Article Sections

Introduction

The major complications associated with diabetes mellitus (DM) include the following:

Macrovascular complications

These affect larger blood vessels and include:

  • coronary artery disease
  • cerebrovascular disease
  • peripheral artery disease.

These complications are driven by accelerated atherosclerosis, plaque formation, and vascular occlusion, as well as effects of comorbid risk factors (eg, hypertension, dyslipidemia, obesity).

Microvascular complications

These involve damage to small blood vessels (ie, microangiopathic damage) and include:

  • diabetic eye retinopathy
  • diabetic nephropathy
  • diabetic neuropathy.

These complications are driven by chronic hyperglycemia-induced endothelial dysfunction.

This article focuses on diabetic kidney disease (DKD).  DKD is characterized by irreversible injury to the glomerular basement membrane and surrounding structures, leading to increased intraglomerular pressure, proteinuria, and overt kidney failure.

Pathophysiology of diabetes complications

In general, diabetic complications are a result of chronic hyperglycemia (and, in the case of type 2 DM [T2DM], insulin resistance) driving chronic metabolic inflammation, which is further compounded by other independent risk factors commonly found in patients with DM (eg, hypertension, hyperlipidemia, obesity).  This hyperglycemia-induced metabolic inflammation manifests with the following pathophysiologic effects:

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