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A STUDY ON PREVALENCE OF CHRONIC COMPLICATIONS AMONG

DIABETIC PATIENTS
P. Lakshmi1*, D. Venkata Chetana2, E. Deepthi2, L. Lahari2, M. Bhanuja2, M. Jyothika2,
Dr. D. Ranganayakulu3, Dr. D. R. Arunakumari 4

1* Associate professor, Sri padmavathi school of pharmacy, Tiruchanoor, Tirupati- 517502


2 B Pharmacy IV year student, Sri padmavathi school of pharmacy, Tiruchanoor, Tirupati-
517502
3 Principal, Sri padmavathi school of pharmacy, Tiruchanoor, Tirupati- 517502
4 Associate professor, seven hills college of pharmacy, Tirupati- 517502

Corresponding address
Mrs. P. Lakshmi
Associate professor
Sri padmavathi school of pharmacy
Tiruchanoor, Tirupati-517502
Email: [email protected]
Phone no: 8074198275
ABSTRACT
Background: The global prevalence of diabetes mellitus has increased fourfold during the
past three decades, making it the tenth most common cause of death. Possible long-term
effects include damage to large (macrovascular) and small (microvascular) blood vessels,
which can lead to heart attack, stroke, and problems with the kidneys, eyes, gums, feet and
nerves. Aim&Objectives: This study aimed to evaluate the prevalence of chronic
complications among diabetic patients and focused on patterns of diabetic complications
among patients. Method: A prospective observational study was carried out for three months
from December 2023 to February 2024 to evaluate prevalence of diabetic complications
among diabetic patients. Results & Discussion: Total 130 patients were included in the study.
The Mean± SD for patients age was 21±7. The male (60%) patients are reported higher than
female (40%) patients. Type II DM was reported in majority of patients. Out of 130
patients,84 patients (64.615%) with comorbidities followed by 46 patients (35.385%) without
comorbidities. The 53 patients (40.76%) were complicated with Hypoglycaemia, followed by
49 patients (39.69%) were complicated with Diabetic foot ulcer, followed by 47 patients
(36.15%) were complicated with Diabetic nephropathy, 42 patients (32.30%) were
complicated with Diabetic retinopathy,39 patients (30%) were complicated with Keto-
acidosis, and 18 patients (13.84%) were complicated with Amputation were excluded in the
study. Conclusion: Diabetic complications are more common in chronic diabetic patients
than newly diagnosed patients. The personal habits (alcohol & smoking) and uncontrolled
glucose levels among patients played a major role in the occurrence of macrovascular and
microvascular complications in diabetic patients.
Introduction:
Diabetes is an endocrine condition characterised by high amounts of glucose in the blood.
Diabetes mellitus, commonly referred to as DM, is a chronic medical disorder characterised
by insufficient insulin production by the pancreas or inadequate utilisation of the body's
insulin. Insulin is a hormone that regulates blood glucose levels. Glucose, sometimes known
as sugar, mostly originates from the carbohydrates present in food and beverages. It is the
primary source of energy for your body. The bloodstream transports glucose to every cell in
the body for energy use1. Glucose requires assistance, in the form of a "key," to reach its
ultimate destination within the bloodstream. This key is insulin, which is a hormone.
Insufficient production of insulin by the pancreas or improper utilisation of insulin by the
body leads to the accumulation of glucose in the bloodstream, resulting in hyperglycaemia.
Diabetes is an incurable condition. However, by medical intervention and modifications to
one's way of life, it is possible to achieve a prolonged and robust lifespan. The bloodstream
transports glucose to every cell in the body to serve as an energy source. Diabetes comes in
different forms, depending on the cause2.

Individuals who are classified as obese, exceeding their optimum body weight for their height
by more than 20%, are particularly prone to a heightened risk of developing type 2 diabetes
and the subsequent health complications that may ensue. Obesity frequently leads to insulin
resistance, necessitating increased pancreatic effort to produce additional insulin. However, it
remains insufficient to maintain blood sugar levels within the usual range. The management
of type 2 diabetes include maintaining a desirable body weight, adhering to a nutritious diet,
engaging in physical activity, and utilising hypoglycaemic drugs3.

