Title: Patient Profile of Diabetic Individuals, Attending Primary Care Diabetic Clinic, In Karimnagar, Telangana
Authors: Ajay Kumar Khandal, D.Raghuraman, D.C.Thirupathi Rao
DOI: https://dx.doi.org/10.18535/jmscr/v5i6.35
Abstract
Background: To determine the clinical profile of diabetic patients its significance for diabetic management. Karimnagar is the fourth largest urban area in the newly formed state of Telangana, and its diabetic burden is presumably on the higher side.
Material and Methods: Diabetic patients in the study were analysed for various components like duration of diabetes prevalence of complications pattern of drug use and associated non diabetic co-morbidities over the study period.
Results: Musculoskeletal symptom, neuropathy, fatigue predominated the health need of diabetics in the study. New diabetics were also detected highlighting the need of frequent screening camps. Thyroid disorders were also found to be more associated in diabetics along with hypertension and dyslipidemia.
Conclusion: The Diabetic profile in the study area is characterised by high CV risk, low penetration of statins usage, high association of hypertension, suboptimal sugar control and very high level of dyslipidemia, implying of a lack of awareness and a need for renewed strategy.
References
1. Wild S, Roglic G, Green A, Sicree R, King H.Global prevalence of diabetes: Estimates for the year 2000 andprojections for 2030.Diabetes Care2004;27:1047-53.
2. Sicree R, Shaw J, Zimmet P. Diabetes and impaired glucose tolerance. In: Gan D, editor. Diabetes Atlas. International Diabetes Federation.3rd ed. Belgium: InternationalDiabetesFederation;2006p.15-103.
3. McKeigue PM, Shah B, Marmot MG. Relation of centralobesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians.Lancet1991;337:382-6.
4. MohanV,SharpPS,ClokeHR,Burrin JM, Schumer B,Kohner EM. Serum immunoreactive insulin responses toa glucose load in Asian Indian and European Type 2 (noninsulin-dependent) diabetic patients and control subjects. Diabetologia 1986;29:235-7.
5. Abate N, Chandalia M. Ethnicity and type2 diabetes: focus on Asian Indians. J Diabetes Complications 2001;15:320-7.
6. Joshi R. Metabolic syndrome-Emerging clusters of theIndian phenol type. J Assoc Physicians India 2003;51:445-6.
7. Deepa R, Sandeep S,Mohan V. Abdominal obesity, visceralfat and type2 diabetes- “Asian Indian phenotype. In: MohanV, Rao GHR, editors. Type 2 diabetes in South Asians:Epidemiology, risk factors and prevention. New Delhi: Jaypee Brothers Medical Publishers (P)Ltd;2006p.138-52.
8. Ramachandran A,Snehalatha C, ViswanathanV, Viswanatha M,Haffner SM. Risk of non insulin dependent diabetesmellitus conferred by obesity and central adiposityin different ethnic groups: a comparative analysis between Asian Indians, Mexican Americans and Whites. Diabetes Res Clin Pract1997;36:121-5.
9. Raji A, Seely EW, Arky RA, Simonson DC. Body fat distribution and insulin resistance in healthy Asian Indians and Caucasians.J Clin Endocrinol Metab2001 ;86:5366-71.
10. Chandalia M, Abate N, Garg A, Stray-Gunderson J, Grundy SM. Relationship between generalized and upper body obesity to insulin resistance in Asian Indian men. J Clin Endocrinol Metab1999;84:2329-35.
11. Gupta OP, Joshi MH, Dave Sk. Prevalence of diabetes in India.Adv Metab Dis1978;9:147-165.
12. Ramachandran A, Snehalatha C, Kapur A et al. High prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey. Diabetologia2001;44:1094-101.
13. Sadikot SM,Nigam A, Das Setal. The burden of diabetes and impaired glucose tolerance in India using the WHO 1999 criteria: prevalence of diabetes In India study (PODIS). Diabetes Res Clin Pract 2004;66:301-07.
14. Murthy PD, Pullaiah B, and Rao KV: Survey for detection of hyperglycemia and diabetes mellitus in Tenali. In Diab-etes mellitus in Developing Countries. Bajaj Js Ed. Interprint, New-Delhi, 1984,55.
15. Ramachandran A, Jali MV, Mohan V, Snehalatha C, Viswanathan M. High prevalence of diabetes in an urban population in South India. Br Med J1988;297:587–590.
