Correlation Between Microvascular and Macrovascular Affection in Type 2 Diabetes Mellitus

Aim of the work: to explore the possible relation between macrovascular disease especially atherosclerosis and microcirculation abnormalities in patients with T2DM and, to assess any relationship between blood glucose level, microvascular and macrovascular affection. Patients and methods: the study recruited 150 participants; 100 patients with T2DM and 50 controls. All participants underwent history taking, clinical examination, biochemistry testing including HBA1c, FPG, 2h-PG, TG, TC, HDL, and LDL. Nailfold video capillaroscopy (NVC) was performed to evaluate morphology of the nailfold capillaries, arterial and venous limb diameter, alteration in Capillary length and loop diameter, presence or absence of capillary hemorrhage, extravasation, scarring, scanty and large capillaries. To score these alterations, a semi-quantitative rating scale (0–3) was used. Carotid duplex was done to all participants to measure the intima media thickness in the common carotid artery (CIMT). Results: Subjects with T2DM showed significantly increased CIMT when compared with controls. There were a significantly higher frequencies of abnormal capillary morphology, hemorrhage, scarring and scanty capillaries, Modified NVC score>1 in T2DM. In comparison to the control group, they also exhibited noticeably greater rates of extravasation, branching, crossed, and corkscrew-shaped capillaries, larger loops, and decreased capillary length. There was significantly higher left and right CIMT in the group of diabetics with Modified NVC score >1. Conclusion: A significant relationship was found between atherosclerosis and microcirculation abnormalities. Videocapilloroscopy could be used to assess microcirculatory abnormalities before detection of atherosclerosis by carotid duplex.