Complicaciones Macrovasculares en Diabetes Tipo 2 Asociación con Factores de Riesgo

Con el objeto de determinar la incidencia de complicaciones macrovasculares en sujetos diabeticos tipo 2 en la ciudad de los Teques, se seleccionaron 40 pacientes que acuden a la consulta de diabetes del HVSR entre Febrero y Noviembre de 1998, con diagnostico de diabetes tipo 2 y 30 pacientes con caracteristicas semejantes, sanas. Se diseno un estudio de tipo descriptivo transversal. A tal fin se realizo historia clinica detallada que incluia la presencia de factores de riesgo cardiovascular (HTA, dislipemias, habito tabaquico, consumo de alcohol, tratamiento dietetico y/o farmacologico). Seguidamente se determinaron parametros antropometricos, perfil lipidico, glicemia basal y hemoglobina glicosilada. Entre los principales resultados cabe senalar diferencias significativas entre el grupo experimental y el grupo control en cuanto a IMC; relacion C/C, glicemia en ayunas y hemoglobina glicosilada. En el grupo experimental, ademas, destacan: edad 48±8.05 anos (x±DE) siendo su distribucion por sexo del 45% varones y 55% mujeres. El tiempo de evolucion de la diabetes desde su diagnostico fue de 10,4 ± 8,3 anos. Se evidencio un consumo de alcohol de 15% en total y 10% de habito tabaquico. El valor promedio, de glicemia basal 160,40±40,6 mg/dL con HbA1c de 7,4±1,2%. La hipertension arterial estuvo presente en 60% de los pacientes. 70% presentaban dislipemia segun los criterios de la Asociacion Venezolana de Aterosclerosis (SVA). El IMC resulto elevado en 78% de los casos con un rango de 31,4±4,2. Se detecto hiperfibrinogenemia de 380±50 mg/dL; el 35,4% de los pacientes presentaba complicaciones macrovasculares al momento de su evaluacion siendo la mas frecuente la enfermedad vascular periferica en 25% de los casos. Todos estos resultados enfatizan la necesidad de realizar un enfoque integral del paciente diabetico que permita no solo un control adecuado de la glicemia sino tambien un correcto tratamiento de los principales factores de riesgo asociados a complicaciones macrovasculares. In order to determine the incidence of gross vascular complications in adults with Diabetes Mellitus Type 2, was designed a descriptive transversal study. We selected 40 patients with diagnosis of Diabetes Mellitus type 2, attending the Outpatient Diabetic Clinic at the Victorino Santaella Ruiz Hospital in Los Teques, Venezuela and 30 healthy subjects with similar characteristics as group control, from February to November 1998. The patient’s age ranged from 30 to 75 years, all with more than five years since their first diagnosis of Diabetes Type 2 and complying with the inclusion criteria. The patient’s medical records included the presence of cardiovascular risk factors such arterial hypertension, blood lipids and lipoproteins disturbances, smoking and drinking habits and dietetic or pharmacological treatment. We recorded weight and height measurements, lipid profile, basal blood glucose and glycosylated hemoglobin. Results show significant differen-ces between experimental control groups as regards to body mass index (BMI), hip/waist relation, fasting blood glucose and glycosylated hemoglobin. In the experimental group we recorded: age 48±8.05 years (x±SD) corresponding 45% to males and 55% to females. Time since first diagnosis of diabetes 10,4 ± 8,3 years; 15% of the group were alcohol consumers and 10% smokers. The mean values for basal blood glucose and glycosylated hemoglobin (HbA1c) were 160,40±40, 6 mg/dL and 7,4±1, 2% respectively. Arterial hypertension was present in 60% of the experimental group and 70% had dyslipemias according to the Venezuelan Association of Atherosclerosis (AVA) criteria. The BMI was high in 78% of the patients with values of 31,4±4,2. Blood fibrinogen was in the range of 380±50mg/dL. Macrovascular alterations were present in 35.4% of patients at the beginning of the study and in 25% of the cases were alterations of the peripheral vascular type. These findings point out the need for an integral approach in the follow-up of the diabetic patient, establishing additional controls as well as the usual fasting blood glucose, aiming at treating and modifying the risk factors associated with macrovascular complications.