Clinical profile of young adult
diabetic patients attending hospital OPD of a tertiary care centre in
central India
Soni P1, Zoheb A2
1Dr P Soni, Assistant Professor, 2Dr A Zoheb, Assistant Professor. Both
are affiliated with Department of Medicine, Chirayu Medical College
& Hospital, Bhopal, (M.P)
Address for
correspondence: Dr P Soni, Email:
roshanchanchlani@gmail.com
Abstract
Background:
Most diabetes prevention efforts in Indian communities have been
secondary or tertiary prevention programs targeting adults with type 2
diabetes. The approaches often combine a number of strategies,
including health education, health fairs, fitness programs, nutrition
education, etc., and are delivered in a shotgun method with the
expectation that one or two of the strategies will be effective. Material and methods:
A Hospital-based cross-sectional study was carried out in the
Department of Medicine of Chirayu Medical College and Hospital, Bhopal
located in central India. All the young adult patients aged between
20-40 years were included in the study and questionnaire was used to
record the clinical profile of the patients. Results: Diabetes
Mellitus was found more in the age group of 35-40 years followed by
30-35 years age group. 08% of the cases had positive family history of
diabetes mellitus and mean BMI of the cases was 23.2 kg/m2. Out of
total 76 symptomatic patients, complications of diabetes mellitus were
found in 32(42.1%) of the cases. Most common complication found was
genital infections seen in 18(13.2%). Conclusion: Early
sign and symptoms of diabetes should be explained in the community
through educational activities, so that the community level of
understanding and knowledge about the disease increased and at the same
time patients should be reinforced to use the health care services for
proper control of sign and symptoms and complications of diabetes and
to modify the lifestyle of the population diagnosed with diabetes
mellitus.
Keywords:
Diabetes Mellitus, Type II DM, Clinical Profile, Young Adult
Manuscript received: 26th
Feb 2015, Reviewed: 10th
Mar 2015
Author Corrected: 24th
Mar 2015, Accepted for
Publication: 13st Apr 2015
Introduction
Type II Diabetes Mellitus spans a continuum from impaired glucose
tolerance (IGT) and impaired fasting glucose (IFG) to frank diabetes
that results from progressive deterioration of both insulin secretion
and action. Type II Diabetes Mellitus starting during adolescence puts
the individual at risk for major morbidity and even mortality, right
during the productive years of life [1].
According to recent estimates, approximately 285 million people
worldwide (6.6%) in the 20–79 year age group will have
diabetes in 2010 and by 2030, 438 million people (7.8%) of the adult
population, is expected to have diabetes. The global increase in the
prevalence of diabetes is due to population growth, aging, urbanization
and an increase of obesity and physical inactivity. The primary
determinants of the epidemic are the rapid epidemiological transition
associated with changes in dietary patterns and decreased physical
activity. Unlike in the West, where older populations are most
affected, the burden of diabetes in Asian countries is
disproportionately high in young to middle-aged adults [2]. Studies
from India and the USA have shown increased prevalence of diabetes in
younger population [3, 4]. In India, 10 per cent of diagnosed patients
with diabetes were less than 30 yr of age in 2002 [5].
Education is one of the key components in ensuring better treatment and
control of diabetes. There is also evidence to show that increasing
knowledge regarding diabetes and its complications has significant
benefits including increase in compliance to treatment, thereby
decreasing the complications associated with diabetes [6]. Most
diabetes prevention efforts in Indian communities have been secondary
or tertiary prevention programs targeting adults with type 2 diabetes.
The approaches often combine a number of strategies, including health
education, health fairs, fitness programs, nutrition education, etc.,
and are delivered in a shotgun method with the expectation that one or
two of the strategies will be effective. Prevention programmes are
often implemented with little or no pilot testing, assuring poor
outcomes [7].
Material
and Methods
A Hospital based cross-sectional study carried out in the Department of
Medicine of Chirayu Medical College and Hospital, Bhopal located in
central India. All the young adult patients aged between 20-40 years,
who visited hospital out-patient department during the period January
2012 to December 2014, and diagnosed with Type II diabetes mellitus
were included in the study. Patients who did not give consent or denied
to participate in the study were excluded.
A pretested and pre-structured questionnaire was used to interview the
subjects and to collect data on demographic characteristics and
clinical profile of the patients.
Procedure
The glucose tolerance test (GTT) is performed after 3 days of
unrestricted carbohydrate diet, after an 8 hour fast and unlimited
physical activity. The subject should remain seated and should not
smoke throughout the test. The Glucose dose is 1.75 g per kg of
anhydrous glucose (to a maximum of 75gm). It should be dissolved in
about 200 ml of water and sipped over about 10 minutes to prevent
nausea. The 2 hour value is from the start of ingestion of the glucose.
The criterion for classification of diabetes mellitus was taken from
American Diabetes Association [8].
Statistical Analysis:
Data were entered in excel sheet and then analyzed using Microsoft
Excel 2007.
