Generalized vascular damage including glomerular dysfunction in newly-detected type 2 diabetic patients

Abstract

Aim: Diabetes mellitus(DM) is considered a vascular disease, we intended to determine prevalence and nature of generalized and glomerular vascular abnormalities the moment it is diagnosed(ND-DM) in a cohort of patients with Arabic descent. Over 9 months, 216 out of 1208 asymptomatic Saudies were referred by the Primary Care Physicians on having risk factors for future development of DM for DM screening. Methods: For the 54 ND-DM patients and 18 non-diabetic controls, clinical examination including body mass index(BMI) and waist:hip ratio(WHR), ultrasound determination of common carotid artery(CCA) intimal-medial thickness(IMT), hemoglobin A1c(A1c), total cholesterol(TC), triglycerides(TG), high-density lipoprotein cholesterol(HDL-C), CRP, albuminuria, serum creatinine(sCr), and glomerular filtration rate(eGFR) were done. Results: About 4.5% were unaware of their diabetes and they had significant(35/54 vs 5/18 p=0.01) preclinical atherosclerosis(increased IMT and/or atheromatous plaques) with similar age, HDL-C, CRP and eGFR compared to controls. Also, they had pathologic microalbuminuria([μA] 145.4±201.4 vs 18.9±7.1, p=0.013) with higher BMI(29.5±3.6 vs 27.2±1.8, p=0.043), WHR(0.94±0.12 vs 0.79±0.1, p=0.001), TC(5.1±0.9 vs 3.8±0.6, p=0.001) and TG(2.3±0.9 vs 1.2±0.4, p=0.001) compared to controls. Diabetic nephropathy(DN), as inferred from glomerular damage marker μA was significantly prevalent(17/54, p=0.014) in ND-DM patients. Those with DN had more IMT(0.96±0.1 vs 0.77±0.1, p=0.0001), WHR(0.98±0.1 vs 0.91±0.13, p=0.037), TC(5.4±0.7 vs 4.9±0.9, p=0.049) and TG(2.7±0.4 vs 2.02±0.4, p=0.012), lower eGFR(86.4±12 vs 104.1±13, p=0.0001), older age(40.9±5 vs 37.9±4, p=0.028) and worse glycamic control(A1c=8. 1±1.6 vs 7.3±1.5, p=0.048). Also, diabetic retinopathy(DR) was significantly prevalent(n=19) in ND-DM patients(p=0.047). Interestingly, DN and DR, were significantly correlated with each other(r=0.841, p=0.0001) and with IMT(r=0.38, p=0.005 and r=0.35, p=0.009, respectively). Conclusion: The newly-detected Saudi diabetics already had more vascular changes including glomerular damage than normal glucose-tolerant subjects with clustering of risk factors in particular abdominal obesity, and dyslipidaemia.