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The World Health Organization (WHO) defines diabetes as a serious and chronic disease that occurs either when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces. Diabetes is considered to be a major public health problem as its prevalence steadily increases over the past few decades. This disease can result to several complications affecting different parts of the body, which can consequently result to an increased risk for premature death. Among the possible complications of diabetes are vision loss and kidney failure. (World Health Organization, 2016)
Ophthalmic complications are often observed among diabetic patients. The most common is diabetic retinopathy, which is also the most potentially blinding among the several ophthalmic complications. (Bhavsar, 2016) Diabetic retinopathy occurs when there has been long-term accumulated damage to the small blood vessels of the retina. It has caused 1.9% of moderate or severe visual impairment globally and 2.6% of blindness in 2010. (WHO, 2016)
Another common complication of diabetes is nephropathy. According to WHO, diabetes is one of the leading causes of kidney failure. (WHO, 2016) Diabetic nephropathy affects around 40% of Type 1 and Type 2 diabetic patients. Risk of death is increased with diabetic nephropathy, mainly due to cardiovascular causes. The main risk factors for diabetic nephropathy include hyperglycemia, increased blood pressure levels, and genetic predisposition. (Gross, 2005) Diabetic nephropathy occurs when urinary albumin excretion (UAE) exceeds 300 mg in a 24-hour urine collection. The patient will experience progressive increase in proteinuria and decline in glomerular filtration rate (GFR). Patients with diabetic nephropathy may also experience hypertension, thereby having an increased risk for cardiovascular morbidity and mortality. (Bull, 2010)
According to the WHO, treatment of diabetes involves diet and physical activity alongside lowering blood glucose and levels of other known risk factors that cause damage to the blood vessels. (WHO, 2016) According to the Diabetes Control and Complications Trial, intensive glucose control was found to decrease the incidence and progression of diabetic retinopathy. Similarly, the United Kingdom Prospective Diabetes Study noted that improved glycemic control and improved blood pressure control reduced the risk of retinopathy. A strict glucose control delays the onset and slows down the progression of diabetic retinopathy. Patient education is also critical in the management of diabetic retinopathy. Patients should be informed that they play a major role in their own eye care. (Bhavsar, 2016) A tight glycemic control is also an important aspect in the prevention and management of diabetes nephropathy. Control of blood pressure is another important aspect of treatment as it is critical in slowing the natural history of diabetic nephropathy. Further, controlling blood pressure also prevents cardiovascular morbidity and mortality. (Gross, 2005) Diabetes, diabetes retinopathy, and diabetes nephropathy are progressive conditions. Hence, a strict monitoring through regular follow-up care with a physician is important in the early detection of any changes that may benefit from early treatment. (Bhavsar, 2016)
Based on the literatures cited in the previous paragraphs, it is clear that strict glucose and blood pressure control is greatly beneficial in the prevention and treatment of diabetes, in general, and diabetes retinopathy and diabetes nephropathy, in particular. In addition, patient education also plays an important role in managing diabetes patients. Health service providers should be keen in providing key reminders and encouragement to their diabetes patients. Patients should be informed that the key to preventing and treating their illness and its complications is within their control. They need to be observant in their diet and lifestyle so as to control blood glucose and blood pressure, thereby targeting diabetes, diabetes retinopathy, and diabetes nephropathy all at once.
Reference:
Bhavsar, A.R., Drouilhet, J.H., Atebara, N.H. (2016). Diabetic retinopathy. Medscape. Retrieved from http://emedicine.medscape.com/article/1225122-overview
Bull, S., Hall, P., & Nurko, S. (2010). Diabetic nephropathy. Cleveland Clinic Foundation. Retrieved from http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/nephrology/diabetic-nephropathy/
Gross J.L., de Azevedo, M.J., Silverio, S.P., Canani, L.H., Caramori, M.L., & Zelmanovitz, T. (2005). Diabetic nephropathy: Diagnosis, prevention, and treatment. Diabetes Care, 28, 164-176
World Health Organization. (2016). WHO diabetes fact sheet. World Health Organization. Retrieved from http://www.who.int/mediacentre/factsheets/fs312/en/
World Health Organization. (2016). WHO global report on diabetes. Switzerland: WHO Press.
