Category: Diabetes/Prediabetes/Hypoglycemia

Monitor: 15

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

Saturday, Apr 27
11:30 AM – 12:00 PM

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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Shrikant Sharma

Associate Professor Internal medicine
SMS Medical College Jaipur Rajasthan India
Jaipur, Rajasthan, India

Serving the masses in cost effective treatment. Make the patient smile

Prakash Keswani

Senior professor
Sms medical college
Jaipur, Rajasthan, India

Serving humanity

Puneet Shah

Senior Resident
SMS Hospital Jaipur
Udaipur, India

I have completed my post graduate md (general medicine) in 2018 from sms hospital ,jaipur. I want to learn each minute details from each topic.

Shrikant Sharma

Associate Professor Internal medicine
SMS Medical College Jaipur Rajasthan India
Jaipur, Rajasthan, India

Serving the masses in cost effective treatment. Make the patient smile