Long Term Complications of Diabetes

Diabetes is the most disabling and notorious metabolic condition that affects approximately 9.1% of the entire US population (1). This corresponds to about 29.1 million Americans according to the estimates of 2012. Unfortunately a fair chunk of this diabetic population (approximately 8.1 million individuals that include both children and adults) are unaware of their disease status. This suggests that these individuals are at much higher chance of developing diabetic complications due to non-availability of pharmacological intervention or much needed dietary or lifestyle modification.In addition:

• The prevalence of diabetes is fairly high in senior population (over the age of 65 years). For example, 25.9% of the senior population in America is currently living diabetes (corresponds to 11.8 million individuals). It is imperative to keep in mind that diabetes in elderly is a recognizable risk factor for several other metabolic and medical conditions like cataract, silent heart attacks, atherosclerosis and sudden death.
• Statistics also indicate that more than 86 million individuals in United States have prediabetes. Needless to say that these people are very likely to develop diabetes in 2-3 years if no emergent measures are adopted to modify the lifestyle and other factors.

What are Some Notable Complications of Diabetes?

Diabetes is marked by persistently high blood glucose concentration due to partial or complete deficiency of insulin (type 1 diabetes). In type 2 variety, insulin production is normal (or even higher) but the peripheral tissues are not responsive/ sensitive to insulin. In either cases, hyperglycemic state can damage blood vessels, nerves and organ.Most common complications of poorly managed diabetes can be discussed as:

Retinopathy

Persistently elevated blood sugar levels can lead to retinopathy (damage to the visual apparatus) due to osmotic swelling of lens. Healthcare providers recommend diabetic patients to see their eye doctor at periodic intervals for dilated eye exam. Most common eye problems in diabetics include:

• Cataracts —irreversible clouding or opacity of the lens that may require surgical/ interventional management).
• Retinopathy — damage to the retina and visual field defects. In untreated cases, permanent loss of vision can also occur.
• Glaucoma — changes in the intraocular pressure of the eye

Classic symptoms include:

• Discomfort or pain in the eyes
• Appearance of spots or lines in the visual field
• Loss of vision
• Blurring of vision that may be mild in the beginning but usually worsens with time, age and blood glycemic control
• Watering of eyes

Nephropathy

Appearance of protein/ sugar or other vital metabolites in the urine is a sign of renal damage. Co-existing circulatory or systemic disturbances can further aggravate the risk of nephropathy; such as high blood pressure, advanced atherosclerosis and related issues. Symptoms of a kidney problem include:

• Edematous swelling of extremities, face or generalized swelling
• Stupor, coma and disturbances in the thinking/consciousness

Cardiovascular and Circulatory Complications

Advanced or poorly managed diabetes significantly aggravates the risk of cardiovascular dysfunction or circulatory defects; such as heart attack, stroke, angina, sudden cardiac death and strokes. Optimal management of blood glycemic state as well as other risks such as high blood pressure and high fats (cholesterol) can minimize the risk of circulatory complications several folds.

Peripheral Complications

High blood sugars can lead to poor blood flow and progressive nerve damage (also referred to as peripheral neuropathy). This can lead to:

• High risk of chronic sores
• Higher propensity to experience injuries due to loss of sensation
• Impaired wound healing
• In advanced cases, the impaired circulation and nerve damage can culminate in amputation of due to gangrene, septicemia and tissue damage.

Neuropathy

Neuropathy is a disorder of the nervous system that can affect people with diabetes. There are different forms of neuropathy, including:

• Damage to the peripheral nervous system (also referred to as peripheral neuropathy)
• Involvement of autonomic nervous system
• Involvement of isolated nerves or in some cases patchy involvement

In advanced cases of neuropathy, patients may develop erectile dysfunction, loss of sensation, gastric discomfort, digestive ailments, Bell’s palsy and related symptoms.The risk of developing long term complications in the setting of diabetes is fairly high in individuals with poor glycemic control. Speak to your primary care provider regarding appropriate pharmacological options and lifestyle modification to maintain normal quality of life.References:

1. http://www.diabetes.org/diabetes-basics/statistics/
2. Rothwell, P. M., Fowkes, F. G. R., Belch, J. F., Ogawa, H., Warlow, C. P., & Meade, T. W. (2011). Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials. The Lancet, 377(9759), 31-41.
3. de Boer, I. H., Rue, T. C., Cleary, P. A., Lachin, J. M., Molitch, M. E., Steffes, M. W., ... & Brunzell, J. D. (2011). Long-term renal outcomes of patients with type 1 diabetes mellitus and microalbuminuria: an analysis of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications cohort. Archives of internal medicine, 171(5), 412-420.
4. Gong, Q., Gregg, E. W., Wang, J., An, Y., Zhang, P., Yang, W., ... & Bennett, P. H. (2011). Long-term effects of a randomised trial of a 6-year lifestyle intervention in impaired glucose tolerance on diabetes-related microvascular complications: the China Da Qing Diabetes Prevention Outcome Study. Diabetologia, 54(2), 300-307.