The Macrovascular Complication of Diabetes

Question 1

Give examples of macrovascular complications of DM

Answer 1

Ischaemic heart disease
Cerebrovascular disease
Renal artery stenosis
Peripheral vascular disease

Question 2

Give the key features of macrovascular complications of DM

Answer 2

Causes morbidity and mortality (unlike microvascular)
systemic disease that is commonly present in multiple arterial beds
Risk increases with increased HbA1C
More common in T2 diabetes

Question 3

Why are macrovascular complications more common in T2DM

Answer 3

they already have the traditional risk factors (central obesity, dyslipidaemia and hypertension) and with the independent risk factor of diabetes (insulin resistance and hyperglycaemia) the risk is heightened

Question 4

Describe ischaemic heart disease

Answer 4

Major cause of morbidity and mortality in diabetes

Mechanisms are similar with and without diabetes

Question 5

How can diabetes lead to macrovascular disease

Answer 5

1. Diabetes
2. Increased risk of atherosclerosis
3. Narrowing of arterial walls
4. Macrovascular disease

Question 6

Describe cerebrovascular disease

Answer 6

Earlier than without diabetes

More widespread

Question 7

Describe vascular disease

Answer 7

Contributes to diabetic foot problems with neuropathy

Question 8

Describe renal artery stenosis

Answer 8

May contribute to hypertension and renal failure

Question 9

What are the non-modifiable risk factors for macrovascular disease

Answer 9

Age
Sex
Birth weight
FH/Genes

Question 10

What are the modifiable risk factors for macrovascular disease

Answer 10

Dyslipidaemia
High blood pressure
Smoking
Diabetes

Question 11

Describe the diabetic foot

Answer 11

Ulcer caused by diabetic neuropathy and peripheral vascular disease
Combination of micro and macrovascular disease

Question 12

Explain how diabetic foot happens

Answer 12

1) Motor neuropathy
2) Limited joint mobility
3) Autonomic neuropathy
4) Trauma- because of the above
5) Sensory neuropathy
6) Peripheral vascular disease
7) Reduced resistance to infection
8) Other diabetic complications eg. Retinopathy

Question 13

How is diabetic foot prevented

Answer 13

Control diabetes
Prevent hyperglycaemia, hypertension, high cholesterol, stop smoking

Test pulse, temperature, numbness (microfilament), deformity
Foot care
Do not walk barefoot
Daily foot inspection + shoe inspection

Question 14

How is a diabetic foot ulcer treated

Answer 14

Relief of pressure
Antibiotics
Debridement 
Revascularisation (angioplasty, arterial bypass)
Amputation

Question 15

Describe the steps of atheroma formation

Answer 15

1. Initial lesion
2. Fatty streak
3. Intermediate lesion
4. Atheroma
5. Fibroatheroma
6. Complicated lesion

Question 16

What factors are associated with atheroma development

Answer 16

HDL
Hypertension
Insulin resistance
Inflammation CRP 
Adipocytokines 
Urine microalbumin 
Waist circumference 
Fasting glucose

Question 17

Describe the treatment for macrovascular complications of diabetes

Answer 17

Treatment targeted to hyperglycaemia alone has minor effect on increased risk of cardiovascular disease
Prevention of macrovascular disease requires aggressive management of multiple risk factors
Insulin resistance before hyperglycaemia itself contributes

Question 18

Describe the neuropathic foot

Answer 18

Numb, warm, dry, palpable foot pulses, ulcers at points of high pressure loading.

Question 19

Describe the ischaemic foot

Answer 19

Cold, pulseless, ulcers at the foot margins.

Question 20

Describe the neuro-ischaemic foot

Answer 20

Numb, cold, dry, pulseless, ulcers at points of high pressure loading and at foot margins.

Question 21

What is assessed in the diabetic foot

Answer 21

Deformity, callus
Hot/cold dry
Dorsalis pedis/posterior tibial pulse
Vibration sensation, temp, ankle jerk reflex, fine touch