Medical Complications of Glucose Intolerance and Diabetes Mellitus

Hyperglycemia and diabetes mellitus are associated with acute and chronic complications associated with significant morbidity and mortality. Diabetic ketoacidosis (DKA), an acute complication of diabetes mellitus, is seen more often in patients with type I than in patients with type II diabetes mellitus and is a serious and potentially fatal complication. Ketoacidosis is defined by low serum pH (<7.35), low serum bicarbonate levels (<15), and an anion gap in the presence of ketonemia (Westphal 1996). The diabetic patient is also susceptible to a variety of chronic complications that affect the cardiovascular system, nervous system, eyes, kidneys, and wound-healing capabilities.

Most of these complications are a result of microvascular and macrovascu-lar disease that is more extensive and appears much earlier in the diabetic patient than in the general population (Newcomer 2001).

Macrovascular disease in the form of atherosclerosis increases the risk of cardiovascular and cerebrovascular events such as myocardial infarction and stroke, accounting for much of the disability and death among diabetic patients (Haupt and Newcomer 2001; Henderson 2001a). According to data amassed by Gerstein and his colleagues from large samples of patients without diabetes (Gerstein et al. 1999), even modest increases in fasting plasma glucose levels that do not meet the diagnostic criteria for diabetes mellitus put patients at increased risk for coronary artery disease, myocardial infarction, and other vascular problems. In peripheral sites, atherosclerosis can cause claudication and "diabetic foot," a condition in which patients develop nonhealing ulcers that are prone to infection on their lower extremities and feet as a result of vascular insufficiency and sensory deficits from impairments in the peripheral nervous system. Diabetic neuropathy is a complication that contributes significantly to morbidity in diabetic patients, because it not only contributes to diabetic foot but can affect any part of the nervous system, resulting in sensory deficits, paresthesias, motor abnormalities, or autonomic dysfunction (Henderson 2001a). A large percentage of diabetic patients also experience ophthalmic complications such as diabetic retinopathy and diseases of the anterior chamber that affect vision (e.g., cataracts), leading to blindness and significant disability in diabetic patients.

Finally, many diabetic patients suffer a great deal from microvascular-and macrovascular-induced nephropathy, which can cause hypertension, proteinuria, and a decrease in the glomerular filtration rate, leading to renal failure. Indeed, diabetic nephropathy accounts for approximately 25% of end-stage renal failure cases in the United States (Expert Committee on the Diagnosis and Classification of Diabetes Mellitus 2000) and is a leading cause of morbidity and mortality in diabetic patients.

In summary, it is clear that diabetes is a disease associated with considerable medical morbidity and mortality.

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