Evaluation of Risk Factors in Diabetic Patients with Macrovascular Complications

Year 2020, , 121 - 128, 31.08.2020

Barış Gelen , Arzu Kılıç Gelen , Ramazan Denizli , Teslime Ayaz

https://doi.org/10.34084/bshr.729754

Abstract

Objecive: In our study, we planned to investigate the risk factors of patients diagnosed with acute myocardial infarction or cerebrovascular event due to macrovascular complications of diabetes mellitus between 2015-2018.
Material and Methods: A retrospective study included 48 patients with diabetes mellitus diagnosed with macrovascular complications, the control group consisted of 97 diabetic patients who had no macrovascular complications and that followed-up in our outpatient clinic. In the last 6 months of the patients who developed complications and the patients in the control group, laboratory results were examined and the risk factors were determined according to age, BMI, fasting blood glucose, Hba1C, MPV, RDW, PLT and creatinine parameters.Statistical analysis was performed with SPSS version 17.0 program. Normal distribution of the variables were evaluated according to histogram graphs and Kolmogorov-Smirnov test; In the independent groups, the T test was used to evaluate the nonparametric groups and the Mann Whitney U test was used.
Results: As a result of our study, we found a statistically significant relationship with the development of macrovascular complications in diabetic patients, advanced age, progression in HbA1c level, MPV value >11,9 and creatinine levels above 1.2 mg / dl, but gender, BMI, fasting blood glucose, RDW and platelet values were similar in both groups.
Conclusion: Based on the data obtained, we think that the follow-up of advanced age, MPV, creatinine, Hba1c values in the follow-up of diabetic patients and the deterioration in these parameters may guide us in terms of the development of macrovascular complications.

Keywords

Diabetes Mellitus, Macrovascular Complications, HbA1c

Makrovasküler Komplikasyon Gelişen Diyabetik Hastalarda Risk Faktörlerinin Değerlendirilmesi

Abstract

Amaç: Biz çalışmamızda 2015-2018 yılları arasında hastanemize diyabetes mellitusun makrovasküler komplikasyonlarından olan akut miyokard infarktüsü veya serebrovasküler olay tanısı konulan hastaların risk faktörleri açısından araştırılmasını planladık.
Gereç ve Yöntemler: Retrospektif olarak yapılan çalışmaya 48 diyabetes mellitus tanılı makrovasküler komplikasyon gelişen hasta alınmış iken kontrol grubu olarak da polikliniğimizden takipli makrovasküler komplikasyon gelişmemiş olan 97 diyabetik hasta çalışmaya dahil edilmiştir. Komplikasyon gelişen hastaların ve kontrol grubu hastaların son 6 ayındaki polikliniğimize olan başvurusunda laboratuar sonuçları incelenerek yaş, BMİ, açlık kan şekeri, Hba1C, MPV, RDW, PLT ve kreatinin parametrelerine göre risk faktörleri belirlenmeye çalışıldı. İstatistiksel analizler SPSS versiyon 17.0 programı ile gerçekleştirilmiştir. Değişkenlerin normal dağılıma uygunluğu histogram grafikleri ve Kolmogorov-Smirnov testi ile normal dağılım gösteren (parametrik) değişkenlerin gruplar arasında değerlendirilirken; bağımsız gruplarda T Testi, normal dağılım göstermeyenler (non parametrik) gruplar arasında değerlendirilirken Mann Whitney U Testi kullanılmıştır. Bulgular: Yaptığımız çalışma sonucunda diyabetik hastalarda makrovasküler komplikasyon gelişimi ile yaştaki artışın, HbA1c düzeyindeki progresyonun, MPV değerinin >11,9 ve kreatinin düzeylerinin 1.2 mg/dl dğerinin üzerinde olması durumuyla istatistiksel olarak anlamlı bir ilişki saptadık fakat cinsiyet, BMI, açlık kan şekeri, RDW ve platelet değerleri her iki grupta benzer olarak bulundu.
Sonuç: Elde edilen veriler doğrultusunda diyabetik hastaların takiplerinde ileri yaş, MPV,kreatinin, Hba1c değerlerinin yakın takibinin yapılması ve bu parametrelerdeki bozulmaların makrovasküler komplikasyon gelişimi açısından bize yol gösterebileceğini düşünmekteyiz.

