Presentations and complications of diabetes patients presenting to diabetic clinic of Eastern Nepal

Abstract

ObjectiveDiabetes mellitus leads to damage, dysfunction and failure of various organs especially eyes, kidneys, nerves and heart. The latency of occurence of hyperglycemia and diagnosis may be of long duration. This study was aimed to find out the mode of presetation of diabetes mellitus in diabetic patients attending out patients clinic of B P Koirala Institute of Health Sciences. Associated complications and comorbid condition present at the time of presenation were also studied. MethodsThe diabetic patients attending the Diabetic Out Patient Clinic of B P Koirala Institute of Health Sciences during June 2006 to June 2007 were included in this study.The patients details were collected from the predefined Proforma for diabetes patient from the database. This included demographic data, biochemical parameters and diabetic complications. For the purpose of study a total of 775 patients were randomly selected.The Data collected were entered and analysed using excel and SPSS(version 11.5) ResultsOut of 775 cases 436 (56.3%) were male and 339(43.7%) were female. Majority of patients 81.55% (n=632) had osmotic sympmtoms or symptoms related to complication of diabetes at the time of presentation to the clinic. Asymptomatic patient constituted 18.45% (n=143). The most common presenting complaints were polyuria (44.58%), followed by polydypsia (39.62%) and polyphagia (24.88%). About 54.97% (n=426) had symptoms of complications related to diabetes. Among them most common complication was neurological (39.67%), followed by renal (10.8%) metabolic (4.93%), cardiac(4.46%), autonomic neuropathy (4.93%) and peripheral vascular disease (3.99%). ConclusionMajority of the patients presenting in our OPD had osmotic symptoms or symptoms related to complication of diabetes. Access to diabetes care and lack of awareness of the disease and its complication might had contributed to this. Community awareness, program for early detection and managemnet may help proper diabetes care and prevention of complications.

Prevalence of peripheral neuropathy in diabetes mellitus and its association with therapy, ethnicity and duration of diabetes mellitus

“…Diabetes mellitus (DM) is a chronic hyperglycemic condition due to metabolic derangements mainly attributed to absolute insulin deficiency or defect in insulin action. 1,2 Almost 6% of world's population are affected by DM and the burden is increasing at an alarming rate. 2 Nepal is also facing the increase burden of DM as like other nations globally.…”

“…1,2 Almost 6% of world's population are affected by DM and the burden is increasing at an alarming rate. 2 Nepal is also facing the increase burden of DM as like other nations globally. 2 It is assumed that one in ten Nepalese have DM and the prevalence is higherin compare to India, Pakistan and Bangladesh.…”

“…2 Nepal is also facing the increase burden of DM as like other nations globally. 2 It is assumed that one in ten Nepalese have DM and the prevalence is higherin compare to India, Pakistan and Bangladesh. [3][4][5][6] Studies from Nepal further indicates that about 50% of the cases of DM remain undiagnosed.…”

“…5 Compounded by lack of quality health service, lack of routine health checkup, personal ignorance, and late consultation to health care provider, the complications of DM might be higher or more severe in our setting. 2 Diabetes mellitus poses significant morbidity and mortality if untreated because of its associated late complications in the form of microvascular and macro-vascular structures. 1 Complications are imputed to hyperglycemia, non-enzymatic glycation, oxidative stress, dyslipidemia, increased polyol pathway activity, altered perfusion, etc.…”

“…5 Furthermore, people with type-2 DM are at high risk of complications due to its insidious nature and late diagnosis, than type -1 DM. 2 Neuropathy has been considered as important micro vascular complication of diabetes and sometimes reasoned as the pathological process for other abnormalities in DM. 1,7,8 Neuropathy is present from early stage of DM which slowly progresses over several years causing systemic damage.…”