Chronic complications of DM

CHRONIC COMPLICATIONS
Microvascular complication
1. Diabetic retinopathy
2. Diabetic retinopathy
3. Diabetic nephropathy
Macrovascular complications
1. Coronary heart disease
2. Peripheral arterial disease
3. Cerebrovascular disease
Nonvascular complications
1. Dermatologic
2. Gastroparesis
 Microvascular
Diabetic retinopathy
1. Nonproliferative-apperas late in the 1st
decade,marked by vascular aneurysms,
blot hemorrhages and cotton wool spots
-pathophysiology includes loss of retinal
pericytes, increased vascular
permeabilityaltered retinal blood flow
leading to ischemia
2.Proliferative- hallmark is the appearance
of neovascularization in response to
retinal ischemia, the newly formed
vessels appear near the optic nerve and
rupture easily leading to vitreal
hemorrhage and retinal detachment.
 Diabetic nephropathy
Is the leading cause of ESRD, it is related
to chronic hyperglycemia, pathogenesis
involves AGEs, hemodynamic alterations
in renal microcirculations and structural
changes in the glomerulus. Causing
microalbuminuria due to renal
hyperperfusion, leading to
macroalbuminuria with decrease in GFR.
 Diabetic neuropathy
Frequently presents with distal sensory
loss, symptoms may include sensation of
numbness, tingling, sharpness,
neuropathic pain develops, as the
neuropathy progresses pain subsides but
a sensory deficit persists in the lower
extremities
 Macrovascular
CHD, PAD & CVD- increased in DM, it
appears to relate to the synergism of
hyperglycemia, individuals with insulin
resistance have high PAI and fibrinogen
w/c enhances coagulation and lowers
fibrinolysis, favoring development of
thrombosis
 Nonvascular
1. Gastrointestinal dysfunction- delayed gastric
emotying and altered bowel motilty caused by
parasympathetic dysfunction secondary to
chronic hyperglycemia
2. Infections-abnormalities in cell mediated
immunity and phagocyte function associated
w/ hyperglycemia. Hyperglycemia aids in the
growth and colonization of a variet of
organisms
3.Dermatologic manifestations
Protracted wound healing and skin
ulccerations. Diabetic dermopathy begins
as erythematous area and evolves to
hyperpigmentation. Acanthosis nigricans is
a feature of insulin resistance