In India, the incidence of diabetes has increased from 7.1% in 2009 to 8.9% in 2019.
Presently, there is an estimated population of 25.2 million adults with impaired glucose
tolerance (IGT), and this number is projected to rise to 35.7 million by the year 2045. For
adults in the United States who are 20 years old or older, statistics at the county level,
adjusted for age, showed that in 2019, the prevalence of diagnosed diabetes varied between
4.1% and 17.6% across different counties4. The median prevalence of diagnosed diabetes at
the county level experienced a rise from 6.3% in 2004 to 8.4% in 2019. At the present time
According to the 2023 study conducted by the Indian Council of Medical Research - India
Diabetes (ICMR INDIAB), the prevalence of diabetes in India is 10.1 crores. 15.3% of the
population, which amounts to an extra 136 million individuals, are pre-diabetic. The latest
national projections for diabetes and other non-communicable diseases (NCDs) indicate that
in India, as of 2021, there are 101 million individuals Introduction Department of Pharmacy
Practice, SPSP Page 7 diagnosed with diabetes and 136 million individuals with prediabetes.
Additionally, 315 million people have been diagnosed with high blood pressure, 254 million
with generalised obesity, and 351 million with abdominal obesity5.

This study provides updated information on prevalence of DM complications, as well as the


various factors such as nutrition, lifestyle, and other risk factors that contribute to the
development of DM and its associated complications. The main aim of the present study was
to evaluate the prevalence of chronic complications among diabetic patients6.

Methods:
A prospective observational study was carried out in the general medicine department, of Sri
Venkateswara Ram Narayana Ruia government general hospital, Tirupati. The study was
started after obtaining permission from the institutional ethical committee, Sri Padmavathi
School of Pharmacy, Tiruchanoor, Tirupati, A.P, India. The study subject details were
collected from the case sheets with diabetes mellitus diagnosis reported in the General
Medicine department through a specially designed proforma which includes patient
demographics, past medical history, family and surgical history, co-morbidities, diagnosis,
and present medications prescribed for each patient. 130 cases were collected from general
medicine wards, according to study criteria. All the patients who were a known case of DM
and with or without complications are included in the study. We obtained our study results
with the help of Microsoft Excel and interpreted them by using SPSS software. Patients of
either gender of age ≥ 20 years and who had a known case of diabetes mellitus with or
without complications reported in the general medicine outpatient department were included
in the study. The Pregnant and lactating women, Immunocompromised patients, Psychiatry
patients and patients who are admitted to the intensive care unit are excluded from the study.

Results:
Out of 130 patients, 36 patients (27.69%) were under the age group of 60-69Y followed by
33 patients (25.38%) under the age group of 50-59Y followed by 27 patients (20.76%) were
under the age group of 40-49Y followed by 19 patients (14.61%) were under the age group of
70-79Y followed by 9 patients (6.92%) were under the age group of 30-39Y followed by 6
patients (4.61%) were under the age group of 20-29Y respectively. The Mean± SD was
calculated as 21±7. Majority of patients are Males 78(60%) are easily exposed to the usage of
comorbidity when compared to Females. Whereas, Females (40%) are exposed to the usage
of comorbidity respectively. In total patients, 51 Male patients are type-II DM and 27 Male
patients are type-I DM when compared to Females. Whereas, 29 Female patients are type-II
DM and 23 Female patients are type-I DM. Among the patients, the 7 categories of
comorbidity, CNS disorders 49 (37.69%) were the most common comorbidity, followed by
Renal system disorders 47 (36.15%), followed by CVS disorders 42(32.30%), followed by
Endocrine disorders 41(31.53%), followed by RS disorders 31(23.84%), and the least
comorbidity were GI disorders 27(20.76%), and skin infections 13(10%) respectively.

