Diabetes - Outlook

Although diabetes is a serious long-term condition, highly effective treatment is available.

Early diagnosisThe process of determining which condition a patient may have. together with careful management to keep bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. sugar levels tightly controlled can help to avoid long-term complications.[1]

If your diabetes is not treated, however, or your bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. is not well controlled, you may experience a number of health problems later on. These may include heart and kidney problems.

Your risk of developing complications is closely associated with how well your glucoseA simple sugar that is an important source of energy in the body. level is controlled.

Atherosclerosis ('furring-up' of the arteries) is often much more widespread in people with diabetes, and occurs at a younger age

A bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. test is available that checks glycated haemoglobinHbA1c, a measure of how well glucose levels have been controlled over the previous three months or so in a person with diabetes. It is expressed as a percentage., a measure of how well bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. has been controlled over the previous few months. Glycated haemoglobin is abbreviated to HbA1cAn abbreviation for glycated haemoglobin, a measure of how well glucose levels have been controlled over the previous three months or so in a person with diabetes. It is expressed as a percentage. and the lower it is, the better your glucoseA simple sugar that is an important source of energy in the body. has been controlled.

Learn more about HbA1cAn abbreviation for glycated haemoglobin, a measure of how well glucose levels have been controlled over the previous three months or so in a person with diabetes. It is expressed as a percentage. and other tests for diabetes.

For every one per cent drop in HbA1cAn abbreviation for glycated haemoglobin, a measure of how well glucose levels have been controlled over the previous three months or so in a person with diabetes. It is expressed as a percentage. in someone with type 2 diabetes, the likelihood of that person developing any complicationA condition that is linked to, or is a consequence of, another disease or procedure. of diabetes falls by about a fifth. This includes a reduced chance of: [1]

  • Heart attack, also called myocardial infarctionDeath of an area of heart muscle due to poor blood supply.
  • Disease of the small bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. vessels, something that can lead to eye disease, kidney problems and other conditions.

In fact, any improvement in a raised HbA1cAn abbreviation for glycated haemoglobin, a measure of how well glucose levels have been controlled over the previous three months or so in a person with diabetes. It is expressed as a percentage. reduces the likelihood of that person developing the complications of diabetes.[1] Good blood pressure control is also important in reducing this risk.[2]

The long-term complications of diabetes may be divided into large vessel or macrovascularRelating to large blood vessels. disease and small vessel or microvascularRelating to small blood vessels. disease.[2,3]

It is important to remember that these complications can be prevented.[2,3]

Macrovascular complications

Complications caused by large bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. vessel (macrovascularRelating to large blood vessels.) disease include cardiovascular disease, such as heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction., stroke and peripheral arterial disease.[2]

Problems caused by macrovascularRelating to large blood vessels. disease are: [3]

  • Heart attack, also called myocardial infarctionDeath of an area of heart muscle due to poor blood supply.
  • Stroke or mini-stroke, also called a transient ischaemic attack
  • Pain caused by a poor bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. supply to the muscles in the legs, known as intermittent claudicationA cramp-like muscular pain that is caused by an inadequate blood supply, and so is brought on by exercise and relieved by rest..

In addition, atherosclerosis ('furring-up' of the arteries) is often much more widespread in people with diabetes, and occurs at a younger age.[3]

Additional risk factors for macrovascularRelating to large blood vessels. disease include: [2]

  • Smoking
  • High blood pressure The pressure of blood within the arteries.(hypertensionHigh blood pressure.)
  • Abnormal levels of cholesterolA substance present in many tissues and an important constituent of cell membranes although high concentrations of a certain type of cholesterol in the blood are unhealthy. and other lipids in the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid.
  • The presence of a protein called albuminA type of chemical called a protein, formed in the liver. in the urine.

Microvascular complications

Complications caused by small bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. vessel (microvascularRelating to small blood vessels.) disease include problems of the retina The innermost layer of the eye, which is sensitive to light. (retinopathy), kidneys (nephropathy) and nerves Bundles of fibres that carry information in the form of electrical impulses.(neuropathy).[2]

Problems caused by microvascularRelating to small blood vessels. disease: [3]

  • Damage to vision
  • Kidney failure
  • Reduced sensation and weakness
  • A fall in blood pressure on standing up (known as postural hypotension), bladderThe organ that stores urine. problems and gastrointestinal problems such as a change in bowel habits
  • Foot disease - ulceration and joint pain and abnormalities
  • Delayed stomach emptying, leading to digestive problems.

The risk of microvascularRelating to small blood vessels. disease is increased by factors such as: [2]

  • The length of time that you have had diabetes
  • Poor control of bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body.
  • High blood pressure The pressure of blood within the arteries.(hypertensionHigh blood pressure.).

More detail on complications of diabetes

References: 
  1. Association of glycaemia with macrovascularRelating to large blood vessels. and microvascularRelating to small blood vessels. complications of type 2 diabetes (UKPDS 35): prospective observational study. Stratton IM, Adler AI, Neil HAW et al. BMJ. 2000;321:405-12.
  2. Prevention and early detection of vascular complications of diabetes. Marshall SM and Flyvbjerg A. BMJ. 2006; 333: 475-80.
  3. Boon NA, Colledge NR and Walker BR. Davidson's Principles and Practice of Medicine Churchill Livingstone Elsevier. 2006; 20th edition.