Diabetes Related Complications: How to Screen for and Prevent

The potential complications of diabetes can be prevented with good glucose, blood pressure, and cholesterol control.

There are many potential complications of diabetes. The four most common are heart disease (hardening of the arteries), nephropathy (kidney damage), neuropathy (nerve damage), and retinopathy (eye damage). Treating diabetes, blood pressure, and cholesterol to recommended treatment will help to prevent these complications.

HEART DISEASE

The most common complication of diabetes and the leading cause of death in people with diabetes is heart disease or hardening of the arteries. Screening for heart disease is done differently than screening for kidney, eye, and nerve damage in that we do not specifically screen the heart. Instead, it is recommended that we screen for and treat the risks factors for heart disease. It would be impractical, expensive, and unreliable; for example, to perform a stress test designed to diagnose heart disease on all people with diabetes. Thus, we screen for the six major risk factors for heart disease:

1. Diabetes

2. High blood pressure

3. High cholesterol

4. Smoking

5. Family history (having an aunt, uncle, parent, child or sibling with premature or early heart disease, which includes heart attacks, angioplasty, stent placements or coronary artery bypass grafting before the age of 60)

6. Age (men greater than age 45 and women greater than age 55).

Once any of these risk factors are identified, we need to then treat them to the recommended treatment goals.

NEPHROPATHY (KIDNEY DAMAGE)

Diabetes is the leading cause of kidney failure leading to dialysis in the United States. Screening for diabetic nephropathy consists of having your urine tested for microalbumin on a yearly basis. Microalbumin is the name for microscopic proteins that are found in the urine when the kidneys are damaged by poorly controlled diabetes, and can be detected by a simple urine test. Testing for blood urea nitrogen (BUN), creatinine, and an estimated glomerular filtration rate (eGFR) are blood tests that evaluate kidney function, and should be done on a routine basis.

NEUROPATHY (NERVE DAMAGE)

Diabetic peripheral neuropathy most commonly occurs in the feet. Since the nerves that travel from your brain to your feet and vice versa are the longest nerves in your body, they are the nerves mostly likely to be damaged by poorly controlled diabetes. The best way to screen for diabetic nerve damage is having your feet examined on a regular basis. Take your shoes and socks off when you visit your primary care provider so your feet can be thoroughly examined. You should have a specific test called monofilament testing which evaluates your feet for normal touch sensation.

RETINOPATHY (EYE DAMAGE)

It is sad to say but diabetes is the leading cause of blindness in America. I truly believe that blindness related to diabetes is nearly completely preventable with good control of glucoses, good blood pressure control, and yearly screening. Screening for retinopathy is done by having a yearly eye exam that includes dilating your eyes with eye drops and looking in the back of your eyes. What the eye doctor is examining are the small blood vessels in the retina (the back of your eyes) that can be damaged from poorly controlled diabetes. The vision testing done during the exam is merely an extra-added bonus.

The take home message is: it very important to screen for the common complications of diabetes, so that any problems can be identified early or, ideally, prevented.

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Steve Feller
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Posted on Jul 22, 2009
Andrew S. Rhinehart, MD, FACP,CDE
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Posted on Jul 22, 2009
Steve Feller
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Posted on Jul 19, 2009