Table 1 Variables of study population


Variables No of Patients (n=130) (%) Mean (SD)
Age range
20-29 6(4.61%)
30-39 9(6.92%)
40-49 27(20.76%) 21±7
50-59 33(25.38%)
60-69 36(27.69%)
70-79 19(14.61%)
Gender n%
Male 78(60%) 65±13
Female 52(40%)
Family History
No of patients without family history 84(64.6%) 65 ±13.4
Patients with-out comorbidities 46(35.4%)
Type of DM
Type II DM 80(61.5%) 65 ±10.60
Type I DM 50(38.5%)
Comorbidities
CNS Disorders 49(37.69%)
Renal Disorders 47(36.15%) 35.7±8.79
CVS Disorders 42(32.30%)
RS Disorders 31(23.84%)
GI Disorders 27(20.76%)
Endocrine Disorders 41(31.53%)
Skin Infections 13(10%)
Complications
Diabetic foot ulcer 49(39.69%) 41.3 ±7.6
Diabetic nephropathy 47(36.15%)
Keto-acidosis 39(30%)
Diabetic retinopathy 42(32.30%)
Amputation 18(13.84%)
Hypoglycaemia 53(40.76%)
Family history
Without family history 79(60.76%) 65 ±9.8
With a family history 51(39.23%)
Education history
Illiterate’s 52(40%) 21.5 ±10.07
Elementary school 23(17.69%)
Secondary school 21(16.15%)
Intermediate 17(13.07%)
Degree holders 12(9.23%)
Pg holders 4(3.07%)

Among study population,79 patients (60.769%) with family history along with 51 patients
(39.230%) with family history. Out of 130 patients, with an education status, 52 patients
(40%) were illiterates, followed by 23 patients (17.692%) were in elementary school,
followed by 21 patients (16.153%) were in secondary school, followed by 17 patients
(13.076%) were in intermediate, followed by 12 patients (9.230%) were in degree holders,
and followed by 4 patients (3.076%) were in PG holders were included in the study
respectively.

Table 2 Personal habits & diabetic status details of patients

Personal habits No of patients (n=130) No of patients P Value


with
complications
Alcohol 34(26.15%) 23(67.64%) 0.001
Smoking 23(18.46%) 14(60.86%) 0.023
Both 77(59.23%) 62(80.51%) 0.041
Nill 24(18.46%) 9(37.5%) 0.058*

Diabetic status
Controlled glucose levels 57(43.84) 12 (21.05%) 0.002
Uncontrolled glucose 73(56.15) 61 (83.56%) 0.023
levels
P value≤ 0.05=significant
Out of 130 Patients, 34(26.15%) patients have a personal habit of alcohol, among them
23(67.64%) Patients are having complications followed by 23 patients(18.46%) having a
habit of Smoking, in them 14(60.86%) patients are having complications followed by
77(59.23%) Patients having both habits (alcohol & smoking), among them 62(80.51%)
patients are having complications followed by 24(18.46%) patients are reported without any
personal habits like alcohol & smoking, in them 9(37.5%) patients are with complications. In
current study, only 57 patients (43.48%) have controlled glucose levels and other 73 patients
(56.15%) have Uncontrolled glucose levels respectively.
Discussion:
Diabetes is a disease that is strongly associated with both microvascular and macrovascular
complications, including retinopathy, nephropathy, and neuropathy (microvascular) and
ischemic heart disease, peripheral vascular disease, and cerebrovascular disease
(macrovascular), resulting in organ and tissue damage in approximately one third to one-half
of people with diabetes. Because of the progressive nature of the disease, physical therapists
will increasingly encounter patients with prediabetes (i.e., impaired glucose tolerance or
insulin resistance), early type 2 DM without or with only a few vascular complications, and
more advanced diseases with several vascular complications.