Keywords

Diyabetes Mellitus, Makrovasküler Komplikasyonlar, HbA1c

References

• 1) Introduction: Standarts of Medical Care in Diabetes-2018. Diabetes Care 2018 Jan; 41(Supplement 1): S1-S2.
• 2) Diyabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu, Türkiye Endokrinoloji ve Metabolizma Derneği Diyabetes Mellitus Çalışma Grubu, 2018, 15.
• 3) International Diabetes Federation. IDF Diabetes Atlas. 8th edn. Brussels, Belgium: International Diabetes Federation, 2017, 7.
• 4) Yumuk V. Diabetes Mellitusa Genel Bir Bakış. In Özata M, Yönem Arif eds. Endokrinoloji, Metabolizma ve Diyabet, İstanbul Tıp Kitapevi; 2011; 539.
• 5) Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J. Diabetes Mellitus.Harrison İç Hastalıkları Prensipleri, 19.edisyon. Çev.ed: Biberoğlu K. Nobel Tıp Kitapevleri 2015;2:2285-2286.
• 6) Adler AI, Neil HA, Manley SE, Holman RR, Turner RC. Hyperglycemia and hyperinsulinemia at diagnosis of diabetes and their association with subsequent cardiovascular disease in the United Kingdom prospective diabetes study (UKPDS 47) Am Heart J. 1999;138:S353–9. doi: 10.1016/S0002-8703(99)70035-9.
• 7) International Diabetes Federation (IDF) Atlas http://www.eatlas.idf.org/Complications/
• 8) Steiner G. Diabetes and atherosclerosis: an overview. Diabetes. 1981;30:1–7.
• 9) Diyabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu, Türkiye Endokrinoloji ve Metabolizma Derneği Diyabetes Mellitus Çalışma Grubu, 2018, 131.
• 10) Alwakeel JS, Al-Suwaida A, Isnani AC, Al-Harbi A, Alam A. Concomitant macro and microvascular complications in diabetic nephropathy. Saudi J Kidney Dis Transpl 2009;20:402-9.
• 11) Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-year cardiovascular mortality for men screened in The Multiple Risk Factor Intervention Trial. diabetescare 1993; 16: 434-44.
• 12) Adams HP Jr, Putman SF, Kassell NF, Torner JC. Prevalence of diabetes mellitus among patients with subarachnoid hemorrhage. ArchNeurol 1984; 41: 1033-5.
• 13) Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)Davies, M.J., D’Alessio, D.A., Fradkin, J. et al. Diabetologia (2018) 61: 2461.
• 14) Diyabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu, Türkiye Endokrinoloji ve Metabolizma Derneği Diyabetes Mellitus Çalışma Grubu, 2018, 101.
• 15) Bilir B, Bilir BE, Atile NS, Takır M, Yılmaz A, Aydın M. Evaluation of Red Cell Distribution Width (RDW) in Diabetic Nephropathy Patients. Med Med J. 2016; 31(3): 156-160.
• 16) Yenigün EC, Okyay GU, Pirpir A, Hondur A, Yıldırım IS. Increased mean platelet volume in type 2 diabetes mellitus. Dicle Medical Journal. 2014; 41 (1): 17-22.
• 17) Tavil Y, Sen N, Yazici HU, Turfan M, Hizal F, Abaci A, et al. Coronary heart disease is associated with mean platelet volume in type 2 diabetic patients. Platelets. 2010;21(5):368-72.
• 18) Patil P, Darshan A, Saroja AO, Kothiwale VA, Association of Mean Platelet Volume with Acute Ischemic Cerebrovascular Accident Among Patients with Type 2 Diabetes Mellitus: A Hospital-Based Study. Journal of The Association of Physicians of India. 2018; 66(8): 44-47.
• 19) WHO. Physical Status: The Use and Interpretation of Anthropometry: Report of a World Health Organization (WHO) Expert Committee. Geneva, Switzerland: World Health Organization; 1995.
• 20) Durmaz A, Barış N, Hekimsoy Z, Atay A, Köseoğlu M. Diyabetik Nefropatili Hastalarda Eritropoetinin Böbrek Fonksiyonları ile İlişkisi. Türk Klinik Biyokimya Derg 2009; 7(3): 87-91
• 21) Nazimek-Siewniak B, Moczulski D, Grzeszczak W. Risk of macrovascular and microvascular complications in type 2 diabetes results of longitudinal study design. J Diabetes Complications 2000; 16:271-6.
