Diabetic Microvascular : Leading Cause Blindness

Why do we treat diabetes? There are a number of downstream events associated with abnormal blood glucose levels. If glucose levels are managed properly, the complications associated diabetes can be controlled, and sometimes completely prevented. The main problem with having more than the normal amount of glucose circulating in the blood stream is the effect that excess glucose can have on both large and small blood vessels (DTC, 2004). Micro-vascular and macro-vascular problems associated with diabetes can be seen in the heart, eyes, kidney, legs and feet. Diabetic patients are twice as likely to suffer from a mycocardial infaraction, twenty-five times more likely to suffer blindness, and seventeen times more likely to suffer kidney failure compared to a non-diabetic (DTC, 2004). Because of great number of risks associated with abnormal blood glucose levels, diabetes is aggressively treated to improve the quality of life and prevent complications in patients.

Diabetes is a disease where the body is unable to produce or use insulin effectively. Insulin is needed for proper storage and use of carbohydrates. Without it, blood sugar levels can become too high or too low, resulting in a diabetic emergency. It affects about 7.8% of the population. The incidence of diabetes is known to increase with age. It’s the leading cause of end-stage renal disease in the US, and is the primary cause of blindness and foot and leg amputation. It is known to cause neuropathy in up to 70% of diabetic patients. Individuals with diabetes are twice as likely to develop cardiovascular disease. There are two types of diabetes: Type 1 and Type 2.

They include: heart and blood vessels, eyes, kidneys, nerves, gums and teeth. In regards to the heart and blood vessels, there are approximately 65% of death that is caused by diabetes due to major complication of heart disease and stroke. In the peripheral artery diseases diabetes also plays a major role in the cause of poor blood flow in the legs and feet. Many studies show that controlling diabetes can prevent or stop the progression of heart and blood vessel disease. Blood vessel damage or nerve damage may also lead to foot problems that can lead to amputations. More than 60% of leg and foot amputations not related to an injury are due to diabetes. Another complication of diabetes is the leading cause of blindness in the U.S. There has been a number of eye problems that if not addressed can lead to eye blindness which include: glaucoma,cataracts and diabetic retinopathy. Ninety percent of diabetic-related blindness as study shown could be prevented if there would be regular eye exams and timely treatment of diabetes-related eye problems. Furthermore, kidney failure is also one leading cause of further complication that resulted from uncontrolled diabetes in the U.S. It is said that drugs that help lower blood pressure can help the chance to developing kidney failure by 33%. Also diabetes on nerves can lead to loss of sensation or pain and burning of the feet because nerves are harmed due to over time high blood sugar levels. It can also

Diabetes mellitus (DM) is a pandemic that affects millions of people. The growth rate of unrecognized pre-diabetes in America is expected to rise up to 52% by 2020 (Lorenzo, 2013). As the prevalence of diabetes increases, so will the complications and burden of the disease. One of the leading causes for cardiovascular disease, renal failure, nontraumatic lower limb amputations, stroke, and new cases of blindness is DM (Lorenzo, 2013).

This article goes in detail about the complications of Type 2 Diabetes, on how hyperglycemia damages the vascular system leading to microvascular disease and macrovascular disease. The complications of microvascular disease are diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. On the other hand, with macrovascular disease includes Cardio Vascular Disease (CVD), such as Atherosclerosis. Furthermore, the article gives recommendations of treating Type 2 Diabetes and the prevention of its health related complications with medication, screening, diet, and exercise.

Even with the improvements in diabetes control and patient care, Type 2 diabetes is associated with a higher risk of death than the general population. For the current modelling analysis, the relative risk (RR) of death was estimated to be 2.45 for patients with DME and this was estimated based on the results from two studies. Mulnier et al. reported a RR of 1.93 (95%:CI: 1.89 to 1.97) for diabetic patients when compared to the general population.23 In the second study, Hirai et al., determined that the RR of death in diabetic patients with clinically significant macular edema was 1.27 (95%CI: 1.01 to 1.61).24 By combining the two estimates, the overall RR of mortality used in the model was 2.45 (i.e. 1.93 x 1.27).

