Diabetic complications account for much of the social and financial burden of diabetes. Diabetes is ranked among the leading causes of blindness, renal failure and lower limb amputation in many countries, while some 50% of people with diabetes die of cardiovascular disease.
Over the last 30 years, type 2 diabetes has changed from being seen as a relatively mild ailment associated with ageing and the elderly (‘just a touch of sugar’) to one of the major contemporary causes of premature mortality and morbidity in most countries. In virtually every developed society, diabetes is ranked among the leading causes of blindness, renal failure and lower limb amputation. Through its effects on cardiovascular disease (50% of people with diabetes die of cardiovascular disease), it is also now one of the leading causes of death.
The changing perceptions of diabetes relate partly to a better appreciation of its devastating complications, but mainly to the rapid rise in its prevalence that has occurred in the last few decades. The main relevance of diabetic complications in a public health perspective is the relationship to human suffering and disability, and the huge socio-economic costs through premature morbidity and mortality 1 .
Chronic elevation of blood glucose, even when no symptoms are present to alert the individual to the presence of diabetes, will eventually lead to tissue damage, with consequent, and often serious, disease. Whilst evidence of tissue damage can be found in many organ systems, it is the kidneys, eyes, peripheral nerves and vascular tree, which manifest the most significant, and sometimes fatal, diabetic complications. Indeed, diabetic complications are those aspects of the disease that are most feared (such as blindness and amputation), and account for much of the social and financial burden of diabetes.
The mechanism by which diabetes leads to these complications is complex, and not yet fully understood, but involves the direct toxic effects of high glucose levels, along with the impact of elevated blood pressure, abnormal lipid levels and both functional and structural abnormalities of small blood vessels.
In an attempt to better describe and understand the burden of diabetic complications, this section presents data on the rates of coronary heart disease (CHD), stroke, diabetic retinopathy, diabetic nephropathy, diabetic peripheral neuropathy and lower extremity amputations. The results of each study are presented against the country in which it was conducted, although given the design and small size of some of the studies, the results should not necessarily be seen as being representative of that country.
1.American Diabetes Association Economic consequences of diabetes mellitus in the U.S. in 1997. Diabetes Care.1998; 21: 296-309