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A study to estimate subclinical atherosclerosis in patients with type 2 diabetes mellitus by measuring the carotid intimal medial thickness.

INTRODUCTION

Atherosclerosis is a leading cause of mortality in developed and developing nations. It forms the major determinant in the reduction of volume of vascular lumen in various parts of the blood vessel. Atherosclerosis and diabetes mellitus have major relations. Diabetic population is expected to reach an epidemic proportion not only in India but in many countries around the world which in turn has greatly accelerated the risk for cardiovascular diseases and early mortality.

In another two decades, cardiovascular diseases complicated by atherosclerosis will be the major cause of death. Carotid intimal medial thickness measurement can serve as an early predictor of subclinical atherosclerosis.!1) The purpose of this study was to evaluate the usefulness of measuring Carotid intimal medial thickness (CIMT) in predicting the subclinical atherosclerosis.

AIMS AND OBJECTIVES

* To estimate subclinical atherosclerosis in patients with type 2 diabetes mellitus by measuring the carotid intimal medial thickness.

* To study the association of age, sex, body mass index, smoking, alcohol, duration of diabetes, hypertension, fasting hyperglycaemia, serum total cholesterol with the carotid intimal medial thickness.

MATERIALS AND METHODS

This study was carried out in a tertiary care hospital over a period of 6 months after obtaining Institutional Ethical Committee approval. This study was a prospective, observational study. In this study, fifty patients with history of type 2 diabetes mellitus (diagnosed according to the ADA 2014 criteria) after 30 years of age who presented to OPDs and admitted in wards were included in the study. Patients who presented with acute metabolic complications like hypoglycaemia, diabetic ketoacidosis, hyperosmolar hyperglycaemic state, cerebrovascular accidents, acute infections and deranged liver functions were excluded from the study.

Patients who had inherited disorders of lipid and lipoprotein metabolism and/or family history of such disorders were not included. Patients who were on lipid lowering treatment, patients with history of CABG or PCI intervention, Hypertensive patients, patients aged more than 60 years and patients with signs and symptoms of CHD/cerebrovascular disease were excluded. Those patients who were included in the study were subjected to symptom analysis and clinical examination. BP was recorded in all 4 limbs with a standard mercury sphygmomanometer. Hypertension was defined in accordance with JNC VIII criteria as a systolic blood pressure >140 mmHg and a diastolic blood pressure >90 mmHg. All peripheral pulses were examined and height, weight and BMI were calculated. Serum total cholesterol, serum creatinine, blood urea, and blood sugar results were obtained by analysing fasting blood sample.

Hyperlipidaemia was considered to be present when the patient had a serum total cholesterol level >200 mg/dL. In addition to the basic laboratory investigations, resting 12-lead ECG and CIMT measurement were done for each patient. CIMT measurement was obtained by performing ultrasonographic scanning of the carotid arteries using Esaote-scanner with a linear transducer (high frequency range 10 to 12 MHz). CIMT was assessed at about 1.0 cm proximal to the carotid bulb. Carotid IMT was measured on both sides and the average value is taken as the mean CIMT. CIMT value of more than 0.9 mm is suggestive of significant atherosclerosis. All these findings were assessed using appropriate statistical methods.

STATISTICAL ANALYSIS AND INFERENCE

Descriptive statistics were done for all data and were reported in terms of mean values and percentages.

Suitable statistical tests of comparison were done. Continuous variables were analysed with the unpaired t test. Categorical variables were analysed with the Chi-Square Test and Fisher Exact Test. Statistical significance was taken as P <0.05. The data was analysed using SPSS version 16 and Microsoft Excel 2007.

Majority of the CIMT<0.9 mm Group patients belonged to the 41-50 years age class interval (n=4, 40%) with a mean age of 44.40 years. In the CIMT>0.9 mm group patients, majority belonged to the same age class interval (n=20, 50%) with a mean age of 43.48 years. The association between the study groups and age distribution is considered to be not statistically significant since p>0.05 as per unpaired t test.

Majority of the CIMT<0.9 mm group patients belonged to the male gender class interval (n=5, 50%). In the CIMT>0.9 mm group patients, majority also belonged to the male gender class interval (n=27, 67.50%). The association between the study groups and gender distribution is considered to be not statistically significant since p>0.05 as per Fisher's exact test.

