Diabetes Mellitus Type 1: Complications

Diabetes mellitus type 1 leads to microangiopathies and macroangiopathies (vascular diseases of small and large vessels), among others:Diabetic microangiopathy – increased permeability of the vessel walls of small blood vessels, leads to

Diabetic macroangiopathy – increased permeability of the vessel walls of large blood vessels, leads to diseases of the cardiovascular system (see below).

The following are the most important diseases or complications that may be contributed to by type 1 diabetes mellitus:

Respiratory system (J00-J99)

  • Diabetic pneumopathy (lung disease) with a restrictive ventilatory disorder (applies to FEV1 and FVC levels as well as diffusing capacity)Note: The best predictor of pulmonary involvement is the presence of diabetic nephropathy.

Eyes and eye appendages (H00-H59).

Endocrine, nutritional, and metabolic diseases (E00-E90).

  • Diabetic ketoacidosis – form of coma diabeticum in which there are blood glucose levels > 250 mg/dl with ketonuria (appearance of ketone bodies in urine)/ketolemia (increased concentration of ketone bodies in blood), metabolic acidosis (metabolic acidosis) with pH < 7.3; occurs primarily in type 1 diabetes mellitus; cause of increased mortality (morbidity) in children and adolescents
  • Development of other autoimmune diseases such as thyroid disease (Hashimoto’s thyroiditis and Graves’ disease).
  • Hypoglycemias (hypoglycemia)

Skin and subcutaneous (L00-L99)

  • Chronic wounds (due todisturbance of wound healing).
  • Diabetic dermopathy – pigmented papules on the lower legs (-50% of diabetics).
  • Diabetic foot (synonym: diabetic foot syndrome).
  • Erysipelas (erysipelas) – infection with group A hemolytic streptococci; the most common complication is chronic lymphedema.
  • Skin ulcers (skin ulcers) – e.g. ulcus cruris (lower leg ulcer).
  • Lipoatrophy – dystrophy of adipose tissue; occurrence due to the lipolytic components of insulin preparations usually several months after the start of insulin therapy.
  • Lipohypertrophy – increase in adipose and connective tissue due to the local anabolic effect of insulin when injected more frequently into the same region (usually occurs in young diabetics).
  • Mycoses (fungal diseases: Candida infections; tinea).
  • Necrobiosis lipoidica – inflammation of the middle dermis with accumulation of lipids, leading to necrosis (tissue death) (1% of diabetics; about 60% of patients with such a skin disease have diabetes mellitus).
  • Pruritus (itching) (-40% of diabetics).

Cardiovascular system (I00-I99)

  • Apoplexy (stroke) – diabetes mellitus is considered an independent risk factor for apoplexy.
  • Atherosclerosis (arteriosclerosis, hardening of the arteries).
  • Heart failure (cardiac insufficiency): in women is a 47% greater increase in risk than in men.
  • Coronary heart disease (CHD) – undersupply of the heart with blood due to atherosclerosis (hardening of the arteries).
  • Peripheral arterial occlusive disease (pAVK) – progressive narrowing or occlusion of the arteries supplying the arms / (more often) legs, mostly due to atherosclerosis (arteriosclerosis, arteriosclerosis).

Infectious and parasitic diseases (A00-B99).

  • Increased susceptibility to viral and bacterial infections, such as pneumonia (lung infections) or cystitis (urinary tract infections)
  • Onychomycosis (nail fungus)
  • Tuberculosis (especially pulmonary tuberculosis / tuberculosis of the lungs) (although not infected more often, about 3 times increased risk of manifest disease).

Mouth, esophagus (food pipe), stomach, and intestines (K00-K67; K90-K93).

  • Chronic inflammatory bowel disease (IBD) – CED prevalence (disease incidence) of children and adolescents with type 1 diabetes is 0.1 percent, a good three times higher than in the population of the same age; have more frequent severe hypoglycemia (low blood sugar) than patients without IBD.
  • Diarrhea (diarrhea)
  • Gastroparesis (paralysis of the stomach)
  • Periodontal disease (periodontitis)

Musculoskeletal system and connective tissue (M00-M99).

