25 Diabetic Complications Overview
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Questions and Answers

What is the primary effect of hyperglycemia on tissues as described in the content?

  • Hyperglycemia stimulates the production of reactive oxygen species, causing oxidative stress and tissue damage.
  • Hyperglycemia leads to protein degradation, weakening the basement membrane.
  • Hyperglycemia directly damages the vascular endothelium, leading to inflammation and microvascular disease.
  • Hyperglycemia causes abnormal thickening of the basement membrane due to glycosylated proteins. (correct)

    • Which of the following complications is NOT directly linked to microangiopathy as described in the content?

  • Diabetic kidney disease
  • Diabetic retinopathy
  • Diabetic neuropathy
  • Coronary artery disease (correct)

    • Which of the following is a potential risk factor for diabetic complications, as implied by the provided content?

  • Genetic predisposition to diabetes
  • Family history of cardiovascular disease
  • Prolonged exposure to high blood pressure
  • All of the above (correct)

    • Based on the information provided, which of the following is a direct consequence of diabetic complications?

    <p>All of the above (D)</p> Signup and view all the answers

    The content describes diabetic complications as a leading cause of ___.

    <p>Non-traumatic amputations (B)</p> Signup and view all the answers

    Which of the following is a common sign or symptom associated with diabetic complications, according to the information provided?

    <p>All of the above (D)</p> Signup and view all the answers

    Which of the following is NOT mentioned as a specific complication of diabetes in the provided content?

    <p>Diabetic encephalopathy (A)</p> Signup and view all the answers

    What is the primary reason that diabetic patients are at increased risk for developing infections?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the primary consequence of thickening of the capillary basement membranes observed in diabetic patients?

    <p>Decreased oxygen transportation to tissues (C)</p> Signup and view all the answers

    Which condition is NOT directly linked to vascular complications of diabetes according to the provided content?

    <p>Cardiomyopathy (D)</p> Signup and view all the answers

    Which mechanism is NOT associated with hyperglycemia-induced tissue damage as described?

    <p>Decreased protein synthesis (D)</p> Signup and view all the answers

    In which organ is diabetic glomerulosclerosis primarily observed?

    <p>Kidney (C)</p> Signup and view all the answers

    Which statement accurately reflects the characteristics of impaired blood vessels in diabetic conditions?

    <p>They are fragile and prone to bleeding. (D)</p> Signup and view all the answers

    What is the risk of myocardial infarction (MI) for individuals with diabetes compared to those without?

    <p>3-5 times higher risk (C)</p> Signup and view all the answers

    Which of the following risk factors significantly contributes to cardiovascular disease in diabetes?

    <p>Low physical activity (C), Poor glucose control (D)</p> Signup and view all the answers

    What is a common presenting feature of type 2 diabetes that relates to macrovascular complications?

    <p>Silent ischemia (D)</p> Signup and view all the answers

    What is the increased risk of stroke in individuals with diabetes compared to those without?

    <p>2-3 times higher risk (D)</p> Signup and view all the answers

    What lifestyle change is NOT recommended for the prevention of macrovascular disease in individuals with diabetes?

    <p>Increase smoking (B)</p> Signup and view all the answers

    What is the estimated total cost of diagnosed diabetes in 2017?

    <p>$327 billion (D)</p> Signup and view all the answers

    Which of the following treatments is recommended for those with atherosclerotic cardiovascular disease (ASCVD)?

    <p>GLP-1 agonists (D)</p> Signup and view all the answers

    Which of the following contributes most significantly to the costs associated with diagnosed diabetes?

    <p>Hospital inpatient care (B)</p> Signup and view all the answers

    Which of the following is NOT a factor that increases risk of diabetic neuropathy?

    <p>Increased albuminuria (A)</p> Signup and view all the answers

    What is the most common form of neuropathy in developed countries?

    <p>Diabetic polyneuropathy (D)</p> Signup and view all the answers

    Which of the following medications is NOT used in the treatment of painful neuropathy?

    <p>Metformin (A)</p> Signup and view all the answers

    Which of the following is a characteristic of Charcot arthropathy?

    <p>Often leads to significant bone destruction (A)</p> Signup and view all the answers

    What is the primary mechanism by which ACE inhibitors or ARBs reduce microalbuminuria?

    <p>Decreasing blood pressure and reducing glomerular pressure (B)</p> Signup and view all the answers

    Which of the following is NOT a common symptom of diabetic neuropathy?

    <p>Increased sensation in the feet (D)</p> Signup and view all the answers

    Which of the following is a common type of neuropathy that can lead to Charcot arthropathy?

    <p>Sensory neuropathy (B)</p> Signup and view all the answers

    What is the most common type of diabetic neuropathy?

