Predictors of Macro and Microvascular Complication in Type 2 Diabetes Mellitus Patients at Dr. Moewardi Hospital, Surakarta

Abstract

Background: Type 2 Diabetes Mellitus (Type 2 DM) is one of the major causes of morbidity and mortality worldwide. Morbidity and mortality due to diabetes are associated with the development of various microvascular complications (retinopathy, nephropathy, and neuropathy) and macrovascular complications (coronary heart disease, stroke, and peripheral vascular disease). This study aimed to examine the determinants of biopsychosocial macro and microvascular complications in patients with type 2 DM at Dr. Moewardi Surakarta. Subjects and Method: This was an analytic observational with a case-control design. The study was conducted at Dr. Moewardi, Surakarta, Central Java, from January to March 2018. A sample of 75 Type 2 DM cases with complication and 75 Type 2 DM cases without complication was selected for this study by fixed disease sampling. The dependent variables were macro and microvascular complications. The independent variables were body mass index (BMI), blood pressure, quality of life, depression, duration of disease, physical activity, diet, medication adherence, health financing, and routine blood sample. Clinical data were taken from medical record. The data of other variables were collected by a set of pre-tested questionnaire. Logistic regression was employed for data analysis. Results: The risk of macro and microvascular complications in type 2 DM patients increased with high BMI (OR= 22.00; 95% CI= 7.50 to 64.52, p<0.001), poor quality of life (OR= 7.06; CI 95%= 3.51 to 14.16, p<0.001), depression (OR= 3.30; 95% CI= 1.39 to 7.79, p= 0.007), longer duration of disease (OR= 9.71; 95% CI= 2.79 to 33.71, p<0.001), lack of physical activity (OR= 8.16; 95% CI= 1.23 to 53.93, p=0.029), poor diet (OR= 3.58; 95% CI= 1.39 to 9.18, p=0.008), poor medication adherence (OR= 4.54; 95% CI= 1.71 to 12.05, p=0.002), and irregular blood sample control (OR= 5.80; 95% CI= 1.97 to 14.65, p=0.001). Conclusion:The risk of macro and microvascular complications in patients with type 2 DM is determined by BMI, quality of life, depression, duration of disease, physical activity, diet, medication adherence, and blood sample control.

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“… 12 Development of microvascular and macrovascular complications cause significant morbidity and mortality among people with diabetes. 24 People with diabetes with uncontrolled blood glucose are at increased risk of developing these complications. 25 Achieving the goal of glycemic control is the most effective way to avoid or delay the occurrence of diabetes complications.…”

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“…However, there was no significant difference with other studied parameters in mixed complications and control groups. Handoko et al [34] indicated that the length of sickness had an effect on the microvascular complications in T2DM patients. This was in accordance with a study conducted by Abu Al-Halaweh et al [35] who observed substantial link between microvascular problems and diabetes duration.…”

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“…Early detection and treatment, on the other hand, reduce the incidence of ulceration. 5 Other macro-vascular complications like Coronary artery diseases (CAD) and cerebrovascular diseases like stroke are rapidly growing and strongly associated with DMT2 and 2-4 folds more common in DMT2 patients compared with those without diabetes. 6 According to the world health organization (WHO), the prevalence of CAD only in the Eastern Mediterranean region (EMRO) is 54% while these deaths may vary from 13% to 49% depending on the country also accounts for a considerable number of deaths in the region.…”