RESULTS

In patients belonging to CIMT<0.9 mm group, the mean duration of diabetes is 2.40 years. In CIMT>0.9 mm group, the mean duration of diabetes is 8.90 years. The decreased mean duration of diabetes in CIMT<0.9 mm group compared to the CIMT>0.9 mm group is statistically significant as the p value is 0.0000 as per unpaired t-test indicating a true difference among study groups. The mean duration of diabetes was meaningfully less in CIMT<0.9 mm group compared to the CIMT>0.9 mm group by 6.50 years. This significant difference of 73% decrease in mean duration of diabetes in CIMT<0.9 mm group compared to the CIMT>0.9 mm group is true and has not occurred by chance. In this study, we can safely conclude that mean duration of diabetes was significantly and consistently higher in CIMT>0.9 mm group compared to the CIMT<0.9 mm group. Hence, we can infer that the incidence of CIMT>0.9 mm increases with increasing duration of diabetes.

RESULTS

In patients belonging to CIMT<0.9 mm group, majority were non-smokers (n=10, 100%). In CIMT>0.9 mm group, majority too were non-smokers (n=28, 70%). The increased incidence of smoking in CIMT>0.9 mm group compared to the CIMT < 0.9 mm group is statistically significant as the p value is 0.0320 as per Fisher's exact test indicating a true difference among study groups. The incidence of smoking was meaningfully more in CIMT>0.9 mm group compared to the CIMT < 0.9 mm group by 30 percentage points. This significant difference of 1.43 times increase in incidence of smoking in CIMT>0.9 mm group compared to the CIMT<0.9 mm group is true and has not occurred by chance. In this study, we can safely conclude that incidence of smoking was significantly and consistently higher in CIMT > 0.9 mm group compared to the CIMT<0.9 mm group. Hence, we can infer that the incidence of CIMT>0.9 mm increases among smokers.

By conventional criteria, the association between the study groups and duration of smoking is considered to be not statistically significant since p>0.05.

RESULTS

In patients belonging to CIMT<0.9 mm group, majority were non-alcoholics (n=10, 100%). In CIMT>0.9 mm group, majority too were non-alcoholics (n=28, 70%). The increased incidence of alcohol intake in CIMT>0.9 mm group compared to the CIMT<0.9 mm group is statistically significant as the p value is 0.0420 as per Fisher's exact test indicating a true difference among study groups. The incidence of alcohol was meaningfully more in CIMT>0.9 mm group compared to the CIMT<0.9 mm group by 30 percentage points. This significant difference of 1.43 times increase in incidence of alcohol intake in CIMT>0.9 mm group compared to the CIMT< 0.9 mm group is true and has not occurred by chance. In this study, we can safely conclude that incidence of alcohol intake was significantly and consistently higher in CIMT>0.9 mm group compared to the CIMT<0.9 mm group. Hence, we can infer that the incidence of CIMT>0.9 mm increases among subjects with the habit of alcohol intake.

By conventional criteria, the association between the study groups and duration of alcohol intake is considered to be not statistically significant since p>0.05.

Majority of the CIMT<0.9 mm Group patients belonged to the normal BMI class interval (n=9, 90%) with a mean BMI of 20.95. In the CIMT>0.9 mm group patients, majority belonged to the same BMI class interval (n=39, 97.50%) with a mean BMI of 21.39. The association between the study groups and BMI distribution is considered to be not statistically significant since p>0.05 as per unpaired t test.

Majority of the CIMT<0.9 mm Group patients had a mean SBP of 132 mm Hg. In the CIMT>0.9 mm group, patients had a mean SBP of 131 mmHg. The association between the study groups and systolic blood pressure distribution is considered to be not statistically significant since p>0.05 as per unpaired t test.

Majority of the CIMT < 0.9 mm group patients had a mean DBP of 77 mmHg. In the CIMT>0.9 mm group, patients had a mean DBP of 77 mmHg The association between the study groups and diastolic blood pressure distribution is considered to be not statistically significant since p >0.05 as per unpaired t test.

