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Title: A Cross Sectional Study To Determine The Prevalence Of Autonomic Dysfunction In Type Ii Diabetic Mellitus Individuals In Rural Population Residing At Three Primary Health Center Phc Areas Associated To Jawaharlal Nehru Medical College Belgaum
Researcher: Sanjay D. Bhalerao
Guide(s): Dr. Shivaprasad S.Goudar
Keywords: autonomic function tests; type 2 diabetes mellitus
cardiovascular autonomic neuropathy
diabetic peripheral neuropathy; heart rate variability
diabetic symptom score; diabetic neuropathy examination score.
University: KLE University
Completed Date: 01/11/2014
Abstract: Introduction: Diabetes Mellitus is emerging as a major health problem owing to its serious complications. Within India, inter-regional disparities in burden of type 2 diabetes mellitus are expected because of varying lifestyles and demographic patterns. DM is also well known for its chronic complication such as tripathy which include neuropathy, retinopathy and nephropathy. Diabetic neuropathy [particularly, Cardiac autonomic neuropathy and Diabetic peripheral neuropathy] is most common clinical complication of DM. Its presence is associated with worsening prognosis and poorer quality of life. The risk of developing autonomic dysfunction in DM depends on several factors. It is important to assess these factors for developing interventions that can decrease and or arrest the progression of the disease. Objectives: Primary: To estimate the prevalence and autonomic dysfunction assessed by heart rate variability analysis and autonomic function tests among T2DM individuals of the rural population residing in areas of three primary health centers associated with Jawaharlal Nehru Medical College, Belgaum. Secondary: 1. To estimate the prevalence of diabetic peripheral neuropathy among type 2 diabetes mellitus individuals. 2. To determine the association of various risk factors such as age, gender, literacy, occupation, diet, body mass index, central and truncal obesity, smoking, alcohol consumption and family history of diabetes with prevalence of T2DM, CAN and DPN. Material and Methods: A cross sectional study was conducted to find out the prevalence and autonomic dysfunction in T2DM individuals of age above 30 years residing at three primary health center areas associated with Jawaharlal Nehru Medical College, Belgaum. 2684 selected participants (using multistage cluster sampling method) were screened for type 2 diabetes mellitus as per WHO criteria. Participants identified as T2DM were screened for autonomic dysfunction by using various cardiovascular reflex tests (Ewing tests criteria). Diabetic peripheral neuropathy was assessed by using diabetic neuropathic examination score (DNE) and diabetic symptom scoring system (DNS). Results and Discussion: - Overall prevalence of T2DM was found to be 17.7%. Risk factors such as age, diet, BMI, truncal obesity, smoking, alcohol consumption and family history of diabetes appear to increase the risk for developing T2DM. Furthermore, advance age and duration of diabetes appear to be risk factors for developing CAN and DPN in the T2DM participants. Abnormal heart rate variability among T2DM participants is associated with abnormal heart rate variability, indicating the autonomic dysfunctions. Conclusion: - High prevalence of T2DM, CAN and DPN even in rural community suggests the impact of socioeconomic transition on the occurrence of the disease. HRV analysis and autonomic function tests can be used as screening tools for assessment of CAN in community settings. There is need to institute screening and awareness programs for early detection of diabetic complication so as to prevent long term consequences. The findings of this study suggest the need for the promotion of preventive measures to prevent or delay the development of chronic complications of diabetes through good glycaemic control, regular monitoring, lifestyle modification, practice of exercise and yoga to maintain the normal balance of sympathetic and parasympathetic tone. newline
Appears in Departments:Faculty of Medicine

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