Nail Fold Capillaroscopic Changes in Type 2 Diabetes Mellitus and Their Correlation with Diabetic Retinopathy in the Indian Population: A Cross-sectional Study
Karthi Kishore, Anuj Bhatnagar, Siva Chaitanya Senapathi, Rohit Kothari, Debdeep MitraAbstract
Background:
Type 2 diabetes mellitus (T2DM) is a disease that has multiple systemic negative effects and a high mortality rate. Ophthalmoscopes and other direct observation instruments were long employed to evaluate the impact of diabetes on the microvasculature because of its vascular involvement. Nailfold capillaroscopy (NFC) is a widely accepted method for evaluating the framework of proximal nail folds and microvascular circulation, predominantly in connective tissue disorders. Its application in the early prognostic evaluation of T2DM requires further research.
Objectives:
(a) To describe various NFC changes in patients with T2DM and (b) to establish its association with surrogate markers of disease such as hemoglobin A1c and diabetic retinopathy (DR).
Materials and Methods:
NFC was done on eight fingers (excluding thumbs) of 312 T2DM patients along with fundoscopy to rule out DR.
Results:
Common nail fold capillaroscopic changes elicited among study subjects were tortuosity (91.0%), followed by sub-papillary venular plexus (87.7%), neoangiogenesis (86.5%), and microhemorrhages (85.3%). Mega-capillaries, capillary density changes, receding capillaries, architectural derangement, and angulated are other frequent associations. Bizarre changes, capillary dropouts, avascular areas, and meandering capillaries were less frequently observed. Diverse patterns of NFC were found significantly higher among cases with poor glycemic status (
Conclusion:
In diabetics, NFC patterns show potential as the early indicator of microvascular involvement and demonstrate associations with glycemic control and disease duration. Certain variations in NFC patterns may reflect underlying microangiopathic changes observed in DR. NFC holds promise as a complementary noninvasive assessment tool in routine clinical evaluation of diabetics.