16. Varma NPS, Mehta SP,Madhu SV, Mather HM, and Keen H: Prevalence of Known diabetes mellitusin an urban Indian environment: the Darya Ganji diabetes survey. BrMedJ1986;293:423.
17. Rao PV, Usabala P, seshaiahV, Ahuja MMS, and Mather HM: The Eluru Survey: Prevalence of known diabetes in a rural Indian population. Diabetes Res Clin Pract1989;7:29.
18. Ramachandran A, Snehalatha C, Dharmaraj D, Viswanathan M. Prevalence of glucose in tolerance in Asian Indians.Urban-rural difference and significance of upper body adiposity. Diabetes Care. 1992;15:1348-55.
19. Ramachandran A, Snehalatha C, Latha E, VijayV,Viswanathan M. Rising prevalence of NIDDM in urban population of India. Diabetologia1997; 40:232-7.
20. Raman Kutty V, Joseph A, Soman CR. High prevalence of type 2 diabetes in an urban settlement in Kerala, India.Ethn Health 1999; 4 : 231-9.
21. Iyer SR, Iyer RR, Upasani SV, Baitule MN. Diabetes mellitus in Dombivli--- an urban population study. J Assoc Physicians India 2001;49:713-16.
22. Misra A, Pandey RM, Devi JR, Sharma R, Vikram NK, Khanna N. High prevalence of diabetes, obesity and dyslipidaemia in urban slum population in northern India. Int J Obes 2001;25:1722-9.
23. Mohan V, Shanthirani CS, Deepa R. Glucose intolerance (diabetes and IGT) in a selected South Indian population with special reference to family history, obesity and lifestyle factors - the Chennai Urban Population Study. J Assoc Physicians India 2003;51:771-7.
24. Ramachandran A, Snehalatha C, Kapur A et al. High prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey. Diabetologia 2001;44:1094-101.
25. Mohan V, Deepa M, Deepa R, et al. Secular trends in the prevalence of diabetes and impaired glucose to lerance in urban South India-the Chenna Urban Rural Epidemiology Study (CURE Diabetologia. 2006;49:1175-1178.
26. Menon VU, Kumar KV, GilchristA, Sugathan TN,SundaramKR,NairV, Kumar H.Prevalence of known and undetected diabetes and associated risk factors in central Kerala--ADEPS. Diabetes Res Clin Pract. 2006 Dec;74(3):289-94.
27. Sadikot SM, Nigam A, Das Setal. The burden of diabetes and impaired glucosetoleranceinIndiausing the WHO 1999 criteria: prevalence of diabetes in India study (PODIS). Diabetes Res Clin Pract 2004;66:301-07.
28. Sadikot SM, Nigam A, Das S, Bajaj S, Zargar AH, Prasanna kumar KM,et al. Diabetes India. The burden of diabetes and impaired fasting glucose in India using the ADA1997 criteria: prevalence of diabetes in India study (PODIS). Diabetes Res Clin Pract 2004; 66 : 293-300.
29. Chow CK, Raju PK, Raju Retal.The prevalence and management of diabetes in rural India. Diabetes Care2006;29:1717-18.
30. Rema M, Ponnaiya M, Mohan V. Prevalence of retinopathy in non insulin dependent diabetes mellitus in southern India. Diabetes Res Clin Practice 1996; 24 : 29-36.
31. Ramachandran A, Snehalatha C, Satyavani K, Latha E, Sasikala R, Vijay V. Prevalence of vascular complications and their risk factors in type 2 diabetes. J Assoc Physicians India 1999; 47 : 1152-6
32. Rema M, Premkumar S, Anitha B, Deepa R, Pradeepa R, Mohan V. Prevalence of Diabetic Retinopathy in Urban India: The Chennai Urban Rural Epidemiology Study (CURES) Eye Study- I. Invest Ophthalmol Vis Sci 2005; 46 : 2328-33
33. Dandona L, Dandona R, Naduvilath TJ, McCarty CA, Rao GN. Population based assessment of diabetic retinopathy in an urban population in southern India. Br J Ophthalmol 1999;83 : 937-40.
34. John L, Sundar Rao PSS, Kanagasabhapathy AS. Prevalence of diabetic nephropathy in non insulin dependant diabetes mellitus. Indian J Med Res 1991; 94 : 24-9.
