Preventing Chronic Complications of Diabetes: Strategies for Managing Blood Sugar and Risk Factors

2023-10-20 07:16:55

Sugary drinks, cola, potato chips, and other instant foods enjoyed by obese patients (AP World Health Organization data photo). ⓒNewsis

[뉴스토피아 남희영 기자]Chronic complications of diabetes are the leading cause of diabetes-related illness or death. Chronic complications of diabetes are largely divided into vascular complications and non-vascular complications, and vascular complications are further divided into microvascular complications and macrovascular complications.

According to the Korea Disease Control and Prevention Agency’s National Health Information Portal, patients with type 2 diabetes have high blood sugar levels before being diagnosed with diabetes but have no symptoms for a long time, so it is common for them to already have complications at the time of diagnosis. However, chronic complications of diabetes can be prevented or slowed by managing blood sugar and other risk factors.

Microvascular complications of diabetes include diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. To reduce microvascular complications of diabetes, it is important to control blood sugar well.

When looking at diabetic retinopathy, the retina is the innermost nerve tissue of the eye, and the longer the duration of diabetes and poor blood sugar control, the higher the risk of complications. Patients with type 1 diabetes must undergo a comprehensive ophthalmological examination, including a fundus examination, within 5 years of diagnosis, and patients with type 2 diabetes must undergo a comprehensive ophthalmological examination, including a fundus examination, immediately upon diagnosis.

Afterwards, you will need to undergo an eye examination every year, but if you do not have retinopathy and your blood sugar is well controlled, you can have the examination every 1 to 2 years. If a diabetic is planning to become pregnant, they must undergo an eye examination in advance, and if they are pregnant, they must undergo an eye examination every three months. If you have diabetic retinopathy, consult with an ophthalmologist to decide on a treatment plan.

Diabetes is the most common cause of chronic kidney disease. At the time of diagnosis, diabetic patients are evaluated for albuminuria (amount of albumin excreted in urine) and estimated glomerular filtration rate (an indicator reflecting kidney function) through urine and blood tests. Afterwards, the same tests must be performed at least once a year. To prevent the occurrence and progression of diabetic kidney disease, it is important to control blood sugar and blood pressure within the target range. Diabetic patients who are taking medication for diabetic retinopathy or high blood pressure should consult with a specialist about selecting the appropriate medication to prevent diabetic kidney disease.

It is the most common complication of diabetes and affects the sensory, motor, and autonomic nerves. Diabetic neuropathy has very diverse symptoms and clinical manifestations are similar to other neuropathies, so it is diagnosed after ruling out all possible causes. To check for diabetic neuropathy, patients with type 1 diabetes are screened for peripheral neuropathy and autonomic neuropathy 5 years after diagnosis, and patients with type 2 diabetes are screened for peripheral neuropathy and autonomic neuropathy immediately after diagnosis, and the test is repeated every year thereafter.

To prevent the development and progression of diabetic neuropathy, it is important to thoroughly control blood sugar. If you have pain due to diabetic neuropathy, you can receive drug treatment to control your symptoms and improve your quality of life.

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Typical macrovascular complications of diabetes include coronary artery disease, stroke, and peripheral artery disease. Macrovascular complications, commonly referred to as cardiovascular disease, are the main cause of death in diabetic patients. In general, the risk of developing cardiovascular disease in diabetic patients is assessed by considering the duration of diabetes, the presence or absence of underlying cardiovascular disease or other diabetes complications, and accompanying cardiovascular disease risk factors. Diabetic patients must properly evaluate and manage not only blood sugar but also other cardiovascular disease risk factors, such as high blood pressure and dyslipidemia, to prevent the occurrence of macrovascular complications and slow their progression.

Diabetic patients with atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease preferentially use diabetes drugs that have proven benefits for these diseases. In cases of high blood pressure or dyslipidemia, drug treatment is administered considering the patient’s disease condition and characteristics. Diabetic patients who already have cardiovascular disease use antiplatelet drugs for secondary prevention. Diabetic patients without cardiovascular disease may consider using antiplatelet drugs for primary prevention if they have a high risk of developing cardiovascular disease and the drug does not increase the risk of bleeding.

In addition to drug treatment, diabetic patients must continue self-management such as nutritional therapy (diet therapy), exercise therapy, smoking cessation, and low blood sugar management to prevent macrovascular complications. The most basic and important diabetes management methods are diet and exercise. Since more than half of type 2 diabetics are overweight, exercise therapy along with diet is essential for weight loss. If blood sugar levels cannot be controlled even with strict implementation, drug therapy is additionally administered.

When blood sugar levels are normally controlled through lifestyle changes, people often think they have cured diabetes and neglect management or consume excessive calories, causing their weight and blood sugar levels to rise again. Don’t forget that diabetes must be managed throughout your life and you must maintain a regular lifestyle. I hope you live happily with the thought that diabetes is your friend.

In addition, if a diabetic patient smokes, it blocks oxygen to the entire body, which can lead to heart attacks, miscarriages, and stillbirths. Cholesterol levels rise, nerve and kidney complications occur, and peripheral nerves are damaged, causing ulcers and inflammation in the feet. You must quit smoking because it increases blood sugar and blood pressure.

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