Approximately five to six million people in our country suffer from diabetes. It is a risk factor for many diseases along with hypercholesterolemia, hypertension, overweight and smoking. When the diagnosis of diabetes appears, it is easy to think about its connection with cardiac ischemia (heart attack and angina pectoris) and cerebrovascular events. Actually, more than 50% of people with type 2 diabetes die from cardiovascular complications. But high blood glucose levels are factors that also facilitate the occurrence of other diseases that take years off our lives and negatively affect our well-being.
“These cardiovascular problems are the leading cause of death in people with diabetes, so they have received more attention. but there are other consequences that are often not thought of and must be taken into account” says Antonio Pérez Pérez, president of the Spanish Diabetes Society (SED).
The problem is poor glucose control maintained over time, as explained by Carlos Miranda Fernández-Santos, head of the Diabetes Working Group of the Spanish Society of General and Family Physicians (SEMG): “Diabetes is a long-term chronic disease. The damage often goes undetected and is proportional to poor glucose control.”
Heart failure and the leading cause of dialysis
The SED president highlights the impact of diabetes on heart failure, a condition where the heart can no longer efficiently pump oxygen-rich blood to the rest of the body: “Diabetes is often associated with heart attack and stroke. Heart failure is one of the great forgotten ones and significantly reduces life expectancy. Antonio Pérez means that diabetes can multiply the risk of heart failure up to two or three times.
High blood glucose is also a sign of kidney damage. “It impairs the irrigation of the arteries that reach the kidney, which loses its function. It’s something silent and doctors find it in analyses,” explains Carlos Miranda. The head of the SEMG working group and the president of the SED agree in emphasizing the very illustrative fact of what this impact means: half of the people who come for dialysis and kidney transplant have diabetes.
Reason for amputations and blindness
Another piece of information highlighted by both experts, which makes it possible to calibrate the severity of some of the consequences of diabetes, is related to the so-called diabetic foot: diabetes is the leading non-traumatic cause of lower limb amputation. “Poor arterial blood flow affects the peripheral arteries,” says Miranda. The problem is that hard-to-heal ulcers can develop and become infected.
Diabetic retinopathy is a specific condition of poorly controlled diabetes: “There is microvascular damage that affects even the small arteries.” Although cases of blindness have decreased drastically with glucose control, diabetes remains the leading cause of blindness in Western countries.
Non-alcoholic fatty liver disease and neuropathic involvement
Diabetes is also a cause of liver damage. According to the president of the SED, 60% of people with type 2 diabetes have non-alcoholic fatty liver disease and around 30% have non-alcoholic steatohepatitisinflammation of the liver caused by excess fat, which can progress to liver fibrosis and cirrhosis.
There are other rarer and more difficult-to-detect neuropathic disorders related to the autonomic nervous system, which controls the muscles of internal organs such as the heart, stomach, and intestines, as well as the salivary and sweat glands. It can cause constipation due to insufficient bowel motility, anal incontinence, poor gastric emptying, urinary retention, anal incontinence or erectile dysfunction.
The appropriate approach is first prevention and then early detection to prevent the progression of these conditions. “Prevention is always the best treatment. When we have to try, we are not always efficient enough” assures Antonio Pérez. “The important thing is that people know about all these problems, glucose must be monitored and controlled so that these complications do not occur“, advises Carlos Miranda, who advocates comprehensive control that includes monitoring blood pressure, cholesterol, body weight and avoiding tobacco.
The essential recommendation for people with diabetes is: keep glycosylated hemoglobin below 7%, although keeping it below 6.5% is recommended for the youngest.. Antonio Pérez explains why: “Young people are at greater risk of diabetes causing injury, so we have to try to be stricter.
In addition to keeping glucose levels at these levels, the SED president points out that there are well-established screening procedures to prevent kidney and eye damage: “Because a person is diagnosed with type 2 diabetes, blood and urine tests must be done once a year“.
Medications effective in controlling blood sugar and preventing kidney deterioration (sodium-glucose transporter type 2 inhibitors) can be used. To monitor the retina, the fundus of the eye should be checked: “For type 1 diabetes, annual screening must be carried out from the age of five, and for type 2 from the moment of diagnosis.“. Diabetic foot units offer the necessary care to prevent any amputation.
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