PREVALENCE AND RISK FACTORS OF MICROVASCULAR COMPLICATIONS AMONG PATIENTS WITH PREDIABETES AT A TERTIARY GOVERNMENT HOSPITAL

Abstract

INTRODUCTION
Prevalence of microvascular complications among newly diagnosed type 2 diabetes mellitus is high, which indicates that these complications namely retinopathy, nephropathy and neuropathy may be present even at mild glycemic dysregulation. Prediabetes has an increasing incidence but local studies that investigate presence of microvascular complications amongst these patients are lacking. They are an important cause of morbidity and progression may lead to blindness, development of end stage renal disease and lower extremity amputation. This study determined the prevalence of microvascular complications among patients with prediabetes seen at the outpatient department of a tertiary government hospital and looked at the association of HbA1C, BMI, LDL, HDL and smoking in the development of these complications.

METHODOLOGY
 This was a descriptive cross-sectional study in which 102 patients aged 18 years old and above diagnosed to have prediabetes based on the ADA guidelines were included. 86 patients were assessed for retinopathy using fundus photo, 94 patients were screened for nephropathy with urine micral test and neuropathy was confirmed in all 102 patients using the 10g monofilament test. Descriptive statistics was used to summarize the clinical characteristics of patients. Frequency and proportion were used for nominal variables, median and range for ordinal variables. Odds ratio was calculated to determine association of HbA1C, BMI, LDL, HDL and smoking with microvascular complications.

RESULTS
A total of 102 patients with prediabetes were enrolled in the study, 46% (n=47) of which were males. The mean age was 63 years old and 77% of them were hypertensive. Mean BMI was 25 kg/m2 , mean FBS was 108 mg/dL and mean HbA1C was 5.97%. Prevalence of retinopathy was 4.65%, neuropathy 12.7% and nephropathy 16.6%. High HbA1C was associated with all three microvascular complications, elevated BMI (23−≥25) was associated with development of nephropathy with p-value 0.0060, low level of HDL was associated with retinopathy. Smoking was associated with development of nephropathy and neuropathy with p values of 0.0401 and 0.0263 respectively.

CONCLUSION
The study emphasizes that microvascular complications are already present even at mild glycemic dysregulation. This is the first study, done locally, that investigated presence of microvascular complications among patients with prediabetes. We recommend screening of patients with prediabetes especially those who are obese and have a history of smoking to avoid progression to blindness, irreversible kidney damage and amputation. Furthermore, education of patients especially those who are high risk is of utmost importance to decrease the burden of these microvascular complications.