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Thursday, 28 November 2013

Diabetes – The Complications

Diabetes is defined as a condition caused by insufficient insulin entering the bloodstream to regulate the glucose. It is either caused by cells in pancreas dying off or receptor sites clogged up by fat and cholesterol. In some cases, diabetes is also caused by allergic reactions of cells in the immune system.
A. Complications
1. Gangrene
Gangrene is defined as a condition of the death of tissue in part of the body. There is a report of  aA 78-year-old diabetic woman experienced multiple sites of gangrene not only in fingers that were directly bitten by a dog but also in fingers and toes that had not been bitten. Her glycemic control was fair and microvascular complications were mild. There were no clinical findings related to angitis, collagenosis or severe infection(26).
2. Loss of sensation in limbs
Accoring to Dr. Boulton AJ. at theUniversities of Manchester, as neuropathy is silent in up to 50% of patients, all diabetic patients should receive an annual screening by careful examination of the lower limbs for evidence of any sensory loss or peripheral vascular disease(27).
3. Amputation
Ampution is a result of nerve damage and poor blood circulation to the foot of that can lead poor healing of foot-ulceration. According to the study by  Department of Biostatistics and Epidemiology, University of Pennsylvania, Lower extremity amputation (LEA) is a life-altering complication of diabetes, in a study of  1,490 individuals who were African Americans and 1,550 were whites.,LEA occurred in 162 (5.3%) subjects, 93 (6.2%) of African Americans and 69 (4.4%) of whites(28).
4. Diabetic retinopathy
Diabetic retinopathy is a condition of diabetic cause of the damage to the blood vessels of the light-sensitive tissue at the back of the eye. According to the study by Isfahan University of Medical Sciences and Health Services, of  the 549 patients free of retinopathy at initial registration with at least one follow-up visit between 1992 and 2001, the incidence of any retinopathy was 89.4 (95% confidence interval (CI): 79.0, 101.0) [96.1 (95% CI: 76.7, 118.0) in males and 86.6 (95% CI: 74.5, 99.9) in females] per 1000 person-years based on 2786 person-years of follow-up. The incidence rate of retinopathy was 60% greater among insulin-treated than non-insulin-treated non-insulin-dependent diabetes mellitus (NIDDM) clinic attenders(29).
5.  Diabetic gastropathy
Diabetic gastropathy is defined as a condition of a number of neuromuscular dysfunctions of the stomach, including abnormalities of gastric contractility, tone, and myoelectrical activity in patients with diabetes(30).
6. Oral and dental complications
According to the study by Department of Medicine, MLN Medical College, Allahabad,  oral manifestations in DM of which included periodontal disease in 34%, oral candidiasis in 24%, tooth loss in 24%, oral mucosal ulcers in 22%, taste impairment in 20%, xerostomia and salivary gland hypofunction in 14%, dental caries in 24%, and burning mouth sensation in 10% cases. Fasting [(FBG) (P = 0.003)] and postprandial blood glucose [(PPBG) (P = 0.0003)] levels were significantly higher among cases(31).
7. Recurrent infections
Women with diabetes have an increased risk of urinary tract infections (UTIs), especially recurrences. Relapses and reinfections were reported in 7.1% and 15.9% of women with diabetes versus 2.0% and 4.1% of women without diabetes, According to the study by University Medical Center Utrecht(32).
8. Rheumatic conditions
Diabetes mellitus (DM) is a chronic systemic disease with a wide range of complications, including complications in the musculoskeletal system. Diabetic patients suffer from diverse rheumatic conditions that affect their life quality, according to the study by Imam Muhammad Ibn Saud Islamic University(33).
9. Risk of fracture-related hospitalization
In the study to examine the association between diabetes, glycemic control, and risk of fracture-related hospitalization in the Atherosclerosis Risk in Communities (ARIC), showed that the study supports recommendations from the American Diabetes Association for assessment of fracture risk and implementation of prevention strategies in persons with type 2 diabetes, particularly those persons with poor glucose control(34).
10. Other complications
Diabetes Mellitus is a metabolic cum vascular syndrome with resultant abnormalities in both micro- and macrovasculature, including abnormalities of the retina, kidneys, and fetus, impaired wound healing, increased risk of rejection of transplanted organs, and impaired formation of coronary collaterals(35).
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Sources
(26) http://www.ncbi.nlm.nih.gov/pubmed/21673466
(27) http://www.ncbi.nlm.nih.gov/pubmed/22817853
(28) http://www.ncbi.nlm.nih.gov/pubmed/23228162
(29) http://www.ncbi.nlm.nih.gov/pubmed/12660857
(30) http://www.ncbi.nlm.nih.gov/pubmed/10389675
(31) http://www.ncbi.nlm.nih.gov/pubmed/23087863
(32) http://www.ncbi.nlm.nih.gov/pubmed/20462975
(33) http://www.ncbi.nlm.nih.gov/pubmed/23247555
(34) http://www.ncbi.nlm.nih.gov/pubmed/23248194
(35) http://www.ncbi.nlm.nih.gov/pubmed/23226636