THESIS

TITLE:SPECTRUM OF CLINICAL PRESENTATIONS IN DIABETICS WITH MULTIMORBIDITIES AND FACTORS INFLUENCING THEIR OUTCOMES

Aim:-

To evaluate the spectrum of clinical presentations and factors influencing outcomes in diabetic patients with multimorbidities 

Problem statement:-

•Diabetes is a chronic metabolic disorder that affects millions of people worldwide. Individuals with diabetes often have multiple comorbidities, which can affect the spectrum of clinical presentations and influence their outcomes[1].

• Some of the common comorbidities seen in individuals with diabetes include cardiovascular disease, hypertension, obesity, and kidney disease.(2)

•The spectrum of clinical presentations in diabetes with multimorbidities can vary widely, depending on the severity and type of comorbidities present. For example, an individual with diabetes and cardiovascular disease may present with symptoms such as chest pain, shortness of breath, or palpitations, while someone with diabetes and kidney disease may experience fatigue, swelling, or changes in urinary habits.[4,6]

•The outcomes of diabetes with multimorbidities are influenced by several factors, including the type and severity of comorbidities, the duration of diabetes, and the level of glycemic control .[3]

•Older patients with diabetes are more likely to have multiple comorbidities, which can complicate management and increase the risk of adverse outcomes.[5]

•Therefore, the problem statement for exploring the factors influencing outcomes in diabetics with multimorbidities is to identify the key clinical, laboratory, and imaging features that contribute to outcomes in these patients.

Objectives:-

1) To look for various clinical presentations of diabetes with multimorbidities.

2)To study various factors that influence the outcomes in these patients

PATIENTS AND METHODOLOGY:

The study is carried out at kamineni institute of medical sciences,narketpally during the period April 2023 to march 2025.Diabetic patients with multimorbidities of any gender equal or above 18 years are enrolled for the study.After taking a written consent from the patients/relatives, a detailed history is taken and a thorough physical  and systemic examinations are performed according to self-designed case report forms. The case report forms, document the patient’s name, age, sex, comorbidities, risk factors associated with diabetes and family history etc. 

PLACE OF STUDY: Department of General medicine , Kamineni Institute of Medical Sciences, Narketpally.

STUDY PERIOD: April 2023- March 2025

STUDY DESIGN : Prospective Study 

SAMPLE SIZE:Proposed no. Of cases to be studied:50

•The study will be approved by ethics committee of Kamineni Institute of Medical Sciences,Narketpally

•All patients satisfying inclusion criteria will be enrolled in the study 

•Written informed consent will be taken from the patients prior to the start of the study.

INCLUSION CRITERIA:

1.Patients of any gender above or equal to 18 years of age at the time of presentation with diabetes and multimorbidities involving more than two comorbidities like Htn,DM,Thyroid disorders,CAD,CVA,CKD,COPD,

visceral fat etc

2.All patients above 18yrs 

EXCLUSION CRITERIA:

1.Patients below 18 yrs of age (minors)

2.Patients above 18yrs who refused for the study 

3.Patients not having any multimorbidities

PROFORMA : 

Name: 

Age:

Sex:

OP/IP No. 

Address:

DOA:.           DOD:

Occupation:

Symptoms:

Signs:

Pasthistory:

Biosychosocial history :

CLINICAL FEATURES AT ADMISSION:

General and Systemic examination:

Pallor:     Icterus:    Cyanosis:.   Clubbing:

Lymphadenopathy:

• Pulse:.    BP:.    Resp.Rate:.   Temp:

• Cardio vascular system:

• Respiratory system:

• Abdominal examination:

• Nervous system

LABORATORY PARAMETERS:

•FBS

•PLBS

•HbA1c:

•Hemogram:

•CUE:

•Blood Urea: 

•Serum Creatinine: 

•Serum electrolytes:

•Urine Albumin: 

•24Hrs Urine Protein: 

•ECG 

•2D ECHO

OUTCOME END POINTS AFTER FOLLOWUP:

•Morbidity- Asymptomatic/symptomatically better/same status;Physical limitations/social and psychological limitations.

•Mortality

References:

1. Tinetti et al. "Multimorbidity and clinical outcomes in diabetes: a systematic review and meta-analysis" (The Lancet Diabetes & Endocrinology, 2014): https://www.thelancet.com/journals/landia/article/PIIS2213-8587(14)70040-2/fulltext

2. Aujoulat et al. "The Impact of Multimorbidity on Quality of Life in Patients with Type 2 Diabetes" (Journal of Diabetes Research, 2016): https://www.hindawi.com/journals/jdr/2016/3091543/

3. Peterson et al. "Multimorbidity and glycemic control among adults with type 2 diabetes" (Diabetes Care, 2014): https://care.diabetesjournals.org/content/37/7/1806.long

4. Marengo et al. "Impact of comorbid conditions on glycemic control in type 2 diabetes mellitus patients: a systematic review and meta-analysis" (Journal of Endocrinological Investigation, 2020): https://link.springer.com/article/10.1007/s40618-019-01174-5

5. Saliba et al. "Multimorbidity and its impact on diabetes outcomes in older adults" (Current Diabetes Reports, 2017): https://link.springer.com/article/10.1007/s11892-017-0854-8

6. Bains and Egede. "Impact of Multimorbidity on Health-Related Quality of Life in Patients with Type 2 Diabetes Mellitus" (Journal of Clinical Medicine, 2018): https://www.mdpi.com/2077-0383/7/5/125

My thesis cases blogs 

http://171mkfarhanelogcases.blogspot.com/2023/10/43f-patient-came-to-opd-with-co.html

https://srigovardhini.blogspot.com/2023/11/46m-diabetes-6-years-insulinwith.html

https://srigovardhini.blogspot.com/2023/11/55m-with-dm2-jaundiceleprosy.html

https://srigovardhini.blogspot.com/2024/04/70m-with-seizurescva-and-uncontrolled.html

https://srigovardhini.blogspot.com/2024/05/65-y-old-female-came-to-casualty-with.html

https://srigovardhini.blogspot.com/2024/05/45-female-with-neck-paindenovo.html

Thank you himaja

Jaba das 

https://himajav.blogspot.com/2023/10/65f-urosepsis-over-active-bladder.html

Balreddy 202336915

https://himajav.blogspot.com/2023/08/80m-aki-1m-htn-10yrs-dm.html

https://himajav.blogspot.com/2023/08/53f-metabolic-syndrome.html

https://himajav.blogspot.com/2023/08/58m-erectile-dysfunction-1yr-with-uti.html

https://himajav.blogspot.com/2023/02/38fbl-ll-pains.html

https://mvineelarollno90.blogspot.com/2023/11/65-y-female-with-co-fever-since-4-days.html?m=1

Thank you Dr kranthi sir

https://srigovardhini.blogspot.com/2024/05/64f-with-htn-ckd-denovo-dm2-altered.html

https://himajav.blogspot.com/2024/05/75f-hfref-ckd-htn-dm.html