RESULTS

In patients belonging to CIMT<0.9 mm group, the mean FBS is 105.60 mg/dL. In CIMT>0.9 mm group, the mean FBS is 148.23 mg/dL. The decreased mean FBS in CIMT<0.9 mm group compared to the CIMT>0.9 mm group is statistically significant as the p value is 0.0000 as per unpaired t-test indicating a true difference among study groups.

The mean FBS was meaningfully less in CIMT<0.9 mm group compared to the CIMT>0.9 mm group by 42.63 mg/dL. This significant difference of 29% decrease in mean FBS in CIMT<0.9 mm group compared to the CIMT>0.9 mm group is true and has not occurred by chance.

In this study, we can safely conclude that mean fasting blood sugar was significantly and consistently higher in CIMT>0.9 mm group compared to the CIMT<0.9 mm group. Hence, we can infer that the incidence of CIMT>0.9 mm increases with increasing levels of FBS.

RESULTS

In patients belonging to CIMT<0.9 mm group, the mean PPBS is 155.40 mg/dL. In CIMT>0.9 mm group, the mean PPBS is 253.38 mg/dL. The decreased mean PPBS in CIMT<0.9 mm group compared to the CIMT>0.9 mm group is statistically significant as the p value is 0.0000 as per unpaired t-test indicating a true difference among study groups.

The mean PPBS was meaningfully less in CIMT<0.9 mm group compared to the CIMT>0.9 mm group by 97.98 mg/dL. This significant difference of 39% decrease in mean PPBS in CIMT<0.9 mm group compared to the CIMT>0.9 mm group is true and has not occurred by chance.

In this study, we can safely conclude that mean postprandial blood sugar was significantly and consistently higher in CIMT>0.9 mm group compared to the CIMT<0.9 mm group. Hence, we can infer that the incidence of CIMT>0.9 mm increases with increasing levels of PPBS.

Majority of the CIMT<0.9 mm Group patients had a mean blood urea levels of 35 mg/dL and mean serum creatinine levels of 0.72 mg/dL. In the CIMT>0.9 mm group, patients had a mean blood urea levels of 37.35 mg/dL and mean serum creatinine levels of 0.89 mg/dL. The association between the study groups and levels of blood urea and serum creatinine is considered to be not statistically significant since p>0.05 as per unpaired t test.

Majority of the CIMT<0.9 mm group patients had urine albumin positive (n=3, 30%). In the CIMT>0.9 mm group, patients mainly had urine sugar positive (n=36, 90%). The association between the study groups, urine test parameters are considered to be not statistically significant since p>0.05 as per unpaired t test.

Majority of the CIMT<0.9 mm Group patients had a mean total cholesterol levels of 175.40 mg/dL, mean LDL levels of 70.50 mg/dL, mean HDL levels of 69.50 mg/dL and mean TGL levels of 138.20 mg/dL. In the CIMT > 0.9 mm group patients had a mean total cholesterol levels of 181.40 mg/dL, mean LDL levels of 65.65 mg/dL, mean HDL levels of 73.43 mg/dL and mean TGL levels of 139.18 mg/dL. The association between the study groups and lipid profile parameters is considered to be not statistically significant since p > 0.05 as per unpaired t test.

RESULTS

Multivariate Analysis Demonstrated that

* The risk of developing CIMT>0.9 mm in patients with duration of diabetics >5 years is 10.18 times significantly more than patients with duration of diabetics <5 years. It is statistically significant with a p-value of 0.0042.

* The risk of developing CIMT>0.9 mm in patients who smoke is 3.04 times significantly more than in non-smokers. It is statistically significant with a p-value of 0.008.

* The risk of developing CIMT>0.9 mm in patients who consume alcohol is 4.29 times significantly more than patients without alcohol intake. It is statistically significant with a p value of 0.0039.

* The risk of developing CIMT>0.9 mm in patients with FBS >150 mg/dL is 1.16 times significantly more than patients with FBS<150 mg/dL. It is statistically significant with a p value of 0.0041.

* The risk of developing CIMT>0.9 mm in patients with PPBS > 250 mg/dL is 3.58 times significantly more than patients with PPBS <250 mg/dL. It is statistically significant with a p value of 0.0043.