Chronic complications have a significant role in diabetic patients and healthcare resources.
Hence it is important to understand the epidemiology of diabetes and its comorbidities. In the
present study among 130 diabetic patients, the prevalence rate of diabetic complications was
considered in the study where 36 patients (27.69%) were under the age group of 60-69Y
followed by 33 patients (25.38%) under the age group of 50-59Y followed by 27 patients
(20.76%) were under the age group of 40-49Y followed by 19 patients (14.61%) were under
the age group of 70-79Y followed by 9 patients (6.92%) were under the age group of 30-39Y
followed by 6 patients (4.61%) were under the age group of 20-29Y respectively which were
similar to study done by M.S.Praythiesh3 et.al., study . It was found the highest diabetes
prevalence was in the age group of 60–69 years among the older adults. The overall
prevalence of diabetes among older adult people was found to be higher than compared to
younger ones. One of the reasons for this is increasing insulin resistance with age. Factors
that contribute to insulin resistance are decreased muscle mass (sarcopenia), overweight, and
reduced physical activity in older people. In addition, the pancreas does not function as well
as in younger people.

Among 130 patients out of which Males 78 (60%) are easily exposed to the usage of
comorbidity when compared to Females 52 (40%) respectively. This is due to exposure to the
usage of comorbidity which were similar to the study done by Karthikeyan 5 et.al., study.
Some research suggests that where people carry fat may help explain the differences in
diabetes rates between the sexes. One of the reasons was, that men have larger amounts of
visceral (mostly abdominal) fat than women. Women tend to have more subcutaneous
(mostly leg and hip) fat than visceral fat. The dietary habits and lifestyle are also noted as
important factors in reporting the high number of males in the present study. The distribution
of patients based on the type of diabetes mellitus was calculated. The type II DM was
recorded in the majority of patients (80). These findings were similar to the study conducted
by Sheleme6 et al., study. Unlike type 1 diabetes, the risk of developing type 2 diabetes
increases with age. The people are more at risk of developing type 2 diabetes than 40 years of
age. Being overweight, obesity and physical inactivity are major reasons behind the
prevalence of type II DM. Extra weight sometimes causes insulin resistance and is common
in people with type 2 diabetes.

In the total study population, the majority of patients i.e. 84(64.6%) are reported patients with
co-morbidities were 46(35.4%) patients were reported without comorbidities. These findings
are similar to the study conducted by Vaz4 et al., study. These results implicate diabetes as one
of the major disorders that result in producing comorbidities. The study population was
classified based on their co-existing conditions. The CNS disorders in 49(37.7%) patients
followed by 47(36.15%) patients in renal system disorders are reported in a majority of
patients. The CNS disorders like neuropathy and nephropathy were noted among patients.
The CVS disorders are also reported in 42(32.30%) patients. The autonomic dysfunction
commonly found in diabetic patients is associated with a high risk of cardiac arrhythmias and
sudden death, as well as other serious CV sequelae including silent myocardial ischemia,
diabetic cardiomyopathy, stroke, and both intraoperative and perioperative CV instability.
These results are noted as similar to the study conducted by Praythiesh 3 et al., on the
prevalence of complications of diabetes among patients with DM attending a tertiary care
centre in Tamil Naidu.

Out of 130 patients, the majority of patients are noted as without family history (79(60.76%)
and most of the patients are reported as illiterates (52(40%) followed by elementary school
education (23(17.69%). As most of the patients in our study are recorded as type II DM and
the prevalence of type II DM was non-genetic and lifestyle modifications. These results are
similar to the study conducted by Seid5 et al., study.

