Complications of Diabetes Flashcards
What is the most common microvascular complication of diabetes?
Retinopathy
What is the pathophysiology of retinopathy?
- Macular edema
- hemorrhage from new vessels
- accumulation of sorbitol and other glycosylation end products
What is the most common cause of renal failure in developed countries
Diabetic nephropathy
What is the pathophysiology of diabetic nephropathy?
- mesangial expansion/injury
2. increased matrix production or glycation of matrix proteins
what is the progression of diabetic nephropathy?
- Normal
- Microalbuminuria with hyperfiltration
- Mesangial expansion; glomerular basement membrane thickening; and glomerular sclerosis
- Proteinuria
- Kimmelstiel-Wilson lesions
- Nephrotic Syndrome
- Renal Failure
What is the standard of care in the management of diabetic nephropathy?
- ACE inhibitors (SOC)
- avoid NSAIDs
- limit protein intake
What is the most common presentation of diabetic neuropathy?
Distal SYMMETRICAL polyneuropathy (DSPN)
aka Diabetic Peripheral Neuropathy (DPN)
What is the etiology of DPN?
Occluded vasa nervorum
What is the major common denominator in Macro and Microangiopathy?
Insulin Resistance
What are the specific causes of:
- Macrovascular disease
- Microvascular disease?
- macro = insulin resistance
2. Micro = hyperglycemia
What did the DCCT study show?
reducing HbA1c decreased MICROvascular disease with INT (intensive therapy)
What did the EDIC study show?
reduction in early stage complicatiosn during the DCCT = substantial reductions in complicatiosn and CVD
What did the UKPDS study show?
Intensive BG control by Sulphonylureas or insulin decreased risk of MICROvascular complications (NOT macrovasc)
-increased risk of hypoglycemia
What did studies of Liraglutide and Empagliflozin show?
lower rates of death from cardiovascular disease
What is the most common reason for death in patients with diabetes?
Macrovascular complications
