Diabetes mellitus: chronic complications
1. Big picture
Chronic complications of diabetes mellitus are the long-term vascular, neural, renal, ocular, and foot complications caused by persistent hyperglycemia plus associated risk factors such as hypertension, dyslipidemia, smoking, obesity, chronic kidney disease, and insulin resistance.
For the oral exam, the examiner mainly wants you to organize them into:
| Group | Main complications | Core exam idea |
|---|---|---|
| Microvascular | Retinopathy, nephropathy, neuropathy | Mostly driven by chronic hyperglycemia |
| Macrovascular | Coronary artery disease, stroke, peripheral arterial disease | Accelerated atherosclerosis |
| Neuropathic/foot complications | Foot ulcers, Charcot joint, infections, amputations | Loss of pain sensation + pressure + ischemia + infection |
| Autonomic complications | Resting tachycardia, silent myocardial infarction, orthostatic hypotension, gastroparesis, bladder dysfunction, erectile dysfunction | “The patient does not feel what should be dangerous” |
The current ADA Standards of Care are updated annually and include specific sections on cardiovascular disease, chronic kidney disease, retinopathy, neuropathy, and foot care. ([Diabetes Professionals][1])
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