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Long-Term Complications of Diabetes Mellitus

By Dayyal Dg.Twitter Profile | Updated: Tuesday, 23 March 2021 21:19 UTC
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Close-up Of Hands Using Lancet On Finger Testing For Diabetes
Close-up Of Hands Using Lancet On Finger Testing For Diabetes Getty Images / AndreyPopov

In long-standing Diabetes Mellitus (DM) of both types, a wide variety of lesions develop in many organs, which are important causes of morbidity and mortality.

Macroangiopathy (Macrovascular disease): In Diabetes Mellitus (DM), atherosclerosis of aorta and of medium size arteries (like coronary, cerebral, and peripheral) occurs earlier in life and is more extensive than in non-diabetic patients. It can cause myocardial infarction, cerebrovascular accident, and gangrene of lower extremities. Pathogenesis of atherosclerosis in Diabetes Mellitus (DM) is related to hyperinsulinemia with peripheral insulin resistance and dyslipidemia (raised triglycerides, low high-density lipoprotein or HDL, and raised low-density lipoprotein or LDL).

Microangiopathy (Microvascular disease): Microangiopathy is due to poor diabetes control (Table 1193.1). Microangiopathy (thickening of walls of small blood vessels with narrowing of lumina) is common in kidneys (leading to renal insufficiency), retina (visual impairment), and peripheral nerves (sensory, motor or autonomic neuropathy).

Table 1193.1: Microangiopathy in diabetes mellitus
  • Risk is directly related to the presence of high glucose level for a long duration
  • Improved glycemic control significantly reduces the risk
  • Consists of:
    – Retinopathy: Visual loss can occur due to vitreous hemorrhage (from proliferating retinal vessels) and maculopathy
    – Nephropathy: The early stage is characterized by an increased glomerular filtration rate and microalbuminuria; with progressive renal damage, overt proteinuria and renal failure develop.
    – Neuropathy: Postural hypotension, impotence, sensory and motor neuropathy, foot ulcer.

Infections: Diabetic patients are susceptible to infections of the skin, respiratory tract (pneumonia, tuberculosis), and kidneys (pyelonephritis).

Average life expectancy of Diabetes Mellitus (DM) patients is reduced. Usual causes of death in Diabetes Mellitus (DM) include myocardial infarction, stroke, renal failure, infections, and ketoacidotic or hyperosmolar hyperglycemic coma.

Major Complications of Diabetes Mellitus
Figure 1193.1: Major Complications of Diabetes Mellitus
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