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126 Cardio Diabetes Medicine 2017

Impaired Glucose Tolerance and Coronary Artery

Disease and Peripheral Artery Disease

Dr. D. Selvaraj, M.D.
SRRA Hospital, Tuticorin.

Coronary Artery Disease (CAD) is the most common Atheroscelorosis in diabetes will cause endothelial
cause of mortality in the developed world. The term damage, platelet aggregation, lipid deposition and
“Coronary Artery Disease” encompasses a range plaque formation with the same risk factor but dis-
of diseases that result from atheromatous changes tribution is different mainly below knee disease and
in coronary vessels. Atherosclerosis is the principal profound femoral artery disease.
cause of death and disability in patients with Type
2 Diabetes Mellitus. In these patients cardiovascular Pathophysiology
disease typically occurs at an early stage with great
severity and different distribution. Macro circulation - Large vessel calcification
Atheroscelerotic plaques
More than half of the patients with newly diagnosed
T2 DM have established coronary artery disease, Micro Circulation:
whereas one third of patients with coronary artery - Thickening of capillary basement membrane
disease have known diabetes mellitus.
- Increased microvascular flow (warm foot)
Screening patients with established coronary artery
disease but without pre-existing diabetes will confirm - Oedema secondary to impaired postural vasocon-
the diagnosis of diabetes mellitus in an additional striction
15 to 20%. Impaired fasting glucose or impaired glu- - Increased metabolic requirement
cose tolerance will be detected in an additional 30
to 40%. Peripheral vascular disease (PVD) is a major - Impaired ability to respond to trauma
cause of morbidity and mortality especially affecting
the elderly population. The prevalence of peripheral - Platelet degranulation increased
vascular disease is multifold higher on patients with Risk of Cardiovascular Disease is elevated prior to
diabetes compared with age and sex matched non- diagnosis of T2DM. Compared with nondiabetics, di-
diabetes subjects. Hence it is very clear that screen- abetic patients have increased risk of hypertension
ing for diabetes mellitus is warranted in patients with 20% and heart diseases 10%. In patients with ACS
cardiovascular disease or risk factor for other cardio and diabetes, there is increased risk of in-hospital
vascular diseases like peripheral vascular disease. mortality nonfatal MI and all cause mortality com-

The American Diabetes Association and the World pared with nondiabetes.
Health Organization both recognize l Impaired glu- PVD in diabetes has a poor prognosis. PVD is 20
cose categories, metabolic stages of glucose inter- times more common in diabetics than in nondiabet-
mediary between normal and diabetes. Impaired Glu- ics. Lower limb amputation is 15 times more common
cose Tolerance (IGT) is defined by both organizations. in diabetes, 10% of diabetics get an ulcer, 10% are
for 2-hour post glucose level >140 but <200 mg/dl. purely ischemic and they are associated with neurop-
Although not all patients of IGT will progress to overt athy infection, biochemical abnormalities and charcot
diabetes mellitus, the rate of conversion is particular- deformity. Increased risk of CAD, CVD, nephropathy,
ly high in this group. retinopathy and death. Diabetes and PVD is com-
mon but complications often preventable. Holistic

GCDC 2017