To Study the Relation Between Ratio of Waist-to-Calf Circumference and Microalbuminuria with Carotid Intima Medial Thickness (Cimt) in Patients of Type 2 Diabetes Mellitus.

UNLABELLED

Carotid atherosclerosis is increased 3 fold in people with DM. Several theories have been proposed that increased Urinary Albumin Excretion Rate (UAER) is associated with impairment of endothelial function leading to atherosclerosis. Calf circumference is considered a surrogate marker of lean mass. Visceral fat gene expression is considered more proatherogenic than subcutaneous adipocytes. It is newly proposed that waist-to-calf circumference ratio(WCR) is one of the best anthropometric measures indicative of carotid atherosclerosis.

MATERIAL

This cross sectional study was conducted in the hospitals attached to Bangalore medical college and research institute. Relevant history taken, clinical examination and laboratory investigations was done on 140 patients of type 2 diabetes mellitus, correlation of waist-calf ratio and urine albumin creatinine ratio(UACR) with carotid intima media thickness (CIMT) was done in these individuals. Chi square/Fischer exact test has been used to find the significance of study parameters on categorical scale between 2 or more groups. Pearson correlation between study variables is performed to find the degree if relationship.

OBSERVATION

Among 140 patients in our study 86 were females and 54 were males with mean age 54.05+/- 11.29 years. Mean +=- SD of HbA1c was 9.04+/- 2.67. Mean +/- SD of WCR was 3.09+/- 0.32. It was observed that 48, 65 and 27 patients were having normoalbuminuria, microalbuminuria and macroalbuminuria respectively. Mean avg CIMT was 0.78+/- 0.075. Pearon's correlation coefficient used in our study was showing strong positive correlation between WCR and CIMT (0.841) and also between UACR and CIMT. There was a linear correlation between WCR and UACR with CIMT and the correlation was statistically significant P value <0.001.

CONCLUSION

Cardiovascular complications are an important cause of mortality and morbidity in type 2 DM. Screening of all diabetics for carotid atherosclerosis by carotid ultrasonography is cumbersome and not cost effective. Hence simple anthropometric measurements of body fat distribution like WCR can be used when assessing vascular risk profile. Microalbuminuria now-a-days is considered to be an atherosclerosis risk factor and predicts future cardiovascular complications in diabetic patients. In our study, it was found that WCR and UACR were strongly positively correlated with carotid atherosclerosis as measured by CIMT.