Prevalence of Certain Chronic Complications of Diabetes among Type 2 Diabetic Patients in Rural Population of Kancheepuram District, Tamil Nadu- A Cross Sectional Study

The type 2 diabetes (T2DM) being the most common type of diabetes has a relatively asymptomatic phase between the actual onset of the condition and its clinical diagnosis which is estimated to 4-7 years.1,2 The diabetics in low and middle income countries who contribute to 70% of diabetics have limited access to diabetic care.3 As a progressive disease diabetic patients are frequently diagnosed with chronic complications including cardiovascular disease, nephropathy, coronary heart disease, retinopathy, and neuropathy. The prevalence of these complications of diabetes is generally expected to be proportional with the duration of diabetes and degree of glycemic control.4 This is of concern as 50% of diabetics in India are undiagnosed5 and that the newly diagnosed diabetes patients are often found to have signs of these complications. Late or undiagnosed cases become victims of diabetic complications early in their life which are directly responsible for poor quality of life, economical catastrophe, premature death and incur heavy burden to the health care system.3 Diabetes mellitus basically produces changes in the blood vessels and therefore affect almost every part of the body. Diabetic nephropathy has become a world epidemic accounting for one third of all cases of End Stage Renal Disease worldwide.5 More than half of non-traumatic amputations are due to diabetic complication. About 11% of total health expenditure for adults in the world is spent on diabetics.6 A significant economical burden is imposed on both the state and the individual for treatment of diabetic complications. India has a prevalence of 8.7%, higher than the world prevalence. Every seventh type 2 diabetes patient in the world is an Indian.7 A quarter of all diabetic deaths happen in India. Study by Mohan et al (CUPS study) has shown that mortality rates are twofold higher in diabetic people when compared to nonABSTRACT Background: Nearly 50% of diabetics in India are undiagnosed and that the newly diagnosed diabetes patients are often found to have signs of complications. Objectives: To estimate the prevalence of diabetic complications, other than retinopathy and peripheral vascular disease, among known diabetic patients treated at healthcare centers in Kancheepuram district of Tamil Nadu; and to analyze the associations between chronic complications and patient’s demographics, T2DM characteristics. Methodology: A cross sectional study was carried out in sixteen out of fifty six health care centers in Kancheepuram district in Tamil Nadu by cluster sampling method using the semi-structured questionnaire, with medical record, physical examination and biochemical investigation to identify chronic kidney disease and co-morbid conditions of type 2 diabetes. A Disability Neuropathy Score (DNS) of more than zero and negative monofilament/vibration tests were used to classify patients as having signs of peripheral neuropathy. Results: Prevalence of Ischemic heart disease and stroke were 7.8% and 0.5% respectively. Prevalence of stage I kidney disease based on the KDOQI guidelines using the estimated GFR and urine PCR values was 30.7% , while chronic kidney disease (i.e., stage II or III or PCR>0.2) was seen in 10.4% patients. Based on the DNS scoring chart 59% of them had peripheral neuropathy while 19% of them had signs of peripheral neuropathy. Participants with at least one chronic complication of diabetes (excluding retinopathy) were 32.8 percent. Prevalence of hypertension was 61.4%. and Hyperlipidemia was 85.9% ,while high LDL, TGL was seen with 60.9% and 64.6% respectively, low HDL among 83.9 % of patient. Conclusion: The high prevalence of undiagnosed microvascular complications in known diabetics treated at primary care emphasis a strong need for routine screening for complications of diabetes and to create awareness on its early detection and prevention of progression.