Chronic Diabetes Complications: The Need to Move beyond Classical Concepts

• Published in: Trends in endocrinology and metabolism 2020-04, Vol.31 (4), p.287-295
• Main Authors: Mauricio, Dídac, Alonso, Núria, Gratacòs, Mònica
• Format: Article
• Language: English
• Subjects: angiopathy; diabetes mellitus; long-term complications; multisystemic disease; neuropathy
• ISSN: 1043-2760; 1879-3061
• DOI: 10.1016/j.tem.2020.01.007

Chronic-diabetes-related complications simultaneously compromise both the micro- and macrovascular trees, with target organs considered as the paradigm of large vessel injury also entailing microangiopathic changes. However, complications independent or partially independent from vascular damage are often overlooked. This includes neuronal dysfunction (e.g., retinal neurodegeneration), interstitial injury (e.g., tubulointerstitial disease), metabolic damage (e.g., in the heart and liver), and nonclassical conditions such as cognitive decline, impaired pulmonary function, or increased risk of cancer. In this scenario, researchers, endocrinologists and primary care physicians should have a holistic view of the disease and pay further attention to all organs and all potential clinical repercussions, which would certainly contribute to a more rational and integrated patient health care. Diabetes complications include pathological changes beyond the vascular system and classical target organs.Microangiopathy may affect nonclassical target organs.Organs affected by microangiopathy may also show neuronal or structural deficits including: neurodegeneration and neurodysfunction of the retina; structural changes in the kidney tubular interstitium; and nerve fiber dysfunction.Organs affected by macroangiopathy also show microvascular and neuronal deficits including: microangiopathy of the arterial wall; microangiopathy and neuropathic changes adding to ischemic and nonischemic heart disease; metabolic peripheral nerve damage; cerebral small vessel disease; and structural changes leading to cognitive impairment.Nonclassical chronic complications include abnormal pulmonary function and microangiopathy, metabolic liver and myocardial damage, and increased risk of carcinogenesis.