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,






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