DISCUSSION

* We did not find any significant association between age and CIMT, the mean age group was found to be almost same.

* There was no significant association between CIMT and gender distribution.

* CIMT was significantly associated more with duration of diabetes (as the duration increased).

* Smokers were found to be at higher risk of increase in CIMT than non-smokers.

* Though the distribution of alcohol intake was equal among both the age groups, but CIMT was more significant among patients with diabetes and alcoholism. As our study group volume is small, we could not prove the exact association between CIMT and alcohol intake.

* In our study population, BMI didn't show any significant association.

* Blood pressure was not found to be statistically significant in our study population.

* Patients with higher fasting and postprandial blood sugar value showed significant association with CIMT values.

* Urine routine, renal parameters and lipid profile didn't show any significant correlation with carotid IMT in our study.

As compared to the cited, original articles which showed direct relation between diabetes and CIMT, our study population had around 80% diabetic patients with significant carotid CIMT values. CIMT was more significant with increase in the duration of diabetes, altered fasting and postprandial glycaemic status.(2) This was similar to the original study article. CIMT greater than 0.9 mm was an individual marker of generalised atherosclerosis. Patients with these values are at higher risk for future cardiovascular events and newer or recurrent ischaemic strokes. 80% of our study group comes under this high risk category. Significant increase in carotid IMT was found with patients who smoke and consume alcohol. Possible explanation for this difference may be related to limited sample size of the study and ethnicity of the study subjects.

CONCLUSION

This study concludes that even in the absence of smoking and alcohol intake, and in the presence of normotension and normal lipid profile, independently type 2 DM was found to be associated with carotid IMT values than other components. Further workup and prospective studies are needed with regards to

1. To predict the trend of future cardiovascular events like CAD and ischaemic strokes.

2. Regression of CIMT with management of type 2 DM patients.

DOI: 10.14260/jemds/2016/1219

Financial or Other, Competing Interest: None.

Submission 22-07-2016, Peer Review 31-08-2016, Acceptance 06-09-2016, Published 12-09-2016.

REFERENCES

(1.) Sibal L, Agarwal SC, Home PD. Carotid intima-media thickness as a surrogate marker of cardiovascular disease in diabetes. Diabetes Metabolic Syndrome Obes 2011;4:23-34.

(2.) Zhao XH, Xu ZR, Zhang Q, et al. Effect of intensive multifactorial treatment on the intima-media thickness of large arteries in patients with new-onset type 2 diabetes mellitus. Journal Zhejiang University Science B 2012;13(5):378-85.

Corresponding Author:

Dr. Natarajan Kandasamy, Oak 39, Ben Foundations, Maple Orchard, Padikuppam Road, Anna Nagar West, Chennai-600040.

E-mail: archana.vmc@gmail.com, nnatarajan72@yahoo.com

Natarajan Kandasamy [1], Rajan Ganesan [2], Thilakavathi Rajendiran [3], Ayyappan [4], Archana Balakrishnan Mani [5], Arungandhi Pachaippan [6]

[1] Professor, Department of Medicine, Government Stanley Medical College, Chennai.

[2] Professor, Department of Medicine, Government Stanley Medical College, Chennai.

[3] Assistant Professor, Department of Medicine, Government Stanley Medical College, Chennai.

[4] Postgraduate, Department of Medicine, Government Stanley Medical College, Chennai.

[5] Postgraduate, Department of Medicine, Government Stanley Medical College, Chennai.

[6] Postgraduate, Department of Medicine, Government Stanley Medical College, Chennai.
Table 1: Table Representing the Age distribution and
their CIMT among the Study Population

                       CIMT [less
                        than or
Age                    equal to]            CIMT >
Distribution             0.9 mm       %     0.9 mm     %

[less than or equal        4        40.00     17     42.50
  to] 40 years
41-50 years                4        40.00     20     50.00
51-60 years                2        20.00     3      7.50
Total                      10        100      40      100

Table 2: Statistics of CIMT
among the Study Population

                CIMT [less
                 than or
Age             equal to]        CIMT >
Distribution      0.9 mm         0.9 mm

