TURNING THE traditional way of assessing the risk of developing cardiovascular problems due to diabetes on its head, Dr. A. Ramachandran, Managing Director, M.V. Hospital for Diabetes, Chennai, went the other way around — studied the prevalence of diabetes in those admitted in two ICU centres in Chennai with heart problems.

The study was done in Apollo Hospitals and a North Chennai ICU centre to cover all strata of the society.

"We found diabetes appeared to be a big risk factor for getting cardiovascular problems compared with other conventional cardiovascular risk factors," Dr. Ramachandran said.

The study was published in the recent issue of American journal Diabetes Care. "This is particularly true when the patients are non-smokers."

Of the 282 patients studied, patients who were either normal or had diabetes — known, undiagnosed or with impaired glucose tolerance (IGT) — were separated to strengthen the association of diabetes and the risk of developing cardiovascular problems. IGT is a stage prior to becoming full-blown diabetes.

Surprisingly 50 per cent of the 282 studied were known diabetics. The diabetes status of the remaining 50 per cent of patients was further studied using glucose tolerance test.

Nearly 84 per cent had glucose intolerance — either had diabetes but were not aware of it (24 per cent), IGT (46 per cent) or possible stress diabetes (nearly 14 per cent).

Only about 14 per cent were found normal.

The review of patients who did not know of their diabetes status at the time of admission to the ICU was done three months after discharge. It was found that about 14 per cent no longer had diabetes.

These could be the people who had glucose intolerance due to possible stress diabetes. According to him, possible stress diabetes is when the HB1Ac is normal but the blood glucose level is above 200, which is a clear marker for diabetes.

Swedish study

The Sweden study published in The Lancet (2002) highlighted that previously undiagnosed diabetes and impaired glucose tolerance were common in those with heart problems (acute myocardial infarction).

The Tokyo study (Diabetes Care, 2005) also showed the prevalence of IGT and undiagnosed diabetes was 37 per cent and 10 per cent respectively in of those with acute coronary syndrome. The study was done on those who were not previously diagnosed with diabetes.

The possible risk factors contributing to heart problems in the Caucasian population, as brought out by the famous Framingham study done a quarter century ago, highlighted smoking as the biggest risk factor followed by high blood pressure. Diabetes was ranked fourth. Stress was not listed as a risk factor though.

Not valid for India

The latest study, as clearly pointed out in the Framingham study, does not hold good for Indians.

"Ranking (of risk factors) may be different in the Indian context with diabetes and high blood pressure being more important," he noted. "But only when smoking is not highly prevalent."

A study published in the Indian Heart Journal, 2001, also found that in the absence of smoking, diabetes and hypertension were significant risk factors.

R. PRASAD
in Chennai

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