Determinants and Stratification of Microvascular Complications of Type 2 Diabetes Mellitus

Abstract

Background Diabetes mellitus (DM) is a prevalent metabolic disorder characterized by high blood sugar levels. It is classified into type 1 (T1DM) and type 2 (T2DM), which have different mechanisms and complications. The global prevalence of diabetes, particularly T2DM, has increased significantly in recent decades, leading to a need for standardized data collection of macrovascular and microvascular complications to track disease progression and guide treatment options. This study aims to assess and correlate the prevalence and severity of microvascular complications in patients with T2DM. Methodology This observational, cross-sectional study was conducted at Poonam Multispeciality Hospital in Ahmedabad, India. A total of 4,123 diabetic patients admitted to the hospital were included. Information on sociodemographics and medical history was collected using standardized forms. Fundus photography and fluorescein angiography were performed to assess diabetic retinopathy, and estimated glomerular filtration rate and albumin-to-creatinine ratio were measured to evaluate renal function. Neurological examinations were conducted to score diabetic neuropathy. Chi-square tests were used to determine associations between medical history with diabetic retinopathy and nephropathy, and t-tests were used to compare diabetic neuropathy scores. Kendall's Tau correlation was used to determine correlations between diabetic retinopathy and nephropathy. P-values <0.05 were considered statistically significant. Results The overall prevalence of diabetic retinopathy, nephropathy, and neuropathy was 37.5%. Of the patients included, 47.9% had diabetic nephropathy and 28.9% had diabetic neuropathy. A significant association was observed between the severity of diabetic retinopathy and age, body mass index, duration of diabetes, and hemoglobin A1c (HbA1C) levels. Similarly, significant associations were found between these factors and the severity of diabetic nephropathy. Unpaired t-tests revealed significant differences in diabetic neuropathy examination scores based on the duration of diabetes and Hba1C levels. Moreover, correlation analysis indicated a low, positive correlation between diabetic retinopathy and diabetic nephropathy. Conclusions This study provides insights into the prevalence, severity, and associations of microvascular complications in patients with T2DM, contributing to the understanding and management of these conditions. Additionally, the research revealed a direct association between diabetic retinopathy and different stages of chronic kidney disease determined by the Kidney Disease Improving Global Outcome guidelines.

Keywords: diabetic nephropathy; diabetic neuropathy; diabetic retinopathy; kdigo; type 2 diabetes mellitus.

Figure 1. Division of patients and severity of diabetic nephropathy based on Kidney Disease Improving Global Outcome (KDIGO) classification.

Rani et al. [13]. Permission to reproduce was obtained from the publisher. LR (low risk) includes, A1G1, A1G2; MR (moderate risk) includes A1G3a, A2G1, A2G2; HR (high risk) includes A1G3b, A2G3a, A3G1, A3G2; VHR (very high risk) includes A1G4, A1G5, A2G3b, A2G4, A2G5, A3G3a, A3G3b, A3G4, A3G5. Green: low risk (if no other markers of kidney disease, no chronic kidney disease); yellow: moderately increased risk; orange: high risk; red: very high risk.

Figure 2. Prevalence of diabetic retinopathy.

DR: diabetic retinopathy

Figure 3. Prevalence of diabetic nephropathy.

Figure 4. Prevalence of diabetic neuropathy.