Prevalence of micro and macro vascular complications and their risk factors in type 2 diabetes in Saudi Arabian population: an analysis from SHIS.

Diabetes Mellitus is a metabolic disorder, which is characterized by an increase in blood glucose levels. The defects in the secretion or action of insulin are the major cause of diabetes. Increase in the blood glucose level exerts a negative effect on the normal functions of the body organs and this leads to the dysfunctions of cells and tissue and causes vascular complications in diabetic patients. Several studies indicate that neuropeptides are released from the neurosensory cells which are mainly known as tachykinins which provoke major vascular complications in diabetic patients. Tachykinins are known as pro-inflammatory peptides which increase vascular complications and vascular permeability. The duration and severity of diabetes disease increase the risk of vascular complication in patients. The aim of this review is to elaborate the role of tachykinins in microvascular and macrovascular complications in diabetic patients. The study concluded that tachykinins increase micro and macrovascular complications in diabetic patients.

Background and Aims: Prospective studies showed that long-term hemoglobin A1c (HbA1c) levels correlate directly with the risk of developing and progression of diabetic complications. The aim of the study was to evaluate the correlation between metabolic control and HbA1c variability with macrovascular complications and assess the role of HbA1c as an independent predictive factor for the occurrence of macrovascular complications in diabetic patients from Bihor County, Romania. Material and method: The study was conducted for a 5 years period (2007-2011) and included 321 diabetic patients with no evidence of macroangipathic complications. During the follow-up all the major vascular events were recorded. Results: At the end of the study a total of 85 chronic macrovascular complications were reported. Distribution plots show significantly higher incidence of vascular complications in patients in the group with poor glycemic control. Multivariate analysis showed that HbA1c can be considered an independent predictor of atherosclerotic complications as well as atherosclerotic complications risk score. The variability of HbA1C was not an independent predictor for macroangiopathic complications (p=0.78). Conclusions: Overall glycemic control was the most important factor in the progression of atherosclerosis but we could not rule out that glycemic variability might play a role in the development of complications in type 2 diabetes mellitus (T2DM) patients.

Tumor necrosis factor (TNF)-alpha has pleiotropic effects in cytokine-mediated inflammation underlying atherogenesis. Activation of this inflammatory process is assumed to be different in diabetic and non-diabetic individuals. Previous studies in non-diabetic subjects showed no association between TNF-alpha -308G>A polymorphism and coronary artery disease. Vascular complications and cytokine serum concentrations were assessed as a function of the TNF-alpha -308G>A polymorphism in 76 diabetic patients on low-dose aspirin. Of 76 adult diabetic patients, 18 (24%) carried the TNF-alpha -308A allele (17 AG, 1 AA) and 58 (76%) carried wild-type alleles (GG). Prevalence of macrovascular complications was 33% in TNF-alpha -308A allele carriers (AG+AA) and 78% in wild-type allele carriers (GG) (p<0.001). In contrast, prevalence of microvascular complications was 78% and 84%, respectively, and did not significantly differ between the study groups. TNF-alpha -308A allele carriers (AG+AA) compared to wild-type allele carriers (GG) had significantly lower median serum concentrations of hs-C-reactive protein (1.5 vs 2.9 mg/L, p=0.030), interleukin 1-beta (0.9 vs 1.2 ng/L, p=0.046), and interleukin-6 (3.6 vs 4.9 ng/L, p=0.023). In multiple regression analysis, the prevalence of macrovascular diabetic complications was significantly associated with TNF-alpha -308G>A polymorphism (p<0.001) and serum concentrations of HDL-cholesterol (p=0.007) while confounding effects of further variables were excluded. TNF-alpha -308G>A polymorphism modulates cytokine serum concentrations and macrovascular complications in diabetic patients on aspirin. Diabetic carriers of the TNF-alpha -308A allele might benefit more from a prophylaxis with low dose aspirin than non-carriers.

