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Type-2 diabetes
Part 2
Many people think of type-2 diabetes as a minor complaint. Nothing could be further from the truth. Recent research has shown that people with type-2 diabetes are at greatly increased risk of coronary heart disease (CHD). For example, women aged 40-59 with type-2 diabetes are 8 times more likely to die of CHD than women without type-2 diabetes.
A wide range of complications occurs among patients with diabetes. These are caused by damage to small blood vessels (microvascular complications) leading in turn to blindness ( retinopathy ), kidney failure ( nephropathy ) and nerve damage ( neuropathy) ; and damage to the larger arteries (macrovascular complications) leading in turn to damage to the brain (stroke), the heart (coronary heart disease) or to the legs and feet (peripheral vascular disease). It can also lead to difficulties in pregnancy, infection, periodontal disease, and many other conditions. So a diagnosis of diabetes should be taken very seriously even though, as will become clear later, its cure and prevention are easily accomplished.
The UK Prospective Diabetes Study (UKPDS) - a multi-centre trial on people with newly diagnosed type-2 diabetes - found that nearly half of those recruited to the trial had one or more complication.[1] About a quarter already had Coronary Heart Disease (CHD). The US National Diabetes Data Group and the World Health Organization have established that much of type-2 diabetes is undiagnosed, that onset of type-2 diabetes occurs at least 7 years before its diagnosis, and that significant ill health and premature deaths occur in subjects with undiagnosed type-2 diabetes. The Table below lists the complications already evident in people newly diagnosed with type-2 diabetes. And note that, as these are new cases, they are likely to be the healthiest.
Table I: Prevalence of complications of diabetes amongst people with newly diagnosed type-2 diabetes, 1977/91, United Kingdom, % [2]
Retinopathy
Abnormal electro-cardiogram
Myocardial infarction
Angina
Stroke/transient ischaemic attack
Intermittent claudication
Absent foot pulses/ischaemic feet
Impaired reflexes/decreased sense of vibration |
21%
18%
2%
3%
1%
3%
14%
7% |
Type-2 diabetes is often not first diagnosed until complications occur.
References
1. United Kingdom Prospective Diabetes Study (UKPDS) IV. Characteristics of newly diagnosed type 2 diabetic patients and their association with different clinical and biochemical risk factors. Diabetes Research 1990; 13: 1-11.
2. UK Prospective Diabetes Study Group. UK Prospective Diabetes Study (UKPDS) VIII. Study design, progress and performance. Diabetologia 1991; 34: 877-890.
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