The aim of study was to assess the prevalence of micro and macro diabetic complications and risk factors of diabetic patients.

The study was conducted in Raghu diabetes & general clinic, Chittoor, Andhra Pradesh.

Sample size of 200 subjects was recruited for the study

It was prospective observational study.

The study was conducted from December 2020 to May 2021.

The patient details were collected using questionnaire form.It contains sociodemographic data and medical history including smoking, alcohol intake, family history of diabetes mellitus, and treatment and management of diabetes. Patient enrollment into the study was done by interacting with the patients.

Data was presented as mean and standard deviation, and numbers with percentages. The variables like age, gender, BMI, smoking status, alcoholic status, and biochemical parameters were considered as risk factors.Multivariate logistic regression was performed to estimate odds ratio (OR) for assessing the risk factors associated with presence of micro & macro vascular complications with 95% confidence interval (CI). Two-tailed value of less than 0.05 was considered as significant.Prescribing pattern of different anti-diabetic drugs was also reported in the form of percentages. All the analyses were carried out using SPSS version 25.0.

The protocol was reviewed and approved by Institutional Ethics Committee (IEC) of RVS Institute of medical sciences (Ref. No.: IEC / RVSIMS / 2021 / 04).

Overall the prevalence of co-morbid DM(Diabetes Mellitus) and HTN(Hypertension) was 6.5% with significant high prevalence among (66.3%) and females (70.4%). But no rural – urban difference was noted. In 5% of respondents, DM, HTN & Dyslipidemia co-existed. Around 1.5% of respondents had more than 2 morbidities, which was significantly higher among elderly (5.04%), females (5.2%) and urban residence (6.31%), physical inactivity (3.15%) and housewife (2.1%). It was shown in Table 1.

Table 1

Parameters	Total	Co–morbidities DM & HTN	DM, HTN & Dyslipidemia	More than 2 Morbidities
Age group 31-51
51-70	119	79	06	02
71-90	25	22	01	01
Gender Male
Female	115	81	06	02
Residence Rural	105	66	04	01
Urban	95	65	06	02
working status Jobless	03	01	00	00
Housewife	94	67	06	02
Business/private	45	29	02	00
Government	07	04	00	00
Retired Cooli	23	13 16	01 01	00 01
Physical activity Yes
No	95	63	05	03

In our study the risk factor for Neuropathy were found to be Age group (71- 90 yrs) [OR, 0.090, 95% CI, P= 0.022], marital status for widow [OR, 0.578, 95% CI, P= 0.005] and for married [OR, 17.304, 95% CI, P= 0.005], education for illiterates [OR, 0.238, 95% CI, P= 0.28] and for primary education [OR, 6.319, 95% CI, P= 0.016], working status (retired) [OR, 0.214, 95% CI, P= 0.050], comorbidities for foot ulcer [OR, 9.337, 95% CI, P= 0.034] and [OR, 0.120, 95% CI, P= 0.047] for hypothyroid, CAD [OR, 0.050, 95% CI, P= 0.003], cataract (yes) patients [OR, 0.116, 95% CI, P= 0.004] and for no patients [OR, 8.608, 95% CI, P= 0.004], Habit of smoking (yes) [OR, 0.124, 95% CI, P= 0.006] and no patients [OR, 16.135, 95% CI, P= 0.007], Intake of alcohol (yes) [OR, 0.145, 95% CI, P= 0.011] and no patients [OR, 4.565, 95% CI, P= 0.019]. The risk factors for having nephropathy were found to be comorbidities (no) patients [OR, 0.162, 95% CI, P= 0.093], In complications of Neuropathy patients [OR, 0.072, 95% CI, P= 0.011], Intake of alcohol (no) patients [OR, 13.834, 95% CI, P= 0.011], Intake of water (3-5 lit) [OR, 7.217, 95% CI, P= 0.065] and 5 lit [OR, 0.162, 95% CI, P= 0.093]. The risk factors for having CVD were found to be gender (male) [OR, 4.664, 95% CI, P= 0.050] and female [OR, 0.214, 95% CI, P= 0.050], BMI [OR, 0.106, 95% CI, P= 0.034], DM duration of 11-14 years [OR, 0.162, 95% CI, P= 0.093], Intake of alcohol (yes) [OR, 0.214, 95% CI, P= 0.050] and no [OR, 09.377, 95% CI, P= 0.034]. The study results were shown in Table 2.

