Symptoms and complications of adult diabetic patients in a family practice
J. C. Konen, L. G. Curtis and J. H. Summerson
Department of Family and Community Medicine, The Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC, USA.
OBJECTIVES: To determine the frequency of common symptoms and complications
amoung adult patients with either non-insulin-dependent or
insulin-dependent diabetes mellitus and to examine associations of these
problems with vascular disease risk factors. DESIGN: Cross-sectional
determination of the prevalence of symptoms, complications, and risk
factors among adult patients with diabetes, and a case-control design of a
subsample of those case patients with non-insulin-dependent diabetes
mellitus who were age-, race-, and sex- matched 2:1 to adult control
patients with hypertension. SETTING: A large family practice ambulatory
care unit in which the patients were demographically representative of the
Piedmont region of North Carolina. PATIENTS: Three hundred thirty-six
adults participated; of these participants, 223 case patients had
non-insulin-dependent diabetes mellitus and 23 case patients had
insulin-dependent diabetes mellitus. An additional 90 control patients were
selected who had hypertension but did not have diabetes. MAIN OUTCOME
MEASURES: Frequencies and odds ratios of symptoms and complications that
were categorized by diabetic type, another chronic disease (eg
hypertension), or vascular risk factors (eg, the duration of diabetes,
levels of glycosylated hemoglobin, fasting blood glucose, total
cholesterol, and high-density lipoprotein cholesterol, or mean arterial
blood pressures). METHODS: Standardized medical histories, physical
examinations and anthropometric and serum chemistry studies were done.
Microalbuminuria was measured by unrinary albumin excretion ratios.
RESULTS: Results: Symptoms of polydipsia, fatigability or cold intolerance,
palpitations, dyspnea, orthostasis, indigestion, frequent urination, male
impotence, blurred vision, paresthesias, forgetfulness occurred in more
that one third of the adult diabetic patients as did complications of
hypertension, microalbuminuria, peripheral neuropathy, and
hypercholesterolemia. Those patients with non-insulin-dependent diabetes
mellitus were more likely than those with insulin-dependent diabetes
mellitus to have recent symptoms of polydipsia, chest pains, shortness of
breath, orthostasis, light-headedness, and vaginal discharge. They were
also more likely to have hypertension and hypercholesterolemia, but less
likely to have dipstick proteinuria. Patients with non-insulin-dependent
diabetes mellitus were more likely than those with hypertension alone to
have a variety of general, cardiovascular, and neurologic symptoms and more
likely to have peripheral vascular disease, neuropathy, retinopathy, and
proteinuria. Regardless of the diabetic type, nearly half of the patients
had microalbuminuria. The presence of symptoms was often associated with
the duration of diabetes and poor glycemic control as were complications,
but complications were often also associated with dyslipidemias and an
elevated mean arterial pressure. CONCLUSIONS: Previous studies have
documented such a wide variety of symptoms and complications, but these
studies have been based on those patients who attended specialized referral
settings. Our findings show that these problems are surprisingly common
among adult diabetic patients who are cared for in a primary care setting.
The fact that nearly half of the patients had microalbuminuria suggests
that the onset of significant vascular complications had already begun in
most of these patients. The occurrence of symptoms of depression, anxiety,
panic, and forgetfulness were unexpectedly common and may have adversely
affected the ability of diabetic patients to comply with the intended
therapy.