Results
In our study out of total 136 subjects 79(58.08%) were males and
57(41.9%) were females. Age range was 20-40 years with mean age
32±4.3 years. Diabetes Mellitus was found more in the age
group of 35-40 years followed by 30-35 years age group. 08% of the
cases had positive family history of diabetes mellitus and mean BMI of
the cases was 23.2 kg/m2. Distribution of subjects according to the age
and sex was shown in table no.1.
Table No. 1: Distribution
of Patient by Age and Sex
|
Age in years
|
Males
|
Females
|
Total
|
|
20-25
|
04
|
02
|
06(04.4%)
|
|
25-30
|
07
|
05
|
12(08.8%)
|
|
30-35
|
26
|
18
|
44(32.3%)
|
|
35-40
|
42
|
32
|
74(54.4%)
|
|
Total
|
79
|
57
|
136
|
In our study out of total 136 subjects 60(44.1%) were
asymptomatic and 76(55.8%) were asymptomatic. Out of total 136 patients
most common symptom found was polyuria in 64(47%) cases followed by
tiredness in 54(39.7%) cases. Clinical symptoms of the patients were
shown in table no.2.
Table No. 2: Clinical
Symptoms of the Patients
|
Symptoms
|
No. of cases
|
Percentage (%)
|
|
Polyuria
|
64
|
47
|
|
Polydipsia
|
37
|
27.2
|
|
Polyphagia
|
17
|
12.5
|
|
Weight loss
|
19
|
13.9
|
|
Tiredness
|
54
|
39.7
|
|
Blurring of vision
|
13
|
07.3
|
|
Delayed Wound Healing
|
13
|
09.5
|
|
Leg pain
|
08
|
05.8
|
|
Paraesthesia
|
09
|
06.6
|
|
DKA
|
05
|
03.6
|
Out of total 76 symptomatic patients, systemic symptoms were
found in 46(60.5%) of the patients. Most common symptom found was
cough/cold and sputum in 24(31.5%) of the cases followed by chest pain
in 11(14.4%) and dysuria in 9(11.7%) of the cases. Hypertension was
found in 18(23.6%) of the cases. Distribution of subjects according to
the systemic symptoms was shown in table no. 3.
Table No. 3: Systemic
Symptoms in Patients with DM
|
System
|
Symptoms
|
n=76 (%)
|
|
CVS
|
Chest pain
|
11(14.4)
|
|
RS
|
Cough/ cold/ sputum
|
24(31.5)
|
|
GI
|
Abdominal pain
|
13(17.1%)
|
|
Nausea
|
04(5.2)
|
|
Vomiting
|
06(7.8)
|
|
Diarrhoea
|
01(1.3)
|
|
Genital
|
Balanoposthitis
|
03(3.9)
|
|
Vulvovaginitis
|
02(2.6)
|
|
White discharge
|
07(9.2)
|
|
Dysuria
|
09(11.7)
|
|
Skin
|
Acanthosis
|
08(10.5)
|
|
Pyoderma
|
01(1.3)
|
|
Vitiligo
|
01(1.3)
|
|
Psoriasis
|
01(1.3)
|
Out of total 76 symptomatic patients, complications of
diabetes mellitus were found in 32(42.1%) of the cases. Most common
complication found was genital infections seen in 18(13.2%) of the
cases followed by skin infections seen in 14(10.2%) of the cases.
Distribution of the cases according to the complications of diabetes
mellitus was shown in table no. 4.
Table No. 4:
Complications of Diabetes Mellitus
|
Complication
|
No. of Cases
|
Percentage (%)
|
|
Neuropathy
|
08
|
05.8
|
|
Nephropathy
|
03
|
02.2
|
|
Retinopathy
|
02
|
01.4
|
|
CAD
|
05
|
03.6
|
|
DKA
|
05
|
03.6
|
|
Hypoglycemia
|
01
|
00.7
|
|
Foot ulcer
|
02
|
01.4
|
|
TB
|
02
|
01.4
|
|
Skin infection
|
14
|
10.2
|
|
Genital infection
|
18
|
13.2
|
Discussion
In our study out of total 136 subjects 79(58.08%) were males and
57(41.9%) were females. Age range was 20-40 years with mean age
32±4.3 years. Diabetes Mellitus was found more in the age
group of 35-40 years followed by 30-35 years age group, which is
similar to the study conducted by Zargar A H et al in 2001[9]. In a
similar type of study conducted by Sosale A, Prasanna Kumar K M in
2014, out of 4600 patients of type II diabetes mellitus, they found 35%
of the diabetics in the age range of 31-40 years [10].
In our study 8% of the cases had positive family history of diabetes
mellitus and mean BMI of the cases was 23.2 kg/m2, whereas in a study
conducted by Zargar A H et al, they found the positive family history
in 4.6% of the cases and mean BMI of the cases was >25 kg/m2
[9].
Out of total 136 patients most common symptom found was polyuria in
64(47%) cases followed by tiredness in 54(39.7%) cases. Abdominal pain
was found in 13(17.1%) of the cases, polydypsia was found in 37(27.2%)
of the cases, Diabetic Keto Acidosis (DKA) was found in 05(3.6%) of the
cases, whereas in a study conducted by Banerjee S, Uday S and Biswas D
in 2007, polydypsia, polyuria and polyphagia was found in 43(64.2%) of
the cases, DKA was found in 13(19.4%)and abdominal pain was found in
nine(13.4%) of the cases[11].