Background: Data regarding the prevalence of morbidity and mortality in patients of Type 2 Diabetes Mellitus (T2DM) is scanty in India. Objectives: To determine the prevalence of micro and macro vascular complications, acute metabolic complications, infections, Non Alcoholic Fatty Liver Disease (NAFLD) and cause of mortality in T2DM patients admitted to a tertiary care teaching hospital in Eastern India. Material and Methods: This was a hospital-based prospective study evaluating 150 T2DM patients admitted to a tertiary care institution in Eastern India. Diagnosis of micro and macro vascular complications, infections and NAFLD was made using standard protocols. In case of death, the most probable cause was noted. Results: Out of 150 patients, 14.7% of patients were newly diagnosed T2DM and out of them 41% of patients had vascular complications and 54.5% had infections. Of the total patients, 56% had nephropathy, 20% neuropathy, 17.3% retinopathy, 31.3% CVD, 11.3% CAD, 4.6% acute metabolic complications, 44% infections and 16.6% had NAFLD respectively. Macrovascular events occured earlier than microvascular complications. Multiple logistic regression analysis showed strong association of age, duration of diabetes, serum cholesterol, triglyceride, LDL-C with retinopathy (Regression coefficient β: -0.1086807, 0.4127152, -0.0513393, 0.0146429, 0.0587475; p < 0.05, < 0.001, < 0.05, < 0.05, < 0.05 respectively), while only duration of diabetes was strongly associated with nephropathy and neuropathy (Regression coefficient β: 0.2538751, 0.2261636; p < 0.001 for each). Increasing age was associated with CAD (Regression coefficient β: 0.055392; p < 0.05) and FBG was a risk factor for CVD (Regression coefficient β: 0.0055014; p < 0.05). 18.6% patients died due to diabetes related complications. Cardiovascular (CV)-related deaths (CVD+CAD) were most common cause (51.5%: CVD 36.4%, CAD 15.1%) to be followed by infections (27.3%) and then chronic kidney disease (12.1%). Conclusions: This study highlights the high prevalence of vascular complications and infections in T2DM patients of Eastern India. CV-related deaths were principal causes of death, similar to that in developed world.

Aim: To perform an observational study on epidemiology of micro and macrovascular complications in diabetes mellitus type II. Objectives: To assess the occurrence and prevalence of micro and macrovascular complications in type 2 diabetes mellitus. Methodology: The study's methodology will be carried out in the internal medicine department of Gleneagles Aware Hospital in Bairamalguda, Saroornagar, Hyderabad, Telangana state. Over 6 month period with 100 patients individuals with microvascular problems. Patients aged 20 to 80 years, included with comorbid conditions in both genders. Patient demographics, medication records, laboratory tests, medical histories, and other relevant data were gathered using a well-designed data-collecting form for any in patients with diabetes mellitus who were experiencing problems. Results: The study findings revealed that most of the complications that occur in diabetic mellitus are macrovascular complications. Out of 100 subjects, 65 were males and 35 were female, 70 had macrovascular complications. In 70, (2) peripheral artery disease, (29) coronary artery disease, (39) ischemic stroke. And 30 are microvascular complications, (1) diabetic retinopathy, (4) diabetic neuropathy, (25) diabetic nephropathy. The age group between 61-70 (36) was found to have the most macrovascular and microvascular complications. Conclusion: The study concluded among 100 patients, who are affected by micro vascular and macrovascular complications in type 2 diabetes mellitus, are studied during the study period

Aim and background:The aim of this study was to determine the prevalence of micro and macrovascular complications among newly diagnosed type 2 diabetes mellitus (T2DM) patients in an Indian clinical setting.Materials and methods: We conducted a cross-sectional study among 4,126 newly diagnosed T2DM patients between January and August 2025.Prevalence was assessed at baseline through clinical evaluation and laboratory tests.Prevalence ratios (PRs) with 95% confidence intervals (CIs) were calculated using log-binomial regression, adjusting for age and sex.Results: At diagnosis, 42% (N = 1,734) of patients had complications.Of these, 17% (N = 701) had microvascular complications, 21% (N = 867) had macrovascular complications, and 4% (N = 166) had both.Microvascular complications were most frequently retinopathy (11%), followed by nephropathy (4%) and neuropathy (2%).Macrovascular complications included ischemic heart disease (IHD) (13%), cerebrovascular disease (5%), and peripheral vascular disease (PVD) (3%).Glycated hemoglobin (HbA1c) 7.5% was associated with microvascular complications (aPR: 1.38; 95% CI: 1.12-1.70)but not macrovascular disease (aPR: 0.94; 95% CI: 0.78-1.15).Macrovascular complications were significantly associated with male gender, age 50 years, obesity, dyslipidemia, smoking, and hypertension.Conclusion: More than two-fifths of Indian patients with newly diagnosed T2DM had established vascular complications at baseline, indicating delayed diagnosis.Hyperglycemia appears more strongly linked to microvascular disease, whereas macrovascular disease is associated with metabolic syndrome and cardiovascular risk factors.Early detection is urgently needed in the Indian setting for achieving an improved outcome.Clinical significance: A substantial proportion of newly diagnosed T2DM patients already have vascular complications, emphasizing the need for early screening and risk stratification.Timely management targeting glycemia may prevent progression and improve outcomes.

