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diabetes

Chronic Complications of Diabetes Major Cause of Morbidity, Mortality and Health Care Costs

Chronic Complications of Diabetes Major Cause of Morbidity, Mortality and Health Care Costs

Teaser: 

Neil Fam, BSc, MSc

Diabetes is a common chronic disease characterized by metabolic abnormalities that have both acute and long term complications. In Canada, at least 1.5 million individuals (5% of the population) are afflicted by the disease, and this number is predicted to increase to 2.2 million by the year 2000. Diabetes has considerable associated morbidity and mortality. It is a major cause of coronary artery disease and stroke and is a leading cause of blindness and kidney disease in adults. Furthermore, individuals with diabetes have a shortened life expectancy when compared to those without the disease. Long-term complications occur in both type 1 and type 2 diabetes and result from the chronic hyperglycemia and hypertension associated with the disease. This article summarizes the chronic complications of diabetes, including effects on the vascular system, kidneys, eyes and nervous system.

The diabetic patient may develop one or all of a myriad of complications, including vascular disease, hypertension, retinopathy, nephropathy, neuropathy and foot disease.

Vascular Complications and Hypertension
The vascular complications of diabetes can be divided into microvascular and macrovascular disease.

Diabetes: New Guidelines on Screening and Diagnosis

Diabetes: New Guidelines on Screening and Diagnosis

Teaser: 

D'Arcy Little, MD, CCFP
York Community Services, Toronto and
Department of Family Medicine, Sunnybrook Campus of Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario

Epidemiology
Diabetes mellitus, a metabolic disease characterized by hyperglycemia secondary to defective insulin secretion and/or action, is an extremely common, chronic illness with a high burden of potentially preventable complications. It is a leading cause of coronary artery disease, peripheral vascular disease, kidney failure, peripheral neuropathy and new-onset blindness. A full five percent of Canadians have been diagnosed with the disease, and this percentage is predicted to translate into 2.2 million cases by the year 2000. However, statistics from the United States suggest that for every person diagnosed with diabetes, another has the disease and remains undiagnosed. Appropriate screening for diabetes provides the means to identify those undiagnosed individuals who may benefit from earlier intervention.

The terms insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) diabetes were eliminated in favour of the terms "Type 1" and "Type 2" diabetes in an effort to emphasize pathogenesis over treatment in disease diagnosis.