    <p>Peripheral neuropathy (A)</p> Signup and view all the answers

    Which of the following is NOT a recommended intervention for preventing diabetic foot ulcers?

    <p>Using compression stockings (C)</p> Signup and view all the answers

    What is the typical distribution of sensory nerve damage in diabetic neuropathy?

    <p>Distal, affecting the feet and hands in a stocking-glove pattern (A)</p> Signup and view all the answers

    What is a significant consequence of decreased NADPH in the polyol pathway related to diabetic tissue damage?

    <p>Decreased levels of glutathione (C)</p> Signup and view all the answers

    Which of the following is a risk factor for the development of diabetic retinopathy?

    <p>Increased duration of diabetes (A)</p> Signup and view all the answers

    What characterizes proliferative diabetic retinopathy (PDR)?

    <p>Neovascularization of the retina (B)</p> Signup and view all the answers

    Which factor is most strongly associated with the risk of developing diabetic nephropathy?

    <p>Duration of diabetes (A)</p> Signup and view all the answers

    In the treatment of non-proliferative diabetic retinopathy (NPDR) with clinically significant macular edema (CSME), which intervention is commonly used?

    <p>Focal laser photocoagulation (A)</p> Signup and view all the answers

    Which growth factor is linked to the pathophysiology of diabetic retinopathy?

    <p>Insulin-like Growth Factor 1 (IGF-1) (B)</p> Signup and view all the answers

    What is a common pathological change observed in diabetic nephropathy?

    <p>Glomerular basement membrane thickening (B)</p> Signup and view all the answers

    Which of the following statements correctly describes the prevalence of diabetic retinopathy in type 2 diabetes?

    <p>About 20% show symptoms at diagnosis. (B)</p> Signup and view all the answers

    Which treatment is indicated for high-risk severe proliferative diabetic retinopathy?

    <p>Panretinal photocoagulation (PRP) (A)</p> Signup and view all the answers

    What is a hallmark feature of diabetic neuropathy?

    <p>Loss of proprioception (C)</p> Signup and view all the answers

    What defines 'clinically significant macular edema' (CSME) in diabetic retinopathy?

    <p>Size of the area affected and its proximity to the macula (D)</p> Signup and view all the answers

    Which of the following factors is NOT directly linked to the pathogenesis of diabetic tissue damage?

    <p>Increased levels of eNOS (C)</p> Signup and view all the answers

    Which condition is considered a complication of diabetes associated with retinal damage?

    <p>Retinopathy (B)</p> Signup and view all the answers

    What class of medications is primarily used to control hypertension in the context of diabetic complications?

    <p>Antihypertensive therapy (C)</p> Signup and view all the answers

    Study Notes

    Complications of Diabetes

    • Diabetes is the 5th leading cause of death.
    • Life expectancy decreases by 5-10 years.
    • Cardiovascular disease risk increases 2-4 times.
    • Nerve damage affects 60-70% of patients.
    • Diabetes is the number 1 cause of new cases of renal failure, blindness, and non-traumatic amputations.

    Learning Outcomes

    • List microvascular and macrovascular complications of diabetes.
    • Explain the pathophysiology of each complication.
    • Outline the risk factors for the development of complications.
    • Outline common signs and symptoms of each complication.
    • Outline overarching principles of investigation and management of diabetes complications.
    • Analyze the impact of diabetic complications on quality of life, healthcare costs, and mortality.

    Health impact

    • Hyperglycemia is strongly correlated with microvascular disease.
    • Progression to retinopathy, albuminuria, clinical neuropathy, and microalbuminuria is related to increasing HbA1c levels.

    Summary of Pathological Complications

    • Coma can occur from hypoglycemia, ketoacidosis, and hyperosmolar non-ketotic conditions.
    • Cardiovascular complications include atherosclerosis, stroke, and peripheral vascular disease (limb amputation).
    • Microvascular complications include cardiac failure, retinopathy, diabetic kidney disease, and neuropathy.
    • Renal failure can be associated with diabetic kidney disease, pyelonephritis, and renal papillary necrosis.
    • Infections, including tuberculosis, bronchopneumonia, COVID-19, skin infections (diabetic foot), and fungal infections, can be complications.
    • Eye complications include retinopathy, cataracts, macular edema, and glaucoma.
    • Pregnancy complications can include gestational diabetes, increased risk of developmental abnormalities, and increased obstetric complications for the mother.

    How Diabetes Damages Tissues

    • In diabetes, the protein basement membrane thickens, reducing blood flow and causing ischemia. The membrane also becomes fragile, increasing risk of hemorrhage.

