Chapters authored
Microvascular Complications of Diabetes Mellitus: Focus on Diabetic Retinopathy (DR) and Diabetic Foot Ulcer (DFU)
Diabetic retinopathy and diabetic foot ulcer are the most frequent, but also the most disabling complications of diabetes mellitus, with a sinister impact on patients’ quality of life. Microvascular changes related to the deleterious effect of chronic hyperglycemia play an important role in the pathophysiology of both clinical entities by multiple molecular pathways. Vision-threating diabetic retinopathy may be treated by laser photocoagulation, anti-vascular endothelial growth factor (VEGF) agents and vitreoretinal surgery. Diabetic foot lesions are best treated by revascularization if needed, off-loading, infection control and therapeutic adjuncts (e.g. special dressings). Treatment should ideally be offered by a multidisciplinary expert team. Prevention and early detection, along with adequate control of glucose, lipids and arterial hypertension are of paramount importance to avoid and mitigate these fearful complications.
Part of the book: Type 2 Diabetes
Cardiovascular Risk/Disease in Type 2 Diabetes Mellitus
People with Type 2 diabetes mellitus (T2DM) have a 2–3 times higher cardiovascular risk (CVR) than people without diabetes. Atherosclerotic cardiovascular disease (ASCVD) is the major cause of morbidity and mortality in T2DM. Over 30% of those with T2DM have CVD (cardiovascular disease), and over half die from it, mainly from coronary heart disease. The presence of T2DM reduces life expectancy by 10–14 years. The European Society of Cardiology stratifies the CVR into moderate (young patients, with a short duration of diabetes, no risk factors), high (duration of diabetes >10 years, no target organ damage, plus any additional risk factor) and very high (patients with established CVD, target organ injury three CVD risk factors: age, hypertension, dyslipidemia, obesity, or Type 1 diabetes mellitus (T1DM) over 20 years duration). The American Association of Clinical Endocrinologists (AACE) considers that diabetes per se involves high risk. Heart failure (HF) is the second most common complication after obstructive peripheral arterial disease. T2DM associates a 75% higher risk of CV mortality or hospitalization for HF. A multifactorial approach is required to reduce CV morbidity and mortality.
Part of the book: Type 2 Diabetes