Long-Term Complications of Diabetes Flashcards
Describe the impact of diabetes and its complications
Responsible for 14.5% of all mortality worldwide in 20-79 year olds.
10% of the total NHS budget is spent on diabetes and related problems.
Name three examples of macrovascular complications of diabetes
- Coronary vascular disease
- Cerebrovascular disease
- Peripheral vascular disease
Name three examples of microvascular complications of diabetes
- Retinopathy
- Nephropathy
- Neuropathy
What are the features of atherosclerosis?
- Macrophages and foam cells
- Intracellular lipids
- Extracellular lipid accumulation
- Fibrotic and calcific layers
- Damage to surface, exposure to platelets and clotting
How is atherosclerosis present in diabetes?
Dyslipidaemia is present in nearly all people with diabetes
• HDL Cholesterol is lower
• Triglycerides are higher
• LDL cholesterol is in the form of small dense particles which are worse
Oxidisation of these particles promotes the features that lead to plaque formation (and glycation of the particles worsens the effect)
Also endothelial dysfunction and hypercoagulability are present
What are the effects of atherosclerosis in diabetes?
- Strokes
- Angina, MI
- Heart failure
- Lower limb ischaemia, leading to ulcers and poor healing of them. Amputations can be required.
What are four strategies for prevention of macrovascular disease?
- Good diabetic control
- Blood pressure control
- Lipid control
- Smoking cessation, weight, exercise
What are the two types of retinopathy (microvascular disease)?
Non-proliferative diabetic retinopathy and proliferative diabetic retinopathy
Describe Non-proliferative diabetic retinopathy
Retinal capillary dysfunction, platelet dysfunction, blood viscosity abnormality.
Describe Proliferative diabetic retinopathy
Retinal ischaemia, new blood vessel formation, vitreous haemorrhage, retinal tears/detachment.
Treatment with laser photocoagulation
Describe the impact of diabetic retinopathy
Over a period of 20 years after diagnosis, 100% of people with Type 1 diabetes and 60% of those with Type 2 diabetes will have some form of retinopathy (mild-to-severe)
What is the treatment of retinopathy?
- Improve glycaemic control
* Laser photocoagulation
What changes occur in nephropathy (microvascular disease)?
- Microalbuminuria - leak of protein (albumin) starts
- Glomerular basement membrane changes
- Mesangial tissue proliferation
- ‘glomerular hypertension’
Describe the impact of diabetic nephropathy
- 75% of people with diabetes have some renal effects, and 20% go on to overt kidney disease that may need treatment.
- Diabetes is the biggest single cause of end stage renal disease needing renal replacement therapy (dialysis).
What is the prevention and treatment of nephropathy?
- Screening of urine for albumin is vital!
- Diabetes control
- Renin-angiotensin system blockade - ACE inhibition, angiotensin receptor blockade, renin inhibition.
- Hypertension control
