SYNOPSIS
SYNOPSIS
Rajiv Gandhi University of Health Sciences, Karnataka,
Bangalore.
“OCCURENCE AND PATTERN OF DYSLIPIDEMIA IN
NEWLY- DETECTED TYPE 2 DIABETES MELLITUS AND
ITS CORRELATION WITH ANTHROPOMETRIC PARAMETERS”
Name of the candidate : Dr. Cynthia Amrutha Sukumar
Guide : Dr.(Col) R. Arunachalam
Co-Guide : Dr. Sudeep K.
Course and Subject : M.D (General Medicine)
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Department of General Medicine,
Father Muller Medical College,
Kankanady, Mangalore – 575002.
August – 2012
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF THE SUBJECT FOR
DISSERTATION
|1. |NAME OF THE CANDIDATE AND ADDRESS |DR. CYNTHIA AMRUTHA SUKUMAR |
| | |P.G. RESIDENT |
| | |FR. MULLER MEDICAL COLLEGE, KANKANADY, |
| | |MANGALORE – 575002. |
|2. |NAME OF THE INSTITUTION |FR. MULLER MEDICAL COLLEGE, KANKANADY, |
| | |MANGALORE – 575002 |
|3. |COURSE OF STUDY AND SUBJECT |M.D. (GENERAL MEDICINE) |
|4. |DATE OF ADMISSION TO COURSE |30-05-2012 |
|5. |TITLE OF THE TOPIC: |
| |OCCURENCE AND PATTERN OF DYSLIPIDEMIA IN NEWLY- DETECTED TYPE-2 DIABETES MELLITUS AND ITS CORRELATION WITH ANTHROPOMETRIC PARAMETERS. |
|6. |Brief Resume of the Intended Work: |
| |6.1. Need for the study: |
| |Diabetes is an iceberg disease. Currently, India has a diabetic burden of |
| |40.9 million (2006) and is called the “Diabetic capital of the world”. Type-2 diabetes mellitus constitutes 95% of the diabetic population in India. This |
| |escalating epidemic of type 2 DM has been attributed to increasing obesity and longevity1. |
| |Macrovascular complications in type-2 DM are coronary artery disease, cerebrovascular accidents and peripheral vascular disease which are major causes of |
| |morbidity and mortality in type 2 DM. Altered lipid metabolism and abnormal lipid levels are major contributors to macrovascular diseases. Despite its |
| |enormous global importance, accurate population-based data with specific dyslipidemic pattern for the Asian population are lacking 2. |
| |Because of the additive cardiovascular risk of hyperglycemia and hyperlipidemia, lipid abnormalities should be aggressively detected and treated as a part |
| |of comprehensive diabetic care. |
| |In view of this, the current study aims at detecting the occurence and pattern of dyslipidemia in newly-detected type-2 diabetic patients in Father Muller|
| |Medical College Hospital. An effort will also be made to relate the dyslipidemia to anthropometric parameters. |
| |6.2 Review of Literature |
| |Macroangiopathic complications (attributed mainly to dyslipidemia) refer to adverse cardiovascular events arising from atherosclerosis. Patients with type |
| |2 DM are at a |
| |2- 4 fold higher risk of macrovascular complications 3. |
| |Smoking, hypertension, obesity and dyslipidemia have been shown to play a major role in the pathogenesis of atherosclerosis. |
| |Atherosclerosis in diabetics affects all the parts of the vascular tree and is morphologically and biochemically identical to that in non-diabetic |
| |subjects. However, the atherosclerosis is premature, more extensive and has accelerated progression in diabetics4. |
| |Patients having one or more lipid abnormalities (TG,cholesterol or LDL chlesteerol) outside the targets recommended by the American Diabetic Association |
| |(ADA) are considered to have dyslipidemia, which includes TG ≥150mg/dl, |
| |cholesterol ≥200 mg/dl, LDL ≥ 100 mg/dl, HDL ≤ 40 mg/dl in males and ≤ 50 mg/dl in females . |
| |In Indian diabetics,the most common dyslipidemia noted is the combined dyslipidemia which manifests as increased LDL and decreased HDL in men and women. |
| |The prevalence of dyslipidemia among Indian diabetics is 85.5% in males and 97.8% in females. However , the consequences of atherosclerosis in the Asian |
| |Indian population are more severe and develops earlier in life 5. |
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| | |
| |Normally, LDL receptors are stimulated by insulin, the lack of which will result in accumulation of plasma LDL which progresses to reach atherogenic |