Table 2

Risk Factors	Neuropathy		Retinopathy		Nephropathy		Cerebro- Vascular disease		Cardio-vascular disease
	Odds ratio	P- value	Odds ratio	P- value	Odds ratio	P- value	Odds ratio	P- value	Odds ratio	P- value
Age group
31-50	0.531	0.222	1.000	1.000	0.244	0.209	0.500	0.572	0.492	0.321
51-70	1.891	0.218	-	-	0.434	0.172	-	-	2.030	0.321
71-90	0.090	0.022	-	-	2.201	0.195	2.000	0.572	0.492	0.321
Gender
Male	0.636	0.360	1.000	1.000	0.750	0.600	0.500	0.572	4.664	0.050
Female	1.571	0.360	-	-	1.333	0.600	2.000	0.572	0.214	0.050
BMI
Under weight	-	-	-	-	-	-	-	-	-	-
(<18.5)									0
Normal	0.852	0.778	-	-	1.206	0.760	0.497	0.569	.106	0.034
weight (18.5 – 24.9 )	1.414	0.559	1.000	1.000	2.030	0.321	2.010	0.569	4.664	0.050
Over weight (25 – 29.9)	0.829	0.760	1.000	1.000	0.492	0.321	-	-	2.010	0.569
Obese (>30)
Marital status
Widow	0.578	0.005	-	-	0.387	0.114	0.497	0.569	0.086	0.019
Married	17.304	0.005	5.050	0.296	2.578	0.114	2.010	0.569	11.582	0.019
Unmarried	1.000	1.000	-	-	-	-	-	-	-	-
Genetic
Yes	1.064	0.338	1.000	1.000	1.347	0.587	0.497	0.569	2.041	0.250
No	0.632	0.338	1.000	1.000	0.742	0.587	2.010	0.569	0.489	0.250
Residence Rural	1.263	0.630	1.000	1.000	0.742	0.587	2.010	0.569	1.414	0.559
Urban	0.791	0.630	1.000	1.000	1.347	0.587	0.497	0.569	0.829	0.760
Education
Illiterates	0.238	0.028	-	-	0.489	0.520	-	-	0.593	0.479
Upto primary education	6.319	0.016	5.050	0.296	8.291	0.471	2.010	0.569	5.012	0.138
Upto secondary education	2.010	0.569	-	-	1.000	1.000	-	-	0.330	0.338
Higher education	0.330	0.338	-	-	1.000	1.000	0.497	0.569	1.000	1.000
working status
Jobless	2.308	0.169	-	-	1.777	0.365	1.000	1.000	2.030	0.321
Housewife	0.134	0.703	-	-	1.340	0.703	1.000	1.000	1.507	0.654
Business/private	-	-	-	-	-	-	-	-	2.010	0.569
Government	1.507	0.654	1.000	1.000	-	-	1.000	1.000	0.162	0.093
Retired	0.214	0.050	1.000	1.000	0.419	0.213	-	-	-	-

The low HDL (High Density Lipoprotein) cholesterol levels were seen among 29.19% (n=41) of patients and high LDL (Low Density Lipoprotein) cholesterol levels were seen in 25.71% (n=36) of the population, 27.14% (n=38) had high TG levels, 14.29% (n=20) had high cholesterol and 19.29% (n=27) had VLDL (Very LowDensity Lipoprotein). The mean & standard values of PCV(36.43%), MCV(28.57%), MCH(27`14%), MCHC(22.86%) significantly decreased in the T2DM, the respective values were 33.39 ± 4.31, 73.47±12.70, 27.98± 8.73 and 35.21± 4.91.The T4 levels were seen among 10%(n=14), TSH levels were seen among 9.29(n=13) and T3 levels were seen among 8.57(n=12). It was shown in Table 3.

