Orthostatic Hypotension and its Relationship with HbA1c Levels in Patients with Diabetes Mellitus

Deep Bavaria; Asmita Rathod; Ankur Patel; Jigisha Chaudhari

doi:10.55489/njmr.12032022901

Authors

Deep Bavaria Surat Municipal Institute of Medical Education & Research, Surat, India
Asmita Rathod Surat Municipal Institute of Medical Education & Research, Surat, India
Ankur Patel Surat Municipal Institute of Medical Education & Research, Surat, India
Jigisha Chaudhari Surat Municipal Institute of Medical Education & Research, Surat, India

DOI:

https://doi.org/10.55489/njmr.12032022901

Keywords:

Orthostatic Hypertension, Diabetes Mellitus, Body Mass Index, HbA1C, Glycosylated Hemoglobin

Abstract

Introduction: For the diagnosis of diabetes mellitus, various tests are available such as FBS (Fasting blood sugar), PPBS ( Post Prandial Blood Sugar), Oral Glucose Tolerance Test, Random Plasma Glucose Test, HBA1c, etc, of which HBA1c is considered to be the most standard test. As diabetes mellitus can be asymptomatic initially, it can lead to important complications such as neuropathy, nephropathy, retinopathy, cardiovascular diseases, etc if not detected early. Postural blood pressure measurement which diagnoses orthostatic hypotension is a cheap, easy and useful tool to predict HBA1c level even in asymptomatic diabetic patients.

Methods: This is a randomized cross-sectional study of 100 diabetic patients attending Medicine OPD or admitted in our tertiary care hospital of South Gujarat. Pretested proforma was used to collect data after taking informed consent. Investigations including blood pressure measured with a standard Sphygmomanometer at the end of 3 min after standing and HBA1c as mentioned in the proforma was carried out. Final analysis has been done with the help of Open EPI and SPSS software.

Results: 33% of patients of our study population were found with abnormal orthostatic hypotension. Our data shows orthostatic hypotension is directly associated with high HbA1c,longer duration of DM, and higher value of BMI. No correlation was found between age and gender.

Conclusion: Among diabetic patients, high HbA1c, prolong duration of DM and high BMI were associated with abnormal orthostatic hypotension, which can be alarming sign of complications of diabetes mellitus.

References

Tsutsu N, Nunoi K, Yokomizo Y, Kikuchi M, Fujishima M. Relationship between glycemic control and orthostatic hypo-tension in type 2 diabetes mellitus--a survey by the Fukuoka Diabetes Clinic Group. Diab Res Clin Pract. 1990;8(2):115-23. Doi: https://doi.org/10.1016/0168-8227(90)90021-K PMid:2307091

Wu JS, Yang YC, Lu FH, Wu CH, Wang RH, Chang CJ. Popula-tion-based study on the prevalence and risk factors of orthos-tatic hypotension in subjects with pre-diabetes and diabetes. Diab Care. 2009;32(1):69-74. Doi: https://doi.org/10.2337/dc08-1389 PMid:18852335 PMCid:PMC2606833

Alvin C. Powers. Spectrum of glucose homeostasis and diabe-tes mellitus (DM). In: Harrisons Principles of Internal Medi-cine. 18th ed. (344).

Williams textbook of endocrinology. (12th ed.). Philadelphia: Elsevier/Saunders. pp. 1371-1435. ISBN 978-1-4377-0324-5.

Spallone V, Ziegler D, Freeman R, et al. Cardiovascular auto-nomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management. Diab Metabolism Res Rev. 2011;27(7):639-53. Doi: https://doi.org/10.1002/dmrr.1239 PMid:21695768

Azidah AK, Hasniza H, Zunaina E. Prevalence of falls and its associated factors among elderly diabetes in a tertiary center, Malaysia. Curr Gerontol Geriatrics Res. 2012;2012:539073. Doi: https://doi.org/10.1155/2012/539073 PMid:22693496 PMCid:PMC3369479

Angelousi A, Girerd N, Benetos A, et al. Association between orthostatic hypotension and cardiovascular risk, cerebrovas-cular risk, cognitive decline and falls as well as overall mortality: a systematic review and meta-analysis. J Hyperten. 2014;32(8):1562-71. Doi: https://doi.org/10.1097/HJH.0000000000000235 PMid:24879490

Budyono C, Setiati S, Purnamasari D, Rumende CM. The Proportion of Orthostatic Hypotension and Its Relationship with HbA1c Levels in Elderly Patients with Diabetes. Acta Med Indones. 2016;48(2):7.

Bhuyan A, Baro A, Sarma D, Choudhury B. A study of cardiac autonomic neuropathy in patients with type 2 diabetes mellitus: A Northeast India experience. Indian J Endocrinol Metab. 2019;23(2):246. Doi: https://doi.org/10.4103/ijem.IJEM_336_18 PMid:31161112 PMCid:PMC6540895

Meher M, Panda JK. Impact of glycemic control over cardiac autonomic neuropathy. J Diabetes Metab Disord. 2020 Dec;19(2):1339-44. Doi: https://doi.org/10.1007/s40200-020-00653-7 PMid:33520839 PMCid:PMC7843741