INTRODUCTION:

Diabetes mellitus is a prevalent metabolic disease characterized by the body's inability to regulate blood glucose levels effectively which is typified by hyperglycaemia, glycosuria, hyperlipemia, a negative nitrogen balance, and occasionally ketonemia. Thickening of the capillary basement membrane, an increase in the matrix of the vessel wall, and cellular proliferation are widespread pathological changes that lead to vascular complications such as lumen narrowing, early atherosclerosis, glomerular capillary sclerosis, retinopathy, neuropathy, and peripheral vascular insufficiency. Diabetes mellitus can be classified into two main types: Type 1 and Type 2 out of which Type 1 diabetes, formerly known as insulin-dependent diabetes mellitus, is an autoimmune disorder where the body's immune system attacks and destroys the insulin-producing beta cells in the pancreas. Type 2 diabetes, the most common form, accounting for approximately 90% of cases, is a complex metabolic disorder characterized by insulin resistance and impaired insulin production due to dysfunction of the pancreatic beta cells. Type 2 diabetes is initially managed through oral antidiabetic medications, lifestyle modifications, and dietary interventions. However, as the disease progresses, some patients may require insulin therapy in addition to other treatments^1-3. Various factors that can influence the body's response to drugs, including age, gender and body size, genetic makeup, personality traits, clinical history, and adherence status. The study explores the association between diabetes mellitus and other associated complications as well as their respective drug therapies.

Orally administered diabetes mellitus medications effectively reduce blood glucose levels. An injection is the only way to provide insulin, which is its main disadvantage. Research has long been done on oral active medications. Commonly used medication for the management of type II diabetes mellitus is given in figure 1^4-6.

Figure 1: Drug therapies for type II diabetes mellitus

Diabetes mellitus is closely linked to acute and chronic problems, both of which can lead to damage to tissues and organs. Acute complications include diabetes ketoacidosis, hypoglycaemia and infections. Chronic complications are long-term effects that can be macrovascular (ischemic heart disease, peripheral vascular disease) or microvascular (retinopathy, nephropathy, and neuropathy). Microvascular problems might arise throughout adolescence or early adulthood, but macrovascular problems typically manifest in later life. Following puberty, the risk of complications increases dramatically and is higher the longer diabetes has been present. Along with hereditary factors, poor glycaemic management, hypertension, dyslipidemia, and smoking are risk factors for developing problems⁷.

Beside it numerous consequences, which might vary depending on the circumstances, are linked to diabetes mellitus. These include lumen constriction, early atherosclerosis, sclerosis of glomerular capillaries, retinopathy, neuropathy, and peripheral vascular insufficiency⁸. Patients receive differing patterns of care in different area/hospitals. Due to the lack of previous research in the chosen area or hospital regarding these complications and their management strategies, the current study was created to examine demographic aspects, the assessment of associated complications with diabetes mellitus, and the management strategies in the general medicine department of a private hospital. The main goal of the current study was to perform a six-month randomised retrospective analysis on selected Diabetes mellitus patients in a multispecialty hospital to evaluate associated complications and the general medicine department's care approach⁹.

RESEARCH METHODOLOGY:

Study Type, Population and Site:

Retrospective study of 200 records on Assessment of Complication of Diabetes Mellitus and Its Management Strategy was conducted in the department of General medicine at Indus International Hospital, Derabassi (Punjab).

Duration of Study:

The study period spanned six months, from August 2023 to January 2024.

Inclusion Criteria:

· Patients with diabetes mellitus for three years or longer.

· Patients who are male and female.

· Patient receiving insulin medication and an oral hypoglycemic agent.

Exclusion Criteria:

· Patient throughout pregnancy.

· Individuals suffering from neurological conditions.

· critically unwell individuals.

Methods:

For this study we used the records from the department of General medicine and Medical Record Department of multispecialty hospital in Dera bassi (Punjab). The collected data was compared and charted with percentage using following parameter.

Gender Distribution:

An unequal number of male and female population data indicate the gender distribution of the study.

Age Distribution:

Patients in the age between of 20 to 50 (group-1) and 50-90 (group-2) years will be recorded separately, with the exception of pregnant patients, critically ill patients, patients with multiple diseases, and neonatal patients.

Microvascular Complication of Diabetes Mellitus:

Patients with diabetes mellitus who experienced a range of microvascular complications, such as diabetic retinopathy, polyneuropathy, burning in the feet, foot ulcers, cardiac problems, or no complications at all, are also included in our study.

Macrovascular Complication of Diabetes Mellitus:

Includes hypertension, coronary artery disease, diabetic ketoacidosis, peripheral vascular disease, atherosclerosis.

Drugs Used for Treatment:

Most prescribed drugs for diabetes mellitus treatment.

Duration of Therapy:

Interpretation of Patient’s duration of drug therapy was done.

RESULTS AND DISCUSSION:

A total of 200 patients were enrolled in the study site during the study period in an effort to better understand the assessment of diabetes mellitus complications and their management in a private hospital.

