Module 9: Chronic complications

This module provides an overview of common complications of diabetes. The exact pathogenesis of the complications is not yet known; however, the formation of advanced glycated end products (or AGEs) is one process that does contribute. Glucose has an affinity for protein and some glucose from the blood glycates or sticks to various proteins throughout the body. This is a normal process and is the reason we get wrinkles and saggy skin as we get older. The AGEs bind to protein receptors and have been shown to alter cellular walls, basement membranes and vessel walls throughout the body. The degree of binding is related to the duration of diabetes and the degree of hyperglycemia. AGEs have been found in retinal and renal vessels and peripheral nerves.

Objectives

You have completed this module when you are able to:

  1. State the reason for encouraging best possible blood glucose levels in people with diabetes;
  2. List the treatment goals for preventing complications;
  3. State the recommended type and frequency of screening for all complications;
  4. Describe why diabetes puts people at higher risk for cardiovascular disease;
  5. Describe the recommendation regarding ASA use in people with diabetes;
  6. Describe the changes that occur on the retina in mild, moderate, severe non-proliferative and proliferative retinopathy;
  7. Describe the changes in vision that accompany each stage of retinopathy;
  8. Outline the stages of nephropathy from onset to chronic kidney disease;
  9. Describe what treatment is recommended in the early stages of kidney disease;
  10. Explain how chronic kidney disease can impact people and their families;
  11. Describe how to assess a foot for sensation;
  12. Describe daily foot care for people with diabetes; and
  13. Describe the prevalence of erectile dysfunction.

To enhance your learning, you may also wish to refer to the "Macrovascular and microvascular complications" and "Erectile dysfunction" sections of the Canadian Pharmacists Journal's supplement on Diabetes. (CPJ 2009;142[SUPPL 1])