The duration of illness and prevalence of complications were recorded among the study
population, the majority of patients with complications were reported in >10 (27(77.14%))
years of illness followed by 6-8 years (32(66.67%)). The poor control of DM & High sugar
levels for chronic periods in blood over a long period can seriously damage blood vessels. If
blood vessels aren't working properly, blood can't travel to the parts of the body it needs to.
These results are similar to Sheleme6 et al., study7 on the Prevalence, Patterns and Predictors
of Chronic Complications of Diabetes Mellitus at a Large Referral Hospital in Ethiopia.
Among 130 patients, the majority of patients are taking both oral hypoglycaemics and insulin
therapy. These results are similar to the vaz4 et al., study as the majority of patients in their
study are reported with taking both insulin and oral hypoglycaemics. The type 2 diabetic
patients are both insulin-deficient and insulin-resistant, thus requiring quite high doses of
exogenous insulin and type 2 DM patients are reported majorly in the current study. Out of
130 Patients, 46 patients (35.38%) were prescribed triple therapy followed by 35 patients
(26.92%) were taking Quadruple therapy followed by 32 patients (24.61%). We're taking the
Dual therapy and 17 patients (13.07%) were taking the monotherapy respectively. These
results are similar to the study conducted by Sheleme 6 et al., study. The number of
medications in prescription was increased as co-morbidities and long-term complications
increased among patients.

In the current study, the majority of patients with complications are reported to have both
alcohol and smoking habits (77(59.23%) patients 62 (80.51%) patients are reported with
complications). The alcohol & smoking significantly interact diabetes with each other in
imposing increased risks of subsequent CVD events, and the cardiovascular benefits of risk
factor management in diabetes could be counteracted by former or current smoking. These
results are similar to the study conducted by Karthikeyan5 et al., study. The values obtained
were statistically evaluated with a chi-square test. The high rate of complications was
significantly associated with personal habits like alcohol and smoking.

The diabetic status among patients was recorded, out of 130 patients, only 57 patients
(43.48%) have controlled glucose levels and the other 73 patients (56.15%) have uncontrolled
glucose levels respectively. It implies that uncontrolled glucose levels are one of the most
common reasons behind increasing complications as diabetic complications are a result of
interactions among systemic metabolic changes, such as hyperglycaemia, differential local
tissue responses to toxic metabolites of glucose metabolism, and genetic and epigenetic
modulators. The high rate of complications is significantly associated with uncontrolled
glucose levels.

Diabetes is a lifelong condition, and without proper management, it can cause numerous
complications. These include chronic kidney disease, nerve damage, and conditions that
affect your eyes, feet, blood vessels, and skin. Reaching or maintaining a moderate weight,
leading an active lifestyle, eating a healthful diet, and following your treatment plan can help
you manage diabetes.
Conclusion: The diabetic complications are more common in chronic diabetic patients than
newly diagnosed patients. The personal habits (alcohol & smoking) and uncontrolled glucose
levels among patients played a major role in the occurrence of macrovascular and
microvascular complications in diabetic patients. The current study also stated that a lower
prevalence of diabetes mellitus complications was linked to effective blood sugar control.
Good diabetic mellitus management and an early diagnosis may help to overcome these
obstacles. Chronic diabetic patients are more likely to experience complications due to
personal habits and uncontrolled glucose levels. Effective blood sugar control and early
diagnosis can help reduce complications. To reduce risk, manage comorbid conditions,
achieve good glycaemic control, and involve clinical pharmacists in disease monitoring and
lifestyle modifications.

References:
1. Cade WT. Diabetes-related microvascular and macrovascular diseases in the
physical therapy setting. Phys Ther. 2008;88(11):1322-35. Available from:
https://doi.org/10.2522/ptj.20080008

2. Knuiman MW, Welborn TA, McCann VJ, Stanton KG, Constable IJ. Prevalence of
diabetic complications in relation to risk factors. Diabetes. 1986- 12;35(12):1332-
1339. Available from: https://doi.org/10.2337/diab.35.12.1332