| |levels. Atherosclerotic changes are initiated by oxidized LDL and not naïve LDL. Both HDL and anti-oxidants impair this process of LDL oxidation thereby |
| |exerting |
| |anti-atherogenic action 4. |
| |Obesity and overweight in adults reflects a risk for type 2 DM and cardiovascular risk in the future. Common surrogate measures of obesity are Body mass |
| |index (BMI) |
| |and Waist circumference (WC). |
| |A study done in Karnataka, to assess the lipid abnormalities in normal healthy subjects and in type 2 DM subjects showed significantly elevated total |
| |cholesterol, triglycerides and reduced HDL levels in the diabetic group6. |
| | |
| |6.3 Objective of the study: |
| |To study the occurrence of dyslipidemia in newly-detected type-2 diabetics. |
| |To analyse the pattern of dyslipidemia in this group. |
| |To assess the relationship between anthropometric measurements and dyslipidemia. |
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|7 |Materials and Methods |
| |7.1 Source of data: |
| |A minimum of 50 patients (male and female) seeking medical attention at the Father Muller Medical College Hospital, during the period of study ,who have |
| |been newly-diagnosed to have type 2 DM will be included in this study. |
| |7.2. Method of collection of data( including sampling procedure if any): |
| |This cross-sectional study is proposed to be conducted at the Father Muller Medical College Hospital. After fulfilling the criteria in the study, a |
| |voluntary informed consent will be obtained from all the study subjects. Each of the subjects will be initially evaluated for BMI, WC and clinical features|
| |of dyslipidemia (which include arcus senilis ,xanthelasma and xanthomas). A detailed clinical evaluation including history and physical examination will be|
| |done on each subject. |
| |Body-weight will be recorded while standing motionless on a digital weighing scale( to the nearest 0.1 kg). Height will be measured while standing erect |
| |against a vertical scale of a portable stadiometer (to the nearest 0.1 cm). BMI will then calculated as weight in kilogram divided by squared height in |
| |meter. |
| |Waist circumference will be measured midway between iliac crest and lowermost margin of ribs at minimum respiration. Optimum cut-offs for Asian Indians |
| |will be applied to the obtained values7. |
| |BMI- Normal BMI: 18.0-22.9 kg/m2 |
| |Overweight:23.0-24.0 kg/m2 |
| |Obesity :>25 kg/m2 |
| |Waist circumference- 90 cms(men) and 80 cms (women) |
| |Clinical features of dyslipidemia included in this study will be arcus senilis, Xanthelasma and xanthomas. |
| |Fasting peripheral venous blood samples will be obtained for estimation of fasting blood sugar levels and serum lipid estimation |
| |(S.triglycerides,S.cholesterol,S.HDL and S.LDL) . Venous blood samples will also be obtained for glycosylated-Hb, post-prandial blood sugar, renal |
| |function test(S.Creatinine) and liver function test(SGPT/SGOT). Wherever there is a clinical suspicion of hypothyroidism, serum TSH will be done. Urine |
| |microscopy and urine albumin-creatinine ratio will be obtained in all subjects.All patients will be subjected to a fundoscopic evaluation to evaluate for |
| |diabetic retinopathy. |
| | |
| |Sample size: |
| |Fifty patients who have been newly-diagnosed to have type-2 DM will be included in this study. |
| | |
| |Design of the study: |
| |Cross-sectional descriptive study. |
| | |
| |Duration of the study: |
| |The study period will be 18 months. |
| |Inclusion Criteria : |
| |Patients fulfilling the ADA criteria for diagnosis of type 2 DM who are- |
| |Newly-diagnosed type-2 diabetics |
| |>20 years of age |
| |Exclusion Criteria: |
| |Acute metabolic complications |
| |Diabetic ketoacidosis |
| |Hyperglycemic hyperosmolar syndrome |
| | |
| |Acute illnesses |
| |Acute Myocardial Infarction |
| |Cerbrovascular accidents |
| |Acute infections |
| | |
| |Alcohol Dependance( according to the ICD-10 criteria) |
| |Hypothyroidism |
| |(clinical/abnormal thyroid function test/on thyroid replacement therapy) |
