Long Term Complications of Diabetes

Question 1

What is the presentation of macrovascular diabetes?

Answer 1

Peripheral arterial disease

MI

Stroke

Question 2

What is the early management of macrovascular diabetes?

Answer 2

Aim for an HbA1c of 53 mmols/ml (7%)

Control BP to less than or equal to 130/80

Stop smoking

Statin therapy to reduce cholesterol

Change in lifestyle – more exercise, healthier diet

Question 3

What is the presentation of microvascular diabetes?

Answer 3

1. Diabetic retinopathy
2. Diabetic renal disease (nephropathy)
3. Peripheral Neuropathy (numbness or weakness)

Question 4

What is the screening of microvascular diabetes?

Answer 4

1. Eye screening
2. Foot screening and patient education, regular podiatry
3. Early intervention and detection
4. Urine screening test to check for early nephropathy
   
   1. 1^st morning urine sample (albumin/creatinine ratio <2.5 mg/mmol in men = normal, female <3.5) used as a screening test
   2. Definitive test is a timed overnight urine collection for albumin excretion rate (normal = <20ug/min)

Question 5

What is the early management of microvascular diabetes?

Answer 5

1. Nephropathy – Optimise Glycaemic control, maintain tight BP, ACE inhibitors
2. Peripheral neuropathy – Proper footwear, regular podiatry, patient education on foot care
3. Diabetic retinopathy – Laser therapy, tight control of blood glucose and BP, vitrectomy