Long-term diabetes can affect many parts of the body and can lead to serious complications. Vascular complications that affect small (microvascular) and large (macrovascular) vessels are linked to the duration of hyperglycemia and hypertension with the three most common microvascular disease manifestations being diabetic retinopathy, nephropathy and neuropathy.10 All three complications are prevalent in longstanding type 1 and 2 diabetes influenced by the degree of glycemic control and remain relatively asymptomatic especially in the first 10 to 20 years after the diabetes diagnosis. Prevention is essential in reducing the potential for systemic dysfunctions.
Diabetic retinopathy by macular edema, i.e., retinal thickening by capillary leakage, is the most common cause of adult blindness in the USA. The disease follows a two-stage progression starting with background retinopathy (non-proliferative) and develops into a more severe proliferative retinopathy that features rapid, abnormal new vessel formation along with perceptible focal blurring with partial or total vision loss.10,11
Diabetic nephropathy is a progressive kidney disease where fluid filtration by the kidneys becomes impaired as the vessels within the functional units (nephrons) become weak and leak plasma proteins (serum albumin) into the urinary excretion. This sets off a cascade of fluid retention (edema) that exacerbates hypertension, which can lead to accelerated renal failure.10,12
Neuropathy refers to nerve damage and is the most common complication and implicated in 50-75% of non-traumatic amputations. The absence of ankle reflexes is a revealing sign with most diabetics developing peripheral neuropathy as a result of impaired blood flow to nerves governing the movement of the arms and legs, affecting especially the feet and hands. The loss of sensation to touch, vibration, proprioception or temperature can lead to foot ulceration, infection and destruction of normal foot architecture by the dulled perception to ill-fitting shoes and abnormal weight bearing.10,13
Macrovascular disease manifests as coronary disease (atherosclerosis), cerebrovascular disease (stroke) and peripheral arterial disease.10 The occurrence of these and other diabetes complications can be reduced by controlling the levels of blood glucose, blood pressure, and blood lipids and by receiving and participating in preventive care practices in a timely manner.