In our study most common complication of diabetes mellitus found was
genital infections seen in 18(13.2%) of the cases followed by skin
infections seen in 14(10.2%) of the cases which is similar to the study
conducted by Suresh K, Maliyappa Vijay Kumar et al. in 2014 [12].
In our study, other complications of Type II DM like neuropathy,
nephropathy, retinopathy and foot ulcers were found in 5.8%, 2.2%, 1.4%
and 1.4% respectively. Whereas Suresh K, Maliyappa Vijay Kumar et al.
found neuropathy in 10 patients, nephropathy in 6 patients, retinopathy
in 7 patients and foot ulcers in 3 patients out of total 130 patients
in their study [12].
Conclusion
Timely diagnosis of diabetes mellitus makes its management effective
and care can be start very early. There should be proper health
facilities available at all the levels of healthcare for early
diagnosis of diabetes mellitus for providing adequate guidance and
support to the patients from the very beginning.
Early sign and symptoms of diabetes should be explained in the
community through educational activities, so that the community level
of understanding and knowledge about the disease increased and at the
same time patients should be reinforced to use the health care services
for proper control of sign and symptoms and complications of diabetes
and to modify the lifestyle of the population diagnosed with diabetes
mellitus.
Funding:
Nil, Conflict of
interest: None initiated.
Permission from IRB:
Yes
References
1. Prasad AN. Type 2 Diabetes Mellitus in Young: Need for Early
Screening. Indian Pediatr. 2011 Sep;48(9):683-8. [PubMed]
2. Ramachandran A, Das AK, Joshi SR, yajnik CS, Shah S, Prasanna Kumar
KM. Current status of diabetes in India and need for novel therapeutic
agents. J Assoc Physicians India 2010; 58: 7-9. [PubMed]
3. Snehalatha C, Ramchandran A, Kapur A, Vijay V. Age-specific
prevalence and risk associations for impaired glucose tolerance in
urban southern Indian population. J Assoc Physicians India. 2003
Aug;51:766-9. [PubMed]
4. Pettitt DJ, Talton J, Dabelea D, Divers J, Imperatore G,
5. Lawrence JM, et al. SEARCH for Diabetes in Youth Study Group.
Prevalence of diabetes in U.S. youth in 2009: the SEARCH for diabetes
in youth study. Diabetes Care. 2014 Feb;37(2):402-8. doi:
10.2337/dc13-1838. Epub 2013 Sep 16.
5. Deepa M, Bhansali A, Anjana R M, Pradeepa R, Joshi S R,
Joshi P P, Dhandhania V K, Rao P V, Subashini R, Unnikrishnan R, Shukla
D K, Madhu S V, Das A K, Mohan V, Kaur T. Knowledge and awareness of
diabetes in urban and rural India: The Indian Council of Medical
Research India Diabetes Study (Phase I): Indian Council of Medical
Research India Diabetes 4. Indian J Endocrinol Metab. 2014
May;18(3):379-85. doi: 10.4103/2230-8210.131191.
6. Kochupillai N, Goswami R. Youth-onset diabetes in India:
6. nature of diabetes and use of bovine insulin in their treatment.
RSSDI textbook of diabetes, April 2002. Available from:
www.iddtindia.org/youth.asp. [Accessed March 18, 2015].
7. Rosenbloom AL, Joe JR, Young RS. Emerging epidemic of
type 2diabetes in youth. Diabetes Care. 1999 Feb;22(2):345-54. [PubMed]
8. Diagnosis and Classification of Diabetes Mellitus.
American Diabetes Association. Diabetes Care. 2010 Jan; 33(Suppl 1):
S62–S69.doi: 10.2337/dc10-S062. [PubMed]
9. Zargar A H, Bhat M H, Laway B A, Masoodi S R. Clinical
and aetiological profile of early onset diabetes mellitus: data from a
tertiary care centre in the Indian subcontinent. J Postgrad Med 2001;
47(1):27-9. [PubMed]
10. Sosale A, Prasanna Kumar K M, Sadikot S M, Nigam A,
Bajaj S, Zargar A H, Singh S K. Chronic complications in newly
diagnosed patients with Type 2 diabetes mellitus in India. Indian J
Endocr Metab 2014;18:355-60.
11. Banerjee S, Uday S, Biswas D. Profile of young diabetes
mellitus and its implications. Int J Dev Ctries. 2007;27(2): 50-55.
12. Suresh K, Maliyappa Vijay Kumar, Badrinath A. K. Socio
Demographic and Clinical Profile of Diabetes Mellitus in Adolescents
and Young Adults. Journal of Evolution of Medical and Dental Sciences
2014; Vol. 3, Issue 09, March 3; Page: 2287-2301, DOI:
10.14260/jemds/2014/2138.
How to cite this article?
Soni P, Zoheb A. Clinical profile of young adult diabetic patients
attending hospital OPD of a tertiary care centre in central India. Int
J Med Res Rev 2015;3(3):317-320. doi: 10.17511/ijmrr.2015.i3.060.