Prevention and early detection of the vascular complications of diabetes
Authors:
F. Saudek; P. Bouček
Authors‘ workplace:
Ředitel: doc. MUDr. Jan Malý, CSc.
; Institut klinické a experimentální medicíny, Praha
; Přednosta: prof. MUDr. Terezie Pelikánová, DrSc.
; Centrum diabetologie
; Přednosta: doc. MUDr. F. Saudek, DrSc.
; Klinika diabetologie
Published in:
Prakt. Lék. 2008; 88(4): 188-194
Category:
Reviews
Overview
Diabetes mellitus has become a serious global health and economic problem mainly due to the impact of its long-term complications. Microvascular complications, retinopathy, nephropathy and neuropathy, are organ complications resulting specifically from the diabetic metabolic milieu. Moreover, diabetes causes a significant increase of the risk of major macrovascular complications (coronary artery disease, cerebrovascular and peripheral vascular disease) which account for the majority of diabetes–related mortality. In many developed countries, diabetes constitutes the single most important cause of working-age blindness, end-stage renal disease and non-traumatic amputations. The risk resulting from the occurrence of micro- and macrovascular complications can be dramatically reduced by the systematic implementation of primary preventive measures and by screening of their incipient stages. From the onset of diabetes, optimal glycaemia, blood pressure and lipid control should be pursued assiduously. It has been shown especially in type 2 diabetes that a multifactorial intervention program results in very important benefits with regard to the risk of progression of vascular complications. Carefully controlled studies have proven the effectiveness of several secondary preventive measures (laser photocoagulation for retinopathy, renin-angiotensin system blocker and other antihypertensive drug treatment for nephropathy, prophylactic footwear for peripheral neuropathy etc.) in the initial and more advanced stages of diabetic complications. Primary and secondary preventive measures should be widely available and systematically implemented in general and specialized care of all patients with diabetes.
Key words:
diabetes mellitus, vascular complications, prevention, diabetic nephropathy, diabetes retinopathy, diabetic foot syndrome.
Sources
1. ÚZIS. Péče o nemocné s cukrovkou. Praha: ÚZIS ČR 2006.
2. ÚZIS. Péče o nemocné cukrovkou 2006 [on line]. 2007-10-22. [cit. 2008-04-11] Dostupné z WWW: http://www.uzis.cz/article.php?article=682&order=&sort=&mnu_id=5100.
3. Ichinose, K., Kawasaki, E.Eguchi, K. Recent advancement of understanding pathogenesis of type 1 diabetes and potential relevance to diabetic nephropathy. Am. J. Nephrol. 2007, 27(6), p. 554-564.
4. Unger, R.H. Reinventing type 2 diabetes: pathogenesis, treatment, and prevention. JAMA 2008, 299(10), p. 1185-1187.
5. Massi-Benedetti, M. The cost of diabetes Type II in Europe: the CODE-2 Study. Diabetologia 2002, 45(7), p. S1-4.
6. Schrijvers, B.F., De Vriese, A.S., Flyvbjerg, A. From hyperglycemia to diabetic kidney disease: the role of metabolic, hemodynamic, intracellular factors and growth factors/cytokines. Endocr. Rev. 2004, 25(6), p. 971-1010.
7. Singh, R., Barden, A., Mori, T., et al. Advanced glycation end-products: a review. Diabetologia 2001, 44(2), p. 129-146.
8. Brownlee, M. The pathobiology of diabetic complications: a unifying mechanism. Diabetes 2005, 54(6), p. 1615-1625.
9. Oates, P.J. Polyol pathway and diabetic peripheral neuropathy. Int. Rev. Neurobiol, 2002, 50, p. 325-392.
10. Ways, D.K., Sheetz, M.J. The role of protein kinase C in the development of the complications of diabetes. Vitam. Horm. 2000, 60, p. 149-193.
11. Vinik, A.I., Erbas, T., Park, T.S. et al. Platelet dysfunction in type 2 diabetes. Diabetes Care 2001, 24(8), p. 1476-1485.
12. Laing, S.P., Swerdlow, A.J., Slater, S.D. et al. Mortality from heart disease in a cohort of 23.000 patients with insulin-treated diabetes. Diabetologia 2003, 46(6), p. 760-765.
13. Laing, S.P., Swerdlow, A.J., Carpenter, L.M. et al. Mortality from cerebrovascular disease in a cohort of 23 000 patients with insulin-treated diabetes. Stroke 2003, 34(2), p. 418-421.
14. Perkins, B.A., Ficociello, L.H., Silva, K.H. et al. Regression of microalbuminuria in type 1 diabetes. N. Engl. J. Med. 2003, 348(23), p. 2285-2293.
15. Rossing, P. The changing epidemiology of diabetic microangiopathy in type 1 diabetes. Diabetologia 2005, 48(8), p. 1439-1444.
16. Rossing, P. Prediction, progression and prevention of diabetic nephropathy. The Minkowski Lecture 2005. Diabetologia 2006, 49(1), p. 11-19.
17. Younis, N., Broadbent, D.M., Harding, S.P. et al. Incidence of sight-threatening retinopathy in Type 1 diabetes in a systematic screening programme. Diabet. Med. 2003, 20(9), p. 758-765.
18. Younis, N., Broadbent, D.M., Vora, J.P. et al. Incidence of sight-threatening retinopathy in patients with type 2 diabetes in the Liverpool Diabetic Eye Study: a cohort study. Lancet, 2003, 361(9353), p. 195-200.
19. Tesfaye, S., Kempler, P. Painful diabetic neuropathy. Diabetologia 2005, 48(5), p. 805-807.
20. The absence of a glycemic threshold for the development of long-term complications: the perspective of the Diabetes Control and Complications Trial. Diabetes 1996, 45(10), p. 1289-1298.
