Sonographic evaluation of carotid intima media thickness (cIMT) in adult diabetic patients in University of Maiduguri Teaching Hospital, North Eastern Nigeria

Abstract

Background:Intima media thickness of the carotid arteries has been used as a subclinical index of atherosclerosis in patients with diabetes mellitus and has also been used in epidemiological and interventional studies as a surrogate index of atherosclerosis. However, to date, there is paucity of data on sonographic carotid artery intima media thickness (IMT) measurements and the prevalence of carotid atherosclerosis and stenosis among adult diabetic patients in our environment.

Objective: The objective of this study was to evaluate carotid artery intima media thickness among adult diabetic patients using carotid duplex ultrasonography (CDUS). 

Methods: This was a cross-sectional study carried out at the University of Maiduguri Teaching Hospital, Nigeria. One hundred and twenty adult diabetic patients aged 20 - 78 years had CDUS for measurements of carotid artery intima media thickness. Measurements were taken at 1cm below and 1cm above the carotid bulb for the common carotid (CCA) and internal carotid arteries (ICA) respectively. Pearson's correlation and Student t-test were used to compare the means between the variables.

Results: There were 72(60%) male and 48(40%) female diabetic patients aged 20 to 78 years (mean = 50.03±11.4 years). Mean intima-media thickness, in millimeters (mm), for normal (non-stenotic) carotid arteries on the right and left were (CCA=0.71±0.09 and 0.70±0.08; ICA=0.71±0.08 and 0.69±0.09) and abnormal (stenotic) on the right and left were (CCA=0.84±0.17 and 0.83±0.19; ICA=0.98±0.10 and 1.03±0.10) respectively. A total of 75 patients (62.5% of study population) had no carotid artery stenosis; 38 patients (31.7%) had <50% carotid stenosis; 6 patients (5.0%) had 50-69% carotid stenosis; and 1 patient (0.8%) had 72% carotid stenosis. The prevalence of carotid stenosis in diabetic patients was 37.5% in this study. There was positive and significant correlation between percentage degree of stenosis with IMT (r=≥ +0.5; p=<0.05).

Conclusion: The findings of this study have indicated the presence of atherosclerotic and haemodynamic changes in the carotid arteries of adult diabetic patients in this environment who are at risk of developing stroke from carotid stenosis. CDUS has proved to be a valuable diagnostic and screening tool in the evaluation of these patients because of its safety, low cost, wide availability, and accuracy in detecting carotid artery disease