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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 6  |  Issue : 2  |  Page : 51-53

Frequency of increased carotid intima media thickness and its relation with vascular complication in newly diagnosed patients of type 2 diabetes: A Hospital-based study


1 Department of Medicine, IGMC, Shimla, Himachal Pradesh, India
2 Department of Internal Medicine, Shri Lal Bahadur Shastri Government Medical College, Mandi, Himachal Pradesh, India
3 Department of Cardiology, IGMC, Shimla, Himachal Pradesh, India

Date of Web Publication19-Jun-2018

Correspondence Address:
Rajesh Kumar Bhawani
Shri Lal Bahadur Shastri Government Medical College, Mandi, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/heartindia.heartindia_5_18

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  Abstract 


Objective: To study the frequency of increased carotid intima-media thickness (CIMT) and its relation with vascular complications in patients of newly diagnosed type 2 diabetes mellitus.
Methodology: All consecutive newly diagnosed type 2 diabetics were enrolled and evaluated for the CIMT by B mode ultrasonography and presence of vascular complications.
Results: 105 newly diagnosed patients of type 2 diabetes with a mean age of 56.55 ± 7.43 years were enrolled in the study. Mean age of patients with increased CIMT in the study was 56.45 ± 8.10 while mean age of patients with normal CIMT was 53.10 ± 9.66 years (P = 0.75) among them 53 were male and 52 were females.
Conclusion: Type 2 diabetes mellitus can present with or without symptoms and with chronic vascular complications at the time of diagnosis, measurement of CIMT by B Mode ultrasonography is an important noninvasive, cost-effective tools for the diagnosis of subclinical/overt atherosclerosis.

Keywords: CIMT, Newly diagnosed type 2 diabetes,Vascualar complications


How to cite this article:
Singh Taneja GP, Bhawani RK, Thakur S, Merwaha R. Frequency of increased carotid intima media thickness and its relation with vascular complication in newly diagnosed patients of type 2 diabetes: A Hospital-based study. Heart India 2018;6:51-3

How to cite this URL:
Singh Taneja GP, Bhawani RK, Thakur S, Merwaha R. Frequency of increased carotid intima media thickness and its relation with vascular complication in newly diagnosed patients of type 2 diabetes: A Hospital-based study. Heart India [serial online] 2018 [cited 2018 Jul 20];6:51-3. Available from: http://www.heartindia.net/text.asp?2018/6/2/51/234663




  Introduction Top


Type 2 diabetes is the most common form of diabetes constituting 90% of diabetic population. India has been proposed as diabetic capital of the world with no of patients expected to rise from 40.9 to 101 million by 2030[1] it is chronic metabolic disorder with significant years of asymptomatic stage leading to under-recognition or diagnosis.[2] One in two patients of diabetes remain undiagnosed for significant number of years highlighting the importance of opportunistic screening of diabetes and the vascular complications of diabetes at the time of diagnosis.

Atherosclerosis is an important cause of vascular complications and is accelerated in patients of diabetes. Intima-media thickness (IMT) of common carotid artery is considered to be an excellent noninvasive measure of generalized atherosclerosis. It also serves a surrogate marker of coronary artery disease (CAD)[3] and correlate strongly with future development of stroke and CAD.[4] IMT is extensively used to examine the stages of atherosclerosis and to evaluate the regression of atherosclerotic lesions in interventional therapies.

This study was planned to study the frequency of intimal media thickness in newly diagnosed patients of type 2 diabetes in sub-Himalayan region Himachal Pradesh.


  Methodology Top


This was a prospective observational hospital-based study conducted in the Department of Medicine at Indira Gandhi Medical College Shimla Himachal Pradesh. A total of 105 newly diagnosed drug naïve patients from June 2013 to May 2014 were included in the study after obtaining informed consent and approval from hospital ethical committee.

Diabetes was diagnosed as per ADA guidelines. The cerebrovascular disease (CVD) risk factor such as hypertension (JNC VII) dyslipidemia (NCEP-ATPIII), smokers (US Center for Disease control and prevention), and obesity as per Indian consensus Guidelines for Obesity were recorded.

