CHRONIC COMPLICATIONS OF DIABETES MEL­LITUS COMMON DISEASES DUE TO DM

HYPERGLYCEMIA AND MICROVASCULAR DISEASE —

• Hyperglycemia is an important risk factor for the development of microvascular disease in patients with type 2 diabetes, as it is in patients with type 1 diabetes.

Chronic Long-term complications result in morbidity and mor­tality. Children and adolescents with type 2 diabetes are at increased risk for associated comorbidities that include:

• Hypertension
• Dyslipidemia
• Nonalcoholic fatty liver disease (NAFLD)

• Dyslipidemia —

  • Dyslipidemia is defined as lipoprotein disorders that promote the development of atherosclerosis and include the following abnormalities: .
  • Increased low-density lipoprotein cholesterol (LDL-C)
  • Decreased high-density lipoprotein cholesterol (HDL-C)
  • Increased triglycerides (TG)

• Hypertension —

  • However, with the increasing prevalence of obesity, primary hypertension is the most common cause of hypertension in adolescents
  • Primary hypertension (also known as essential hypertension) was once considered uncommon in children.
  • In diabetics with more than 20 years disease non­proliferative retinopathy is always present.

Microvascular Chronic Long-term Complications Of Diabetes Mel­litus

• Eye disease:
  • · Retinopathy
  • ·Macular edema Neuropathy:
  • · Sensory and motor
  • ·Autonomic Nephropathy
• Macrovascular
  • · Coronary artery disease
  • · Peripheral vascular disease
  • · Cerebrovascular disease
  • · Gastrointestinal
  • · Genitourinary
  • · Dermatologic
  • · Infectious
  • · Cataracts
  • · Glaucoma

Complications common from Long-term 10 – 20 years after hy­perglycemia.

• Often complications seen at the time of diagnosis.
• Microvascular complications occur due to hypergly­cemia in type 1 and type 2,
  • so a reduction in blood sugar levels prevents retinopathy,
  • neuropathy
  • and nephropathy.
• Genetic factors also responsible for complication of diabetes mellitus.
• In type 2 diabetes mellitus coronary heart disease occurs and mortality is high.
• In Diabetes mellitus risk depends on :
  • · Blood sugar
  • · Dyslipidemia
  • · Hypertension
  • · Genetic factors.

Mechanism of Chronic Complications Of Diabetes Mel­litus

Intracellular glucose leads to formation of AGE’s (Ad­vanced glycosylation end products) which:

• · Promote atherosclerosis
• · Cause glomerular dysfunction
• · Reduce NO (Nitric OXide) synthesis
• ·Induce endothelial dysfunction.
• Growth factors :
  • Play an important role
  • VEGF is involved locally in diabetic proliferating retinopathy.
• Hyperglycemia :
  • Leads to increased production of reactive oxy­gen or super oxide which is responsible for the complications of diabetes mellitus.
  • Hyperglycemia increases glucose metabolism via sorbitol pathway. This causes generation of re­active oxygen species leading to generalized cellular dysfunction.

Relation of glycemic control and Chronic Complications Of Diabetes Mel­litus

• The Diabetes Control and Complication Trial (DCCT) offers proof that controlling blood sugar levels pre­vent early complications of Diabetes mellitus type 1.
• DCCT demonstrated that control of blood sugar leads to decreased incidence of retinopathy, nephropathy and neuropathy.
• There is also data to support strict glycemic control to reduce complications in type Il DM.