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Chronic Complications of Diabetes Mellitus
Chronic Complications of Diabetes Mellitus
DIABETES MELLITUS
Microvascular
complications:
• Diabetic retinopathy
• Diabetic nephropathy
• Diabetic neuropathy
Macrovascular
complications
Systemic atheroscerosis
Mixted: diabetic foot
Pathogeny of chronic complications
in diabetes mellitus
Main factors:
• Genetic factors
• Duration of diabetes
• Metabolic control
Pathogenic mechanisms:
• Glycosilation of proteins
• Poliol pathway activation
• Increased production of oxidative stress
• Haemorrheological disturbancies
CONTRIBUTIONS OF FASTING AND POST-
PRANDIAL GLYCEMIA IN INCREASING HbA1c
Uncontrolled Diabetes HbA1c 8%
Basal hyperglycaemia
300 contributes ~2%
Post-prandial
Plasma glucose (mg/dL)
hyperglycaemia
contributes HbA1c ~1%
200 Post-prandial
hyperglycaemia
Fasting
hyperglycaemia
100
Normal
HbA1c ~5%
0
6 B 12 L 18 D 24 6
Time of day (h)
B=breakfast; L=lunch; D=dinner.
Adapted from Riddle MC. Diabetes Care. 1990;13:676-686.
Classification of diabetic
retinopathy
Non-proliferative DR:microaneurisms, “hard”
exudates,microhaemorrhagies
- Oftalmologic control in 1 year
Diabetic maculopathy:macular oedema or ischaemical
disorders
-ophtalmologic control in 3-4 months
Every year :
• At puberty or 5 years of type 1 diabetes
• At first diagnosis of type 2 diabetes
Optimal treatment of arterial hypertension in
diabetic patient
Intensive glycemic Intensive treatment Optimising lifestyle
control to decrease
cadiovascular
risk
• CVD/risc: ACE
• Losing progressivelly
the elasticity of vessels
• Vascular remodelation
• intraluminal plaques
Risk factors for atherosclerosis
• Smoking • Age
• Dislipidemia • Sex
• Arterial hypertension
• Genetic factors
• Diabetes mellitus,
insulin-resistance
• pro-trombotic status
• Lipoprotein(a)
PATHOGENY of
ATHEROSCLEROSIS
ENDOTHELIAL DISFUNCTION
“FOAM” CELL
Cardiac disturbancies in diabetes
Genetic factor Abdominal
Hyperglycemia
obesity
Age,sex
Arterial
Macroangiopathy hypertension
Family history Autonomic cadiac neuropathy dyslipidemia
Endothelial
dysfunction insulinresistence
Microangiopathy
Diabetic cardiomiopathy
Protein
Oxidative glycosilation
stress Procoagulant
status
Peripheral artery disease
(PAD)
• Peripheral artery disease (PAD) is a
narrowing of the peripheral arteries to the
legs, stomach, arms, and head - most
commonly in the arteries of the legs
PAD
• The most common symptoms of PAD
involving the lower extremities are
cramping, pain or tiredness in the leg or hip
muscles while walking or climbing stairs.
• Typically, this pain goes away with rest and
returns when patient walk again.
PAD
• Risk factors
• Factors that increase your risk of developing peripheral artery
disease include:
• Smoking
• Diabetes
• Obesity (a body mass index over 30)
• High blood pressure
• High cholesterol
• Increasing age, especially after reaching 50 years of age
• A family history of peripheral artery disease, heart disease or
stroke
• High levels of homocysteine, a protein component that helps
build and maintain tissue
PAD
Complications