3. Praythiesh Bruce, M. S., & Vasantha Mallika, M. C. Prevalence of complications


of diabetes among patients with diabetes mellitus attending a tertiary care centre in
Tamil Nadu. Int J Community Med Public Health. 2019;6(4):1452–1456.
Available from: https://doi.org/10.18203/2394-6040.ijcmph20191049
4. Vaz NC, Ferreira A, Kulkarni M, Vaz FS, Pinto N. Prevalence of diabetic
complications in rural Goa, India. Indian Journal Community Med. 2011 -
10;36(4):283-6. Available from DOI: 10.4103/0970-0218.91330.
5. Karthikeyan M, Logaraj M. Prevalence of Certain Chronic Complications of
Diabetes among Type 2 Diabetic Patients in Rural Population of Kancheepuram
District, Tamil Nadu- A Cross Sectional Study. Int J Med. Public Health. 2017;
7(1): 41-46. Available from DOI : 10.5530ijmedph.2017.1.7
6. Sheleme, T,Mamo G, Melaku, T, Sahilu, T. Prevalence, Patterns and Predictors of
Chronic Complications of Diabetes Mellitus at a Large Referral Hospital in
Ethiopia: A Prospective Observational Study. Diabetes, Diabetes Metab Syndr
Obes. 2020; 13: 4909-4918. Available from DOI: 10.2147/DMSO.S281992
7. Seid, M.A., Akalu, Y., Gela, Y.Y., Belsti, Y, Diress, M., Fekadu, S.A., Dagnew,
B., & Getnet, M. (2021). Microvascular complications and its predictors among
type 2 diabetes mellitus patients at Dessie town hospitals, Diabetology &
metabolic syndrome, 13(1), 86. Available from: https://doi.org/10.1186/s13098-
021-00704-w
8. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025:
prevalence, numerical estimates, and projections. Diabetes Care. 1998-
9;21(9):1414-1431. Available from: https://doi.org/10.2337/diacare.21.9.1414
9. Ramachandran A, Snehalatha C, Dharmaraj D, Viswanathan M. Prevalence of
glucose intolerance in Asian Indians. Urban-rural difference and significance of
upper body adiposity. Diabetes Care. 1992;15(10):1348-1355. Available from:
https://doi.org/10.2337/diacare.15.10.1348.
10. Songer TJ, Zimmet PZ. Epidemiology of type II diabetes: an international
perspective. Pharmacoeconomics. 1995;8 Suppl 1:1-11. Available from:
https://doi.org/10.2165/00019053-199500081-00003
11. Hayfron-Benjamin C, van den Born BJ, Maitland-van der Zee AH, Amoah AGB,
Meeks KAC, Klipstein-Grobusch K, Bahendeka S, Spranger J, Danquah I,
Mockenhaupt F, Beune E, Smeeth L, Agyemang C. Microvascular and
macrovascular complications in type 2 diabetes Ghanaian residents in Ghana and
Europe: The RODAM study. J Diabetes Complications. 2019-9;33(8):572-578.
Available from: DOI: 10.3389/ijph.2021.1604056.
12. Govindarajan Venguidesvarane A, Jasmine A, Varadarajan S, Shriraam V,
Muthuthandavan AR, Durai V, Thiruvengadam G, Mahadevan S. Prevalence of
Vascular Complications Among Type 2 Diabetic Patients in a Rural Health Center
in South India. J Prim Care Community Health. 2020;2(11):215-11. Available
from: https://doi.org/10.1177/2150132720959962
13. Uddin F, Ali B, Junaid N. Prevalence of Diabetic Complications In Newly
Diagnosed Type 2 Diabetes Patients In Pakistan: Findings From National Registry.
J Ayub Med Coll Abbottabad.2018 (10-12);30(Suppl 1) (4): S652-S658. Available
from: https://pubmed.ncbi.nlm.nih.gov/30838825/
14. Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, Hadden D,
Turner RC, Holman RR. Association of glycemia with macrovascular and
microvascular complications of type 2 diabetes (UKPDS 35): a prospective
observational study. BMJ. 2000 Aug 12;321(7258):405-12. Available from:
https://doi.org/10.1136/bmj.321.7258.405
15. Kaveeshwar SA, Cornwall J. The current state of diabetes mellitus in India.
Australas Med J. 2014 ;7(1):4. Available from: DOI: 10.4066/AMJ.2013.1979.

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