35. Gupta DK, Verma LK, Khosla PK, Dash SC. The prevalence of microalbuminuria in diabetes: a study from north India. Diabetes Res Clin Pract 1991; 12 : 125-8.
36. Mohan V, Meera R, Premalatha G, Deepa R, Priya M, Rema M. Frequency of proteinuria in Type 2 diabetes mellitus seen at a diabetes centre in Southern India. Postgrad Med J 2000;76 : 569-73.
37. Unnikrishnan RI, Rema M, Pradeepa R, Deepa M, Shanthirani CS, Deepa R, et al. Prevalence and risk factors of diabetic nephropathy in an urban south Indian population: The Chennai Urban Rural Epidemiology Study (CURES - 45). Diabetes Care 2007; 30 : 2019-24.
38. Viswanathan V, Thomas N, Tandon N, Asirvatham A, Rajasekar S, Ramachandran A, et al. Profile of diabetic foot complications and its associated complications - a multicentric study from India. J Assoc Physicians India 2005; 53 : 933-6.
39. Pradeepa R, Rema M, Vignesh J, Deepa M, Deepa R, Mohan V. Prevalence and risk factors for diabetic neuropathy in an urban south Indian population: the Chennai Urban Rural Epidemiology Study (CURES-55). Diabet Med 2008;25:407-12
40. Chadha SL, Radhakrishnan S, Ramachandran K, Kaul U, Gopinath N. Epidemiological study of coronary heart disease in urban population of Delhi. Indian J Med Res 1990; 92 :424-30.
41. Mohan V, Premalatha G, Sastry NG. Ischaemic heart disease in south Indian NIDDM patients – A clinic based study on 6597 NIDDM patients. Int J Diab Developing Countries 1995; 15 : 64-7.
42. Mohan V, Deepa R, Shanthirani CS, Premalatha G. 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). J Am Coll Cardiol 2001; 38: 682-7. Census 2001, Govt of India.
43. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2010;33(Suppl. 1):S62–S69.
44. American Diabetes Association: Clinical Practice Recommendations 2001, Diabetes Care 24:S69-S72, 2001 (suppl1).
45. McClellan WM, Knight DF, Karp H, Brown WW: Early detection and treatment of renal disease in hospitalized diabetic and hypertensive patients: Important differences between practice and published guidelines. Am J Kidney Dis 29: 368-375, 1997.
46. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease, Vol 3, Issue 1, January 2013.
47. ADA, Standards of Medical Care in Diabetes-2013, Diabetes Care January 2013 36:S11-S66; doi: 10.2337/dc13-S011.
48. ADA, Diagnosis and Classification of Diabetes Mellitus, Diabetes Care January 2013 36:S67-S74; doi: 10.2337/dc13-So67.
49. Professional Practice Committee for the 2013 Clinical Practice Recommendations Diabetes Care January 21013 36: S109-S110; doi: 10.2337/dc13-S109.
50. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, IZZO JL et al. The seventh report of the Joint National Committee on prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC-7). JAMA 2003;289:2560-71.
51. Ramachandran A, Snehalatha C, Dharmaraj D, Viswanathan M. Prevalence of glucose in tolerance in Asian Indians. Urban-rural difference and significance of upper body adiposity. Diabetes Care. 1992;15:1348-55.
52. Raman Kutty V, Joseph A, Soman CR. High prevalence of type 2 diabetes in an urban settlement in Kerala, India.Ethn Health 1999; 4 : 231-9.
53. Singh TP, Singh AD, Singh TB. Prevalence of diabetes mellitus in Manipur. In: Shah SK. Editor. Diabetes Update. Guwahati. North Eastern Diabetes Society. 2001;13-19.
54. Sadikot SM, Nigam A, Das S, Bajaj S, Zargar AH, Prasannakumar KM, et al. Diabetes India. The burden of diabetes and impaired fasting glucose in India using the ADA1997 criteria: prevalence of diabetes in India study (PODIS). Diabetes Res Clin Pract 2004; 66 : 293-300.
55. Holmström IM, Rosenqvist U. Misunderstandings about illness and treatment among patients with type 2 diabetes. J Adv Nurs 2005. 49(2):146-154.
