ditions affecting the exocrine part of the pancreas such as pancreatitis, cystic fibrosis, etc.
DM is associated with increased atherosclerotic cardiovascular disease (ASCVD) and treating blood pressure, statin use, regular exercise, and smoking cessation are of great importance in ameliorating risk. The overall excess mortality in those with T2DM is around 15% higher but varies widely. The prevalence of vision-threatening diabetic retinopathy in the United States is about 4.4% among adults with diabetes, while it is 1% for end-stage renal disease. Today, with pharmacotherapy for hyperglycemia, as well as lowering LDL cholesterol and managing blood pressure with ACE/ARB therapy, with other antihypertensive medications and aspirin in secondary prevention, vascular complications can be managed adequately, resulting in a reduction in morbidity and mortality.
Persistent hyperglycemia in uncontrolled diabetes mellitus can cause several complications, both acute and chronic. Diabetes mellitus is one of the leading causes of cardiovascular disease (CVD), blindness, kidney failure, and amputation of lower limbs. Acute complications include hypoglycemia, diabetic ketoacidosis, hyperglycemic hyperosmolar state, and hyperglycaemic diabetic coma. Chronic microvascular complications are nephropathy, neuropathy, and retinopathy, whereas chronic macrovascular complications are coronary artery disease (CAD), peripheral artery disease (PAD), and cerebrovascular disease. It is estimated that every year 1.4 to 4.7% of middle-aged people with diabetes have a CVD event.
Deterrence and Patient Education
Patients must be educated about the importance of blood glucose management to avoid complications associated with DM. Stress must be given on lifestyle management, including diet control and physical exercise. Self-monitoring of blood glucose is an important means for patients to take responsibility for their diabetes management. Regular estimation of glucose, glycated hemoglobin, and lipid levels is necessary.
Healthcare professionals should educate patients about the symptoms of hypoglycemia (such as tachycardia, sweating, confusion) and required action (ingestion of 15 to 20 gm of carbohydrate).
Patients should be motivated to stop smoking. Emphasis is required on regular eye check-ups and foot care.
Pearls and Other Issues
- T1DM is characterized by the autoimmune destruction of pancreatic beta cells in the majority.
- T2DM is caused due to duel defects in insulin resistance and insulin secretion.
- Gestational diabetes is associated with maternal as well as fetal complications.
- Exercise and a healthy diet are beneficial in both type 1 and type 2 diabetes mellitus.
- Novel therapies, such as GLP-1 receptor agonists and SGLT2 inhibitors, are safer since they do not cause hypoglycemia, are weight neutral or result in weight loss and blood pressure and impact vascular complications favorably.
Enhancing Healthcare Team Outcomes
The diagnosis and management of type 2 diabetes mellitus are with an interprofessional team. These patients need an appropriate referral to the ophthalmologist, nephrologist, cardiologist, and vascular surgeon. Also, patients need to be educated about lifestyle changes that can help lower blood glucose. All obese patients should be encouraged to lose weight, exercise, and eat a healthy diet. The primary care provider and the diabetic nurse must encourage all people with diabetes to stop smoking and abstain from drinking alcohol. The complications of diabetes mellitus are limb and life-threatening and seriously diminish the quality of life.