Diabetes Mellitus;

Abstract

Diabetes mellitus is a modifiable risk factor for generalized atherosclerosis.Measurement of carotid intima media thickness by Doppler ultrasonography can be used tomeasure the extent of atherosclerosis. Objectives: To determine the association of carotidatherosclerosis in patients with type 2 diabetes mellitus and its relationship with glycemiccontrol. Study Design: Cross-sectional comparative study. Period: 12 months June 2015 toMay 2016. Setting: Creek General Hospital in the Department of Medicine and Radiology,Karachi, Pakistan. Method: The subjects were selected from diabetic patients presenting tothe Out-Patient Department and controls from their attendants. All subjects had a detailedhistory, physical examination and laboratory investigations recorded. The variables includedage, gender, weight, BMI, blood pressures, fasting and post prandial blood sugars, HbA1cand lipid profile. All individuals underwent B-mode ultrasound for carotid Doppler studies. Asingle operator conducted all the Doppler studies. The carotid intima media thickness wasmeasured and the presence of carotid plaque was recorded for each subject. The data wasentered on SPSS ver 20.0. Numbers and percentages were calculated for categorical datawhile mean±standard deviation was calculated for continuous data. The carotid intima mediathickness and its association with diabetes were analyzed by Student’s t test. P-value of <0.05was considered significant. Among the diabetic patients the relationship of glycemic controland carotid intima media thickness was analyzed through student’s t-test. P-value of <0.05was considered significant. The association of presence of carotid plaque for diabetic and nondiabeticsubjects was assessed by Chi-square test. P-value of <0.05 was taken as significant.Association of carotid plaque among diabetic patients with satisfactory and unsatisfactoryglycemic control was also assessed through the Chi-square test and p-value of<0.05 wasconsidered significant. Result: Out of the total study population of 237 subjects, which consistedof 119 diabetic and 118 normal controls, there were 105 male and 132 female patients. Themean fasting blood sugar was 113.3±55.2 mg/dl, mean random blood sugar was 185.9±102.0mg/dl, mean HbA1c was 6.98±2.5 %. Mean ±SD of carotid intima media thickness was0.91±0.17 mm. Results revealed that diabetes has significant association with the thicknessof carotid intima media (p-value<0.000). A total of 28 individuals (11.8%) had a carotid intimamedia thickness that was classified as a localized carotid artery plaque. The presence of carotidplaque also showed a significant association with the presence of diabetes. The degree ofglycemic control showed no relationship with carotid intima media thickness. The presenceof carotid plaque also showed no association with degree of glycemic control. Conclusion:CIMT measured by Doppler ultrasonography was found to be significantly associated with thepresence of diabetes mellitus. There was no relationship of glycemic control with CIMT amongthe diabetic patients.