Chronic Complications of Diabetes Mellitus

Chapter: Chronic Complications of Diabetes Mellitus
McMaster Section Editor(s): Juan P. Brito, Victor M. Montori
Section Editor(s) in Interna Szczeklika: Barbara Jarząb, Ewa Płaczkiewicz-Jankowska
McMaster Author(s): René Rodríguez-Gutiérrez, Dania L. Quintanilla-Flores, Anally J. Soto-Garcia, Jose G. Gonzalez-Gonzalez
Author(s) in Interna Szczeklika: Jacek Sieradzki, Ewa Płaczkiewicz-Jankowska
Additional Information

IntroductionTop

Diabetes mellitus is a worldwide public health problem that affects >420 million people of all ages, genders, and racial and ethnic groups. One of the paramount aspects of treating patients with diabetes mellitus is the association of the disease with chronic complications, which represent a burden not only to public health-care systems but predominantly to individuals who cope with them on a day-to-day basis.

While the exact pathophysiologic mechanisms behind both microvascular and macrovascular diabetes complications remain uncertain, oxidative stress appears to play a determining role in their development. An increased mitochondrial superoxide production is the first event that leads to activation of other pathways involved in the pathogenesis of chronic diabetes complications (eg, formation of advanced glycation end products, activation of protein kinase C isoforms, increased polyol pathway flux). Those changes may lead to defective formation of new vessels in response to ischemia and activation of inflammatory processes that may persist after relative normalization of glucose metabolism. Endothelial dysfunction also plays a critical role in diabetes-related complications and represents an imbalance in the production of vasodilator factors.

The duration of diabetes mellitus along with glycemic, blood pressure, and lipid control are common risk factors for the development of complications. Criteria for recognizing these conditions are well established, but other causes must be excluded to confirm diagnosis.

Chronic complications of diabetes mellitus:

1) Microvascular complications:

a) Diabetic nephropathy.

b) Diabetic retinopathy.

c) Diabetic neuropathy.

2) Macrovascular complications are mainly related to the accelerated development of atherosclerosis (diabetes mellitus is an independent risk factor for atherosclerosis). It is characterized by early onset, disseminated lesions in smaller arteries, impaired development of collateral circulation due to microvascular complications, and a painless course of atherosclerosis-related conditions (eg, myocardial infarction, stroke, death). Macrovascular complications are the leading cause of morbidity and mortality in individuals with diabetes.

3) Diabetic foot syndrome, which is caused by microvascular and macrovascular lesions and neuropathy.

4) Other complications: Skeletal (eg, Dupuytren contracture), joint (eg, Charcot foot), visual impairment (eg, subcapsular cataracts), and cutaneous (eg, necrobiosis lipoidica).

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