Background:
The
development of type 2 diabetes mellitus (T2DM) as a major public health problem
in Asian Indians. Asian Indians develop T2DM at a younger age, and progresses
faster than in other ethnic groups. As a result, many diabetes complications
are more prevalent and in more advanced stages in Asian countries than in other
regions. Asian Indians have one of the highest incidence rates of pre-diabetes
and T2DM among all major ethnic groups, and the conversion from pre-diabetes to
T2DM occurs more rapidly in this population (Anjana et al, 2011). According to
the Indian Council of Medical Research- India diabetes
study (57 117 individuals), the prevalence of prediabetes in all 15 states was
7·3% (Anjana et al,2017).
The
tendency of Asian Indian to develop T2DM is enhanced by greater insulin
resistance, dysglycemia, subclinical inflammation and non-alcoholic fatty liver
disease (NAFLD).
Acanthosis nigricans (AN) describes clinically a
darkly pigmented thickening skin, which produces epidermal and dermal hyperplasia with orthokeratotic hyperkeratosis and papillomatosis of the stratum spinosum with basal layer hyperpigmentation, in the absence of actual acanthosis and melanocytosis on histologic examination. It
is a reactive cutaneous change closely associated with obesity, insulin
resistance, and hyperinsulinemia; endocrinopathy; or malignancy, in
particular gastrointestinal adenocarcinoma. The prevalence varies, and
ethnicity seems an independent factor. Evidence indicates that AN is a useful
clinical marker to identify patients susceptible to insulin resistance,
the MetS, and type 2 diabetes (T2DM).
This Prospective
observational study will be of 12-18 months’ duration where 150 T2DM patients
from urban areas of Delhi will be randomly screened. The population will be
representative of different socio-economic strata of the society. Clinical and
dietary profiles, blood pressure and phenotypic markers (acanthosis nigricans,
buffalo hump, skin tags: xanthelasma, double chin, arcus, hirsutism and tendon
xanthoma), diabetic retinopathy, peripheral arterial disease (PAD), neuropathy,
nephropathy HTN, CHF, CT Coronary Angiography, CAD, Arrhythmias, Coronary
Calcification, Cerebrovascular Disease, peripheral vascular disease, micro
albumin urea, fibro scan and hand grip (average of three values) JAMAR measurement
will be assessed.
Hypothesis: Moderate to severe acanthosis nigricans in people with T2D
is associated with higher magnitude of complication than people who do not have acanthosis nigricans.
Objectives: To correlate moderate to severe acanthosis nigricans with diabetes
complication
Inclusion
Criteria:
1. Patients with T2DM (up to 30 years
Duration)
2. Age 20 to 70 years
3. BMI >25 kg/m² to >40 kg/m²
4. Gender- Both (Male & Female)
5. Mild, Moderate and Severe
Acanthosis
Exclusion
Criteria:
1. Alcoholic with Moderate to Severe.
2. BMI >40 kg/m²
3. Congestive heart disease
4. Positive hepatitis B or hepatitis
C, secondary causes of fatty liver (eg. consumption of amiodarone and
tamoxifen) and congestive hepatopathy.
5.
Severe
end organ damage or chronic diseases: renal/hepatic failure, any malignancy,
major systemic illness etc.
Methodology:
T2DM patient will be
recruited from endocrine OPD
1. Clinical History and Examination:
a.
General Physical Examination: Height, weight, waist
circumference,
hip
circumference, BMI, Blood Pressure, Hand grip.
Acanthosis Nigricans.
b.
Complications Assessment: Patient will be analysed for:
Micro Vascular
(a)
Diabetic retinopathy
(i)
Mild NPDR
(ii)
Mod NPDR
(iii)
Macular Edema / CSME
(b)
Neuropathy (Mild/Mod/Severe)
(c)
Chronic Kidney Disease
(i)
Micro/Macro albumin urea
(ii)
Increased Creatinine
(iii)
Decreased eGFR
Macro Vascular
(a) Low
ABI/PAD
(b)
CVD-MI/PTCA/CABG/Heart Failure
(c)
CVS-Stroke/ TIA/Carotid Blockage >50% |