BACKGROUND Type 2 diabetes mellitus (T2DM) represents a major global public health challenge, with projections indicating that the number of affected individuals could reach 853 million by 2050. While microvascular and macrovascular complications in diabetic patients are well-documented, there is a growing focus on skeletal involvement, particularly diabetic osteoporosis. Traditionally, the increased fracture risk in T2DM has been attributed to mechanisms like the accumulation of advanced glycation end products and oxidative stress. However, emerging evidence suggests that T2DM patients may experience compensatory skeletal adaptations, such as increases in bone density, which complicate the relationship between T2DM and fracture risk. This study utilizes an umbrella meta-analysis to systematically assess the association between T2DM and fracture risk, aiming to clarify existing controversies in the literature. AIM To thoroughly evaluate the association between T2DM and fracture risks at various anatomical sites, including overall fractures, hip fractures, and non-vertebral fractures. The goal is to provide an evidence-based foundation for developing individualized fracture management strategies in clinical practice. METHODS Conducted in accordance with PRISMA guidelines, this umbrella meta-analysis involved a systematic literature search across the PubMed, Web of Science, and EMBASE databases up to October 1, 2025. The search aimed to identify meta-analyses that evaluated the association between T2DM and fracture risk. Inclusion criteria were limited to studies involving T2DM patients, with fracture risk as the outcome measure, expressed as relative risk (RR) and 95% confidence intervals (CIs). The methodological quality of the studies was assessed using the AMSTAR 2 tool. Statistical analyses employed either fixed-effects or random-effects models based on I 2 heterogeneity statistics, and sensitivity analyses were performed to confirm the robustness of the findings. RESULTS A total of 16 studies were included in the analysis. The findings revealed a significant association between T2DM and an increased risk of total fractures (RR = 1.23, 95%CI: 1.17-1.28), with low heterogeneity observed (I 2 = 44.8%). Site-specific analyses showed heterogeneous associations: Increased risks were identified for non-vertebral fractures (RR = 1.22, 95%CI: 1.18-1.27), ankle fractures (RR = 1.43, 95%CI: 1.21-1.64), and upper arm fractures (RR = 1.43, 95%CI: 1.21-1.64). Conversely, the risk of hip fractures was significantly reduced (RR = 0.80, 95%CI: 0.72-0.89), although this result exhibited considerable heterogeneity (I 2 = 94.9%). No significant associations were found for vertebral or humeral fractures. Sensitivity analyses confirmed the robustness of the hip fracture outcome after excluding outliers. A forest plot for total fractures visually illustrated a consistent trend toward increased risk. Furthermore, funnel plot analysis indicated mild publication bias, which did not compromise the primary conclusions. The observed heterogeneity in the hip fracture analysis was mainly due to specific study deviations. CONCLUSION T2DM shows a heterogeneous association with fracture risk, highlighting the need for the development of site-specific clinical strategies. The reduced risk of hip fractures may indicate compensatory skeletal adaptation, while the increased risk at other sites is linked to diabetic complications like neuropathy. Future research should focus on large-scale cohort studies, inclusive of ethnic diversity, and the optimization of risk prediction tools to improve fracture prevention and management in T2DM patients.

To determine the prevalence of vascular complications among inpatients with type 2 diabetes mellitus (T2DM) and factors independently associated with vascular complications in a tertiary care department in Ningbo, China, the authors conducted a cross-sectional study using an existing computerised medical records database. A total of 3370 adult patients with T2DM were admitted to this tertiary care department for the first time between 2012 and 2017. Patients were categorised as those (1) with at least one vascular complication, (2) with at least one microvascular complication, and (3) with at least one macrovascular complication. Over 5 years, the prevalence of vascular, microvascular, and macrovascular complications among inpatients with T2DM was 73.2%, 57.5%, and 51.4%, respectively. The odds of vascular, microvascular, and macrovascular complications increased with age and were higher in patients with hypertension. The odds of vascular and microvascular complications were higher in single, divorced, or widowed patients, patients with T2DM for a long time, and patients on advanced T2DM therapeutic regimen. The odds of vascular and macrovascular complications were lower in women. The odds of microvascular complications decreased with education. The odds of macrovascular complications were higher in smokers. In conclusion, in the tertiary care department, more than half of inpatients with T2DM had vascular complications, and factors independently associated with vascular complications were identified. The study findings could be used in future interventional studies to prevent and manage vascular complications among these patients.