• 22) Famuyiwa OO, Sulimani RR, Laajam MA, AlJasser J, Mekki MO. Diabetes mellitus in Saudi Arabia. The clinical pattern and complications in 1000 patients. AnnSaudiMed 1992;12(2):140-51.
• 23) Hirata-Dulas CA, Rith-Najarian SJ, Mcintyre MC, Ross C, Dahl DC, Keane WF, et al. Risk factors for nephropathy and cardiovascular diseases in diabetic Northern Minnesota American Indians. ClinNephrol 1996;46(2):92-8.
• 24) Zuberi BF, Akhtar N, Afsar S. Comparison of mean platelet volume in patients with diabetes mellitus, impaired fasting glucose and non-diabetic subjects. SingaporeMed J 2008;49:114-6.
• 25) Jindal S, Gupta S, Gupta R, Kakkar A, Singh HV, Gupta K, et al. Platelet indices in diabetes mellitus: indicators of diabetic microvascular complications. Hematology 2011;16:86-9.
• 26) Kodiatte TA, Manikyam UK, Rao SB, Jagadish TM, Reddy M, Lingaiah HM, et al. Mean platelet volume in type 2 diabetes mellitus. J LabPhysicians 2012;4:5-9.
• 27) American Diabetes Association (ADA). Executive summary: Standards of medical care in diabetes 2009. DiabetesCare 2009;32(1):6-12.
• 28) Handelsman Y, Bloomgarden ZT, Grunberger G, Umpierrez G, Zimmerman RS, Bailey TS, et al. American association of clinical endocrinologists and american college of endocrinology (AACE): clinical practice guidelines for developing a diabetes mellitus comprehensive care plan. EndocrPract 2015; 21(1):1-87.
• 29) UKPDS, United Kingdom Prospective Diabetes Study. UKPDS 35. BMJ 2000; 321: 405-12.
• 30) Gur CC, Polat H, Muderrisoglu C, Altunoglu E, Yilmaz M. In patients with type-2 diabetes, diabetes regulation, Hba1c, duration of diabetes, BMI, dyslipidemia, and microalbuminuria compared with macrovascular complications. IstanbulMedicalJournal, vol. 14, no. 4, 2013, p. 243-7.
• 31) Haffner SM, Mykkänen L, Festa A, Burke JP, SternMP. Insulin resistant prediabetic subjects have more atherogenic risk factors than insulin-sensitive prediabetic subjects: implications for preventing coronary heart disease during the prediabetic state. Circulation 2000; 101: 975-80.
• 32) Chappidi M, Sivananjiah S, Thirthahalli C, Kunnavil R, Murthy NS. Complications of diabetes mellitus among patients attending the outpatient department of a tertiary care hospital. Int J Community Med Public Health. 2018; 5: 341-8.
• 33) Mishra KP, Mawar A, Kare PK, Verma N. Relationship between fasting blood glucose, serum urea, serum creatinine and duration of diabetes in Type-2 diabetic patients. Flora Fauna. 2015;21(1):127-32.
• 34) Zoungas S, Woodward M, Li Q, Cooper ME, Hamet P, Harrap S, et al. Impact of age, age at diagnosis and duration of diabetes on the risk of macrovascular and microvascular complications and death in type 2 diabetes.Diabetologia. 2014; 57: 2465-2474.
• 35) Booth GL, Kapral MK, Fung K, Tu JV. Relation between age and cardiovascular disease in men and women with diabetes compared with non-diabetic people: a population-based retrospective cohort study. Lancet.2006; 368:29–36.
• 36) Vaccaro O, Eberly LE, Neaton JD, Yang L, Riccardi G, Stamler J. Multiple Risk Factor Intervention Trial Research Group. Impact of diabetes and previous myocardial infarction on long-term survival: 25-year mortality follow-up of primary screenees of the Multiple Risk Factor Intervention Trial. ArchInternMed.2004; 164:1438–1443.
• 37) Malandrino N, Wu WC, Taveira TH, Whitlatch HB, Smith RJ. Association between red blood cell distribution width and macrovascular and microvascular complications in diabetes. Diabetologia 2012; 55: 226–235.
• 38) Shuta T, Katsumi M, Takatoshi K, Manabu O, Tomotaka D, Tadashi M, et al. Impact of Red Blood Cell Distribution Width on Long-Term Mortality in Diabetic Patients After Percutaneous Coronary Intervention, Circulation Journal, 2013, Volume 77, Issue 2, Pages 456-461.