Diabetes

Overview of Clinical Complications of Diabetes

Diabetes Control and Complications Trial

The Diabetes Control and Complications Trial (DCCT), a landmark 10-year study, demonstrated that persons who lowered their blood glucose concentration have a better chance of delaying or preventing complications that affect the eyes (retinopathy), kidneys (nephropathy), and nerves (neuropathy). Two groups of patients with type 1 diabetes were studied: one group followed a standard treatment regimen and the other group followed an intensive treatment regimen. Persons who lowered their blood glucose levels practiced the intensive treatment regimens which included careful self-monitoring of glucose, multiple daily insulin injections, and close physician contact.

United Kingdom Prospective Diabetes Study

The United Kingdom Prospective Diabetes Study (UKPDS), the longest and largest study of persons with type 2 diabetes, was completed in Europe in 1998. The study demonstrated that intensive control of glucose and blood pressure in these persons reduced the risk of kidney disease, blindness, stroke, and heart attack.

What are the clinical complications associated with diabetes?

Clinical complications associated with diabetes may include the following:

  • cardiovascular disease
    Cardiovascular disease, in many cases, is caused by atherosclerosis - an excess build-up of plaque on the inner wall of a large blood vessel, which restricts the flow of blood.

    • Heart disease is the leading cause of diabetes-related deaths.

    • Heart disease and stroke are two to four times more common in persons with diabetes.

  • hypertension
    High blood pressure affects 60 to 65 percent of persons with diabetes.

  • dental disease
    Periodontal (gum) disease occurs with greater frequency in persons with diabetes.

  • retinopathy or glaucoma (eye disease or blindness)
    Blindness due to diabetic retinopathy is a more important cause of visual impairment in younger-onset people than in older-onset people. Males with younger-onset diabetes generally develop retinopathy more rapidly than females with younger-onset diabetes.

    • Diabetes is the leading cause of blindness among adults 20 to 74 years of age.

  • renal disease (kidney/urinary tract disease)
    Ten percent to 21 percent of all people with diabetes develop kidney disease.

    • Diabetes is the leading cause of end-stage renal disease (ESRD), a condition in which the patient requires dialysis or a kidney transplant in order to live.

  • neuropathy (nerve disease)

    • Approximately 50 percent of people with diabetes have mild to severe forms of diabetic nerve damage.

    • Severe forms of diabetic nerve disease are the major contributing cause of lower-extremity amputations.

  • amputation
    More than half the amputations in the US occur among people with diabetes.

  • diabetic ketoacidosis (DKA)
    DKA is one of the most serious outcomes of poorly controlled diabetes, and primarily occurs in persons with type 1 diabetes. DKA is marked by high blood glucose levels along with ketones in the urine.

Preventing diabetes complications:

Persons with diabetes must stay alert for symptoms that can lead to clinical complications. The best way to do this is to:

  • get regular checkups - finding problems early is the best way to keep complications from becoming serious.

  • keep appointments with your physician - even when you are feeling well.

  • be aware of symptoms and warning signs of potential problems, including the following:

    • vision problems (blurriness, spots)

    • fatigue

    • pale skin color

    • obesity (more than 20 pounds overweight)

    • numbness or tingling feelings in hands or feet

    • repeated infections or slow healing of wounds

    • chest pain

    • vaginal itching

    • constant headaches
  • carefully self-monitor blood sugar levels several times a day, as directed by your physician.

  • control weight.

  • eat a healthy, well-balanced diet.

  • get regular exercise.

  • check your feet every day for even minor cuts or blisters.

  • quit smoking.

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