Vascular Complications of Chronic Hyperglycemia

Question 1

What 3 things does chronic hyperglycaemia lead to?

Answer 1

Chronic hyperglycaemia leads to chronic vasoconstriction, arterial stiffening, and pro-thrombosis. This is due to decreases NO, increased reactive oxygen species, increased prostaglandins and thromboxanes, increased growth factors (angiogenesis, smooth muscle proliferation), increased endothelium, and increased angiotensin II.

Question 2

Describe the progression of diabetic retinopathy.

Answer 2

No retinopathy becomes non-proliferative retinopathy that progress to proliferative retinopathy and finally macular edema.

Question 3

When should screening start for complications in T1DM and T2DM?

Answer 3

T1DM: start screening 5 yrs after diagnosis & >15 years old
T2DM: screen immediately upon diagnosis

Question 4

What are the features of non-proliferative retinopathy?

Answer 4

Cotton wool spots (due to retinal ischemia), micro-aneurysms, hard exudates, and intra-retinal bleeds (these are due to leakage of RBCs and proteins from retinal vessels).

Question 5

What are the features of proliferative retinopathy?

Answer 5

Friable blood vessels above retinal surface (due to schema and chronic hyperglycaemia which results in VEGF production and increased blood flow). Vitreous hemorrhages may also be visible.

Question 6

What measurements are required for the diagnosis of diabetic nephropathy?

Answer 6

ACR >/= 2.0 mg/mmol OR eGFR 20 or 2/3 ACRs >2.0 then the patient has chronic kidney disease. Note that DM increases the risk of HTN and other kidney-related problems. Therefore, diabetic nephropathy is a diagnosis of exclusion.

Question 7

What is the first sign of diabetic nephropathy?

Answer 7

The first sign of diabetic nephropathy is hyper-filtration; which results in an increased GFR.

Question 8

What is the treatment of diabetic nephropathy?

Answer 8

1. ACEi or ARB (more effective as GFR worsens)
2. Glycemic control (PERSISTING/LEGACY EFFECT!)
3. BP control: no legacy effect, only protective when BP is actually controlled

Achievement of BP control, glycemic control, and cholesterol control can result in regression of proteinuria.

Question 9

What is the main cause of death in DM?

Answer 9

Coronary Disease