DIABETES MELLITUS;

CAROTID THICKNESS - ASSOCIATION OF GLYCEMIC CONTROL

Abstract

Diabetes mellitus is a modifiable risk factor for generalized atherosclerosis.
Measurement of carotid intima media thickness by Doppler ultrasonography can be used to
measure the extent of atherosclerosis. Objectives: To determine the association of carotid
atherosclerosis in patients with type 2 diabetes mellitus and its relationship with glycemic
control. Study Design: Cross-sectional comparative study. Period: 12 months June 2015 to
May 2016. Setting: Creek General Hospital in the Department of Medicine and Radiology,
Karachi, Pakistan. Method: The subjects were selected from diabetic patients presenting to
the Out-Patient Department and controls from their attendants. All subjects had a detailed
history, physical examination and laboratory investigations recorded. The variables included
age, gender, weight, BMI, blood pressures, fasting and post prandial blood sugars, HbA1c
and lipid profile. All individuals underwent B-mode ultrasound for carotid Doppler studies. A
single operator conducted all the Doppler studies. The carotid intima media thickness was
measured and the presence of carotid plaque was recorded for each subject. The data was
entered on SPSS ver 20.0. Numbers and percentages were calculated for categorical data
while mean±standard deviation was calculated for continuous data. The carotid intima media
thickness and its association with diabetes were analyzed by Student’s t test. P-value of <0.05
was considered significant. Among the diabetic patients the relationship of glycemic control
and carotid intima media thickness was analyzed through student’s t-test. P-value of <0.05
was considered significant. The association of presence of carotid plaque for diabetic and nondiabetic
subjects was assessed by Chi-square test. P-value of <0.05 was taken as significant.
Association of carotid plaque among diabetic patients with satisfactory and unsatisfactory
glycemic control was also assessed through the Chi-square test and p-value of<0.05 was
considered significant. Result: Out of the total study population of 237 subjects, which consisted
of 119 diabetic and 118 normal controls, there were 105 male and 132 female patients. The
mean fasting blood sugar was 113.3±55.2 mg/dl, mean random blood sugar was 185.9±102.0
mg/dl, mean HbA1c was 6.98±2.5 %. Mean ±SD of carotid intima media thickness was
0.91±0.17 mm. Results revealed that diabetes has significant association with the thickness
of carotid intima media (p-value<0.000). A total of 28 individuals (11.8%) had a carotid intima
media thickness that was classified as a localized carotid artery plaque. The presence of carotid
plaque also showed a significant association with the presence of diabetes. The degree of
glycemic control showed no relationship with carotid intima media thickness. The presence
of carotid plaque also showed no association with degree of glycemic control. Conclusion:
CIMT measured by Doppler ultrasonography was found to be significantly associated with the
presence of diabetes mellitus. There was no relationship of glycemic control with CIMT among
the diabetic patients.