Microvascular complications. - those resulting from damage to small blood vessels - are the most common complications of diabetes and include:

Type 2 diabetes is becoming more and more common in children and teenagers because of the increase in obesity in young people” (Journal of the American Medical Association, 2011). As a result, there a many risk factors and health risks associated with type 2 diabetes. Risk factors include people with poorly managed blood glucose, overweight, family history, and poor diet. In people with diabetes kidney disease or kidney damage is a complication of diabetes, the nephrons slowly thicken and become scarred over time. The kidneys begin to leak and protein (albumin) passes into the urine. This damage can happen years before any symptoms begin” (National Library of Medicine, 2014). Secondly, diabetic retinopathy is a condition which causes progressive damage to the retina, the light sensitive lining at the back of the eye. Diabetic retinopathy is the result of damage to the tiny blood vessels that nourish the retina. They leak blood and other fluids that cause swelling of retinal tissue and clouding of vision” (American Optometric Association, 2014). Lastly, according to the U.S. Department of Health and Human Services, (2013) diabetic neuropathies are a family of nerve disorders which can occur overtime and develop nerve damage throughout the

Diabetic retinopathy which is the eye damage occurs to the retina due to diabetes, eventually leads to blindness. A systemic disease which affects up to 80 percent of all patients has diabetes for 20 years or more, it is an ocular manifestation of diabetes. Research indicates that at least 90% of these new cases could be condensed if there were proper and watchful handling and checking of the eyes despite these intimidating statistics. The extensive a person has diabetes, the advanced his or her chances of developing diabetic retinopathy. Diabetic retinopathy interprets for 12% of all new belongings

Diabetes is associated with an increased risk of developing primarily vascular complications that contribute to morbidity and mortality of diabetic patients. Poor glycaemic control leads to vascular complications that affect large (macrovascular), small (microvascular) vessels or both. Macrovascular complications include coronary heart disease, peripheral vascular disease and stroke. Microvascular complications contribute to diabetic neuropathy (nerve damage), nephropathy (kidney disease) and retinopathy (eye disease).

Patients with type 2 diabetes are at risk of macrovascular and microvascular complications. Evidence has shown that an improvement in blood glucose control, as shown by a reduction in HbA1c levels, is associated with a reduction in microvascular complications (2,3,4).

One of many major diabetic health complications is retinopathy. Retinopathy is the scarring of the retina, which is caused by a lack of oxygen reaching the blood vessels in the retina. As a result, the retina grows new but abnormal blood vessels that leak blood and causes scarring. Retinopathy is the leading cause of blindness in adults.

Diabetic retinopathy is caused by blocked blood flow to the eye, causing ischemia or increased permeability of the blood vessels in the eye. Macular edema is caused by swelling in the eye due to the increased permeability, and both of these are common causes of vision loss of those with diabetes. Some factors that can be seen in the retina from a fundoscopic exam that can cause these issues (all of which were detected in our patient), are micro-aneurysms, intrarenal hemorrhages, and hard exudates. All three of these can disrupt the blood-retinal barrier, causing issues with blood flow and swelling. Additionally, lipids and proteins both play important roles in the eye, and if there is improper breakdown of these molecules, they can make deposits in the outer layer eye. The more deposits (hard exudates) a patient has, the larger affect it can have on their vision.

Diabetes Mellitus is “a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both. It is a disease which is caused by the insufficient insulin secretion or decrease in the peripheral effects of insulin. It is a serious problem in terms of morbidity and mortality. The hyperglycemia is associated with long term damage, dysfunction and failure of various organs especially the eyes, kidneys, nerves, heart and blood vessels. It’s associated with many complications which includes blindness of the eyes and amputations of the extremities. It is also associated with neuropathy, retinopathy, and cardiovascular diseases which lead to mortalities.

Diabetes is a systemic disease caused by a decrease in the secretion of insulin or reduced sensitivity or responsiveness to insulin by target tissue. (Beale, et al., 2011) The incidence of diabetes is growing rapidly in the United States and worldwide. An estimated 347 million people around the world are afflicted with diabetes. (Whalen, et al., 2012) According to World Health Organization (WHO), Diabetes prevalence among adults over 18 years of age has risen from 4.7% in 1980 to 8.5% in 2014. It is the major cause of blindness, kidney failure, heart attack, stroke and limbic amputation. World Health Organization (WHO) projects that diabetes will be the 7th leading cause of death in 2030. It is a complex and costly disease that can affect nearly every organ in the body and result in devastating consequences. The leading cause of non-traumatic lower extremity amputations, renal failure, and blindness in working-age adults, diabetes is also a major cause of premature mortality, stroke, cardiovascular disease, peripheral vascular disease, congenital malformations, perinatal mortality, and disability. (Cefalu, 2000) Insulin therapy and oral hypoglycemic agents have demonstrated improvement in glycaemic control. However, Insulin therapy has some disadvantages such as ineffectiveness following oral administration, short shelf life, of the need for constant refrigeration, and fatal hypoglycaemia, in the event of excess dosage.