From the Guidelines
Diabetes can lead to severe and potentially life-threatening complications, including cardiovascular disease, diabetic nephropathy, diabetic retinopathy, and diabetic neuropathy, emphasizing the need for rigorous blood glucose control and lifestyle modifications to mitigate these risks. The main complications of diabetes affect multiple body systems and can be categorized into microvascular and macrovascular complications. Microvascular complications, such as diabetic retinopathy, nephropathy, and neuropathy, are directly linked to prolonged high blood sugar levels damaging small blood vessels in the eyes, kidneys, and nerves 1. Macrovascular complications, including heart disease and stroke, result from the damage to larger blood vessels.
Key preventive measures to delay or prevent these complications include:
- Maintaining good blood glucose control through medication adherence and regular monitoring
- Adopting a healthy diet, such as a Mediterranean diet supplemented with olive oil and/or nuts, which has been shown to reduce the incidence of major cardiovascular events 1
- Engaging in regular physical activity, with moderate-to-vigorous exercise recommended for more than 150 minutes per week 1
- Achieving and maintaining a healthy weight, as even modest weight loss can significantly reduce the risk of developing type 2 diabetes and its complications 1
- Avoiding smoking and managing blood pressure and cholesterol levels
The importance of lifestyle changes and weight management in preventing diabetes and its complications is underscored by recent studies, including the Diabetes Remission Clinical Trial (DiRECT), which demonstrated that almost half of the participants achieved remission to a non-diabetic state through a weight-management program 1. Furthermore, bariatric surgery has been shown to cause long-term weight loss and reduce the risk of diabetes and its complications, with effects superior to lifestyle and intensive medical management alone 1.
In terms of specific management strategies, the 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases recommend reduced calorie intake to lower excessive body weight in patients with diabetes, and emphasize the importance of lifestyle changes in preventing cardiovascular complications 1. The United Kingdom Prospective Diabetes Study (UKPDS) also highlights the benefits of intensive blood glucose control in reducing the risk of microvascular and macrovascular complications in patients with type 2 diabetes 1.
Overall, the management of diabetes requires a comprehensive approach that incorporates lifestyle modifications, weight management, and rigorous blood glucose control to prevent or delay the onset of complications and improve quality of life. By prioritizing these strategies, individuals with diabetes can significantly reduce their risk of developing severe and potentially life-threatening complications.
From the Research
Complications of Diabetes
The complications of diabetes are numerous and can affect almost every organ of the body, leading to multi-organ dysfunction 2. Some of the complications include:
- Diabetic nephropathy (DN), which is one of the most prevalent lethal complications of diabetes 3
- Dyslipidemia, which is a common complication of diabetes 3
- Obstructive sleep apnea (OSA), which is an independent risk factor for cardiovascular disease (CVD) 3
- Cardiovascular disease, which is a major cause of mortality in people with diabetes 4, 5
- Cognitive decline, functional disability, affective disorders, and liver disease, which are emerging complications of diabetes 6
- Cancer and dementia, which are now leading causes of death in people with diabetes in some countries or regions 6
Microvascular and Macrovascular Complications
Diabetes can cause both microvascular and macrovascular complications. Microvascular complications include:
- Diabetic nephropathy (DN) 3
- Retinopathy 2
- Neuropathy 2 Macrovascular complications include:
- Cardiovascular disease (CVD) 4, 5
- Stroke 2
- Peripheral artery disease 2
Prevention and Management of Complications
Prevention and management of complications are crucial in reducing the burden of diabetes. Some strategies include:
- Tight blood pressure control 5
- Use of angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB) 4, 5
- Use of novel antidiabetic drugs, such as Glucagon Like Peptide - 1 (GLP-1) agonists, Dipeptidyl Peptidase IV (DPP-4) inhibitors, amylin analogues, Sodium-Glucose transport -2 (SGLT- 2) inhibitors, and dual Peroxisome Proliferator-Activated Receptor (PPAR) agonists 2
- Lifestyle modifications, such as diet and exercise 2