A STUDY OF CLINICAL, METABOLIC AND ANTHROPOMETRIC PROFILE AND POSSIBLE ETIOLOGICAL FACTORS AMONG NEWLY DETECTED TYPE 2 DM IN NORTH KERALA

BACKGROUND Type 2 diabetes is one of the leading causes for financial burden in developing countries like India. Most cases of diabetes are detected years after its onset and one or the other complication would have set in by the time of diagnosis. The proposed mechanisms of diabetes include reduced insulin secretion, increased insulin resistance, sedentary life style, obesity and inappropriate diet. Early detection of diabetes and optimal blood sugar control along with diet modification, weight reduction and management of other coexisting illnesses can delay the diabetes related complications significantly and improve the quality of life MATERIALS AND METHODS This is a cross sectional study of patients with type 2 diabetes detected within last 1 year who presented to General Medicine OPD or Diabetic clinic or those who were in-patients in General Medicine wards in Government Medical College, Kozhikode. 300 patients were included in the study. Data was collected by a detailed history taking, clinical and anthropometric examination, biochemical and radiological investigations. RESULTS Age of the patients in the study population varied from 22 to 88 years. All the 32 patients in the age group of 20-29 years had low levels of physical activity. 62.5% (20 out of the 32) of patients in the age group between 20-29 years had history of diabetes in their parents when compared only 55.5% in age group 30-49 years and 10.2% in patients with aged 50 and above. Cereals constituted the main food item in patients in all the age groups. 269 patients (89.6%) had cereals served 3-4 times a day. Intake of pulses was deficient in all age groups, with only 20 patients out of the 300 (6.7%) having near adequate pulses intake (3-4 times/week). Only 8 out the 300 patients (2.7%) used fruits at least 3 times a week. Fast and junk food intake was high among young individuals. 28 out of 32 patients aged 30 years or less used these at least once a day. "At-risk" waist hip ratio was seen only in 8 patients and all of them were in the age group 30-49 years. Majority (89 out of 108) of patients with age above 50 years had "excellent" waist hip ratio. Classical symptoms were less prominent in patients aged above 50 years with only 7 out of 108 (6.5%) patients having these symptoms when compared with 27.3% patient with age less than 50 years. Microvascular complications (albuminuria, neuropathy and retinopathy) were more frequent in patients with age above 50 years. Systemic hypertension was seen in 118 patients (39.3%), coronary artery disease in 50 patients (16.7%), stroke in 27 patients (9%) and obstructive sleep apnoea in 83 patients (27.7%). 84 patients had evidence of peripheral neuropathy in the nerve conduction study. CONCLUSION Majority of detected diabetics were males and there is a shift in age of onset of diabetes to about 20.6 years in younger population. Most of the diabetics do not take a balanced diet and is usually having high calories and deficient in fruits and vegetables. Low levels of physical activity and diabetes seem to be associated. Only 14.3 % had symptoms of diabetes, hence routine screening is necessary. Family history of diabetes is usually seen in younger onset diabetes. The "metabolically obese but normal weight phenomenon" described in Indian population is further substantiated. Most common complications in newly detected diabetes were hypertension and OSAS and most common microvascular complication was nephropathy.