Study of Cutaneous Manifestations and Nail fold Capillaroscopic findings in Diabetes Mellitus and their correlation with Diabetic Retinopathy and Nephropathy- A Cross Sectional Observational Study

Abstract

Long-term diabetes can lead to complications including diabetic macro- and microangiopathy. Capillaroscopy is a non-invasive method to evaluate capillary microvasculature which can be used to demonstrate changes in capillary microarchitecture noted in diabetic microangiopathy. The objective of this study was to study cutaneous manifestations of diabetes mellitus (DM), nailfold capillaroscopic changes due to diabetic microangiopathy, as well as to determine association between nailfold capillaroscopy (NFC) and cutaneous manifestations due to DM. Two hundred cases suffering from type 2 DM having cutaneous manifestations were enrolled in the study. Patients with autoimmune diseases, smokers and on long-term corticosteroids were excluded from the study. Detailed history was taken and the cutaneous manifestations related to type 2 DM were noted. NFC was done for all ten fingers of all patients. Additional investigations including HbA1c, urine microalbumin and fasting lipid profile were performed. Out of 200 cases, 88 showed positive findings on NFC with the most common finding being altered tortuosity (seen in 85.2% cases). Chi-square test was done to demonstrate association between duration of DM and NFC which showed P-value of 0.027, which is statistically significant. Of the cases having nailfold capillaroscopic findings, 69/88 (78.4%) were found to have elevated HbA1C levels, 57/88 (57.9%) were found to have changes of diabetic retinopathy and 56/88 (63.6%) were found to have changes of diabetic nephropathy. NFC can provide key data for determination of vascular damage in diabetic patients and, thus, allows evaluation of progression of the disease making this technique a potential future utility in microvascular disease evaluation.