N                   10             40
Mean              44.40          43.48
SD                 6.95           5.90
P value                          0.7049
  Unpaired
  t Test

Table 3: Table representing the Gender distribution and
their CIMT among the Study Population

               CIMT [less
                than or
Gender           equal              CIMT >
Distribution   to] 0.9 mm     %     0.9 mm     %

Male               5        50.00     27     67.50
Female             5        50.00     13     32.50
Total              10        100      40      100
P value                             0.4627
  Fishers
  Exact Test

Table 4: Table Correlating the duration of
Diabetes and their CIMT among the Study
Population

              CIMT [less
Duration       than or
of              equal                CIMT >
Diabetes      to] 0.9 mm      %      0.9 mm      %

< 5 years         10        100.00      6      15.00
6-10 years         0         0.00      25      62.50
11-15 years        0         0.00       9      22.50
Total             10         100       40       100

Table 5: Statistics of CIMT among the Study Population

                 CIMT
Duration       [less than
of            or equal to]   CIMT > 0.9
Diabetes         0.9 mm          mm

N                  10            40
Mean              2.40          8.90
SD                0.84          3.25
P value Unpaired t Test        0.0000

Table 6: Table representing the trend of Smoking
and their CIMT among the Study Population

              CIMT [less
             than or equal            CIMT >      %
Smoking       to] 0.9 mm       %      0.9 mm

Smoker             0          0.00      12      30.00
Non-Smoker        10         100.00     28      70.00
Total             10          100       40       100

P value Fisher's Exact Test           0.0320

Table 7: Table Correlating the duration of Smoking and
CIMT among the Study Population

                CIMT
              [greater
Duration       than or
of            equal to]          CIMT >
Smoking        0.9 mm      %     0.9 mm     %

< 10 years        0       0.00     5      12.50
11-20 years       0       0.00     4      10.00
21-30 years       0       0.00     3      7.50
Total             0        0       12      30

Table 8: Statistics of duration of Smoking
and CIMT among the Study Population

               CIMT
              [greater
              than or
Duration     equal to]    CIMT >
of Smoking     0.9 mm     0.9 mm

N                0          12
Mean            0.00       16.25
SD              0.00       7.72
P value Unpaired t Test     NA

Table 9: Statistical Table representing the trend of
Alcohol Intake in relation with CIMT among the Study
Population

                     CIMT
                   [greater
                    than or
                   equal to]            CIMT >
Alcohol Intake      0.9 mm       %      0.9 mm     %

Alcohol Intake +       0        0.00      12     30.00
Alcohol Intake -      10       100.00     28     70.00
Total                 10        100       40      100

P value Fishers Exact Test              0.0420

Table 10: Table representing the duration of Alcohol
intake in relation to CIMT among the Study Population

                CIMT
Duration      [greater
of             than or
Alcohol       equal to]          CIMT >     %
Intake         0.9 mm      %     0.9 mm

< 10 years        0       0.00     5      12.50
11-20 years       0       0.00     4      10.00
21-30 years       0       0.00     3      7.50
Total             0        0       12      30

Table 11: Statistics representing the duration
of Alcohol intake in relation to CIMT among
the Study Population

Duration    CIMT [less
of           than or
Alcohol       equal      CIMT >
Intake      to] 0.9 mm   0.9 mm

N               0          12
Mean           0.00       16.25
SD             0.00       7.83
P value Unpaired t Test    NA

Table 12: Table representing the BMI Distribution in
relation to CIMT among the Study Population

                CIMT [less
                 than or
BMI             equal to]            CIMT >
Distribution      0.9 mm       %     0.9 mm      %

Underweight         1        10.00      1      2.50
([less than
or equal to]
18.49)

Normal              9        90.00     39      97.50
(18.50 to
24.99)

Overweight          0        0.00       0      0.00
(25 to
29.99)

Obese               0        0.00       0      0.00

Total               10        100      40       100

Table 13: Statistics representing the BMI Distribution
in relation to CIMT among the Study Population

               CIMT [greater
                 than or
                equal to]
BMI               0.9 mm       CIMT > 0.9 mm

Distribution
N                   10              40
Mean               20.95           21.39
SD                 1.71            1.80
P value Unpaired t Test           0.4846

