Correlation of increased neck circumference with microvascular complications in diabetes mellitus: Conversations

Thesis topic is correlation of increased neck circumference with microvascular complications in diabetes mellitus: 

Case 1 A male Patient name ** age 55 carpenter by occupation with ip no 201740710 came to hospital for scrotal swelling to general surgery department.. 

History of Present illness:

Pt was apparently asymptomatic 6 years back then he developed blurring of vision which gradually progressed and pt started developing ocular morbidity and pt was unable to see objects at a distance of 6 mts. Associated with H/o increased urination. H/o increased thirst hunger at the time of presentation..

Patient was taken to a local hospital were pt was diagnosed as diabetes and opthalmologist examined the patient and told the patient that he had started developing changes related to diabetes and was told to start treatment for  diabetes with glimiperide 1gm and metformin 500mg .. but the patient was not adherence to the the treatment.. the patient vision didn't improve rather than it started to deteriorate.. now pt vision is 6/36 and pt started developing macular edema.. 

No H/o headache , nausea , vomiting
No H/o weight loss or weight gain, diarrhoea , constipation, heat/ cold intolerance, changes in appetite
No H/o abdominal pain, decrease urineoutput , burning micturition

Personal H/o pt was born in 1962 in a village near Nalgonda.. pt parents were farmers and patient is younger son in the family. Pts childhood was uneventful and patient was married at the age of 24 years and have a son and daughter in their family. Patient was healthy up to 49 years and after which he was diagnosed as diabetic No H/ o of HTN, CAD, epilepsy,tb, thyroid 

Family H/o : patients elder brother was diabetic for a period of 10 years and expired 4 years back due to sepsis secondary to a infected wound on his leg and uncontrolled sugars and Pedigree chart I'm sending it below..

On examination pt us conscious
Afebrile
Pr -82 bpm
BP -120/70mmhg
Neck Circumference-38.5cm

His investigations
FBS 154mg/dl
PLBS 204mg/dl
HBA1c 8.2
Spot urine albumin creatine ratio awaited
Non proliferative Retinopathy in both eyes more in left eye..

 

 

  

Ashwini: What is the relation between neck circumference with the complications? Is there a criteria

Vinnu: Neck circumference is a indicator for An upper body distribution of fat. The evidence supporting a relationship between obesity and increased risk of development of microvascular complications.. and to prove the role of obesity in the development and severity of microvascular complications I have used neck circumference. And positive correlation has already proved for macrovascular complications.. but studies for microvascular complications are inconclusive.. if a positive correlation can be proved we can use increased neck circumference as an independent risk factor for screening microvascular complications. 

Kishore: Are there any cutoff points for neck circumference.

Dr. Rakesh: Vinuthna please share online links to the average normal Indian neck circumference cut offs. Please share the links to macrovascular. Vinuthna have you seen this paper

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4532819/

Abhishek: How does it correlate to weight lifting practice or other muscle building exercise? Does that imply need for case wise discretion?

Dr. Rakesh: Yes we need a good study on the spectrum of neck circumferences