  • Osteoporosis (bone loss)

Neoplasms – tumor diseases (C00-D48)

  • Cervical carcinoma (cervical cancer).
  • Endometrial carcinoma (cancer of the uterus)
  • Gastric carcinoma (stomach cancer)

Ears – mastoid process (H60-H95)

  • Sensorineural hearing loss

Psyche – nervous system (F00-F99; G00-G99)

  • Anxiety and affective disorders – children > 11 years of age relatively newly diagnosed.
  • Dementia
  • Depression
  • Diabetic neuropathy – nerve damage with sensory disturbances.
  • Circulatory disorders of the brain (due tocerebral atherosclerosis / arteriosclerosis).
  • Epilepsy (children and adolescents: 3.17-fold increased risk).
  • Erectile dysfunction (ED; erectile dysfunction) (prevalence in:
  • Eating disorders-children > 11 years of age who were relatively newly diagnosed
  • Cognitive deficits in verbal memory and pattern recognition due to hypoglycemia (low blood glucose): diabetics would have less hypoglycemic awareness as a result, which in turn promotes severe hypoglycemia
  • Male libido disorders (40%).
  • Female sexual dysfunction – sexual dysfunction (42%).

Pregnancy, childbirth, and puerperium (O00-O99).

  • Premature birth (22.3%)
  • Macrosomia (birth weight above the 95th percentile (4350 g)).

Symptoms and abnormal clinical and laboratory parameters not elsewhere classified (R00-R99).

  • Dyspnea (shortness of breath)-this may include pulmonary disease. Notice: Only one in ten patients with dyspnea has cardiac disease (heart disease).
  • Urinary incontinence in women
    • Continence problems (31%)
    • Poor glycemic control over ten years increased risk (odds ratio, OR 1.03 per mmol/mol HbA1c increase and OR 1.41 per HbA1c increase by one percentage point, respectively
  • Hypoglycemia (hypoglycemia; at night); esp. in children who exercised during the day.
  • Cachexia (emaciation; very severe emaciation).
  • Subclinical inflammation (English “silent inflammation”) – permanent systemic inflammation (inflammation affecting the entire organism), which runs without clinical symptoms.
  • Suicidality (suicide risk) (insb. young type 1 diabetics).

Genitourinary system (kidneys, urinary tract – sex organs) (N00-N99).

  • Diabetic nephropathy (kidney disease).
  • Urinary tract infections (UTIs) ( 3- to 5-fold increased risk) (women: 17%).
  • LUTS (Lower Urinary Tract Symptoms; lower urinary tract symptoms) (females: 22%; males: 24%).
  • Renal failure – process leading to a slowly progressive reduction in kidney function (20-30%).

Further

  • Dead-in-bed syndrome – probably due tohypoglycemic-induced arrhythmias (hypoglycemia leading to cardiac arrhythmia; (bradycardia 6 times more common; these may prompt early afterdepolarization); affects young type 1 diabetics during overnight sleepNote: Early afterdepolarizations can trigger torsades de pointes (TdP), polymorphic ventricular tachycardia, and ventricular fibrillation (arrhythmia of the heart that is life-threatening) if QT is long.

Prognostic factors

Patients with disease onset in childhood have an increased risk of mortality (death rate) in the 20th-30th year of life compared with the rest of the population. Associated with the increased mortality rate were:

  • Low socioeconomic status
  • Poor blood glucose control
  • At least four severe hypoglycemic episodes (low blood glucose) during childhood disease

Risk of mortality compared with the normal population as a function of HbA1c level (Swedish National Diabetes Registry):

  • HbA1c value ≥ 9.7 percent: 8.51-fold increased risk of mortality.
  • HbA1c level of 8.8 to 9.6 percent: 3.65-fold increased risk of death
  • HbA1c value from 7.9 to 8.7 percent: 3.11-fold increased risk of mortality
  • HbA1c value from 7.0 to 7.8: 2.38-fold increased risk of death.
  • HbA1c value ≤ 6.9 percent: 2.36-fold increased risk of death.

Further notes

  • Celiac disease increased the risk of microvascular complications in type 1 diabetics. All children and adolescents with type 1 diabetes should be screened for celiac disease.Celiac disease is a chronic disease of the small intestinal mucosa (lining of the small intestine) due to hypersensitivity to the grain protein gluten.
  • Adolescents type 1 diabetics with highly fluctuating HbA1c values (“long-term blood glucose value”) have an increased risk of microangiopathies (diseases of the small vessels; albuminuria (increased excretion of albumin), retinopathy retinal disease), cardiac autonomic neuropathy/nerve damage to the heart).
  • Increase in mortality risk (risk of death) due to:
    • HbA1c level increase of 1 percentage point was associated with a 22% increase in mortality rate over time
    • Microalbuminuria doubles the risk of death, macroalbuminuria quadruples it
    • Kidney function