J Med Assoc Thai 2018; 101 (10):1349-55

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Prevalence of Chronic Microvascular Complications and Diabetic Foot Problems in Patients with Diabetes Mellitus at Siriraj Hospital
Laotaveerungrueng N , Wanthong S , Wannachalee T , Lertwattanarak R Mail

Background: The chronic disease diabetes mellitus [DM] and its associated complications substantially increase morbidity and mortality, resulting in major burdens on healthcare systems. Early detection and prevention of DM-related complications have proven to be cost-saving and cost-effective.

Objective: 1) To determine the prevalence of each microvascular complication in patients with DM at Siriraj Hospital and 2) To determine the factors associated with each microvascular complication.

Materials and Methods: In this cross-sectional observational study, the authors recruited patients with type 1 and type 2 DM who attended the diabetes clinic at Siriraj Hospital between January 1, 2012 and December 31, 2013 by searching the hospital database. Subjects who had been treated at the clinic for less than 12 months were excluded. Data was collected from the medical records for the 12 months preceding each patient’s last visit.

Results: The study included 430 patients. The majority were female; tended to be aged 60 years or older; had a long duration of type 2 DM (more than 10 years); were either pre-obese (BMI 23.0 kg/m2 or more but less than 24.9 kg/m2) or obese (BMI of 25.0 kg/m2 or more); and had the co-morbidities of hypertension [HT] and dyslipidemia. The mean fasting plasma glucose [FPG] and HbA1C were 147 mg/dl and 7.93%, respectively. The prevalence of diabetic nephropathy [DN], diabetic retinopathy [DR], and diabetic foot were 38.8% (95% CI 33.7 to 44), 40.4% (95% CI 35.7 to 45.3), and 39.1% (95% CI 34.4 to 43.9), respectively. The factors associated with DN were insulin use, HbA1C greater than 7%, HT, DR, and diabetic foot. Those associated with DR were insulin use, HbA1C greater than 7%, HT, an old cerebrovascular accident [CVA], DM duration longer than five years, DN and diabetic foot. The factors associated with diabetic foot were insulin use, HbA1C greater than 7%, duration of DM of longer than five years, smoking, type of DM (type 2 DM), coronary artery disease [CAD], DN and DR.

Conclusion: The prevalence of DN, DR, and diabetic foot were 38.8%, 40.4%, and 39.1%, respectively. Diabetic microvascular complications are common and are associated with poor glycemic control (HbA1C greater than 7%), insulin use, a long duration of diabetes, HT, and the presence of other microvascular complications.

Keywords: Microvascular complications, Diabetes mellitus

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