21. Stratton, I.M., Adler, A.I., Neil, H.A. et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000, 321(7258), p. 405-412.
22. Singleton, J.R., Smith, A.G., Russell, J.W. et al. Microvascular complications of impaired glucose tolerance. Diabetes 2003, 52(12), p. 2867-2873.
23. Cryer, P.E. Hypoglycemia risk reduction in type 1 diabetes. Exp. Clin. Endocrinol. Diabetes 2001, 109, Suppl 2, p. S412-423.
24. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N. Engl. J. Med. 1993, 329(14), p. 977-986.
25. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998, 352(9131), p. 837-853.
26. Sustained effect of intensive treatment of type 1 diabetes mellitus on development and progression of diabetic nephropathy: the Epidemiology of Diabetes Interventions and Complications (EDIC) study. JAMA 2003, 290(16), p. 2159-2167.
27. Nathan, D.M., Cleary, P.A., Backlund, J.Y. et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N. Engl. J. Med. 2005, 353(25), p. 2643-2653.
28. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ 1998, 317(7160), p. 703-713.
29. Adler, A.I., Stratton, I.M., Neil, H.A. et al. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ 2000. 321(7258), p. 412-419.
30. Hansson, L., Zanchetti, A., Carruthers, S.G. et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 1998, 351(9118), p. 1755-1762.
31. Strippoli, G.F., Craig, M., Craig, J.C. Antihypertensive agents for preventing diabetic kidney disease. Cochrane Database Syst. Rev. 2005(4), p. CD004136.
32. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. N. Engl. J. Med. 1998, 339(19), p. 1349-1357.
33. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet 2002, 360(9326), p. 7-22.
34. Colhoun, H.M., Betteridge, D.J., Durrington, P.N. et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet 2004, 364(9435), p. 685-696.
35. Collins, R., Armitage, J., Parish, S. et al. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. Lancet 2003, 361(9374), p. 2005-2016.
36. Pyorala, K., Pedersen, T.R., Kjekshus, J. et al. Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease. A subgroup analysis of the Scandinavian Simvastatin Survival Study (4S). Diabetes Care 1997, 20(4), p. 614-620.
37. Sacks, F.M., Pfeffer, M.A., Moye, L.A. et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators. N. Engl. J. Med. 1996, 335(14), p. 1001-1009.
38. Shepherd, J., Barter, P., Carmena, R. et al. Effect of lowering LDL cholesterol substantially below currently recommended levels in patients with coronary heart disease and diabetes: the Treating to New Targets (TNT) study. Diabetes Care 2006, 29(6), p. 1220-1226.
39. Keech, A., Simes, R.J., Barter, P., et al. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet 2005, 366(9500), p. 1849-1861.
40. Ansquer, J.C., Foucher, C., Rattier, S. et al. Fenofibrate reduces progression to microalbuminuria over 3 years in a placebo-controlled study in type 2 diabetes: results from the Diabetes Atherosclerosis Intervention Study (DAIS). Am. J. Kidney Dis. 2005, 45(3), p. 485-493.
41. Gaede, P., Lund-Andersen, H., Parving, H.H. et al. Effect of a multifactorial intervention on mortality in type 2 diabetes. N. Engl. J. Med. 2008, 358(6), p. 580-591.
42. Photocoagulation treatment of proliferative diabetic retinopathy: the second report of diabetic retinopathy study findings. Ophthalmology 1978, 85(1), p. 82-106.
43. Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 1991, 98(5 Suppl), p. 766-785.
44. Treatment techniques and clinical guidelines for photocoagulation of diabetic macular edema. Early Treatment Diabetic Retinopathy Study Report Number 2. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 1987, 94(7), p. 761-774.
45. Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy. Four-year results of a randomized trial: Diabetic Retinopathy Vitrectomy Study Report 5. Arch. Ophthalmol. 1990, 108(7), p. 958-964.
46. Captopril reduces the risk of nephropathy in IDDM patients with microalbuminuria. The Microalbuminuria Captopril Study Group. Diabetologia 1996, 39(5), p. 587-593.
47. Parving, H.H., Lehnert, H., Brochner-Mortensen, J. et al. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes N. Engl. J. Med. 2001. 345(12), p. 870-878.
48. Jirkovská, A. a kol. (Ed.). Syndrom diabetické nohy. Praha: Maxdorf 2006, 397.
49. Singh, N., Armstrong, D.G., Lipsky, B.A. Preventing foot ulcers in patients with diabetes. JAMA 2005, 293(2), p. 217-228.
50. Standards of medical care in diabetes-2008. Diabetes Care 2008. 31 Suppl 1, p. S12-54.
51. Global Guideline for Type 2 Diabetes: recommendations for standard, comprehensive, and minimal care. Diabet. Med. 2006. 23(6), p. 579-593.
52. Molitch, M.E., DeFronzo, R.A.. Franz, M.J. et al., Nephropathy in diabetes. Diabetes Care 2004, 27 Suppl 1: p. S79-83.
53. Gross, J.L., de Azevedo, M.J., Silveiro, S.P. Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes Care 2005, 28(1), p. 164-176.
Labels
General practitioner for children and adolescents General practitioner for adultsArticle was published in
General Practitioner
2008 Issue 4
Most read in this issue
- Sarcoidosis- a systemic disease. What is new?
- Extraintestinal symptoms of coeliac disease
- Triplane fracture of distal tibia in children
- Fatal abscessing pneumonia caused by oxacillin-resistant Staphylococcus aureus producing Panton-Valentine leukocidin