes of Mortality in Type 2 Diabetes Patients: Data from a Tertiary Teaching Hospital from Eastern India
Department of Medicine, VSS Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha, India
,
PG Department of Medicine, Faculty of Medicine, Sriram Chandra Bhanja Medical College, Cuttack, Odisha, India
,
PG Department of Medicine, Faculty of Medicine, Sriram Chandra Bhanja Medical College, Cuttack, Odisha, India
,
PG Department of Medicine, Sriram Chandra Bhanja Medical College, Cuttack, Odisha, India
,
PG Department of Medicine, Faculty of Medicine, Sriram Chandra Bhanja Medical College, Cuttack, Odisha, India
,
PG Department of Medicine, Faculty of Medicine, Sriram Chandra Bhanja Medical College, Cuttack, Odisha, India
1 Department of Medicine, VSS Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha, India
2 PG Department of Medicine, Faculty of Medicine, Sriram Chandra Bhanja Medical College, Cuttack, Odisha, India
3 PG Department of Medicine, Faculty of Medicine, Sriram Chandra Bhanja Medical College, Cuttack, Odisha, India
4 PG Department of Medicine, Sriram Chandra Bhanja Medical College, Cuttack, Odisha, India
5 PG Department of Medicine, Faculty of Medicine, Sriram Chandra Bhanja Medical College, Cuttack, Odisha, India
6 PG Department of Medicine, Faculty of Medicine, Sriram Chandra Bhanja Medical College, Cuttack, Odisha, India
Background: Data regarding the prevalence of morbidity and mortality in patients of Type 2 Diabetes Mellitus (T2DM) is scanty in India. Objectives : To determine the prevalence of micro and macro vascular complications, acute metabolic complications, infections, Non Alcoholic Fatty Liver Disease (NAFLD) and cause of mortality in T2DM patients admitted to a tertiary care teaching hospital in Eastern India. Material and Methods: This was a hospital - based prospective study evaluating 150 T2DM patients admitted to a tertiary care institution in Eastern India. Diagnosis of micro and macro vascular complications, infections and NAFLD was made using standard protocols. In case of death, the most probable cause was noted. Results: Out of 150 patients, 14.7% of patients were newly diagnosed T2DM and out of them 41% of patients had vascular complications and 54.5% had infections. Of the total patients, 56% had nephropathy, 20% neuropathy, 17.3% retinopathy, 31.3% CVD, 11.3% CAD, 4.6% acute metabolic complications, 44% infections and 16.6% had NAFLD respectively. Macrovascular events occured earlier than microvascular complications. Multiple logistic regression analysis showed strong association of age, duration of diabetes, serum cholesterol, triglyceride, LDL-C with retinopathy (Regression coefficient β : -0.1086807, 0.4127152, -0.0513393, 0.0146429, 0.0587475; p < 0.05, < 0.001, < 0.05, < 0.05, < 0.05 respectively), while only duration of diabetes was strongly associated with nephropathy and neuropathy (Regression coefficient β : 0.2538751, 0.2261636; p < 0.001 for each). Increasing age was associated with CAD (Regression coefficient β : 0.055392; p < 0.05) and FBG was a risk factor for CVD (Regression coefficient β : 0.0055014; p < 0.05). 18.6% patients died due to diabetes related complications. Cardiovascular (CV) - related deaths (CVD+CAD) were most common cause (51.5%: CVD 36.4%, CAD 15.1%) to be followed by infections (27.3%) and then chronic kidney disease (12.1%). Conclusions: This study highlights the high prevalence of vascular complications and infections in T2DM patients of Eastern India. CV-related deaths were principal causes of death, similar to that in developed world.
Chawla, R. (2012) Complications of Diabetes. Jaypee Brothers Medical Publishers, New Delhi, 1-53. https://doi.org/10.5005/jp/books/11685
Mohan, V., Deepa, R. and Shanthirani, S. (2001) Prevalence of Coronary Artery Disease and Its Relationship to Lipids in a Selected Population in South India—The Chennai Urban Population Study (CUPS No 5). Journal of the American College of Cardiology, 38, 682-687. https://doi.org/10.1016/S0735-1097(01)01415-2
Premlatha, G., Shanthirani, S. and Deepa, R. (2000) Prevalence and Risk Factors of Peripheral Vascular Disease in a Selected South Indian Population: The Chennai Urban Population Study. Diabetes Care, 23, 1295-1300. https://doi.org/10.2337/diacare.23.9.1295
Schuetz, P., Castro, P. and Shapiro, N.I. (2011) Diabetes and Sepsis, Preclinical Findings and Clinical Relevance. Diabetes Care, 34, 771-778. https://doi.org/10.2337/dc10-1185
United Nations (2009) World Population Prospects. The 2008 Revision.