Table 14: Statistics of the Mean Systolic Blood
Pressure values among the Study Population

                  Right     Left    Right     Left
Systolic Blood    Upper    Upper    Lower    Lower
Pressure           Limb     Limb     Limb     Limb     Mean

CIMT <     N        10       10       10       10       10
0.9 mm     Mean   122.00   137.00   133.00   134.00   131.50
           SD     11.35     9.49     9.49     5.16     5.30

CIMT >     N        40       40       40       40       40
0.9 mm     Mean   124.25   129.75   137.00   134.50   131.38
           SD     11.96    12.30     4.64     5.04     5.69

P value           0.5877   0.0581   0.2241   0.7873   0.9485
  Unpaired
  t Test

Table 15: Bar Diagram representing the mean
Diastolic Blood Pressure values among
the Study Population

                    Right     Left    Right
Diastolic           Upper    Upper    Lower
Blood Pressure       Limb     Limb    Limb

CIMT <       N        10       10      10
0.9 mm     Mean     79.00    74.00    80.00
            SD       3.16     5.16    0.00

CIMT >       N        40       40      40
0.9 mm     Mean     77.50    75.75    80.00
            SD       4.39     5.01    0.00
P value Unpaired    0.2329   0.3518    NA
t Test

                     Left
Diastolic           Lower
Blood Pressure       Limb     Mean

CIMT <       N        10       10
0.9 mm     Mean     75.00    77.00
            SD       5.27     1.58

CIMT >       N        40       40
0.9 mm     Mean     74.50    76.94
            SD       5.04     2.80
P value Unpaired    0.7908   0.9262
t Test

Table 16: Table correlating the Fasting Blood Sugar
Values with CIMT among the Study Population

               CIMT [less
                than or
Fasting        equal to]            CIMT >
Blood Sugar      0.9 mm       %     0.9 mm     %

[less than         3        30.00     0      0.00
or equal to]
100 mg/dL

101-150            7        70.00     22     55.00
mg/dL

>150 mg/dL         0        0.00      18     45.00

Total              10        100      40      100

Table 17: Statistics correlating the
Fasting Blood Sugar values with CIMT
among the Study Population

           CIMT [less
Fasting      than or
Blood         equal      CIMT >
Sugar      to] 0.9 mm    0.9 mm

N              10          40
Mean         105.60      148.23
SD            9.08       19.35
P value Unpaired t Test  0.0000

Table 18: Table correlating the Postprandial Blood
Sugar Values with CIMT among the Study Population

               CIMT [less
                than or
Postprandial     equal              CIMT >
Blood Sugar    to] 0.9 mm     %     0.9 mm      %

[less than         5        50.00      0      0.00
or equal
to] 150
mg/dL

151-200            4        40.00      6      15.00
mg/dL

201-250            1        10.00      9      22.50
mg/dL

> 250              0        0.00      25      62.50
mg/dL

Total              10        100      40       100

Table 19: Statistics correlating the Postprandial Blood
Sugar Values with CIMT among the Study Population

                CIMT [less
                  than or
Postprandial      equal       CIMT >
Blood Sugar     to] 0.9 mm    0.9 mm

N                   10          40
Mean              155.40      253.38
SD                 31.26      34.28
P value Unpaired t Test       0.0000

Table 20: Statistics correlating the Renal
Parameters with CIMT among the
Study Population

Renal Parameters           Urea    Creatinine

CIMT [less than     N       10         10
or equal           Mean   35.00       0.72
to] 0.9 mm          SD     3.30       0.09

CIMT > 0.9 mm       N       40         40
                   Mean   37.35       0.89
                    SD     3.77       0.22
P value Unpaired t Test   0.1489     0.2227

Table 21: Statistics correlating the Renal Parameters
with CIMT among the Study Population

                 CIMT
              [less than
Urine          or equal             CIMT >
Parameters      0.9 mm        %     0.9 mm     %

Albumin +ve        3        30.00     14     35.00

Sugar +ve          0        0.00      36     90.00

Pus Cells >        1        10.00     25     62.50
4/cu mm

                P value
               Fisher's
Urine            Exact
Parameters       Test

Albumin +ve     0.9999

Sugar +ve       0.3671

Pus Cells >
4/cu mm

Table 22: Statistics correlating Lipid Profile
with CIMT among the Study Population