    Proteins Damaged in Blood Vessels

    • Capillary basement membranes thicken throughout the body.
    • These vessels function poorly, reducing blood flow to adjacent tissues and increasing fragility, leading to bleeding.
    • Kidney vessels can develop diabetic glomerulosclerosis and renal papillary necrosis.
    • Vessels supplying nerves can develop neuropathy.
    • Vessels in the eyes can develop diabetic retinopathy.
    • Vessels in the skin, especially the feet, can develop ulcers.

    Diabetic Nephropathy

    • The abnormal capillaries in the kidneys are best seen with a PAS stain.
    • Kidney glomerulus thickening and protein deposition in the mesangium are characteristics of this condition.

    Proposed Mechanisms of Hyperglycemia-Induced Tissue Damage

    • Genetic factors can contribute to tissue damage.
    • Repeated acute changes in cellular metabolism also play a role.
    • Cumulative long-term changes in stable macromolecules are another factor.
    • Independent factors like hypertension and hyperlipidemia can accelerate tissue damage.

    Molecular Pathways Implicated in Diabetic Tissue Damage

    • Polyol pathway: Glucose is converted to sorbitol, decreasing NADPH and glutathione, contributing to oxidative stress and modifications of intracellular and extracellular proteins.
    • Advanced glycosylation end products (AGE): modification of proteins.
    • Increased inflammatory cytokines and growth factors.
    • Protein Kinase C activation: alters gene expression.
    • Reduced endothelial nitric oxide synthase (eNOS). Increased expression of endothelin-1, TGF-β, PAI-1, VEGF, and NFKB lead to vasoconstriction, coagulation, angiogenesis, and inflammation.
    • Hexosamine pathway: Diverts from glycolysis pathway and increases N-acetyl glucosamine leading to altered gene expression of TGF-β and PAI-1.

    Microvascular Complications of DM

    • Retinopathy
    • Nephropathy
    • Neuropathy

    Diabetic Retinopathy

    • Diabetic retinopathy (DR) is a common cause of blindness in adults (20-74).
    • Many patients experience no symptoms until the late stages, making treatment difficult.
    • Symptoms include reduced visual acuity, worsening with disease progression.
    • Type 1 diabetes: onset 3-5 years after diagnosis; 15-20 years after diagnosis nearly all patients are affected.
    • Type 2 diabetes: prevalence ~20% at time of diagnosis; onset averages 4-7 years before diagnosis; ~50-80% incidence by 20 years.

    Risk Factors for Diabetic Retinopathy

    • Duration of diabetes
    • Level of glycemic control
    • Hypertension
    • Other microvascular complications (e.g., nephropathy, neuropathy)
    • Dyslipidemia
    • Pregnancy

    Pathophysiology of Diabetic Retinopathy

    • Hyperglycemia disrupts retinal blood flow.
    • Oxidative stress and inflammation occur.
    • Increased vascular permeability leads to edema
    • Microthrombosis causes ischemia.
    • Growth factors (IGF-1, PDGF, VEGF) promote proliferation.
    • Genetic factors, first-degree relatives
    • Hypertension
    • Dyslipidemia

    Classification of Retinopathy

    • Two major categories
      • Non-proliferative retinopathy (NPDR): Mild, moderate or severe
      • Proliferative retinopathy (PDR): Early/High-risk/severe
    • Macular edema can occur at any stage: Clinically significant macular edema (CSME).

    Eye Findings in Retinopathy

    • Mild: Microaneurysms, dot hemorrhages, hard exudates
    • Moderate/Severe: Above plus soft exudates (cotton wool spots), venous beading, intraretinal microvascular abnormalities (IRMA) with occluded, dilated and tortuous capillaries.

    Diabetic Nephropathy

    • Leading cause of kidney disease.

    Risk Factors for Nephropathy

    • Poor glycemic control
    • Hypertension
    • Age
    • Genetic factors
    • Race (e.g., Black or African American, Pima Indian, Mexican-American)
    • Obesity
    • Tobacco use
    • Other microvascular disease (e.g., retinopathy)

    Pathologic Changes in Nephropathy

    • Glomerular disease (mesangial expansion, basement membrane thickening, glomerular sclerosis)
    • Microalbuminuria (30-300 mg/g creatinine)
    • Proteinuria (>300 mg/g creatinine)

    Natural History of Diabetic Nephropathy

    • Glomerular hyperfiltration (increased kidney size on ultrasound).
    • Microalbuminuria.
    • Regression to normoalbuminuria.
    • Progression to macroalbuminuria (associated with risk-factor management).
    • Decreased GFR.
    • Progression to end-stage kidney failure (ESKD).

