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Diabetes – complications quick review chart

Diabetes complications – Microvascular Neuropathy Nephropathy Retinopathy , Macrovascular Cardiovascular disease Stroke Peripheral arterial disease

 

Diabetic retinopathy  most common microvascular complication develops slowly & affects 1 in 3 with diabetes a leading cause of visual loss in working -age population risk of developing DR is related to both presence of hypertension & severity of hyperglycemia two main stages
○ Non-proliferative ( NDPR ) – early stage of DR , main changes are increased vascular permeability & capillary occlusion retinal pathologies noticed include microaneurysm , haemorrhages & hard exudates
○ Proliferative ( PDR ) due to neovascularization. In PDR , patients may experience severe visual impairment due to vitreous haemorrhage or when tractional retinal detachment is present visual loss in DR is mostly due to development of diabetic macular edema any one over 12 in the UK with diabetes are invited for retinal screening once a year.

 

Diabetic neuropathy – involve both peripheral and autonomic nerves DN increases with age, the duration of diabetes and the magnitude of hyperglycemia DN can affect > 90 % of diabetic patients Diabetic neuropathic pain ( DPN ) patients c/o symptoms of burning , numbness, tingling, shooting , lancinating or even electric shock sensation, tends to be worse at night distal symmetric polyneuropathy ( DSPN ) – often described as stocking-glove distribution is the most common form , tends to affect the toes and distal foot but slowly progresses proximally to involve the feet and legs mechanism of injury is not clear but hyerglycemia induced polyol pathway , injury from AGE’s and enhanced oxidative stress have been implicated foot ulceration and painful neuropathy are the main complications agents used to control symptoms include duloxetine , tapentadol and pregabalin autonomic neuropathy may result in symptoms as orthostatic hypotension , gastroparesis , diarrhoea , chronic constipation , reduced anal sphincter tone , urinary incontinence , erectile dysfunction , silent ischaemia , loosing hypoglycemia awareness.

 

Diabetic kidney disease – most feared chronic microvascular complication & major cause of end stage renal disease DKD is defined as persistently raised urinary albumin-to-creatinine ratio 30 mg/g or 3.4 mg/mmol & or a sustained reduction in eGFR below 60 , on the background of long standing diabetes and classically accompanied by retinopathy up to a 3rd with diabetes would develop microalbuminuria or macroalbuminuria after about 20 yrs most important risk factors for DKD are hypertension ( which can cause microalbuminuria itself ) and sustained hyperglycemia data from UK PDS shows that albuminuria is a dynamic fluctuating condition rather than a linearly progressive process natural history includes glomerular hyperfiltration , progressive albuminuria , declining GFR and ESRD not all diabetic develop nephropathy and progression is variable main modifiable risk factors are hypertension , glycemic control and dyslipidemia management.

REFERENCES

  1. Chawla, Aastha et al. “Microvasular and macrovascular complications in diabetes mellitus: Distinct or continuum?.” Indian journal of endocrinology and metabolism vol. 20,4 (2016): 546-51. doi:10.4103/2230-8210.183480
  2. Lim, Andy Kh. “Diabetic nephropathy – complications and treatment.” International journal of nephrology and renovascular disease vol. 7 361-81. 15 Oct. 2014, doi:10.2147/IJNRD.S40172 Diabetic nephropathy – complications and treatment (nih.gov)
  3. Schreiber, Anne K et al. “Diabetic neuropathic pain: Physiopathology and treatment.” World journal of diabetes vol. 6,3 (2015): 432-44. doi:10.4239/wjd.v6.i3.432 Diabetic neuropathic pain: Physiopathology and treatment (nih.gov)
  4. Shukla UV, Tripathy K. Diabetic Retinopathy. [Updated 2021 Aug 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560805/
  5. BMJ Best Practice Diabetic Kidney Disease Diabetic kidney disease – Symptoms, diagnosis and treatment | BMJ Best Practice

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