VINAY DISSERTATION REVIEW

Project Title :  

MICROVASCULAR AND MACROVASCULAR COMPLICATIONS IN TYPE 2 DIABETES MELLITUS.

Need for study : 

Diabetes Mellitus is a group of metabolic  diseases characterized by chronic hyperglycemia associated with disturbances of carbohydrate, fat and protein metabolism due to absolute or relative deficiency in insulin secretion and/or action. Diabetes causes long term  damage, dysfunction and failure of various organs; especially the eyes, kidneys, nerves, heart and blood vessels. In a nutshell diabetes is appropriately described as  a “Metabolic cum Vascular disorder”

The  micro-vascular complications of both Type  1 and Type 2 DM  result from chronic hyperglycemia. Since  type 2 DM often has a long  asymptomatic period of hyperglycemia, many individuals with Type  2 DM have  complications at the time of diagnosis.

To understand whether microvascular complications distinctly precede macrovascular complications or do both of them progress simultaneously as a continuum... To study the complications and the outcomes of diabetes mellitus.

AIM :

To study about microvascular and macrovascular complications in type 2 diabetes mellitus.

OBJECTIVES : 

1) To study about microvascular complications in type 2 diabetes mellitus.
A) Diabetic retinopathy - by fundoscopy
B) Diabetic neuropathy - by clinical examination
C) Diabetic nephropathy - by laboratory investigations

2) To study about macrovascular complications in type 2 diabetes mellitus.
A) Peripheral arterial diseases. - by color doppler
B) Coronary artery disease. - ecg, 2d echo
C) Cerebro vascular disease. Clinical history/ MRI

3) To study risk factors such as hypertension, obesity, dyslipidemia ,alchol , smoking

PATIENTS AND METHODS:

PLACE OF STUDY: Department of General medicine , Kamineni Institute of Medical Sciences, Narketpally.

STUDY PERIOD: November 2020- October 2022

STUDY DESIGN : Prospective Study 

SAMPLING: 50

INVESTIGATIONS : 

• Complete blood picture
• Fasting blood sugar 
• Post lunch blood sugar 
• HBA1C 
• Complete urine examination
• Fasting lipid profile 
• Spot urine protein creatinine ratio

PROFORMA : 

Name: 
OP No. 
HISTORY TAKING 
Type of Diabetes Melitus: 
Duration of Diabetes Melitus:     
Age :       
History & Duration  of  Hypertension: 
H/o Anginal Chest Pain: 
H/o Previous treatment  for MI: 
H/o Smoking:  
H/o Stroke 
H/o TIA  
H/o Diabetes Mellitus 
GENERAL EXAMINATION 
Height: 
Weight: 
Waist Circumference:     
Sex : 

VITALS 
Pulse: Rate, Rhythm, Felt in all peripheral palpable vessels. 
B.P.: 

EXAMINATION OF SYSTEM: 

CARDIOVASCULAR SYSTEM : 
 APICAL  IMPULSE:    
HEART  SOUNDS:    
ADDED  SOUNDS: 

RESPIRATORY  SYSTEM:   
BREATH  SOUNDS:   
ADDED  SOUNDS: 

ABDOMEN:   
ORGANOMECIALY:   
FREE  FLUID :

CENTRAL NERVOUS SYSTEM : 
Higher  Fuction:   
Cranial  Nerves:   
Motor System:   
Sensory  System:   

OPTHALMOLOGICAL EXAMINATION OF FUNDUS INVESTIGATION 

Blood Sugar - 
 Fasting: -  
Postprandial (2Hrs)  : 
Blood Urea: 
Serum Creatinine: 
Total Cholesterol: 
Urine Albumin: 
24Hrs Urine Protein: 

ECG 

ECHO
Color doppler



Patient blog links: 


https://pavitrabaldawa.blogspot.com/2022/01/a-case-of-diabetic-ulcer.html

 https://rithikamukkawar113.blogspot.com/2022/01/64-year-old-with-decreased-urine-output.html

 https://caseopinionsbyrollno156.blogspot.com/2022/03/36-year-old-with-pain-in-left-lower-rib.html

 https://alekyatummala.blogspot.com/2020/09/45-yr-female-with-anasarca.html

 https://sridevi0090.blogspot.com/2020/09/sridevis-e-log.html

 http://meghanabonaboina.blogspot.com/2020/10/type-2-diabetes-melitus-with.html

 https://shivanibhashyam.blogspot.com/2020/08/this-is-online-e-log-book-to-discuss_24.html

