Over the last two or three decades, there has been an increasing awareness of the magnitude of the problem presented by diabetic complications. The major complications include:
Cardiovascular disease is the major cause of death in diabetes, and people with diabetes without previous heart attacks have been shown to have as high a risk of heart attacks as have non-diabetic patients with previous myocardial infarction1Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998; 339:229-234.. Find out more
Diabetes is an increasingly important cause of renal failure (see figure below), and has now become the single most common cause of end stage renal disease, ie that which requires either dialysis or kidney transplantation, in the USA2United States Renal Data System: Annual Data Report. In http://www.usrds.org/adr.htm, accessed 2002.. Prevalence of diabetic nephropathy.
Diabetes leads to a wide range of effects on the peripheral nervous system, but the most common manifestation of diabetic neuropathy is sensory loss in the feet. Although neuropathy can sometimes lead to severe pain, it is often silent. However, even in the absence of symptoms, it puts the individual at high risk of foot ulceration and amputation. Prevalence of diabetic neuropathy.
Through effects on peripheral nerves and arteries, diabetes can lead to foot ulceration, infection and the need for amputation. People with diabetes carry a risk of amputation that may be more than 25 times greater than that seen in those without diabetes3Calle-Pascual AL, Redondo MJ, Ballesteros M, Martinez-Salinas MA, Diaz JA, De Matias P, Calle JR, Gil E, Jimenez M, Serrano FJ, Martin-Alvarez PJ, Maranes JP. Nontraumatic lower extremity amputations in diabetic and non-diabetic subjects in Madrid, Spain. Diabetes Metab 1997; 23:519-523.. Prevalence of lower limb amputations.
Foot complications are one of the most serious and costly complications of diabetes. However, through a care strategy that combines: prevention; the multi-disciplinary treatment of foot ulcers; appropriate organization; close monitoring, and the education of people with diabetes and healthcare professionals, it is possible to reduce amputation rates by between 49% and 85%. To raise awareness of the importance of proper feet care, last year's World Diabetes Day focused on 'Diabetes and foot care'. More information may be obtained at www.worlddiabetesday.org.
Diabetic retinopathy is probably the most characteristic, easily identifiable and treatable complication of diabetes, but remains an important cause of visual loss in the developed world4Rahmani B, Tielsch JM, Katz J, Gottsch J, Quigley H, Javitt J, Sommer A. The cause-specific prevalence of visual impairment in an urban population. The Baltimore Eye Survey. Ophthalmology 1996; 03:1721-1726.. Since type 2 diabetes often remains undiagnosed for several years, a significant number of people, even in developed countries, already have retinopathy and other complications at the time of diagnosis of diabetes5Davis TM, Stratton IM, Fox CJ, Holman RR, Turner RC. U.K. Prospective Diabetes Study 22. Effect of age at diagnosis on diabetic tissue damage during the first 6 years of NIDDM. Diabetes Care 1997;20:1435-1441.. Prevalence of diabetic retinopathy.