Mohan, V., Shantirani, C.S. and Deepa, M. (2006) Mortality Rates Due to Diabetes in a Selected Urban Study Indian Population: The Chennai Urban Population Study (CUPS 16). Journal of the Association of Physicians of India, 54, 113-117.
Das, S., Mishra, R.K. and Jena, B.B. (1991) Mortality Events amongst Non-Insulin Dependent Diabetes Mellitus Patients in Orissa. Journal of the Association of Physicians of India, 39, 519-520.
World Health Organization (1980) Expert Committee on Diabetes Mellitus Second Report. WHO Technical Report Series, Geneva.
American Diabetes Association (2006) Position Statement: Standards of Medical Cars in Diabetes. Diabetes Care, Suppl. 2, S5-S42.
National Kidney Foundation (2007) KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease. American Journal of Kidney Diseases, 49, S42-S61.
Mythili, A., Kumar, K.D., Subrahmanyam, K.A., Kenkateswarlu, K. and Butchi, R.G. (2010) A Comparative Study of Examination Score and Quantative Sensory Testing in Diagnosis of Diabetic Polyneuropathy. International Journal of Diabetes in Developing Countries, 30, 43-48. https://doi.org/10.4103/0973-3930.60007
Das, S., Singh, S.P, Parida, P.K. and Mallik, R.N. (2010) Non-Alcoholic Fatty Liver Disease in Subjects with Type-2 Diabetes Mellitus and Non-Diabetics with Special Reference to Insulin Resistance, Hepatic Histopathological Changes. Diabetes & Metabolic Syndrome: Clinical Research and Reviews, 4, 226-229.
Cade, W.T. (2008) Diabetes-Related Microvascular and Macrovascular Diseases in the Physical Therapy Setting. Physical Therapy, 88, 1322-1335. https://doi.org/10.2522/ptj.20080008
Agarwal, R.P., Ola, V. and Bishnoi, P. (2014) Prevalence of Micro and Macrovascular Complications and Their Risk Factors in Type-2 Diabetes Mellitus. The Journal of the Association of Physicians of India, 62, 504-508.
Pradeepa, R., Prabhu, A.K. and Jebarani, S. (2011) Use of Large Diabetes Electronic Medical Record System in India: Clinical and Research Applications. Journal of Diabetes Science and Technology, 5, 543-552. https://doi.org/10.1177/193229681100500309
Varghese, A., Deepa, R. and Reema, M. (2001) Prevalence of Microalbuminuria in Type-2 Diabetes Mellitus at a Diabetes Centre in South India. Postgraduate Medical Journal, 77, 399-402. https://doi.org/10.1136/pmj.77.908.399
Yajnik, C.S., Naik, S.S. and Rout, K.N. (1992) Urinary Albumin Excretion Ratio (AER) in Newly Diagnosed Type 2 Indian Diabetic Patients Is Associated with Central Obesity and Hyperglycemia. Diabetes Research and Clinical Practice, 17, 55-60.
Diabetes Drafting Group (1985) Prevalence of Small Vessel and Large Vessel Disease in Diabetic Patients from 14-Centres. The World Health Organisation Multinational Study of Vascular Disease in Diabetics. Diabetologia, 28, 615-640. https://doi.org/10.1007/BF00290267
Ashok, S., Ramu, M. and Deepa, R. (2002) Prevalence of Neuropathy in Type 2 Diabetic Patients Attending a Diabetes Centre in South India. Journal of the Association of Physicians of India, 50, 546-550.
Raman, R., Rani, P.K. and Reddi Rachepalle, S. (2009) Prevalence of Diabetic Retinopathy in India: Sankar Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetics Study Report 2. Ophthalmology, 116, 311-318.
Das, S. (1993) Cerebrovascular Complications in NIDDM. Journal of the Association of Physicians of India, 41, 57-65.
Das, S., Chakravorty, K. and Patnaik, M. (2011) The Relationship of Carotid Plaque, Intima Media Thickness (IMT), Resistivity Index (RI) and Pulsatility Index (PI) in Asian-Indian Patients with Acute Ischemic Stroke with and without Type-2 DM. International Journal of Clinical Medicine, 2, 561-566. https://doi.org/10.4236/ijcm.2011.25092
Nagaraja, D., Gururaj, G. and Girish, N. (2009) Feasibility Study of Stroke Surveillance: Data from Bangalore, India. Indian Journal of Medical Research, 130, 396-406.
Padma, M.V. and Bajaj, J.S. (1999) Diabetes and Stroke. In: Bansal, B.C., Ed., Recent Concepts in Stroke, The Association of Physicians of India, Mumbai, 79-95.
