Diabetes is a significant health problem worldwide, and its
Damage to medium and large vessels is called macroangiopathy or macrovascular disease. Macrovascular complications cause most of the mortality associated with type 2 diabetes. They can occur even in individuals without diabetes. Individuals with diabetes have a higher risk of developing myocardial infarction, stroke, and peripheral artery disease.
Persistent hyperglycemia is associated with increased risk of atherosclerosis. It is a type of macrovascular disease, referring to a progressive narrowing of arteries resulting from a variety of processes including smooth muscle cell proliferation and deposition of cholesterol and lipids within the arterial wall. It progresses more rapidly in patients with type 2 diabetes.
Cardiovascular disease, an important manifestation of macrovascular complications, is the major cause of death for patients with type 2 diabetes. It is also responsible for a major portion of the morbidity and costs associated with type 2 diabetes.
Patients with diabetes are at particularly high risk of developing the cardiovascular disease for several well-recognized reasons. Patients with diabetes often have elevated cholesterol levels, termed hypercholesterolemia, providing more cholesterol for the development of fatty plaque.
The particular type of Low Density Lipids (LDL) cholesterol that is more prevalent in patients with diabetes – small, dense LDL particles – is thought to be associated with a greater cardiovascular risk in some studies.
Hypertension is also common in patients with type 2 diabetes and substantially increases risk of cardiovascular disease in these patients. Insulin resistance, commonly seen in type 2 diabetes and associated with obesity, also increases the risk of developing cardiovascular disease.
Common types of cardiovascular disease are mentioned below;
1. Coronary Artery Disease
Diabetes dramatically increases (2-4 times) the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis).
- Narrowing or blockage of the arteries that supply the heart with blood.
- Reduced blood flow and resulting lack of oxygen can lead to myocardial Infarction.
2. Peripheral Vascular Disease
A condition in which the arteries in the legs, and sometimes the arms, are narrowed by fatty plaque. Peripheral vascular disease is 20 times more common in people with diabetes than in the general population.
- Narrowing or blockage of the arteries that supply the extremities with blood; leg pain with walking is a symptom of lower extremity Ischemia.
- Leads to slow healing of trauma or even tissue death, which can lead to amputation, particularly in the feet; the macrovascular complication of nerve damage also involved.
- 60% of non-traumatic amputations amputations in the United States are in patients with type 2 diabetes.
Diabetic Foot : Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can develop serious infections, which often heal poorly. These infections may ultimately require toe, foot or leg amputation.
3. Cerebrovascular Disease / Stroke
The patients are at 2-4 times higher risk to develop the cerebrovascular disease. Cerebrovascular disease refers to a group of conditions that can lead to a cerebrovascular event, such as a stroke. These events affect the blood vessels and blood supply to the brain.
- Narrowing or blockage of the major arteries that supply the brain with blood.
- Reduced flow of oxygen and nutrients to the brain leads to a stroke when the artery becomes blocked by plaque or a clot.
Some clinical trials have shown that controlling hyperglycemia, hypertension, and hypercholesterolemia can have benficial effects on vascular disease in patients with type 2 diabetes.
Individuals with diabetes are more prone to develop a variety of infections. These infections are also common in non-diabetics. Respiratory tract infections, Gastrointestinal tract infections, Skin infections, Urinary tract infections. Also fungal or microbial infections can also be seen in diabetic individuals.
Gestational diabetes: Most women who have Gestational diabetes deliver healthy babies. However, untreated or uncontrolled blood sugar levels can cause problems for both mother and baby. Gestational diabetes causes complications in baby including excess growth, Low blood sugar, Type 2 diabetes later in life or Death. Consequently complications in the mother including Preeclampsia and subsequent gestational diabetes can occur.
Once chronic complications develop, the treatment options are unsatisfactory. Hence, to prevent these complications from developing in the first place should be the prime target. Failing this, to detect them at early enough stage in order to prevent their progression or even reverse them.