Diabetes Mellitus; Carotid Thickness - Association of Glycemic Control

Abstract

Diabetes mellitus is a modifiable risk factor for generalized atherosclerosis. Measurement of carotid intima media thickness by Doppler ultrasonography can be used to measure the extent of atherosclerosis. Objectives: To determine the association of carotid atherosclerosis in patients with type 2 diabetes mellitus and its relationship with glycemic control. Study Design: Cross-sectional comparative study. Period: 12 months June 2015 to May 2016. Setting: Creek General Hospital in the Department of Medicine and Radiology, Karachi, Pakistan. Method: The subjects were selected from diabetic patients presenting to the Out-Patient Department and controls from their attendants. All subjects had a detailed history, physical examination and laboratory investigations recorded. The variables included age, gender, weight, BMI, blood pressures, fasting and post prandial blood sugars, HbA1c and lipid profile. All individuals underwent B-mode ultrasound for carotid Doppler studies. A single operator conducted all the Doppler studies. The carotid intima media thickness was measured and the presence of carotid plaque was recorded for each subject. The data was entered on SPSS ver 20.0. Numbers and percentages were calculated for categorical data while mean±standard deviation was calculated for continuous data. The carotid intima media thickness and its association with diabetes were analyzed by Student's t test. P-value of <0.05 was considered significant. Among the diabetic patients the relationship of glycemic control and carotid intima media thickness was analyzed through student's t-test. P-value of <0.05 was considered significant. The association of presence of carotid plaque for diabetic and nondiabetic subjects was assessed by Chi-square test. P-value of <0.05 was taken as significant. Association of carotid plaque among diabetic patients with satisfactory and unsatisfactory glycemic control was also assessed through the Chi-square test and p-value of<0.05 was considered significant. Result: Out of the total study population of 237 subjects, which consisted of 119 diabetic and 118 normal controls, there were 105 male and 132 female patients. The mean fasting blood sugar was 113.3±55.2 mg/dl, mean random blood sugar was 185.9±102.0 mg/dl, mean HbA1c was 6.98±2.5 %. Mean ±SD of carotid intima media thickness was 0.91±0.17 mm. Results revealed that diabetes has significant association with the thickness of carotid intima media (p-value<0.000). A total of 28 individuals (11.8%) had a carotid intima media thickness that was classified as a localized carotid artery plaque. The presence of carotid plaque also showed a significant association with the presence of diabetes. The degree of glycemic control showed no relationship with carotid intima media thickness. The presence of carotid plaque also showed no association with degree of glycemic control. Conclusion: CIMT measured by Doppler ultrasonography was found to be significantly associated with the presence of diabetes mellitus. There was no relationship of glycem...