Intended for healthcare professionals

Clinical Review

Prevention and early detection of vascular complications of diabetes

BMJ 2006; 333 doi: (Published 31 August 2006) Cite this as: BMJ 2006;333:475

Diabetes management

Glucotoxicity and lipotoxicity result in endothelial dysfunction
(microangiopathy) manifested as Retinopathy Nephropathy and Neuropathy.

Retinopathy is detected by fundoscopy.

Nephropathy is detected by checking for microalbuminuria if dipstick for
protein is negative. As it can be episodic, 2 out of 3 tests have to be

Neuropathy is detected by checking with monofilament and tuning fork.Feet
pulses if present, we can assume that there is no significant
macrovascular disease.

If glycaemic control is satisfactory, lipid profile is
satisfactory(TChol/HDL ratio <_4 then="then" no="no" statin="statin" is="is" necessary.="necessary." p="p"/>If there is microangiopathy then an Ace-inhibitor or Angiotensin receptor
blocker should be given +/-Aspirin.

Target BP for uncomplicated diabetes is 140/80. In presence of
nephropathy, it should be 130/70.

Exercise is very important as it helps to take insulin to all parts of the
body. Disabled patients can perform upper body exercise. Where adequate
glycaemic control cannot be achieved, then other factors like BP lipids
etc are treated.

Early diagnosis is essential and impaired glucose tolerance should also be
corrected by lifestyle changes.

Competing interests:
None declared

Competing interests: No competing interests

07 September 2006
Subrata K Mallik
Locum Consultant Physician
Prince Charles Hospital, Merthyr Tydfil CF47 9DT