Mohan, V., Ravikumar, R. and Shanthirani, S. (2000) Intimal Medial Thickness of the Carotid Artery in South Indian Diabetic and Non Diabetic Subjects: The Chennai Urban Population Study (CUPS). Diabetologia, 43, 494-499. https://doi.org/10.1007/s001250051334
Ramachandran, A., Snehalatha, C. and Satyavani, K. (1999) Prevalence of Vascular Complications and Their Risk Factors in Type 2 Diabetes. Journal of the Association of Physicians of India, 47, 1152-1156.
Das, S. and Behera, M. (2015) Coronary Artery Disease in Diabetes. World Clinics: Diabetology, 1, 173-191.
Mishra, T.K., Das, S. and Patnaik, U.K. (2004) Relationship of Metabolic Syndrome with Quantum of Coronary Artery Disease in Indian Patients with Chronic Stable Angina. Metabolic Syndrome and Related Disorders, 2, 187-191. https://doi.org/10.1089/met.2004.2.187
Das, S., Dash, G.K. and Behera, M. (2007) Prevalence of Metobolic Syndrome in Angiographically Established Coronary Artery Disease Patients. South Asian Journal of Preventive Cardiology, 11, 93-99.
Misra, D.P., Das, S. and Sahu, P.K. (2012) Prevalence of Inflammatory Markers High-Sensitivity C-Reactive Protein, Nuclear Factor B, and Adipanectin in Indian Patients with Type 2 Diabetes Mellitus with and without Macrovascular Complications. Metabolic Syndrome and Related Disorders, 10, 209-213. https://doi.org/10.1089/met.2011.0044
Kitabchi, A.E., Umpierrez, G.E. and Murphy, M.B. (2001) Management of Hyperglycemic Crisis in Patients with Diabetes. Diabetes Care, 24, 131-153. https://doi.org/10.2337/diacare.24.1.131
Faich, G.A., Fishbein, H.A. and Ellis, S.E. (1983) The Epidemiology of Diabetic Acidosis: A Population Based Study. American Journal of Epidemiology, 117, 551-558. https://doi.org/10.1093/oxfordjournals.aje.a113577
Sridhar, C.B., Anjana, S. and Thomas, M.J. (2002) Acute Infections. In: Tripathy, B.B., Das, A.K., Madhu, S.B. and Mohan, V., Eds., RSSDI Text Book of Diabetes Mellitus, Jaypee Publishers, 471-477.
Bettegowda, S., Iyengar, V.S. and Gosain, V. (2014) Clinical Profile and Spectrum of Infections in Type 2 Diabetes Mellitus Patients: A Retrospective Study from Rural Tertiary Care Hospital of South Karnataka, India. Scholars Journal of Applied Medical Sciences, 2, 3331-3336. https://doi.org/10.4103/0971-4065.57107
Jenifer, J., Geethalakshmi, S., Satyavani, K. and Viswanathan, V. (2009) Prevalence of Lower Urinary Tract Infection in South Indian Type 2 Diabetic Subjects. Indian Journal of Nephrology, 19, 107-111.
Patel, J.C. (1989) Complications in 8793 Cases of Diabetes Mellitus 14 Years Study in Bombay Hospital, Bombay, India. Indian Journal of Medical Sciences, 43, 177-183.
Samar, B. (1998) Endocrine & Metabolic Aspects in Tuberculosis. Update on Tuberculosis. API, WB Branch, 25-29.
Viswanathan, V., Thomas, N. and Tandon, N. (2005) Profile of Diabetic Foot Complications and Its Associated Complications—A Multicentric Study from India. Journal of the Association of Physicians of India, 53, 933-936.
Pendsey, S.P. (1994) Epidemiological Aspects of Diabetic Foot. International Journal of Diabetes in Developing Countries, 14, 37-38.
Kalra, S., Vithalani, M. and Gulati, G. (2013) Study of Prevalence of Nonalcoholic Fatty Liver Disease (NAFLD) in Type 2 Diabetes Patients in India (SPRINT). Journal of the Association of Physicians of India, 61, 448-453.
Agarwal, A.K., Jain, V. and Baruah, B.P. (2011) Prevalence of Nonalcoholic Fatty Liver Disease and Its Correlation with Coronary Risk Factor in Patients with Type 2 Diabetes. Journal of the Association of Physicians of India, 59, 351-354.
Bhansali, A., Chattopadhyaya, A. and Dash, R.J. (2003) Mortality in Diabetes: A Retrospective Analysis from a Tertiary Care Hospital in North India. Diabetes Research and Clinical Practice, 60, 119-124.