What are the chronic complications of Diabetes Mellitus (DM)?

From the Guidelines

Chronic complications of diabetes include both macrovascular and microvascular conditions, such as cardiovascular disease, diabetic nephropathy, retinopathy, and neuropathy, which can be effectively managed with tight glycemic control, regular screening, and lifestyle modifications, as recommended by recent guidelines 1.

Key Complications

• Macrovascular complications: cardiovascular disease, peripheral arterial disease, and cerebrovascular disease
• Microvascular complications: diabetic nephropathy, retinopathy, and neuropathy
• Other complications: foot ulcers, infections, amputations, skin conditions, dental disease, and increased susceptibility to infections

Management and Prevention

• Tight glycemic control (maintaining HbA1c below 7%) is essential for prevention, as recommended by the American Diabetes Association 1
• Regular screening, including eye exams, foot checks, kidney function tests, and cardiovascular assessments, allows for timely intervention to slow progression and preserve quality of life
• Blood pressure management, lipid control, and lifestyle modifications, such as weight reduction, exercise, and oral glucose-lowering agents, are also crucial for managing chronic complications of diabetes 1

Recent Guidelines

• The American Diabetes Association, the Kidney Disease: Improving Global Outcomes, and the European Association for the Study of Diabetes recommend the use of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists for patients with diabetic kidney disease to provide both kidney and cardiovascular protective benefits 1

From the Research

Chronic Complications of Diabetes

The chronic complications of diabetes can be categorized into microvascular and macrovascular complications.

• Microvascular complications include:
  • Retinopathy, which can lead to vision loss 2, 3, 4, 5
  • Nephropathy, also known as diabetic kidney disease, which can progress to end-stage renal disease (ESRD) 2, 3, 6, 4, 5
  • Neuropathy, which can cause significant impairment and affect the peripheral nerves 2, 3, 6, 4, 5
• Macrovascular complications include:
  • Cardiovascular disease, which can lead to increased risk of heart attacks, strokes, and peripheral vascular disease 2, 3, 4, 5
  • Peripheral vascular disease, which can affect blood flow to the limbs and increase the risk of foot ulcers and amputations 3, 5

Management and Prevention of Complications

The progression of diabetic complications can be slowed or prevented with:

• Tight glucose and blood pressure control 2, 6, 4
• Lifestyle modifications, such as diet and exercise 2
• Medications, including angiotensin receptor blockers (ARBs) for nephropathy and statins for cardiovascular disease 6, 4
• Regular screening for kidney disease and other complications 4