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Metabo Project

Diabetes Chronic Complications

CARDIAC DISEASE

• According to the American Diabetes Association, 65% (until 70% according to Toronto University) of diabetics die due to coronary diseases or Heart Failure
• DM is associated to a considerable increase in the risk of developing a cardiovascular disease (CVD) in comparison to healthy persons: double for men and 5 times higher for women in ages between 47 – 65 years. The figures rise up to 4 – 8 in the elderly.
• This susceptibility is seen in both T1DM and T2DM. The development of arterial diseases fastens in the case of T1DM is is often present in the diagnosis of T2DM.
• 77% of hospitalizations for diabetes in US are related to CVD. Glycemic control has proved to improve cardiac metabolism and myocardial function
• Patients with cardiac disorders suffer a change in their drugs, nutrients and insulin patterns → absorption = blood flow function

RETINOPATHY

Diabetic rethinopathy is the 1st cause of non-reversable blindness in the western world. The appearance and progression of this complication is strictly dependent upon glycemic control and blood pressure level, although a genetic predisposition is also involved. A person with diabetes has 10– to 20-fold increased risk of blindness.

NEPHROPATHY

Diabetes is the leading cause of end-stage renal disease. Although renal disease has several known risk factors (above all hyperglycemia and hypertension), the genetic component behind development and progression of nephropathy may play a significant role, especially in type 1 diabetics. Nephropathy increases cardiovascular morbidity and mortality.

DIABETIC NEUROPATHY

It usually occurs in patients with long-standing and often poorly controlled diabetes. Diabetic neuropathy may affect the peripheral nervous system – leading to neuropathic pain, loss of limb sensitivity (a major risk factor for food ulceration) and loss of muscular strength – , but also the autonomic system leading to development of cardiovascular symptoms (orthostatic hypotension, syncope, arrhythmias, etc.), gastrointenstinal disturbances (including chronic abdominal pain, diarrhoea with loss of sphincterial competence, vomit, hypo-nutrition, etc.), urinary incompetence, or male impotence. Patients with CVD may not experiment angina symptoms as others → increase in morbidity for „silent“ myocardial ischemia → possible relation with the neuropathy.

FOOT ULCERATION

It is the first cause of lower limb amputation in the western world. Commonest Risk factor → Chronic sensorimotor neuropathy and/or impaired blood supply.

OTHER

Diabetes is also associated with an increased incidence of infections (especially dermatological, dental and urinary) and skin diseases. Chronic cerebrovascular disturbances and liver disease have also been associated with diabetes.