                      Total
Lipid Profile       Cholesterol     LDL      HDL      TGL

CIMT [less    N         10          10        10       10
than or      Mean     175.40       70.50    69.50    138.20
equal to]     SD       12.55       4.14      4.09     4.76
0.9 mm

CIMT >        N         40          40        40       40
0.9 mm       Mean     181.40       65.65    73.43    139.18
              SD       11.41       8.13      7.06     9.94
P value Unpaired      0.1919      0.513 2   0.0705   0.6571
t Test

Table 23: Statistics of the Mean CIMT Values
on both Sides

CIMT                 RIGHT   LEFT   MEAN

CIMT [less     N      10      10     10
than or       Mean   0.69    0.69   0.69
equal          SD    0.11    0.11   0.11
to] 0.9 mm

CIMT >         N      40      40     40
0.9 mm        Mean   1.45    1.39   1.42
               SD    0.27    0.22   0.23

Multivariate logistic Regression model for
statistically Significant Predictor of
Immediate Adverse Event

                           CIMT > 0.9 mm

                                  95%
Independent        Odds       Confidence
Variables          Ratio       Interval       P value

Age > 50 years     4.36       0.56-33.74      0.158

Gender--Male       1.91        0.33-38.4      0.216

Duration of        10.18      1.09-94.73      0.042 *
Diabetes > 5
years

Smoking            3.04        1.33-6.95      0.008 *

Alcohol Intake     4.29       1.12-16.52      0.039 *

FBS > 150 mg/dL    1.16       1.17-12.49      0.041 *

PPBS > 250         3.58       1.15-11.13      0.043 *
mg/dL

Fig. 1: Bar Diagram Representing the Age distribution
and their CIMT among the study Population

Age Distribution                             Number of Subjects

                                    CIMT [less than or   CIMT > 0.9 mm
                                       equal to] 0.9 mm

[less than or equal to] 40 years           4                  17
41-50 years                                4                  20
51-60 years                                2                   3

Note: Table made from bar graph.

Fig.2: Bar Diagram representing the Gender Distribution
and their CIMT among the Study Population

Gender Distribution            Number of Subjects

                      CIMT [less than or   CIMT > 0.9 mm
                        equal to] 0.9 mm

Male                             5             27
Female                           5             13

Note: Table made from bar graph.

Fig. 3: Bar Diagram representing the duration of Diabetes
and their CIMT among the Study Population

Duration of Diabetes                        Number of Subjects

                                    CIMT [less than or   CIMT > 0.9 mm
                                     equal to] 0.9 mm

[less than or equal to] 5 years           5                   5
6-10 years                                0                  25
11-20 years                               0                   9

Note: Table made from bar graph.

Fig. 4: Bar Diagram depicting the trend of Smoking and
their CIMT among the Study Population

Smoking                        Number of Subjects

                      CIMT [less than or   CIMT > 0.9 mm
                        equal to] 0.9 mm

Smoker                          0              12
Non Smoker                     10              28

Note: Table made from bar graph.

Fig. 5: Bar Diagram correlating the Duration of Smoking
and CIMT among the Study Population

Duration of Smoking                          Number of Subjects

                                    CIMT [less than or   CIMT > 0.9 mm
                                     equal to] 0.9 mm

[least than or equal to] 10 years          0                  5
11-20 years                                0                  4
21-30 years                                0                  3

Note: Table made from bar graph.

Fig. 6: Bar Diagram representing the trend of Alcohol
Intake in relation with CIMT among the Study Population

Alcohol Intake                 Number of Subjects

                      CIMT [less than or    CIMT > 0.9 mm
                        equal to] 0.9 mm

Alcohol Intake +                 0              10
Alcohol Intake -                12              28

Note: Table made from bar graph.

Fig. 7: Bar Diagram representing the duration of Alcohol
intake in relation to CIMT among the Study Population

Duration of Alcohol Intake                   Number of Subjects

                                    CIMT [less than or   CIMT > 0.9 mm
                                     equal to] 0.9 mm

[less than or equal to] 10 years           0                  5
11-20 years                                0                  4
21-30 years                                0                  3

Note: Table made from bar graph.

