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What are the possible long-term complications of diabetes?

It is important to be aware that if diabetes is well controlled by diet and/or medicines, then in many cases no complications may develop even after 30 or more years. This has just been re-emphasised with the release of the results of the 20-year UK Prospective Diabetes Study. This involved 5,000 people with type 2 diabetes in 23 clinical centres. It showed that the rigorous management of blood glucose levels and blood pressure substantially minimised long-term complications. It showed that better blood glucose control reduced the risk of diabetic eye disease by a quarter and early kidney disease by a third. Most important, it also showed that control of blood pressure to near normal levels resulted in:

a reduction in death from the long-term complications of diabetes by a third one third fewer strokes
a reduction in serious sight defects by one third

The intensive therapy that people in this study were given did not impair life quality, though some people gained weight and others had more frequent hypos. Overall, it was concluded that ‘...a substantial improvement in health of people with type 2 diabetes can be obtained’. These data provide motivation and incentive for people with diabetes to manage their condition better, in the knowledge that improved health and fewer complications will result. Despite this encouragement, many people do experience problems, especially after many years of living with diabetes. These often arise through damage to blood vessels. If the blood vessels damaged are small (i.e. capillaries), then blood supply to the eyes, kidneys and various nerves may become restricted. Over time, this can lead to damage to the retina in the eye and to impaired sight (retinopathy), to kidney disease that can further complicate the maintenance of the body’s chemical balance (nephropathy), and to pain (sometimes severe) and loss of sensation, especially in the legs and feet (neuropathy). The combination of blood vessel and nerve damage predisposes some people to foot problems such as diabetic ulcers and even gangrene. Less commonly, neuropathy can also affect other parts of the body such as the arms, hands, face or internal organs, depending on which nerves are affected. If large blood vessels are damaged, then there will be an increased risk of circulatory disorders such as hypertension and heart disease.

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