| |Liver disorders ( clinical findings/ > 3-4 times upper limit of normal LFT) |
| |Renal disease (of non-diabetic etiology) |
| |Known inherited disorders of lipids |
| |Secondary dyslipidemia |
| |Pregnancy |
| |Drugs |
| |Beta-blockers |
| |Thiazides |
| |Steroids |
| |Hypolipidemic drugs |
| |Oral contraceptives |
| |Anti -coagulants |
| |Data Analysis |
| |The data obtained will be collected and the occurence and pattern of dyslipidemia will be studied. Further, its relation with the obtained anthropometric |
| |measurements will be analysed by frequency,percentage,mean,standard deviation and chi-square test. |
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| |7.3 Does the study require any investigation/ intervention on patients/other humans. If so, describe briefly: |
| | |
| |Blood and urine tests as enumerated in “Methods of Study” will be done in all subjects. |
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| |7.4 Has ethical clearance been obtained from your institution in case of 7.3: |
| |YES |
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|8. |References: |
| |1.Mohan V, Sandeep S, Deepa R, Shah B, Varghese C. Epidemiology of type-2 diabetes:Indian scenario. Indian J Med Res 2007; 125:217 -30. |
| |2.King H, Rewers M .Global Estimates for the prevalence of diabetes mellitus and impaired glucose tolerance in adults. Diabetes Care 1993;16:157-77. |
| |3.Huxley R, Barzi F, Woodward M. Excess risk of coronary artery disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort|
| |studies. BMJ 2006; 33:73-8. |
| |4.National Diabetes Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 1979;28:1039-57. |
| |5.Parikh RM, Joshi SR, Menon PS, Shah NS. Prevalence and pattern of diabetic dyslipidemia in Indian type-2 diabetic patients, Diabetes Metab Syndrome |
| |2010; 4(1):10-12. |
| |6.Rai N, Jeganathan PS. A correlative study of status of serum cholesterol, triglyceride and HDL-cholesterol in Type-2 diabetes mellitus patients with |
| |and without hypertension. Research J of Pharmaceutical, Biological and Chemical Sciences 2010; 1(3):377 –81. |
| |7.Misra A, Chowbey PS, Makkar BM, Wasir JS, Chadha D, Joshi SR, et al'. Consensus statement for diagnosis of Obesity,Abdominal Obesity and the metabolic |
| |syndrome for Asian Indians and Recommendations for Physical Activity,Medical and Surgical Management. J Assoc Physicians India 2009;57:163-70. |
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|9 |SIGNATURE OF THE CANDIDATE - | |
|10. |REMARKS FROM GUIDE- | |
|11. |11.1 NAME & DESIGNATION OF |DR. (Col) R. ARUNACHALAM, MD |
| |GUIDE |PROFESSOR AND UNIT HEAD, |
| | |DEPARTMENT OF GENERAL MEDICINE |
| | |FR. MULLER MEDICALCOLLEGE |
| | |MANGALORE – 575002 |
| |11.2 SIGNATURE | |
| |11.3 NAME AND DESIGNATION OF |DR. SUDEEP K, MD. DNB(ENDOCRINOLOGY), ASSISTANT PROFESSOR , |
| |CO-GUIDE |DEPARTMENT OF GENERAL MEDICINE |
| | |FR. MULLER MEDICALCOLLEGE |
| | |MANGALORE – 575002 |
| |11.4 SIGNATURE | |
| |11.5 HEAD OF DEPARTMENT |DR. NARASIMHA HEGDE , MD |
| | |PROFESSOR AND HOD OF MEDICINE |
| | |DEPARTMENT OF GENERAL MEDICINE |
| | |FR. MULLER MEDICAL COLLEGE |
| | |KANKANADY, MANGALORE – 575002 |
| |11.6 SIGNATURE | |
|12 |12.1 REMARKS OF THE CHAIRMAN AND DEAN | |
| | | |
| |12.2 SIGNATURE | |
|9 |SIGNATURE OF THE CANDIDATE - | |
|10. |REMARKS FROM GUIDE- | |
|11. |11.1 NAME & DESIGNATION OF |DR. (Col) R. ARUNACHALAM, MD |
| |GUIDE |PROFESSOR AND UNIT HEAD, |
| | |DEPARTMENT OF GENERAL MEDICINE |
| | |FR. MULLER MEDICALCOLLEGE |
| | |MANGALORE – 575002 |
| |11.2 SIGNATURE | |
| |11.3 NAME AND DESIGNATION OF |DR. SUDEEP K, MD. DNB(ENDOCRINOLOGY), ASSISTANT PROFESSOR , |
| |CO-GUIDE |DEPARTMENT OF GENERAL MEDICINE |
| | |FR. MULLER MEDICALCOLLEGE |
| | |MANGALORE – 575002 |
| |11.4 SIGNATURE | |
| |11.5 HEAD OF DEPARTMENT |DR. NARASIMHA HEGDE , MD |
| | |PROFESSOR AND HOD OF MEDICINE |
| | |DEPARTMENT OF GENERAL MEDICINE |
| | |FR. MULLER MEDICAL COLLEGE |
| | |KANKANADY, MANGALORE – 575002 |
| |11.6 SIGNATURE | |
|12 |12.1 REMARKS OF THE CHAIRMAN AND DEAN | |
| | | |
| |12.2 SIGNATURE | |
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