Prevalence of cardio metabolic risk factors in women with newly diagnosed Type 2 Diabetes	

S.A. Abhayaratna1, N.P. Samasundaram2.
1Faculty of Medicine-University of Colombo, Department of Pharmacology, Colombo 08, Sri Lanka.
2National Hospital of Sri Lanka, Diabetes and Endocrinology Unit, Colombo 10, Sri Lanka.

Background

Cardiovascular (CV) disease is a major cause of morbidity and mortality among  patients with Type 2 Diabetes.  Traditionally women (even with  type 2 Diabetes) were considered to have a lower cardiovascular risk than men till the time of menopause due to the protective effect of oestrogens. However some of the recent studies have confirmed that women with Type 2 Diabetes has higher cardiovascular risk than age matched men and indeed have higher CV mortality (Dawson SI,2008).This is important finding which needs further confirmation as some medications used in CV risk reduction has shown to work better in men and in addition access to  healthcare seems to be limited for women when compared to men.
Aim
To evaluate the cardio metabolic  risk factors present in women with newly diagnosed Type 2 Diabetes.

Method
A prospective cross sectional study carried out in a tertiary care hospital diabetic clinic where patients with Diabetes were referred after seen by a medical officer. Consecutive female patients with newly diagnosed Type 2 diabetes(within 12 months)  were recruited for this study. Anthropometric, blood pressure measurements and laboratory investigations were carried out following the standard protocols.   

Results
There were 282 women who underwent laboratory evaluations after initial recruitment to the study. Majority were in the 41-60 age group and were obese (BMI >25 kg/m2).Basic characteristics are mentioned in Table 1

Table 1:Basic characteristics of the study population
Mean Age-  yrs (SD)	49.7(10.4)
Age groups	
18-20 yrs  (%)	 1 (0.35)
21-40 yrs (%)	        60 (21.2)
41-60 yrs (%)	       186 (65.9)
61-80 yrs (%)	        35 (12.4)

Mean duration of DM(SD)	3.4  months(3.2)

BMI category  (kg/m2)	
< 18.5 (underweight)	          9 (3.1%)
18.5-22.9 (normal weight)	67 (23.7%)
23-24.9 (Over weight)	59 (20.9 %)
More than 25 (Obese)	147 (52.1%)
 
Of the cardio metabolic risk factors following were present (Table 2)in the women with newly diagnosed type 2 Diabetes



Table 2 :Prevalence of cardio metabolic  risk factors
Cardio metabolic  risk  factors	          Number (%)
Hypertension (BP >130/85)	          115 (40%)
Low HDL (< 50 mg/dL)	                  172 (60.9%)
High Triglycerides (>150 mg/dL)	     92 (32.2%)
Abnormal waist circumference (>80cm)	233 (82.6%)
Type 2 DM	                                          282(100%)
All 5 of above	                                     23(8.1%)
Metabolic syndrome (IDF criteria)	  203 (71.9%)
Overweight	                                              59 (20.9%)
Obesity	                                                    147 (52.7%)
In addition to Type 2 Diabetes  one additional risk factor of Metabolic syndrome was present in 96% while two additional risk factors were present in 76.2 %.
Table 3: Other CV risk factors
Other CV risk factors        	Mean (SD)               
HbA1c                           	8.2 (1.8)
FBS(mg/dL)	                    152 .8( 63)
PPBS (mg/dL)                    189.2(89)
Body fat %	                        36.3(4.8)
Visceral fat %	                 8.8 (4.4)
 
30 (10.6%) patients were on lipid lowering therapy with a statin and 61(21.63%)patient were on antihypertensive therapy.
Discussion
In this group of women with newly diagnosed Type 2 Diabetes, majority had obesity, low HDL level ,abnormal waist circumference and Metabolic syndrome. Abnormal waist circumference was the most prevalent cardio metabolic risk factor in this group while triglyceride level above 150 mg/dL was the least prevalent risk factor out of the measured risk factors. Alarming number had one and two additional Metabolic syndrome risk factors present in addition to Type 2 Diabetes.  Current American Heart association guidelines recommend to start lipid lowering therapy with a statin in Type 2 Diabetes patients above 40 years of age. Out of the 221 patients above 40 years in this study only 30 (13.5%)received a statin after they have been seen by a medical officer  and started on antihyperglycaemic therapy( in 70% of the patients) prior to referring them to this tertiary care hospital. High prevalence of cardio metabolic risk factors at a very early stage of Type 2 Diabetes in this group of women remains to be a significant concern. It is even more worrying to note that effective therapy in reducing the cardio metabolic risk is not employed at a early stage when these women posses a high risk for future CV events.

Prevalence of cardio metabolic risk factors in women with newly diagnosed type 2 diabetes