Nail-fold capillaroscopy as a rapid non-invasive tool for assessment of microvascular complications in diabetes mellitus: A cross-sectional study

Background: Chronic hyperglycaemia in diabetes leads to micro-vascular complications, like diabetic retinopathy, peripheral neuropathy and diabetic nephropathy. Microangiopathic changes can be detected and monitored in the nail fold capillaries using nail fold capillaroscopy. Objectives: The present study was undertaken to detect nailfold capillary changes in patients with diabetes mellitus by hand-held dermoscope and to find their association with disease duration, glycated haemoglobin (HbA1c) levels, and microvascular complications including retinopathy, nephropathy and peripheral neuropathy. Material and Methods: A cross-sectional study was conducted over 18 months on 100 diabetics and 100 controls. Screening for retinopathy, nephropathy and neuropathy was done. Nail-fold capillaroscopy (NFC) was done, and findings were graded according to the pre-defined criteria. Results: Out of the total 200 subjects included in the study, 100 were cases of diabetes, and 100 were controls. Twenty-five (25%) of participants with diabetes had Type 1 diabetes mellitus (T1DM), and 75 (75%) had Type 2 diabetes mellitus (T2DM). Overall, 26 (26%) of the apparently healthy controls were found to be pre-diabetic. NFC changes were present in 66 (66%) of Cases as opposed to 38 (38%) Controls. The mean NFC score was highest in T1DM (3.12), followed by T2DM (2.05), pre-DM (0.69) and controls (0.59). The NFC changes demonstrated an association with disease duration, glycaemic control, and micro-vascular complications. Conclusion: NFC is a simple, fast, inexpensive, non-invasive, and effective modality to analyse the functional and morphological details of the micro-vasculature. It could help in early diagnosis and timely intervention to prevent serious complications such as blindness, amputations, and renal failure in diabetics. NFC alterations were also observed in apparently healthy pre-diabetics. The small sample size of the study is one of the limitations