Cutaneous Manifestations In Type 2 Diabetes Mellitus In Urban Areas Of Belagavi - A Longitudinal Study

Abstract

Introduction: Diabetes mellitus is a worldwide problem being the most common metabolic disorder. At present there are more than 422 million diabetics globally and predicted to double in 2030 with a maximum increase in India afflicting up to 79.4 million individuals. Cutaneous signs of diabetes mellitus are extremely valuable to clinicians as some of them may alert the physicians to the diagnosis of diabetes mellitus, as it can be the presenting symptom and reflect the status of glycemic control or may indicate the development of diabetes in due course of time. Thus these cutaneous lesions can often presents as the first warning signals for this metabolic disorder and can be used as a good predictor for evaluating not only the risk of developing diabetes but also treatment success Objective: To know the incidence of cutaneous manifestations in type 2 diabetes mellitus in urban areas of Belagavi. Methodology: Data was be collected from type 2 diabetes mellitus patients attending Diabetes clinic in Urban Health Centre Ashok Nagar and Ram Nagar under field practice area of Department of Community Medicine, Jawaharlal Nehru Medical College, Belagavi. Only after obtaininginformed written consent the diagnosis of diabetes mellitus type 2 is confirmed by verifying the diabetic register, maintained in the Urban Health Centresandmedical records was reviewed for information of duration, medications, and complications of diabetes. Information about socio-demographic profile, general physical examination, systemic and cutaneous examination was recorded using questionnaire validated, predesigned and pretested proforma. All patients were subjected to detailed history regarding skin complaints, duration of diabetes mellitus type 2, family history and treatment of diabetes mellitus. All cases were subjected to thorough cutaneous and mucosal examination under natural light. They were screened for cutaneous diseases with known or postulated or without a clear pathogenesis as well as with complications and treatment of diabetes mellitus type 2. All patients were called for follow-up monthly till 31th December 2016. Data analysis: The data was tabulated and master chart was prepared. Data collected in the questionnaire was coded and entered in Microsoft excel sheet. Data was analysed using Statistical Package for Social Sciences (SPSS), version 21.0 and the incidence of cutaneous manifestations was expressed in terms of percentages. Statistical analysis was done using Pearson’s Chi- Square test to find out the association between cutaneous manifestations and risk factors. A probability value (p value) of less than 0.05 was considered as significant. Results: Of the 180 study participant, 36.67% were in the age group of 56-65 years and 28.8% were in the age group of 66-75 years forming the majority of the participants. The average age of the study participant was 59.88 ±11.06 (mean ± S.D.) with a range of 27 to 87 years of age. 74.44% were female forming the major portion and 25.56% were male. In this study Muslim and Hindu participant were almost equal with 48.89% and 45.56% respectively, and the remaining 5.56% of the participant were Christians. Most of the study participant 36.11% were illiterate and 28.89% of them had studied up to Primary school. 83.33% were unemployed and 11.11% were skilled workers. Among the 180 study participant 22 (12.22%) were of Class I, 49 (27.22%) were of Class II, majority were of Class III with 56 (31.11%) participant. 43 (23.89%) were of Class IV and 10 (5.56%) were of Class V. Among the 180 study participant the prevalence of cutaneous manifestations was found to be in 88 (48.88%) and 92 (51.11%) did not have any skin lesion at the time of collection of baseline information. 177 total subject were followed up for a total of 10 month. 3 study participant were accounted to loss to follow up. 1 was due to death and other 2 were due to change in residence. These study participant contributed to 6, 8 and 9 months of follow up. This amounting to 1793 months, which is 99.61% of follow up. And the attrition rate was 0.38%.So, the cumulative incidence was found to be 0.4777 or 47.77 per 100 Diabetics and incidence rate was found to 0.0479 per Diabetics – Years. Conclusion: Dermatological manifestations were highly prevalent causing considerable morbidity although the true burden is difficult to define. The most common lesion noted were Xerosis during the winter months and Tinea paedis during the monsoon season. The incidence newer lesions was low owing the chronicity of the diabetes mellitus. However there are cutaneous markers such as Acanthosis nigricans and skin tag which are considered precursors for the development of diabetes mellitus.