Diabetes mellitus with complication
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Diabetes Mellitus with Complications: An Overview
Introduction to Diabetes Mellitus
Diabetes Mellitus (DM) is a group of metabolic diseases characterized by chronic hyperglycemia due to defects in insulin secretion, insulin action, or both. This condition leads to long-term damage and dysfunction of various organs, particularly the eyes, kidneys, nerves, heart, and blood vessels . The primary pathogenic processes include autoimmune destruction of pancreatic β-cells and insulin resistance, which can coexist in the same patient .
Long-term Complications of Diabetes Mellitus
Microvascular Complications
Retinopathy, Nephropathy, and Neuropathy are hallmark microvascular complications of diabetes. Retinopathy can lead to vision loss, nephropathy can progress to renal failure, and neuropathy increases the risk of foot ulcers, amputations, and Charcot joints . These complications arise from metabolic and hemodynamic disturbances, including hyperglycemia, insulin resistance, dyslipidemia, and hypertension, which cause increased reactive oxygen species (ROS) production, inflammation, and ischemia.
Macrovascular Complications
Cardiovascular Diseases are prevalent among diabetic patients due to the increased incidence of atherosclerotic cardiovascular, peripheral arterial, and cerebrovascular diseases. Hypertension and abnormalities in lipoprotein metabolism further exacerbate these risks . Chronic hyperglycemia leads to endothelial dysfunction, hypercoagulability, and inflammation, which are critical in the development of these vascular complications.
Postoperative Complications in Diabetic Patients
Diabetes significantly increases the risk of postoperative complications and mortality after non-cardiac surgeries. Diabetic patients are more prone to infections, wound healing disorders, renal insufficiency, and myocardial infarction. The risk is higher in insulin-dependent diabetes compared to non-insulin-dependent diabetes. Additionally, diabetes increases the likelihood of postoperative reoperation, readmission, and death.
Oral Complications Associated with Diabetes
The oral cavity, being highly vascularized and innervated, is susceptible to complications from diabetes. Beyond periodontitis, diabetic patients may experience dental caries, dry mouth, oral mucosal lesions, oral cancer, taste disturbances, temporomandibular disorders, burning mouth syndrome, apical periodontitis, and peri-implant diseases. These complications are linked to the same metabolic disturbances that affect other organs.
Gastrointestinal Complications
Diabetes can lead to gastrointestinal issues such as gastroparesis, pancreatic function disturbances, and exacerbation of conditions like gastroesophageal reflux and periodontitis. Additionally, diabetes is associated with a higher incidence of autoimmune diseases like celiac disease and autoimmune gastritis, as well as hepatic microangiopathy and certain tumors.
Diabetes in Acromegaly
In patients with acromegaly, diabetes is a frequent complication due to insulin resistance induced by excess growth hormone. This condition increases cardiovascular morbidity and mortality, and may necessitate specific therapeutic approaches to manage both acromegaly and diabetes.
Conclusion
Diabetes mellitus is a complex disease with a wide range of complications affecting multiple organ systems. Effective management requires a comprehensive understanding of these complications and their underlying mechanisms. Early diagnosis and tailored treatment strategies are essential to mitigate the long-term impacts of diabetes and improve patient outcomes.
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