NEUROPATHY, RETINOPATHY AND GLYCEMIIC CONTROL IN TYPE 2 DIABETES.

N.M.Bhagwat, J.B.Vora, P.H.Chauhan, N.S.Shah and Menon P.S.,Seth G.S. Medical College & K.E.M.Hospital, Parel, Mumbai.

Major studies have shown that good glycemiic control can prevent microvascular complications in type2 diabetes.   The aim of this study is to evaluate the effect of  glycemic control on the development of neuropathy and  retinopathy in type 2 diabetics in a busy out-patient setting.

507 type2 diabetics with duration>5 years and regular follow up were re-evaluated.  Detailed history and examination including funduscopy for retinopathy was done and compared with baseline evaluation available on the records at the onset of clinical diabetes.

ADA 1988 recommendations (Fasting plasma glucose<140mg/dl, post prandial plasma glucose  < 200mg/dl) were used for assessing glycemic control.  An average from all the available values for a year was calculated.  This as done for the entire duration of follow up.  If values were>75%, 50-75% and <50% of the times in the above range,  patients were categorized into good, fair and poor control groups respectively.

There were 44.2%,28.4%,13.6% and 13.8% patients in groups 5-10,11-15, 16-20 and >20 years duration of   diabetes.  40.8%, 20.9% and 38.3% patients belonged to Good, Fair and Poor control groups respectively.

Peripheral neuropathy increased from 10.3% at onset to 50.9% presently.  The difference in the development of neuropathy between Good, Fair and Poor control groups was  statistically significant (X²=269.84,P<0.01).  Neuropathy also increased with duration of diabetes and the association was also statistically significant (X²=36.89,P=<0.001).

5.7% and 0.6% had background (BDR) and proliferative (PDR) retinopathy respectively at onset, which increased to 35.5% and 7.7% during present evaluation.  The association between the glycemic control and retinopathy was statistically significant (BDR: X²=234,P<0.01, PDR: X²=142;P<0.01).  Retinopathy also increased with duration of diabetes and the association was statistically significant.  (BDR: X²=49.34, P=<0.001, (PDR: X²=12.27, P=<0.001).

Logistic regression analysis using variables like glycemic control, age, sex, duration of diabetes, body mass index, waist-hip ratio, lipids, hypertension and smoking showed that glycemic control is the most important factor related to development of neuropathy and retinopathy.

Thus we conclude that good glycemic control  prevents the development of neuropathy and  retinopathy in type 2 diabetics.