    Prevention of Nephropathy

    • Glycemic control
    • Blood pressure control
    • Treatment of dyslipidemia
    • Measuring spot urine microalbumin/creatinine ration annually after 5 years in T1DM or at diagnosis in T2DM.

    Treatment of Nephropathy

    • ACE inhibitors or angiotensin II receptor blockers (ARBs).
    • Dietary sodium restriction.
    • Weight loss.

    Diabetic Neuropathy

    • Most common microvascular complication.
    • Diabetic polyneuropathy is the most common form of neuropathy in developed countries.
    • 50-70% lifetime incidence of at least one form of neuropathy.

    Risk Factors for Diabetic Neuropathy

    • Age
    • Duration of diabetes
    • Poor glucose control
    • Blood vessel damage
    • Mechanical injury to nerves
    • Genetic susceptibility
    • Hypertension
    • Dyslipidemia (hypertriglyceridemia)
    • Tobacco use
    • Excessive alcohol use.

    Types of DM Neuropathy

    • Motor neuropathy
    • Sensory neuropathy
    • Mixed sensorimotor neuropathy
    • Compression neuropathies
    • Cranial nerve palsies
    • Mononeuritis multiplex
    • Autonomic neuropathy

    Peripheral Neuropathy

    • Most common type of diabetic neuropathy, distal, symmetric.
    • Axonal neuropathy ("Stocking-glove" distribution)
    • Sensory symptoms > motor symptoms
    • Decreased sensation, paresthesia (tingling, burning, electrical shock), hyperesthesia, worse at night.

    Treatment of Painful Neuropathy

    • Anticonvulsants (pregabalin, valproic acid, gabapentin).
    • Tricyclic antidepressants (TCAs).
    • Serotonin norepinephrine reuptake inhibitors (SNRIs).
    • Topical agents (capsaicin cream).
    • Opioids (dextromethorphan, morphine, oxycodone).
    • Antioxidants (alpha-lipoic acid).
    • TENS (transcutaneous electrical nerve stimulation).

    Prevention of Neuropathy

    • Glucose control
    • Blood pressure control
    • Treatment of dyslipidemia
    • Smoking cessation
    • Reduced alcohol intake

    Diabetic Foot Pathology

    • Charcot arthropathy, a complication of neuropathy.

    Prevention of Foot Ulcers

    • Avoid walking barefoot.
    • Proper fitting shoes.
    • Trimmed toenails.
    • Daily foot inspection (use a mirror, or have someone else check).
    • Daily foot washing.
    • Use moisturizing cream or lotion.
    • Follow up with a podiatrist.

    Summary: Microvascular Complications

    • Retinopathy (NPDR without CSME: risk factor management; PDR or CSME: photocoagulation).
    • Nephropathy (microalbuminuria, renin-angiotensin inhibition).
    • Neuropathy (polyneuropathy).

    Macrovascular Complications of Diabetes Mellitus

    • Coronary artery disease
    • Cerebrovascular disease
    • Peripheral vascular disease

    Cardiovascular Disease (CVD) & Diabetes

    • Leading cause of death in people with diabetes.
    • Risk is increased approximately 2-fold in men, and 3-4-fold in women. For diabetes, accounts for 2/3 of all deaths

    Risk Factors for Cardiovascular Disease in Diabetes

    • Age
    • Duration of diabetes
    • Poor glucose control
    • Hypertension
    • Dyslipidemia
    • Albuminuria and kidney disease
    • Gender (W > M)
    • Obesity
    • Smoking
    • Sedentary lifestyle

    Prevention of Macrovascular Disease

    • Glucose control
    • Blood pressure control
    • Lipid control
    • Reduction of microalbuminuria
    • Weight loss and exercise
    • Smoking cessation
    • Aspirin (secondary prevention or high-risk)
    • Treatment with GLP-1 agonists and SGLT-2 inhibitors (for individuals with established ASCVD).

    Costs and Effects on QOL

    • Total costs of diagnosed diabetes in 2017 were $327 billion.
    • 30% of costs for hospital inpatient care.
    • Prescription medications for diabetes complications account for 30% of costs.
    • Anti-diabetic agents and diabetes supplies account for 15% of costs.
    • Physician office visits account for 13% of costs.

    Summary: Macrovascular Complications

    • Glucose control (early intervention).
    • Risk factor management (blood pressure, dyslipidemia, microalbuminuria).
    • Weight loss and exercise.
    • Smoking cessation.
    • Aspirin (secondary prevention or high-risk cases).

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    Complications of Diabetes Mellitus Path Slides PDF

    Description

    Test your knowledge on diabetic complications and their effects on tissues. This quiz covers key concepts related to hyperglycemia, microangiopathy, and other risks associated with diabetes. Challenge yourself and learn more about the complications stemming from diabetes.

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