Long-Term Complications of Diabetes
There has been a steady decline in the number of deaths of dia-betic patients attributable to ketoacidosis and infection, but an alarming rise in the number of deaths from cardiovascular and renal complications. Long-term complications are becoming morecommon as more people live longer with diabetes. The long-term complications of diabetes can affect almost every organ system of the body. The general categories of chronic diabetic complications are macrovascular disease, microvascular disease, and neuropathy.
The specific causes and pathogenesis of each type of compli-cation are still being investigated. It appears, however, that in-creased levels of blood glucose may play a role in neuropathic disease, microvascular complications, and risk factors contribut-ing to macrovascular complications. Hypertension may also be a major contributing factor, especially in macrovascular and micro-vascular diseases.
Long-term complications are seen in both type 1 and type 2 diabetes but usually do not occur within the first 5 to 10 years of the diagnosis. However, evidence of these complications may be present at the time of diagnosis of type 2 diabetes, as the patient may have had undiagnosed diabetes for many years. Renal (micro-vascular) disease is more prevalent among patients with type 1 diabetes, and cardiovascular (macrovascular) complications are more prevalent among older patients with type 2 diabetes.