56. Al-Maskari F, El-Sadig M. Prevalence of risk factors for diabetic foot complications. BMC Fam Pract 2007. 8:59.
57. Al-Kaabi J, Al-Maskari F, Saadi H, Afandi B, Parkar H, Nagelkerke N. Assessment of dietary practices among diabetic patients in the United Arab Emirates. The Review of Diabetic studies 2008;5(2):110-15.
58. Diabetes & Metabolic Syndrome: Clinical Research & ReviewsVolume 4, Issue 1, January–March 2010, Pages 10–12, Prevalence and pattern of diabetic dyslipidemia in Indian type 2 diabetic patients Rakesh M. ParikhShashank R. Joshib, Padmavathy S. Menonc, Nalini S. Shah
59. Prevalence of Diagnosed and Undiagnosed Diabetes and Hypertension in India—Results from the Screening India’s Twin Epidemic (SITE) Study. Shasankh R Joshi et al, DIABETES TECHNOLOGY & THERAPEUTICS Volume 14, Number 1, 2012 Mary Ann Liebert, Inc. DOI: 10.1089/dia.2011.0243.
60. Prevalence of Coronary Risk Factors in Type 2 Diabetics without Manifestations of Overt Coronary Heart Disease AK Agarwal*, http://www.japi.org/february_2009/O-3.html.
61. National Programme for Prevention and Control of Cancer, Diabetes, Cardiov-ascular diseases and Stroke (NPCDCS), http://www.pib.nic.in/newsite/erelease.aspx?relid=63087
62. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010;87(1):4-14.
63. Health situation in the South East Asia Region 1998-2000. WHO Regional office for South East Asia, New Delhi. 2002.
64. American Heart Association. Heart Disease and Stroke Statistics – 2008. Update. Dallas, Texas: American Heart Association.
65. U.K. Prospective Diabetes Study 27. Plasma lipids and lipoproteins at diagnosis of NIDDM by age and sex. Diabetes Care 1997;20(11):1683-7.
66. Expert Panel on Detection, Evaluation, and Treatment ofHigh Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001;285(19):2486-97.
67. Agrawal SK, Dash SC, Irshad M et al. Prevalence of Chronic Renal Failure in adults in Delhi, India. Nephro Dial Transplant 2005;20:1638-1642.
68. Modi GK, Jha.V. The incidence of end stage stage renal disease in India; a population based study. Kidney Int 2006;70:2131-2133.
69. Mani MK – Prevention of Chronic renal failure at the community level. Kidney Int 2003;83:86-89. Vijay Vishwanathan, C. Snehalata, Terin mathai, Muthu Jayara-man,
70. Ramachandran – Cardiovascular Morbidity in Proteinuric South Indian NIDDM Patients. Diabeties Research and Clinical Practice, 1998;39:63-67.
71. Smith LL, Burnet SP, McNeil JD. Musculoskeletal manifestations of diabetes mellitus: A review. Br J Sports Med. 2003;37:30–5
72. South Med J. 2008 Jun;101(6):591-5. doi: 10.1097/SMJ.0b013e3181705d39. The prevalence of a diabetic condition and adhesive capsulitis of the shoulder. Tighe CB1, Oakley WS Jr.
73. Fatigue in patients with diabetes: A review Cynthia Fritschi Laurie Quinn Journal of Psychosomatic Research Vol 69, Issue 1, July 2010, Pages 33–41
74. Fatigue symptoms relate to systemic inflammation in patients with type 2 diabetes Julie Lasselina, b, Sophie Layéa, b, Sandra Dexperta, b, Agnès Auberta, b, Concepcion Gonzalezc, Henri Ginc, Lucile Capuron
75. Autoantibodies to GAD65 and IA-2 Antibodies Are Increased, but Not Tissue Transglutaminase (TTG-Ab) in Type 2 Diabetes Mellitus (T2DM) Patients from South India C. B. SANJEEVI1,*, M. BALAJI2, V. BALAJI2and V. SESHIAH Volume 1005, IMMUNOLOGY OF DIABETES II: PATHOGENESIS FROM MOUSE TO MAN pages 387–389, November 2003
76. The islet autoantibody titres: their clinical relevance in latent autoimmune diabetes in adults (LADA) and the classification of diabetes mellitus, A. W. Van Deutekom, R. J. Heine and S. Simsek Diabetic Medicine Volume 25, Issue 2, pages 117–125, February 2008.