Nail Folds Capillaries Abnormalities Association with Type 2 Diabetes Progression and Correlation with Diabetic Retinopathy

Abstract

Abstract Background Retinopathy is regarded one of the most important complications of diabetes that occurs after long duration of the disease with untight glycemic control, and it is regarded as one of the preventable causes of blindness so proper evaluation of diabetic patients and their complications can prevent blindness. Aim of the Work to assess the capillaroscopic changes in type 2 diabetes mellitus patients and correlate the findings to the microvascular complication of the retina (diabetic retinopathy). Patients and Methods Our study was conducted on 62 patients of type 2 diabetes mellitus (16 male, 46 female) their ages above 18 years lies between (36-66) years. All patients were subjected to full history taking and thorough clinical examination. Results Nailfold capillaroscopy imaging revealed that 31 patients with positive capillaroscopic findings had branched and tortuous capillaries, 34 patients had hemorrhage,5 patients with dilated apical capillary, 46 patients had elongated capillaries,16 with normal capillary length and 48 patients with dilated capillary width capillary. Fundus examination revealed 26 patients with DR and 36 patients nonDR. Our study reported that DR patients had higher duration of diabetes more than non-DR patients. Also, DR patients showed higher levels of HbA1c more than the non-DR patients. Patients with diabetic retinopathy show high percentages of tortuous, branched capillaries. 46.2% of the DR patients had precapillary edema verses 19.4% of the non-DR patients. The mean capillary width in the DR group of patients was 27.68 ± 5.7 verses 23.02 ± 3.29 in the non-DR patients which indicate that patients with DR had more wide capillaries than the non-DR patients. Higher fasting glucose levels were detected in the DR patients than the non-DR patients. Branched, tortuous capillaries, hemorrhage and dilated apical capillaries are documented in the patients with higher median diabetic years 15-20 years in the DR group of patients. Tortuosity, precapillary edema and dilated apical capillaries are positive in patients with higher median diabetic years. (24) patients documented to have DR with HbA1c ≥7% and only 2 DR patients with HbA1c <7. (29) patients had tortuous capillaries with HbA1c ≥7 verses 2 patients had tortuous capillaries with HbA1c <7. Also, (19) patients had precapillary edema in HbA1c ≥7 group while (0) patient had precapillary edema in the HbA1c <7 group. Capillary width and branched capillaries are found to be a predictor of diabetic retinopathy in multivariant analysis. Conclusion nailfold capillaroscopy is regarded a helpful noninvasive newly emerging tool to assess the capillaroscopic changes in diabetic patients as an indicator to diabetic complication development such as diabetic retinopathy.