Sarcouncil Journal of Medical Series

Abstract: Diabetic microvascular complications – such as retinopathy, peripheral neuropathy, cardiac autonomic neuropathy, and nephropathy – are the leading causes of preventable blindness, lower-limb amputation and progressive renal insufficiency in persons with type 2 diabetes mellitus (T2DM) where also Objective: To outline the prevalence, severity distribution and multivariate determinants of diabetic retinopathy (DR) and diabetic peripheral neuropathy (DPN) in a hospital-based sample of 98 people with established Type 2 Diabetes (T2DM), and to quantify the independent association of HbA1c and diabetes duration with each complication, once fully adjusted for recognised confounders. Method: Cross-sectional; observational; 98 consecutive adult outpatients with T2DM (median duration of disease 11.0 years) at a tertiary diabetes centre. Seven-field fundus photography and the ETDRS protocol were used to grade retinopathy. Neuropathy was evaluated using the Michigan Neuropathy Screening Instrument (MNSI) and nerve conduction studies (NCS). The Ewing battery was used to assess cardiac autonomic neuropathy. The albumin to creatinine ratio (ACR) in urine was used for staging nephropathy, as was eGFR by CKD-EPI. Logistic regression models were built for both any DR and any DPN as primary outcomes, with model performance evaluated using the area under the curve (AUC), Nagelkerke R², and Hosmer–Lemeshow goodness of fit. Results: Mean HbA1c was 8.94 ± 1.87% (median 8.70%). 62.2% of the participants (n=61) had any retinopathy, and 12.2% (n=12) had proliferative DR. Any DPN was identified in 58.2% (n=57); severe neuropathy in 15.3% (n=15). 47.9% had micro or macro albuminuria. HbA1c (adjusted OR 1.71 per 1% increment, 95% CI 1.30–2.24, p<0.001) and diabetes duration (adjusted OR 1.09 per year, 95% CI 1.04–1.15, p<0.001) were the most important and independent factors associated with retinopathy, with excellent model discrimination (AUC 0.847) Conclusions: Chronic hyperglycemia (A1c levels and duration of diabetes) is the most important modifiable risk factor for retinopathy and peripheral neuropathy in this hospital-based T2DM cohort.