Homocisteína en el paciente con diabetes mellitus

Non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) are closely associated, and liver fibrosis has been related to macrovascular complications. We examined whether liver fibrosis, diagnosed by FibroScan® , correlates with chronic vascular complications in a cohort of T2DM. We recruited 394 outpatients with T2DM attending five Italian diabetes centres who underwent liver ultrasonography (US), FibroScan® and extensive evaluation of macrovascular and microvascular diabetic complications. Steatosis by US was present in 89%. Almost all patients (96%) were on hypoglycaemic drugs, 58% had at least one chronic vascular complication, 19% a macrovascular complication (prior myocardial infarction and/or ischaemic stroke) and 33% a microvascular one (26% chronic kidney disease [CKD]; 16% retinopathy; 6% neuropathy). In all, 171 (72%) patients had CAP≥248dB/m (ie hepatic steatosis), whereas 83 (21%) patients had LSM≥7.0/6.2kPa (M/XL probes) (significant liver fibrosis). CAP was not associated with any macro/microvascular complications, whereas LSM≥7.0/6.2kPa was independently associated with prior cardiovascular disease (adjusted OR 3.3, 95%CI 1.2-8.8; P=.02) and presence of microvascular complications (adjusted OR 4.2, 95%CI 1.5-11.4; P=.005), mainly CKD (adjusted OR 3.6, 95%CI 1.3-10.1; P=.01) and retinopathy (adjusted OR 3.7, CI 95% 1.2-11.9; P=.02). Neither diabetes duration nor haemoglobin A1c differed according to CAP or LSM values. Significant fibrosis, detected by FibroScan® , is independently associated with increased prevalence of macrovascular and microvascular complications, thus opening a new scenario in the use of this tool for a comprehensive evaluation of hepatic and vascular complications in patients with T2DM.

The predictive value of Thromboelastography (TEG) parameters in vascular complications in patients with type 2 diabetes mellitus

Introduction: Vascular complications are the major cause of morbidity in patients with diabetes mellitus. Screening for these complications is crucial in early detection and tertiary prevention. Hence, this study aimed at finding the prevalence of micro and macrovascular complications and their associated factors in type 2 diabetes mellitus patients in a rural health center by using simple and easily available tools. Methodology: This hospital based cross sectional study was conducted in Rural Health and Training Centre (RHTC) of Sri Ramachandra medical college from Jan 2017 to Aug 2017. All type 2 diabetes patients registered at RHTC were included in the study. By the use of questionnaire, clinical examination and laboratory investigations, the prevalence of macro and microvascular complications and associated factors were ascertained. Multiple logistic regression was used to identify factors associated with vascular complications of diabetes. Results: The study included 390 type 2 diabetes patients. The overall prevalence of macrovascular and microvascular complications in our study population was 29.7% and 52.1%, respectively. Among the macrovascular complications, both coronary artery disease (CAD) and peripheral vascular disease (PVD) had a prevalence rate of 15.1%. Among the microvascular complications, peripheral neuropathy (44.9%) had the highest prevalence followed by nephropathy (12.1%) and diabetic foot (7.2%). Multiple logistic regression analyses showed high HbA1c level, lower education, high postprandial blood sugar, hypertension, abdominal obesity were significantly associated with increased risk of vascular complications of diabetes. Conclusion: This study demonstrated the increased prevalence of vascular complications in Type 2 diabetes patients in rural India. Regular screening to identify those patients at risk could prevent further progression of complications.

Targets for Glycemic Control

The following study has been undertaken to establish if antiradicalar agents (1) and serum selenium are linked to hypertension and micro and macrovascular complications in diabetic patients. We also addressed the question of any nutritional role of selenium in diabetes, by searching for any relation between selenium and BMI (Body Mass Index) in patients with type 1 insulin dependent (IDDM) and type 2 non insulin dependent (NIDDM).

BackgroundDiabetes mellitus (DM) is a global health concern that is predicted to involve over 10% of the adult population by the next decade. Vascular complications are the major source of mortality and morbidity in diabetics. Mean platelet volume (MPV) which indicates platelet activity may play a crucial role in the vascular effects of DM and, hence, can be used as a prognostic marker. We have attempted to study the association of MPV with the glycemic status, duration of diabetes, and presence of vascular complications in diabetics.MethodsA cross-sectional study of 300 patients with type 2 DM aged ≥18 years admitted to the inpatient department of medicine was carried out in a tertiary care hospital. After subgrouping patients according to their glycemic status and MPV, the association between microvascular and macrovascular complications was studied.ResultsThe majority of patients were >60 years of age and an increasing prevalence of vascular complications was noted with increasing age. Forty-six percent and 45% of the patients had microvascular and macrovascular complications, respectively. Ischemic heart disease (IHD) and retinopathy were the most common macrovascular and microvascular complications, respectively. Vascular complications in DM showed a significant association with MPV, fasting blood sugar (FBS), post-prandial blood sugar (PP2BS), glycated hemoglobin (HbA1c), and the duration of diabetes.ConclusionA high MPV was linked to poor glycemic control, a longer duration of diabetes, and an increased prevalence of vascular complications. Hence, MPV could be used as a cost-effective marker to predict vascular complications in patients with type 2 DM.