Complications of Diabetes Mellitus

Observational and clinical trial data show a clear relationship between the degree of hyperglycemia and the risk to develop diabetic retinopathy, diabetic nephropathy and diabetic neuropathy. Intervention trials comparing two different levels of glycemic control demonstrate that for every 1% reduction in HbA 1c , there is approximately a 25-30% reduction in these complications of diabetes. Furthermore, data from the Diabetes Control and Complications Trial show that the effects of early intensive therapy are durable for periods of at least 7 years. Early detection of the complications permits early intervention. Furthermore, other specific intervention strategies may also reduce the r isk for progression of complications. These strategies include laser photocoagulation for diabetic retinopathy (proliferative retinopathy and clinically significant macular edema), BP control and modulation of the renin-angiotensinaldosterone system for diabetic nephropathy and unloading devices for diabetic neuropathy. Other potential strategies to reduce the risk for onset and progression of these complications include such approaches as lipid lowering, aldose reductase inhibition and protein kinase C inhibition.