Diabetes Mellitus Chronic Complications

Overview
  • Chronic Complications of Diabetes Mellitus refer to the clinico-patholgoical consequences that develop over years in individuals with Type I and Type II Diabetes Mellitus (DM). These complications have been categorized into those centering around the microvasculature and macrovasculature although a variety of non-vascular sequelae also exist. Microvascular complications are almost certainly the result of chronic hyperglycemia and are less likely to occur in those with excellent glycemic control. In contrast, macrovascular Complications appear to have a more complex etiology and occur even in those with careful glycemic control.
Chronic Complications
  • Microvascular Complications:
  • Macrovascular Complications:
    • The macrovascular chronic complications of DM include an increased risk of cardiovascular, cerebrovascular, and peripheral artery disease. *As mentioned the precise etiopathogenesis of these macrovascular complications is poorly understood and does not correlate well with levels of hyperglycemia. Whatever the ultimate etiology, the vasculature of patients with DM display acceleration of atherosclerosis and hyaline arteriosclerosis above and beyond other patients with otherwise similar risk factors. These pathological changes are associated with increased risk for developing ischemic heart disease, stroke, and hypertension. In addition, patients with chronic DM display significantly increased risk of pathologies in the lower extremities, especially ulcers and gangrene. Reduced blood flow to the legs, due to Peripheral Artery disease is certainly plays a role, although diabetic neuropathy and poor wound healing (see below) likely contribute.
  • Non-vascular Complications
    • Infection Susceptibility and poor wound healing is observed in patients with chronic DM and likely arise due to subtle defects in immunity.