The vascular complications CAD was defined by the presence of any of the following:

  1. Documented acute myocardial infarction based on history of chest pain, electrocardiogram (EKG) changes and elevated levels of markers of myocardial necrosis, history of Coronary artery bypass grafting/percutaneous transluminal coronary angioplasty, history of chest pain with inducible ischemia on stress, ECG evidence of silent myocardial infarction identified by Minnesota code 1:1, 1:2, and ECG evidence of the left bundle branch block with regional wall motional abnormality on echocardiography
  2. CVD was defined as a history of transient ischemic attack (TIA) or focal deficit or evidence of stroke on computerized tomography scan. Peripheral vascular disease (PVD) was defined as a history of intermittent claudication or rest pain associated with any absent or feeble peripheral pulse or ankle-brachial index <0.9.


Carotid IMT (CIMT) was measured by B mode scanning of both carotid arteries in each patient by ultrasound sonography 7.5 MHZ linear probe of i-33 Phillips Echo machine. The intimal plus medial thickness was measured as the distance from the leading edge of the first echogenic line to the second echogenic line. CIMT of both right and left side was measured and average CIMT was calculated. IMT of >0.9 mm was taken as increased IMT.

Statistical analysis

Data were recorded on a Microsoft Excel spreadsheet, statistical analysis was performed using Epi Info 2000 (center for diseases control and prevention, Atlanta, GA, USA) and SPSS student version 16.0 (SPSS Inc., Chicago, USA). All discrete variables were expressed as percentages. The differences in the distribution of discrete variables were analyzed using Chi-square test.

Age and sex distribution

Mean age of patients with increased CIMT in the study was 56.45 ± 8.10 while mean age of patients with normal CIMT was 53.10 ± 9.66 years (P = 0.75) the number of males and females with increased CIMT were 18 (48.65%) and 19 (51.35%).

Presenting symptoms

Forty-one (39.05%) were asymptomatic while 64 (61.95%) of patients out of 105 patients had symptoms suggestive of diabetes. In asymptomatic patients, 26 (24.76%) were diagnosed on routine checkup while 15 (14.29%) patients were detected to have diabetes during preoperative checkup for fitness for surgery [Table 2] and symptomatic patients, 19 (18.09%) patients presented with classical symptoms of polyuria, polydipsia, and weight loss, 14 (13.33%) patients had some infection at the time of diagnosis, 10 (9.52%) presented as acute coronary syndrome, 5 (4.76%) had stroke/TIA, and 3 (2.86%) patients had lower limb vascular ischemia. The various clinical and biochemical characteristics of the patients with newly diagnosed type 2 diabetes are listed in [Table 1]. Association of macrovascular complications such as CVD, PVD, diabetic kidney disease (DKD) was statistically significant in this study [Table 2].
Table 1: Clinical and biochemical characteristics with normal and increased carotid intima media thickness

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Table 2: Association of carotid intima-media thickness with vascular complications

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  Discussion Top


IMT of the common carotid artery is an excellent noninvasive measure of generalized atherosclerosis. B mode ultrasound is recommended by the American Heart Association as a safe inexpensive tool for the detection of subclinical and clinical atherosclerosis.[5] Thirty-seven (35%) of patients had increased CIMT >0.9 mm (mean 0.81 ± 0.15 mm) in this study. Temelkova-Kurktschiev et al.[6] have reported higher degree of early atherosclerosis in newly diagnosed patients of type 2 diabetes than normal glucose tolerant subjects matched for age and sex. The mean CIMT reported in the study was 0.98 ± 0.15 mm. In another study of newly diagnosed type 2 diabetes patients by Gu et al.[7] has also noted increased IMT in both type 1 and type 2 diabetes patients more so in patients with type 2 diabetes. Although data on CIMT in newly diagnosed patients of type 2 diabetes in India are limited in CURES-22 study by Mohan et al.[8] the mean CIMT in newly diagnosed patients was 0.79 ± 0.19 mm, which is in concordance with our study. There was statistically significant association of increased CIMT in newly diagnosed patients of type 2 diabetes with vascular complications of diabetes than patients without vascular complications. The mean CIMT in patients with vascular complications was 0.86 ± 0.15 mm as compared to 0.79 ± 0.11 in patients without vascular complications (P ≤ 0.023). Vascular complications CVD, PVD, DKD, and cardiovascular risk factors such as hypertension and dyslipidemia were statistically more significant as compared to other biochemical and clinical characteristics in our study. The risk factors for increased CIMT in diabetes are different in different studies. Temelkova-Kurktschiev et al. have reported increased CIMT in patients with dyslipedemia. Mohan et al. have shown a correlation of increased CIMT with age, total cholesterol, low-density lipoprotein cholesterol, waist: hip ratio, and systolic blood pressure in nondiabetic patients and with age and duration of diabetes in the patients with diabetes. Agarwal et al. in a study have reported statistically significant increased CIMT in patients od CAD with diabetes.[9] Ghosh et al. have reported all variety if stroke were significantly higher in patients of diabetes with increased CIMT.[10] Since in this study newly diagnosed type 2 diabetes patients were included, considering conflicting outcomes of different studies along with limited data from india further.


