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  1. Sally M Marshall, professor of diabetes (s.m.marshall@ncl.ac.uk)1,
  2. Allan Flyvbjerg, professor in experimental medical research2
  1. 1 Diabetes Research Group, Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH
  2. 2 University of Aarhus, Denmark, DK 8000
  1. Correspondence to: S M Marshall

    Introduction

    Diabetes reduces life expectancy by five to 10 years. Premature cardiovascular disease is the most common cause of morbidity and mortality, but the microvascular complications specific to diabetes (box 1) are also contributory factors. Diabetes is the most common reason for renal replacement therapy worldwide, the most common cause of blindness in the under 65s, and the most common cause of non-traumatic amputation. With our current knowledge, most of these devastating events could be prevented or delayed, or their impact minimised. This review focuses on the prevention, early detection, and initial management of the vascular complications of diabetes in adults.

    Why are the complications of diabetes important?

    Complications are common and the cost to the individual and society is enormous. The onset of complications reduces quality of life, particularly when both microvascular and macrovascular disease are present.w1 The CODE-2 study gathered data on 7000 people with type 2 diabetes from eight European studies—72% had at least one complication and 24% had both (microvascular and macrovascular) complications.w2 Over six months, 13% of the patients were admitted to hospital for a mean of 23 days. The estimated average yearly cost per patient was €2834 (£1934, $3585); 55% of this cost was attributable to hospital admissions and only 7% to the cost of insulin and oral drugs for lowering glucose.1

    Who develops complications?

    The risk of developing complications is variable (table 1). For nephropathy, in particular, a strong but unknown genetic influence exists. The duration of diabetes, glycaemic control, and hypertension are the strongest risk factors for microvascular disease; smoking, blood pressure, lipids, and albuminuria are the strongest risk factors for macrovascular disease.

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    Table 1

    Risk factors and markers for the development of complications of diabetes

    Macrovascular disease

    Excess mortality from cardiovascular disease is seen in all age groups, particularly in young people with type 1 diabetes (box 2), and is exacerbated by social …

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