From the Guidelines
Non-vascular complications of diabetes can be effectively managed and their progression delayed through tight glycemic control, with a target HbA1c below 7%, as evidenced by the Diabetes Control and Complications Trial (DCCT) which showed a 60% reduction in development or progression of diabetic retinopathy, nephropathy, and neuropathy 1.
Key Complications
- Diabetic neuropathy: affects peripheral nerves, causing numbness, tingling, or pain in extremities, and can also impact autonomic functions leading to digestive issues, sexual dysfunction, and bladder problems.
- Nephropathy: involves kidney damage that can progress to end-stage renal disease if uncontrolled.
- Dermatological issues: include bacterial and fungal infections, diabetic dermopathy (shin spots), and necrobiosis lipoidica diabeticorum.
- Gastrointestinal problems: like gastroparesis may develop due to autonomic neuropathy.
- Increased susceptibility to infections: like urinary tract infections and skin infections due to impaired immune function.
Management
- Tight glycemic control with target HbA1c below 7% is crucial for delaying the progression of these complications, as supported by the UKPDS which demonstrated the importance of glycemic control in type 2 diabetes 2.
- Regular screening for complications.
- Proper foot care.
- Prompt treatment of infections. These complications result from chronic hyperglycemia causing oxidative stress, inflammation, and advanced glycation end-products that damage tissues throughout the body. Early detection through regular check-ups is essential for preventing progression of these complications.
From the Research
Non-Vascular Complications of Diabetes
- Diabetic neuropathy is a common complication of diabetes, affecting up to 50% of diabetic populations 3
- The incidence of diabetic nephropathy, a leading cause of kidney disease, can be delayed or slowed by angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) 4, 5
- Diabetic retinopathy is another complication that can be prevented or mitigated by controlling blood pressure and blood glucose levels 3
Pathophysiology and Management
- The pathophysiology of diabetes involves complex interplay of multiple hormones, requiring a multifaceted approach to management 6
- Available therapies for diabetes, including pharmacological and non-pharmacological approaches, have limitations and potential adverse effects 7, 6
- Novel treatments, such as Glucagon Like Peptide-1 (GLP-1) agonists and Sodium-Glucose transport-2 (SGLT-2) inhibitors, are being developed to improve outcomes and reduce the economic burden of diabetes 6
Prevention and Mitigation
- ACE inhibitors and ARBs have been shown to prevent or mitigate diabetic nephropathy and neuropathy by correcting vascular dysfunction and reducing blood pressure 3, 4, 5
- Lifestyle modifications, such as dietary changes and increased physical activity, are essential for preventing and managing diabetes and its complications 7