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[Risk factor: diabetes mellitus]
13rd Department of Internal Medicine, Yamagata University School of Medicine.
Abstract:
The prevalence of diabetic microangiopathy (retinopathy, microalbuminuria, and neuropathy) and macroangiopathy (ischemic changes in EKG) in patients with diabetes mellitus was compared between patients newly found on occasion of mass-screening without any symptoms and signs in Funagata, Japan, and patients who visited the outpatient clinic of our university hospital. The mean fasting blood glucose level in the Funagata group was lower, and the mean duration of diabetes was shorter. The prevalence of every microangiopathic complication was significantly lower in the Funagata group than in the outpatient clinic group. However, the prevalence of ischemic changes in EKG was not different between the two groups. The conclusion that prevalence of diabetic microangiopathic complications was primarily related to the degree and duration of hyperglycemia seemed to be in accordance with the results of the Diabetes Control and Complications Trial (DCCT). The role of hyperglycemia for pathogenesis of macroangiopathy and atherosclerosis has been controversial. Not only hyperglycemia but also hypertension, dyslipoproteinemia, and other factors due to insulin resistance resulting from visceral fat syndrome, might be responsible for the occurrence of atherosclerosis.
Insights
Diabetic microangiopathy is less common in individuals with shorter diabetes duration and lower blood glucose. Macroangiopathy, however, shows no difference, suggesting other factors contribute to atherosclerosis.
Area of Science:
- Endocrinology and Metabolism
- Cardiovascular Research
Context:
- Diabetes mellitus is a global health concern with significant microvascular and macrovascular complications.
- Early detection and management are crucial for preventing long-term sequelae.
- Mass screening programs offer a unique opportunity to study disease prevalence in asymptomatic populations.
Purpose:
- To compare the prevalence of diabetic microangiopathy and macroangiopathy between asymptomatic individuals identified through mass screening and symptomatic patients attending a university hospital outpatient clinic.
- To investigate the relationship between glycemic control, diabetes duration, and the development of vascular complications.
Summary:
- A study in Funagata, Japan, compared diabetic patients from mass screening with hospital outpatients.
- The mass-screening group had lower fasting blood glucose and shorter diabetes duration, with significantly lower rates of microangiopathy (retinopathy, microalbuminuria, neuropathy).
- Electrocardiogram (EKG) ischemic changes, a marker of macroangiopathy, did not differ between groups, indicating hyperglycemia's primary role in microvascular complications but suggesting multifactorial causes for macrovascular disease.
Impact:
- Findings support the Diabetes Control and Complications Trial (DCCT) hypothesis linking hyperglycemia to microangiopathy.
- Highlights the multifactorial nature of diabetic macroangiopathy and atherosclerosis, involving factors beyond hyperglycemia such as hypertension and dyslipidemia.
- Emphasizes the importance of comprehensive risk factor management in diabetes care to prevent both micro- and macrovascular complications.