Title of the Project/Thesis/Dissertation:

“Nailfold Capillaroscopy to assess microcirculation in patients of Diabetes Mellitus, an Observational Study”

Introduction

•       Diabetes is currently considered a chronic disease with a high mortality rate due to its longterm cardiovascular and renal complications.

•       Data from the Diabetes Control and Complications Trial (DCCT) and the UK Prospective Diabetes Study (UKPDS) shows that chronic hyperglycemia is the most important risk factor for the development of microvascular complications in patients with type I and II diabetes mellitus and that endothelial dysfunction plays an important role in the development of vascular diseases and represents the initial stage in pathogenesis of the disease.

•       The current trend for evaluating microvascular damage in diabetic patients is the use of: Doppler flowmetry, direct and indirect ophthalmoscopy, ambulatory blood pressure monitoring, but capillaroscopy is not commonly used.

•       Nailfold capillaroscopy (NFC) is a non-invasive, easy to perform, painless, and sensitive technique for evaluating microvascular involvement, mainly in Raynaud’s phenomenon (RP), systemic sclerosis and connective tissue patients.

•       Moreover, capillaroscopy is now applied to predict the risk of development of future visceral complications and digital ulcers in patients with systemic disease.

•       The nailfold capillary bed is accessible and revealing capillaries lie parallel to skin allowing the whole capillary loops to be visualized.

•       Several capillary alterations have been explained in diabetes with poor metabolic control. In previous studies correlation between the severities of microvasculature changes and metabolic control of diabetes has also been reported.

•       Despite all these findings, little data exist on the relationship between microvascular changes in capillaroscopy and type 1, 2 diabetes features.

•       Capillaroscopy is a method of recognized value in the study of morphological and functional abnormalities of the microcirculation. Its use in the clinical field dates from the early twentieth century,1 extending the clinical applications gradually over the years,2,3 to be considered a “routine investigation” in (nowadays) rheumatological practice.

•       The advantages of capillaroscopy can be identified in the absence of invasiveness, in its remarkable sensitivity and specificity together with ease procedure and speed execution time. The relatively videocapillaroscopy low cost could be considered another big advantage of this procedure

•       Microvessel videocapillaroscopy study seems to be very interesting in diabetes because microangiopathy is the most common and fearsome complication of diabetes and because it seems that the alterations of cutaneous microvessels and of the fundamental substance of connective constitute the earliest manifestations of the disease. 

Research Question

·         What are the nailfold capillaroscopy findings in patients of diabetes mellitus?

·         Do they correlate with presence of retinopathy?

·         Do they correlate with Hba1c levels?

·         Do they correlate with the duration of the disease?

Aim/Goal

•      Aim: To study the Nailfold Capillaroscopic changes in patients of Diabetes Mellitus

Objectives: - Ã˜  Primary

Ø  To study the Nailfold Capillaroscopic changes according to the given parameters in patients of DM and report any new findings if found in the patients.

Ø  Secondary

Ø  To study assosciation between diabetic retinopathy and nailfold capillaroscopic changes

Ø  To study assosciation between Hba1c levels and NFC changes

Ø  To study assosciation between duration of diabetes and of NFC changes

Methodology

Study design/type - This will be an Observational, cross-sectional, comparative study

Study population - â€¢      All newly diagnosed and Established diagnosis of Type II Diabetes Mellitus according to the criteria of the American Diabetes Association, attending dermatology OPD of Sir-T Hospital Bhavnagar.

•      Age & Sex matched controls without any significant comorbidities will be enrolled accordingly

 Sample size - 122 patients in total –  76 cases and 46 controls.

Study duration - 10 months

Study site -

•