Microvascular complications

Microvascular complications are specific for diabetes and are almost certainly related to hyperglycemia (see Figure 5.1). Hyperglycemia leads to multiple biochemical changes, some of which are listed in Figure 5.2, that cause tissue damage [1, 2]. These lead to changes in various organs as summarized in Figure 5.1. Most of these changes can be prevented by good glycemic control which prevents the development of the complications and slows their progression [3].

Eye: Diabetic retinopathy is a specific abnormality: cataract and glaucoma are common.

Figure 5.1 Biology of microvascular complications of diabetes

Hyperglycemia Kidney

Nephropathy - microalbuminuria - albuminuria

Nerves

Neuropathy

- peripheral

- autonomic ers

Nephropathy - microalbuminuria - albuminuria

Neuropathy

- peripheral

- autonomic

Amputation

Amputation

Figure 5.2 Mechanisms of diabetes complications

Glycation of proteins (e.g. hemoglobin, collagen, advanced glycation products)

Accumulation of sorbitol and fructose (e.g. in nerves, lens)

Altered protein function and turnover

Cytokine activation and inflammation

Osmotic effects

Activation of protein kinase C

Oxidative stress

Acute changes in nerve conduction velocity

Changes in glomerular filtration rate and renal plasma flow

Kidney: Diabetic nephropathy going through various stages of microalbuminuria to overt proteinuria and kidney failure are specific to diabetes, but other conditions, such as urinary tract infections, may be more common in patients with uncontrolled diabetes.

Nerves: Diabetic neuropathy is specific for diabetes and frequently leads to both peripheral and autonomic neuropathy, and ultimately amputation.

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