  Conclusion Top


The measurement of CIMT by B Mode ultrasonography is an important noninvasive cost-effective tools for the diagnosis of subclinical/overt atherosclerosis. Due to the long asymptomatic phase of diabetes, the newly diagnosed patients of type 2 diabetes should be screened for the vascular complications for which the increased CIMT a surrogate marker of CAD is and important means to asses atherosclerosis in these patients of type 2 diabetes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047-53.  Back to cited text no. 1
[PUBMED]    
2.
Spijkerman AM, Henry RM, Dekker JM, Nijpels G, Kostense PJ, Kors JA, et al. Prevalence of macrovascular disease amongst type 2 diabetic patients detected by targeted screening and patients newly diagnosed in general practice: The Hoorn Screening Study. J Intern Med 2004;256:429-36.  Back to cited text no. 2
[PUBMED]    
3.
Mukherjee SC, Basu AK, Bandyopadhyay R, Pal SK, Bandopadhyay D, Mandal SK, et al. Correlation of lipid profile and carotid artery plaque as detected by Doppler ultrasound in ischaemic stroke patients – A hospital-based study. J Indian Med Assoc 2006;104:325-6, 330.  Back to cited text no. 3
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4.
Hodis HN, Mack WJ, LaBree L, Selzer RH, Liu CR, Liu CH, et al. The role of carotid arterial intima-media thickness in predicting clinical coronary events. Ann Intern Med 1998;128:262-9.  Back to cited text no. 4
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5.
Smith SC Jr., Greenland P, Grundy SM; AHA Conference Proceedings. Prevention conference V: Beyond secondary prevention: Identifying the high-risk patient for primary prevention: Executive summary. American Heart Association. Circulation 2000;101:111-6.  Back to cited text no. 5
    
6.
Temelkova-Kurktschiev TS, Koehler C, Leonhardt W, Schaper F, Henkel E, Siegert G, et al. Increased intimal-medial thickness in newly detected type 2 diabetes: Risk factors. Diabetes Care 1999;22:333-8.  Back to cited text no. 6
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7.
Gu W, Huang Y, Zhang Y, Hong J, Liu Y, Zhan W, et al. Adolescents and young adults with newly diagnosed type 2 diabetes demonstrate greater carotid intima-media thickness than those with type 1 diabetes. Diabet Med 2014;31:84-91.  Back to cited text no. 7
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8.
Mohan V, Ravikumar R, Shanthi Rani S, Deepa R. Intimal medial thickness of the carotid artery in South Indian diabetic and non-diabetic subjects: The Chennai Urban Population Study (CUPS). Diabetologia 2000;43:494-9.  Back to cited text no. 8
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9.
Agarwal AK, Singla S, Singla S, Singla R, Lal A, Wardhan H, et al. Prevalence of coronary risk factors in type 2 diabetics without manifestations of overt coronary heart disease. J Assoc Physicians India 2009;57:135-42.  Back to cited text no. 9
[PUBMED]    
10.
Ghosh US, Chattopadhyay P, Banerjee S, Karmakar M, Majumder S. Status of carotid intima-media thickness and associated risk factors in diabetic, prediabetic and non-diabetic acute stroke. J Assoc Physicians India 2012;60:26-32.  Back to cited text no. 10
    



 
 
    Tables

  [Table 1], [Table 2]



 

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