Chronic diabetic complications

Chronic diabetic complications 

Updated: 01/21/2021

© Jun Wang, MD, PhD

General features
  • Multisystem involvement
  • Hyperglycemia associated cellular dysfunction, including lymphocytes
Key pathogenesis
  • Advanced glycation end products
Bind to receptor (RAGE) on inflammatory cells, endothelium and vascular smooth muscle, promoting inflammatory process and smooth muscle proliferation
Cross-linking structural proteins, such as collagen in matrix, promoting trapping of other proteins like LDL
  • PKC: Activating plasminogen activator inhibitor-1 (PAI-1)
  • Oxidative stress and disturbances in polyol pathways: Intracellular increased fructose and reduced glutathione
  • Hexosamine pathways: Excess proteoglycans
Clinical features
  • Macrovascular diseases: Most common cause of mortality in long-standing diabetes
Myocardial infarction
Renal vascular insufficiency
Cerebrovascular accidents
  • Microvascular diseases:
Nephropathy
Retinopathy
Neuropathy
  • Compromised immune function
Susceptibility to skin infections, tuberculosis, pneumonia, and pyelonephritis, etc
  • Others: Cataract, glaucoma, etc



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