Diabetic patients 167 (83.5%) were prescribed combination of Biguanides and Sulfonylureas followed by Biguanides 44 (22%), Sulfonyl urea’s 17 (18.5%), α-Glucosidase inhibitors 83 (41.5%), Thiazolidinediones 02 (1%), Meglitinide 04 (2%),insulin in combination with OHA 38 (19%). About 108 (54%) patients were prescribed with anti-hypertensives, 33 (16.5%) patients

were prescribed with cardiovascular drugs, 34 (17%) were prescribed with statins, 160 (80%) were prescribed multivitamins and 181 (90.5%) were prescribed with other drugs that includes (antibiotics, painkillers, PPI, antipyretics). It is shown in Figure 1.

The mean ± SD FBS levels of subject in the study was 147.93±18.89 mg/dl. The subjects belonging to 30-50 age group had mean ±SD FBS levels of 174.17±64.79 mg/dl, 51-70 yrs was 139.20±45.33 and 71-90 yrs was 130.43±53.22 mg/dl. The mean ± SD PPBS levels of subject in the study group were 230.96±23.33 mg/dl. PPBS levels in subjects belonging to 30-50 age group had mean ± SD 260.78± 80.73, 51-70 (228.29±64.75) and 71-90 years (203.81±65.20)mg/dl. The mean HbA1c level in the study group was 8.43±1.00%. The mean ± SD of HbA1c levels was higher in 30-50 age group 9.33±1.35, 51 – 70 years was 8.93±2.18 and 71-90 years was 7.03 ±0.70. as presented in Figure 2.

Figure 2

In this study 57.5% were females and 42.5% were males. The mean ± SD of FBS among females was 149.83%±50.14 mg/dl and among males was 145.28 ±60.93 mg/dl. The mean ±SD PBBS levels of females were 234.53 ± 67.21 mg/dl and among males was 234.53±78.02 mg/dl. The mean±SD of HBA1c was 9.44 ±1.33% in females and 8.33±2.20 % in females. It is shown in Figure 3.

DM is a complex disease. The time lag between the onset of DM & clinical diagnosis results in the development of chronic micro & macro vascular complications. Based on our study results this proposition might be higher in developing countries like India. 11, 12, 13, 14, 15 In this study, we assessed the prevalence of micro & macro vascular complications in 200 DM patients and found 17% presented with microvascular complication and 11.5% presented with macrovascular complication. 16, 17, 18, 19 Similar cross-sectional studies have been done in India reporting prevalence rates ranging from 13 to 30%. This study revealed that about 9% of subjects suffer from moderate to severe neuropathy which needs immediate attention, as they are at high risk of foot infection and amputation. 20 Also in this study, age, obesity, and lipids parameters were the main significant risk factors for the development of diabetic retinopathy. A high prevalence of obesity, poor glycemic control and cardiovascular events were reported in previous studies to be major causes of co-morbidities in patient, especially in middle and old age group. 21

The key findings of the present study include:

Obesity is an emerging global problem giving rise to increase in Diabetes, HTN, Dyslipidemia & CVD. Weight reduction achieved between life-style interventions like dietary regulations & regular physical activity will help overweight individuals accomplish higher BP & glucose control & thereby reduce their complications. 23 Regarding medications sulfonylureas was most utilized medication alone or in combination with other Anti-diabetic medication. Diabetic patients with chronic health issues require extensive healthcare which can be fulfilled by providing the healthcare terms with sufficient, comprehensive, reliable, compactible & co-relating patients information across the different health sectors. 24 Thus study reported the prevalence of diabetes is more in the subjects of sedentary life-style, obese, Hypertensive & smokers. 25

The study reported the prevalence of DM progression, comorbidities, risk factors and associated micro & macro complications. This study shows the prevalence of diabetes is high in the subjects having overweighed, gender, hypertensive and also found that females & patients aged 51-70 years were most affected by diabetes. Apart from glycemic control there is a need of tight lipid management in DM patients as TG, LDL and HDL, total cholesterol were shown as significant risk factors for micro & macro vascular complications. Regular exercise, intake of more fibrous diet, vegetables and fruits can reduce the prevalence of diabetes in subjects with poor literacy status and use of educational attainment promote an interest in own health and acquisition of knowledge that strongly influence people’s ability to reduce risk by successfully adopting a healthier life-style. Future research studies are need to be conducted for an in-depth analysis and understanding of the possible causal and risk factors. Thus research in the field of diabetes needs to be intensified.