 https://anujabetty.blogspot.com/2020/08/anaemia-under-evaluation.html

 https://bhavyayammanuru.blogspot.com/2020/09/aki-secondary-to-uti.html

 https://supraja97.blogspot.com/2020/09/a-35yr-old-male-with-slurring-of-speech.html

 https://shubhasri98.blogspot.com/2022/01/48-yr-old-patient-ckd.html

 https://nehapurohit115.blogspot.com/2022/01/general-medicine-case-discussion_11.html

 https://pranativ.blogspot.com/2022/02/chinna-suraram.html
 
https://52santoshkumar.blogspot.com/2021/10/a-case-of-ckd.html

 https://jyothi97.blogspot.com/2022/02/blog-post_2.html

 https://sanjay129gm.blogspot.com/2021/12/chief-complaints-70-years-old-male.html

 http://manikaraovinay.blogspot.com/2021/10/type-2-diabetes-melitus-with.html

 http://manikaraovinay.blogspot.com/2021/10/this-is-online-e-log-book-to-discuss.html

 http://manikaraovinay.blogspot.com/2021/10/this-is-online-e-log-book-to-discuss_82.html

http://manikaraovinay.blogspot.com/2021/10/type-2-diabetes-melitus-with.html
  http://manikaraovinay.blogspot.com/2021/10/this-is-online-e-log-book-to-discuss.html
  https://spoorthychikati.blogspot.com/2021/05/case-of-48-years-old-female-with-dka.html
  https://raagameghana.blogspot.com/2021/09/a-60year-old-female-with-altered.html
  https://ashiness92.blogspot.com/2021/10/a-74-year-old-woman-with-recurrent.html?m=1
  https://httpmedicin.blogspot.com/2021/10/70-yr-old-male-with-altered-sensorium.html
  https://trishaalareddy121.blogspot.com/2021/11/75-year-old-male-with-altered-sensorium.html?m=1
  https://drkulkarnithesis.blogspot.com/2021/10/case-4-55-f-with-right-sided-weakness.html
  https://drkulkarnithesis.blogspot.com/2020/10/65m-with-recurrent-cva-with-visual.html
  https://drkulkarnithesis.blogspot.com/2021/10/case-17-60-yer-old-female-cva-with-left.html
  https://drkulkarnithesis.blogspot.com/2021/10/case-21-65-m-with-altered-sensorium-and.html
  https://chvaishnavirollno28.blogspot.com/2022/06/50-year-man-with-stroke.html
  https://caseopinionsbyrollno05.blogspot.com/2022/09/48-year-male-with-fever-and-headache.html

 https://jyothi97.blogspot.com/2022/06/a-case-of-48-yr-old-male-with.html
 
https://anuraag10-2k16.blogspot.com/2022/05/45ymale-with-co-altered-sensorium-and.html?m=1
  https://shravanireddy15.blogspot.com/2022/05/52-yr-female-with-uncontrolled-sugars.html
  https://amatulbaseerrollno4.blogspot.com/2022/05/39-year-old-female-with-uncontrolled.html
  https://1601006029spoorthireddy.blogspot.com/2022/05/30-yrs-old-female-with-uncontrolled.html
  https://baddamramyarollno14.blogspot.com/2022/04/a-55-year-old-male-with-uncontrolled.html
  https://12avirnenivaishnavi.blogspot.com/2022/04/70-year-old-female-with-uncontrolled.html?m=1

PATIENT INFORMATION SHEET

English:

https://drive.google.com/file/d/12LLDgFBVfnTxDdNv5K715uSyLYPUEgrY/view?usp=drivesdk

Telugu:

https://drive.google.com/file/d/13Df9wCu9zhjECpPxcHEULSAphv6-tDHl/view?usp=drivesdk


Template of this "patient information sheet" is borrowed from this website:

https://www.ncbi.nlm.nih.gov/books/NBK261334/

And modified accordingly to my thesis topic.


Refernces: 

1) Chawla, Aastha et al. “Microvasular and macrovascular complications in diabetes mellitus: Distinct or continuum?.” Indian journal of endocrinology and metabolism vol. 20,4 (2016): 546-51. doi:10.4103/2230-8210.183480


2)Raman R, Rani PK, Reddi Rachepalle S, Gnanamoorthy P, Uthra S, Kumaramanickavel G, et al. Prevalence of diabetic retinopathy in India: Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetics Study report 2. Ophthalmology. 2009;116:311–8. 


