Objectives
To determine the frequency of common symptoms and complications among adult patients with either non-insulin-dependent or insulin-dependent diabetes mellitus and to examine associations of these problems with vascular disease risk factors.
Design
Cross-sectional determination of the prevalence of symptoms, complications, and risk factors among adult patients with diabetes, and a case-control design of a subsample of those case patients with non—insulindependent diabetes melllitus who were age-, race-, and sexmatched 2:1 to adult control patients with hypertension.
Setting
A large family practice ambulatory care unit in which the patients were demographically representative of the Piedmont region of North Carolina.
Patients
Three hundred thirty-six adults participated; of these participants, 223 case patients had non—insulindependent diabetes mellitus, and 23 case patients had insulin-dependent diabetes mellitus. An additional 90 control patients were selected who had hypertension but did not have diabetes.
Main Outcome Measures
Frequencies and odds ratios of symptoms and complications that were categorized by diabetic type, another chronic disease (eg, hypertension), or vascular risk factors (eg, the duration of diabetes, levels of glycosylated hemoglobin, fasting blood glucose, total cholesterol, and high-density lipoprotein cholesterol, or mean arterial blood pressures).
Methods
Standardized medical histories, physical examinations, and anthropometric and serum chemistry studies were done. Microalbuminuria was measured by urinary albumin excretion ratios.
Results
Symptoms of polydipsia, fatigability, heat or cold intolerance, palpitations, dyspnea, orthostasis, indigestion, frequent urination, male impotence, blurred vision, paresthesias, and forgetfulness occurred in more than one third of the adult diabetic patients as did complications of hypertension, microalbuminuria, peripheral neuropathy, and hypercholesterolemia. Those patients with noninsulin-dependent diabetes mellitus were more likely than those with insulin-dependent diabetes mellitus to have recent symptoms of polydipsia, chest pain, shortness of breath, orthostasis, light-headedness, and vaginal discharge. They were also more likely to have hypertension and hypercholesterolemia, but less likely to have dipstick proteinuria. Patients with non—insulin-dependent diabetes mellitus were more likely than those with hypertension alone to have a variety of general, cardiovascular, and neurologic symptoms and more likely to have peripheral vascular disease, neuropathy, retinopathy, and proteinuria. Regardless of the diabetic type, nearly half of the patients had microalbuminuria. The presence of symptoms was often associated with the duration of diabetes and poor glycemic control as were complications, but complications were often also associated with dyslipidemias and an elevated mean arterial pressure.
Conclusions
Previous studies have documented such a wide variety of symptoms and complications, but these studies have been based on those patients who attended specialized referral settings. Our findings show that these problems are surprisingly common among adult diabetic patients who are cared for in a primary care setting. The fact that nearly half of the patients had microalbuminuria suggests that the onset of significant vascular complications had already begun in most of these patients. The occurrence of symptoms of depression, anxiety, panic, and forgetfulness were unexpectedly common and may have adversely affected the ability of diabetic patients to comply with the intended therapy.
