1b Micro and Macro-Vascular Complications of Diabetes Flashcards
What are the three main microvascular complications of diabetes?
retinopathy
nephropathy
neuropathy
What are the three main macrovascular complications of diabetes?
Cerebrovascular Disease
Ischaemic Heart Disease
Peripheral vascular Disease
What is the target HbA1c level to reduce risk of microvascular complications?
< 53 mmol/mol
What does prevention of microvascular complications involve?
Reduction in HbA1c and Blood Pressue
What are some other factors which influence the development of microvascular complications of diabetes?
Smoking
Duration of Diabetes
Genetics
Hyperlipideamia
Hyperglycaemic memory
What is meant by hyperglycaemia memory?
When inadequate glucose control early on can result in higher risk of complications LATER - even if HbA1c is improved
What forms as a result of endothelial damage?
Mitochondrial superoxide free radicals in the endothelium
What are AGEs?
Glyctaed plasma proteins - forms Advanced Glycation End Products
What does the formaiton of AGE’s result in?
Kick starts the inflammatory pathways
What are the consequences of a damaged endothelium?
Leaky Capillaries
Ischaemia
What causes the blurred vision which is sometimes seen in patients with diabetes?
Swelling of the lens due to more glucose in the blood = not the same as retinopathy
Why is screening for retinopathy needeD?
Early stages of retinopathy is asymptomatic , therefore screening is needed to detect it early on before it causes a visual disturbance
What are the three main characteristics of background retinopathy?
Hard exudates
Microaneurysms
Blod Haemorrhages
What are hard exudates?
Leakages of lipid from the capillary
What are the signs of pre-proliferative retinopathy?
Cotton wool Spots / soft exudates
haemorrhage
What do the changes associated with pre-proliferative retinopathy indicate?
Retinal ischaemia
What is the sign of proliferative retinopathy?
Visible new blood vessels - on the disc or elsewhere in the retina
What is maculopathy?
Same disease as background retinopathy - hard exudates, but NEAR THE MACULA
Why is maculopathy particularly threatening?
Macula is important for nearby colour vision, so loss can threaten vision significantly
What is the first step in treating any stage of retinopathy?
- improve HbA1c, Stop Smoking, Lower Lipids
- Good blood pressure control
What is the treatment of background retinopathy?
Continued annual surveillace
What is the treatment of pre-proliferative retinopathy?
panretinal photocoagulation