3)Unnikrishnan RI, Rema M, Pradeepa R, Deepa M, Shanthirani CS, Deepa R, Mohan V. Prevalence and risk factors of diabetic nephropathy in an urban South Indian population: the Chennai Urban Rural Epidemiology Study (CURES 45). Diabetes Care. 2007 Aug;30(8):2019-24. doi: 10.2337/dc06-2554. Epub 2007 May 8. PMID: 17488949.


4) Chawla A, Chawla R, Jaggi S. Microvasular and macrovascular complications in diabetes mellitus: Distinct or continuum?. Indian J Endocr Metab 2016;20:546-51


5) Alaboud AF, Tourkmani AM, Alharbi TJ, 

Alobikan AH, Abdelhay O, Al Batal SM, et al. 

Microvascular and macrovascular complica�tions of type 2 diabetic mellitus in Central, 

Kingdom of Saudi Arabia. Saudi Med J. 2016 

Dec;37(12):1408–11.


6) Cade WT. Diabetes-related microvascular and macrovascular diseases in the physical therapy setting. Phys Ther. 2008;88(11):1322-1335. doi:10.2522/ptj.20080008


7) Alwin Robert A, Al Dawish MA. Microvascular complications among patients with diabetes: An emerging health problem in Saudi Arabia. Diab Vasc Dis Res. 2019 May;16(3):227-235. doi: 10.1177/1479164118820714. Epub 2019 Jan 1. PMID: 30599757.


8) Park, S., Kang, HJ., Jeon, JH. et al. Recent advances in the pathogenesis of microvascular complications in diabetes. Arch. Pharm. Res. 42, 252–262 (2019). https://doi.org/10.1007/s12272-019-01130-3


9) Valencia Willy Marcos, Florez Hermes. How to prevent the microvascular complications of type 2 diabetes beyond glucose control BMJ 2017; 356 :i6505


10)Thomas T van Sloten, Sanaz Sedaghat, Mercedes R Carnethon, Lenore J Launer, Coen D A Stehouwer,

Cerebral microvascular complications of type 2 diabetes: stroke, cognitive dysfunction, and depression,

The Lancet Diabetes & Endocrinology,

Volume 8, Issue 4,

2020,






Popular posts from this blog

20100006005 LONG CASE

Image
  This is an online e logbook to discuss our patients deidentified health data shared after taking her/guardian's signed informed consent Here we discuss our individual patient problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs This E log also reflects my patient centre’s online learning portfolio and valuable inputs on the comment box is welcome. CASE : 21 year old woman, working as a nurse in an outside hospital, residing at Nalgonda presented to casualty on 26/8/2021 with the chief complaints of Fever since 4 months  Generalized weakness since 4 months Cough since 1 month  Vomitings 2 episodes since 1 day  Unable to walk since 1 day Unable to pass urine and stool since 1 day H/O PRESENTING ILLNESS She was born out of a non consanguinous marriage. She cried immediately after birth.  At birth - she was in the hospital for 2 - 3 days for jaundice
Read more

50/Male came with altered sensorium

Image
50/Male who is a resident of choutuppal Daily wage labourer by occupation Came with cheif complaints of  Fever since 10 days Facial puffiness and periorbital edema since 4 days  Weakness of right upper limb and lower limb since 4 days Altered sensorium since 2 days History of present illness: Patient was apparently asymptomatic 3 years back and went to local hospital in/v/o Regular checkup and came to diagnosed with Hypertension since then he was on regulate medication...  And on 18/04/21 He went to local PHC for COVID 19 vaccination.. Since that night patient is complaining of Fever associated with chills and rigors, high grade fever, no diurnal variation which was relieved on medication...  No c/o cold and cough Followed by patient is having similar complaints after three days and he visited local hospital which is not subsided by medication ( Antipyretics) ( not taken medication such as steroids, oxygen therapy, anti virals)  On 28/04/21 , c/o Generalized weakness and facial puffine
Read more

21F with bilateral lower limb weakness

Image
This is an online e logbook to discuss our patients deidentified health data shared after taking her/guardian's signed informed consent Here we discuss our individual patient problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs This E log also reflects my patient centre’s online learning portfolio and valuable inputs on the comment box is welcome. Case:- 21 year old woman, working as a nurse in an outside hospital, residing at Nalgonda presented to casualty on 26/8/2021 with the chief complaints oof Fever since 4 months  Generalized weakness since 4 months Body pains along with multiple joint pains since 4 months Cough since 1 month  Vomiting 1 day back  Unable to walk since 1 day Unable to pass urine and stool since 1 day She was born out of a non consanguinous marriage. She cried immediately after birth.  At birth - she was in the hospital for 2
Read more