What is the difference between a complication and a risk factor

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What CDC Does. Research evaluating the association with BMI and risk of death among patients with diabetes has shown inconsistent results with many studies showing a U-shaped association with BMI and all-cause mortality [ 31 ]. Katulanda et al. The prevalence of overweight and obese individuals in our study population was alarmingly high at However, central obesity was not measured in this study. Hypertension in diabetics is an important issue as the combination often coexists.

Several studies have shown the close association of diabetes with hypertension. Hypertension is significantly more prevalent among patients with type 2 diabetes.

This link is mainly attributed to hyperinsulinemia [ 34 ]. The prevalence of hypertension is 1. The presence of hypertension will increase the risk of CAD, stroke, retinopathy, and nephropathy. In this study, the prevalence of hypertension was Multiple drugs are usually needed to achieve blood pressure targets.

It is important to note that blood pressure was inadequately controlled in almost half of the patients on treatment for hypertension in this study. More focus should be upon achieving targets using multiple drug combinations to alleviate the risk CAD. Dyslipidemia is one of the key risk factors for CVD among diabetic patients. However, all these promote atherogenesis. In this study population, the prevalence of dyslipidemia was Out of the patients with dyslipidemia, The most commonly deranged component of the lipid profile was HDL.

Low HDL was commoner among females Such gender-based predisposition in low HDL has been observed by Weerarathna et al. This may be due to the fact that most females in this study sample were menopausal and thus have lost the favorable increase in HDL due to estrogen. Furthermore, higher level of inactivity among this population may also contribute to the low HDL levels.

As of present, guidelines do not recommend specific pharmacotherapy for increasing HDL apart from statins. High prevalence of dyslipidemia among these patients while on treatment suggests that intensive medical therapy and lifestyle modification need to be emphasized. This is self rated, and more objective methods of assessing smoking would have been appropriate and yielded a higher prevalence. Smoking is an independent risk factor for all-cause mortality mainly due to CVD [ 41 ].

This should be reemphasized during the consultations with the patients. It is interesting to note the gender-based discrepancy among the metabolic parameters and vascular complications in this study population. This was in contrast to vascular complications, where almost all the complications were more prevalent in men than in women with significant difference observed in CAD, neuropathy diabetic foot, and lower limb amputation.

However, diabetes seems to erase this gender-based advantage that women have over men. Women with diabetes are said to have a high risk for CAD than men [ 43 ]. However, this fact is somewhat controversial.

Some studies have shown that diabetes definitely eliminates this female advantage over men while other studies have not shown a significant difference [ 44 , 45 ]. More studies would be required to determine the relationship between gender and CAD among patients with diabetes. Major complex gender differences exist between diabetes-related LEA. Evidence suggests that men are more liable to experience LEA than women [ 46 , 47 ].

Men are more likely to have independent risk factors such as diabetic foot, PVD, cigarette use, and peripheral neuropathy leading to amputation [ 48 , 49 ]. Sensory neuropathy is the most common neuropathy associated with amputation, and men have twice the risk of developing this than women.

This gender-based predisposition was evident in our study population as well. There are several limitations of this study. The target population of patients attending the clinic in a tertiary referral centre reflects a population with more complex disease burden. Therefore, the prevalence reported may be an overestimation of the actual disease burden.

Thus, to generalize the findings of this study to the entire population of patients with T2DM may not be quite appropriate. The diagnosis of CAD was based on medical records without considering if the patient had any current ischemic symptoms.

Due to the scarcity of laboratory resources, the diagnosis of nephropathy was based on a single UACR. Limiting the evaluation of obesity to general obesity without taking central obesity into consideration was another important limiting factor.

This study is evidence for the high prevalence of chronic vascular complications with increased disease burden. Age, duration of diabetes, and HBA1c were significantly associated with microvascular complications and diabetic foot while only age was associated with macrovascular complications. Furthermore, this population was at high risk of CVD with high prevalence of hypertension, dyslipidemia, obesity, and microalbuminuria.

Appropriate measures to intensify medical therapy and lifestyle measures to control modifiable risk factors and routine screening for the detection of new complications need to be emphasized in order to prevent morbidity and mortality.

The authors acknowledge all the staff members and research assistants at the diabetic clinic at the National Hospital of Sri Lanka. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors.

Read the winning articles. Journal overview. Special Issues. Maulee Hiromi Arambewela , 1,2 Noel P. Received 27 Nov Revised 23 Mar Accepted 15 Apr Published 23 May Abstract Diabetes incurs heavy burden to patients and the healthcare system. Introduction The global epidemic of diabetes has become one of the biggest challenges to mankind in the 21st century. Methods This was a descriptive cross-sectional single-centre study carried out at the National Hospital of Sri Lanka during the time period of 1 January to 31 July Baseline Data Definitions 2.

Staging of chronic kidney disease was calculated by using the Cockcroft-Gault equation. Ethical Issues Ethical clearance was obtained from the ethical review committee of the University of Colombo prior to the initiation of the study. Results Out of the patients studied, were females Table 1. Metabolic profile and its significance to the study population by gender.

Figure 1. Prevalence of cardiovascular risk factors in the study population by gender females , males. Disease complication Overall prevalence Females Males value Significance Cardiovascular diseases Table 2.

Figure 2. Variation of chronic complications with age among patients with type 2 diabetes. Figure 3. Variation of chronic complications with disease duration among patients with type 2 diabetes. Table 3. Logistic regression analysis showing risk factors which were significantly associated with chronic complications. Table 4. Comparison of chronic complications with other regions in Asia. References D. Whiting, L. Guariguata, C. Weil, and J.

Katulanda, G. Artificial pancreas. Accessed March 11, Natural medicines in the clinical management of diabetes. Natural Medicines. Morrow ES. Allscripts EPSi. Mayo Clinic. Kasper DL, et al. Diabetes mellitus: Diagnosis, classification and pathophysiology. In: Harrison's Principles of Internal Medicine.

Accessed April 16, American Diabetes Association. Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetes — Facilitating behavior change and well-being to improve health outcomes: Standards of Medical Care in Diabetes — Type 1 diabetes mellitus. Mayo Clinic; FDA authorizes first interoperable, automated insulin dosing controller designed to allow more choices for patients looking to customize their individual diabetes management device system.

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