Diabetes - complication risks
This section signposts selected general resources about complications that can arise in diabetes and what can cause these complications.
A number of major research trials which have looked at how management of blood glucose levels impacts on complications which are frequently referred to in the literature on diabetes are also described in this page.
Further pages signpost resources on acute complications and longer-term chronic complications.
You can find out more about the kinds of complications that can arise from diabetes in the RCN learning area Diabetes essentials: Managing diabetes – see section on What happens if good blood glucose control is not maintained?
These resources were last accessed on 3 April 2013. Some of them are in PDF format - see how to access PDF files.
Department of Health (2001) National Service Framework for Diabetes: Detection and management of long-term conditions
The NSF sets standards for preventing long term complications, minimising their impact and for providing care for those with complications arising from their diabetes.
Diabetes UK: Just one in five people with diabetes has condition under control
An analysis by Diabetes UK based on data from the National Diabetes Audit shows that 19.9 per cent of people with diabetes in England meet the recommended targets for blood glucose, blood pressure and cholesterol. This figure includes all types of diabetes. In Wales the figure is 18.5 per cent. For type 1 diabetes specifically, only 11.4 per cent are meeting the target. Diabetes UK say in this news story of 2 April 2013: "This is one of the main reasons for the high rates of diabetes-related complications such as kidney failure and stroke, and goes a long way towards explaining why 24,000 people with diabetes die early every year in England and Wales".
Diabetes UK: Complications: how to protect yourself
This section within the Diabetes UK website describes both short term and long term complications, what might cause them, and how to reduce the risk of these complications occurring.
Diabetes UK: 15 healthcare essentials checklist
Checklist of important aspects of diabetes that should be checked at least once a year. These checks can help to prevent complications developing.
Diabetes UK: State of the Nation 2012: England
This highlights the increase in unnecessary complications between 2008 and 2010: Retinopathy increased by 118 per cent; stroke increased by 87 per cent; kidney failure increased by 56 per cent; cardiac failure increased by 43 per cent; angina increased by 33 per cent; amputations increased by 26 per cent.
NHS Choices: Map of Medicine Healthguides: Diabetes - complications
Map of Medicine Healthguides "show you the ideal, evidence-based patient journey for common and important conditions". This one for Diabetes complications organises information under: Diabetic foot disease; renal disease; visual impairment; cardiovascular disease prevention; other complications.
NICE Pathways: Diabetes overview: Identifying and managing long-term complications
The pathway brings together the relevant Nice guidance and related resources and aims to provide fast access to these. There is a section on identifying and managing long-term complications in the person with type 2 diabetes NICE quality standard: Diabetes in adults: Quality statement 8: Complications
NICE quality standard: Diabetes in adults: Quality statement 8: Complications
NICE quality standards are a concise set of statements designed to drive and measure priority quality improvements within a particular area of care.
Open University Open Learn learning space: Diabetes Care Chapter Five: Diabetes complications
This chapter, made available by the Open University from their course on Diabetes Care, describes various monitoring processes that people with diabetes and the healthcare practitioners caring for them are likely to be involved in order to identify possible risk factors for complications.
Studies on blood glucose control and diabetes complications
DCCT and EDIC: The Diabetes Control and Complications Trial and follow-up study
The Diabetes Control and Complications Trial (DCCT) was a landmark study conducted from 1983 to 1993, funded by the National Institute of Diabetes and Digestive and Kidney Diseases in America. The study compared intensive diabetes therapy with the then conventional therapy and “showed that keeping blood glucose levels as close to normal as possible slows the onset and progression of the eye, kidney, and nerve damage caused by diabetes”. This study involved volunteers with type 1 diabetes. The follow up study called Epidemiology of Diabetes Interventions and Complications (EDIC) seemed to show that intensive control of blood glucose also reduces cardiovascular risk.
UK Prospective Diabetes Study
This study of people with newly diagnosed type 2 diabetes ran from 1977 to 1997 and “showed conclusively that the complications of type 2 diabetes, previously often regarded as inevitable, could be reduced by improving blood glucose and/or blood pressure control”.
Results of further studies on intensive glycaemic control undertaken in the ACCORD and ADVANCE trials both published in 2008 came up with some contradictory results.
An editorial in the New England Journal of Medicine published 12 June 2008 compares the trials and concludes that “For now, rather than changing our current glycemic target, we may best serve our patients with type 2 diabetes by implementing programs to help more of them reach the currently recommended goals” – see Intensive glycaemic control in ACCORD and ADVANCE Trials.
Guidance around blood glucose levels and HbA1c (Glycated haemoglobin) targets from NICE are brought together in the NICE Pathway: Diabetes overview.
For further information see also lifestyle: blood glucose monitoring.