Micro- And Macrovascular Complication Of Diabetes Flashcards
What are the microvascular complication of Diabetes?
Retinopathy
Nephropathy
Neuropathy
What are the macrovascular complications of Diabetes?
Cerebrovascular disease
Ischaemic heart disease
Peripheral vascular disease
What is the relationship between risk of microvascular complications and HbA1c levels?
Extent of hyperglycaemia, measured by HbA1c, is strongly associated with the risk of developing microvascular complications
What is the target HbA1c to reduce the risk of microvascular complications?
53 mmol/mol (<7%)
Is glycaemic control the only factor that should be monitored in prevention of microvascular complications?
No systolic BP must also be monitored as there is a relationship between rising systolic BP and risk of MI and microvascular complications in people with T1 and T2DM
What other factors are related to the development of microvascular complications in people with T1 and T2DM?
Duration of diabetes
Smoking - endothelial dysfunction
Genetic factors - development of complications despite reasonable glycaemic control
Hyperlipidaemia
Hyperglycaemic memory - inadequate glycaemic control early on may increase risk of complications later on despite improved HbA1c
What is the mechanism of damage in microvascular disease?
- Hyperglycaemia and hyperlipidaemia lead to increased formation of mitochondrial superoxide free radicals in the endothelium
- Generates glycated plasma proteins that form advanced glycation end products (AGEs)
- Activates inflammatory pathways that damage endothelium (exacerbated by smoking)
- Causes leaky capillaries (proteins flows out) and ischaemia (impaired blood flow)
What is the main cause of visual loss in people with diabetes?
Diabetic retinopathy
What is the main cause of blindness in people of working age?
Diabetic retinopathy
Why is screening necessary for diabetic retinopathy and what are the aims of screening?
Diabetic retinopathy is asymptomatic in early stages
Aim is to detect retinopathy early when it can be treated - before it causes visual disturbance/loss
What type of retinal screening is offered for patients with diabetes in the UK?
Annual retinal screening for all diabetes patients
What condition does this image show and what are the abnormalities?
Background retinopathy (early stage)
Hard exudates (cheese colour - lipids/protein)
Microaneurysms (dots)
Blot haemorrhages
Label the abnormalities on this image. What condition does it show?
Pre-proliferative retinopathy
‘Cotton wool spots’ - soft exudates
What do cotton wool spots represent?
Retinal ischaemia
What stage of retinopathy is shown in this image?
Pre-proliferative retinopathy
What condition does this image show and what are the abnormalities?
Proliferative retinopathy
Visible new vessels on disc or elsewhere in retina - response to ischaemia, susceptible to damage
How is maculopathy different from retinopathy?
Same disease as background retinopathy but happens to be around the macula
Threatens vision - macula is important for fine, detailed colour vision
Hard exudates/oedema near the macula
What is the first step of management for all stages of diabetic retinopathy/maculopathy?
Lifestyle:
Improve HbA1c
Stop smoking
Lipid lowering
Good BP control <130/80 mmHg
After lifestyle, what is the treatment for background retinopathy?
Continued annual surveillance
After lifestyle, what is the treatment for pre-proliferative retinopathy?
If left alone, will progress to new vessel growth
Early panretinal photocoagulation treatment - burning of new vessels to prevent haemorrhages
After lifestyle, what is the treatment for proliferative retinopathy?
Panretinal photocoagulation
After lifestyle, what is the treatment for diabetic maculopathy?
Anti-VEGF (vascular endothelial growth factor) injections directly into the eye
Grid photocoagulation
What is a consequence of pan-retinal photocoagulation?
Reduced peripheral vision (as you’ve burned a hole in the retina)
What does this image show?
Retina after pan-retinal photocoagulation (laser treatment)