Fig. 8: Bar Diagram representing the BMI Distribution in
relation to CIMT among the Study Population

BMI Distribution               Number of Subjects

                      CIMT [less than or    CIMT > 0.9 mm
                        equal to] 0.9 mm

Underweight (less than
 or equal to] 18.49)             1                9
Normal (18.50 to 24.99)          1               39

Note: Table made from bar graph.

Fig. 9: Bar Diagram representing the Mean Systolic Blood Pressure values
among the Study Population

Systolic Blood Pressure                         Mean DBP Values (mm Hg)

                         CIMT [less than or   CIMT > 0.9 mm
                           equal to] 0.9 mm

Right Upper Limb                122                124
Left Upper Limb                 137                130
Right Lower Limb                133                137
Left Lower Limb                 134                135
Mean                            132                131

Note: Table made from bar graph.

Fig. 10: Bar Diagram representing the Mean Diastolic Blood
Pressure values  among the Study Population

Diastolic Blood Pressure                         Number of Subjects

                         CIMT [less than or   CIMT > 0.9 mm
                           equal to] 0.9 mm

Right Upper Limb                 79                 78
Left Upper Limb                  74                 76
Right Lower Limb                 80                 80
Left Lower Limb                  75                 75
Mean                             77                 77

Note: Table made from bar graph.

Fig. 11: Bar Diagram correlating the Fasting Blood Sugar values
with CIMT  among the Study Population

Fasting Blood Sugar                           Number of Subjects

                                      CIMT [less than or    CIMT > 0.9
                                       equal to] 0.9 mm        mm

[less than or equal to] 100 mg/dl           3                   0
101-150 mg/dl                               7                  22
> 150 mg/dl                                 0                  18

Note: Table made from bar graph.

Fig. 12: Bar diagram correlating the Postprandial Blood Sugar values
with CIMT among the Study Population

Post Prandial Blood Sugar                           Number of Subjects

                                      CIMT [less than or   CIMT > 0.9 mm
                                       equal to] 0.9 mm

[less than or equal to] 150 mg/dl           5                   0
151-200 mg/dl                               4                   6
201-250 mg/dl                               1                   9
> 150 mg/dl                                 0                  25

Note: Table made from bar graph.

Fig. 13: Bar Diagram correlating the Renal Parameters with CIMT
among the study Population

Renal Parameters                 Number of Subjects

                      CIMT [less than or    CIMT > 0.9 mm
                        equal to] 0.9 mm

Urea                       35.00              37.35
Creatine                    0.72               0.89

Note: Table made from bar graph.

Fig. 14: Bar Diagram correlating the Urine Parameters with CIMT
among the Study Population

Urine Parameters                 Number of Subjects

                      CIMT [less than or    CIMT > 0.9 mm
                        equal to] 0.9 mm

Albumin +ve                 3                    14
Sugar + ve                  0                    36
Pus Cells >
 4/cu mm                    1                    25

Note: Table made from bar graph.

Fig. 15: Bar Diagram correlating Lipid Profile with CIMT
among the Study Population

Lipid Profile                 Mean Value mg/dl

                      CIMT [less than or    CIMT > 0.9 mm
                        equal to] 0.9 mm

Total Cholesterol           175                  181
LDL                          71                   66
HDL                          70                   73
TGL 1                       138                  139

Note: Table made from bar graph.

Figure 16: Bar Diagram depicting the Mean CIMT Values on both Sides

CIMT                   Mean Value mg/dl

               CIMT [less than or    CIMT > 0.9 mm
                 equal to] 0.9 mm

RIGHT               0.69                  1.45
LEFT                0.69                  1.39
MEAN                0.69                  1.42

Note: Table made from bar graph.
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Article Details
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Title Annotation:Original Research Article
Author:Kandasamy, Natarajan; Ganesan, Rajan; Rajendiran, Thilakavathi; Ayyappan; Mani, Archana Balakrishnan
Publication:Journal of Evolution of Medical and Dental Sciences
Article Type:Report
Date:Sep 12, 2016
Words:5375
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