Age distribution:

Patients in the age range of 30 to 90 years are included in the study, with the exception of patients who are pregnant, very sick, have numerous diseases, or are neonatal patients. The age distribution shows that 10% of people are between the ages of 30 and 40, 11% are between the ages of 40 and 50, 58% are between the ages of 50 and 60, 12% are between the ages of 60 and 70, 10% are between the ages of 70 and 80, and 4% are between the ages of 80 and 90. This indicates that the majority of patients fall into the 50–60 age group for late adulthood. (Figure 2).

Figure 2: Age Distribution

Gender distribution:

Research on the gender distribution of the cases collected reveals that 67% of patients are male and 33% of patients are female (Figure 3).

Figure 3: Gender Distribution

Microvascular complication of diabetes mellitus:

In order to determine the distinct percentage of associated microvascular complications of diabetes mellitus, such as diabetic retinopathy, diabetic nephropathy, poly neuropathy, and diabetic foot ulcers, a study was carried out. This research demonstrates that the most prevalent microvascular problem related with diabetes is nephropathy (47.50%) (Figure 4).

Figure 4: Microvascular complication of diabetes mellitus

Macrovascular complication of diabetes mellitus:

Patients in the research include those with atherosclerosis, peripheral vascular disease, hypertension, coronary artery disease, and diabetic ketoacidosis, among other macrovascular complications of diabetes mellitus. Peripheral vascular disease is most closely linked macrovascular complication to Diabetic mellitus. (Figure 5)

Figure 5: Macrovascular complication of diabetes mellitus

Drugs used for treatment:

The prescribed medications for the treatment of diabetes mellitus are also included in our study. According to the research, the most often prescribed medication is metformin (36%), the least commonly prescribed medication is acarbose (2 %), and the remaining medications are prescribed in between (Figure 6).

Figure 6: Drugs used for treatment

Duration of therapy:

The duration of the patient's therapy is included in our analysis. The length of therapy indicates that 11.50% corresponds to two years, 12% to three years, 12.50% to four years, 18% to five years, 24.00% to six years, 14.50% to seven years, and 7.50% to eight years. This indicates that the majority of patients are receiving treatment from last six years (Figure 7).

Figure 7: Duration of therapy

DISCUSSION:

According to recent studies, a micro- and macronutrient imbalance is linked to type 2 diabetes. In individuals with T2DM with a HbA1c of ≥7, the amounts of magnesium, zinc, and chromium were found considerably lower. The glycemic state and the ratios of these metal ions were substantially correlated. It is recommended to track these bioactive metal cation ratios rather than only the free ion concentration of a particular mineral in patients with type 2 diabetes. Patients with type 2 diabetes will have improved glycemic control if these micro- and macronutrient abnormalities are documented and corrected. Frequent monitoring of the metal ion ratios can reduce oxidative stress, systemic inflammation, and insulin resistance, which will postpone or avoid the emergence of micro and macrovascular problems of type 2 diabetes^10-12.

One frequent and possibly fatal side effect of both type 1 and type 2 diabetes is diabetic nephropathy. The rate at which the disease progresses can be greatly slowed down by aggressively managing identified risk factors in addition to preventing and early detecting microalbuminuria. Controlling blood pressure and tight glycemia are crucial, although they can be challenging to do in clinical settings. Because co-existing CKD restricts the use of many oral anti-diabetic medications in type 2 diabetes, regular medication and clinical reviews are necessary^13-15. Study evaluating the efficacy of the current management of type 2 diabetes shows significant percentage of inadequate target delivery is found in almost two-thirds of patients who visit the endocrine clinic. The risk variables for problems persisted after a two-year follow-up, despite a high prevalence of complications at baseline. There is a demand for the implementation of improved pharmaceutical accessibility, effective lifestyle change strategies, and a rigorous and interdisciplinary approach to awareness raising as top priorities^16,17. Our analysis revealed that 33% of patients were female and 67% of patients were male (Figure: 3). In terms of age distribution, 10% of the population is between 30 and 40 years old, 11% is between 40 and 50 years old, 58% is between 50 and 60 years old, 12% is between 60 and 70 years old, 10% is between 70 and 80 years old, and 4% is between 80 and 90 years old. (Figure 2).

Diabetic nephropathy was found to be a significant complication rate (47.50%) when compared to other microvascular complications of diabetes mellitus, which also include retinopathy, foot ulcers, heart problems, and poly neuropathy. (Figure 4). Hypertension, Coronary artery disease, peripheral vascular disease, and atherosclerosis are examples of macrovascular problems associated with diabetes mellitus. One study found that, in comparison to other complications, peripheral vascular disease had a high rate of 42.0 percent. (Figure 5). Our study also shows that after three years of diabetes, the majority of diabetic patients experienced complications. Medication distribution shows that metformin is the most frequently prescribed drug (36%), whereas acarbose is the least frequently given drug (2%), as shown in Figure 6.

CONCLUSION:

According to this study, the most common consequence among people with type 2 diabetes is nephropathy. In comparison to female patients, male patients are more likely to suffer from type 2 diabetes and have greater complications. For individuals with diabetes, metformin was often recommended as a single treatment.

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Received on 30.06.2024 Revised on 19.10.2024

Accepted on 15.01.2025 Published on 28.02.2025

Available online from March 26, 2025

A and V Pub Int. J. of Nursing and Med. Res. 2025; 4(1):1-5.

DOI: 10.52711/ijnmr.2025.01

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