Long term complications of diabetes

Question 1

What are the long-term complications of diabetes?

Answer 1

Microvascular: retinopathy, nephropathy, neuropathy.
Macrovascular: IHD, CVD, PVD.

Question 2

Which cells are affected by microvascular complications?

Answer 2

retinal endothelial cells, mesangial cells of glomerulus, Schwann cells and peripheral nerve cells.

Question 3

What are the pathological findings of diabetic retinopathy?

Answer 3

Loss of pericytes
Basement membrane thickening
Capillary closure
Ischaemia - VEGF production, increased capillary permeability

Question 4

What are the clinical stages of retinopathy?

Answer 4

Non-proliferative - background, pre-proliferative.
Proliferative
Macular oedema - sight threatening, non sight threatening.

Question 5

What is the treatment of retinopathy?

Answer 5

Diabetic control important
Blood pressure control important
Laser treatment - pan retinal, focal
Intra-vitreal anti VEGF Ab

Question 6

What are the different types of neuropathy?

Answer 6

peripheral neuropathy, mononeuropathy, autonomic neuropathy.

Question 7

Which complications of diabetes affect the feet?

Answer 7

neuropathic ulcer, callus, Charcot foot

Question 8

What are the symptoms and signs of autonomic neuropathy?

Answer 8

Gastroparesis
Postural hypotension
Erectile dysfunction
Gustatory sweating
Diarrhoea

Question 9

What are the pathological findings of diabetic nephropathy?

Answer 9

Basement membrane thickening - loss of negative charge.
Podocyte loss - loss of integrity of filtration barrier.
Glomerular sclerosis.
Mesangial expansion.

Question 10

How is diabetic nephropathy managed?

Answer 10

Blood pressure control important.
Blockers of RAS system preferred.
Glucose control important but less so once overt proteinuria.
Associated with increased CVD risk.
Ultimately renal replacement / transplantation.

Question 11

Which modifiable risk factors are important in macrovascular disease?

Answer 11

Blood pressure, lipids, smoking, (glucose control)