Diabetes - chronic complications
Longer-term complications of diabetes are often described as: microvascular - those arising from damage to the smaller blood vessels such as retinopathy, renal disease and neuropathy; macrovascular - those arising from damage to the larger blood vessels such as myocardial infarction, stroke, and peripheral arterial disease (PAD).
This page signposts selected resources on complications of diabetes but is not intended to be an exhaustive list of potential areas of complications. You can also find out 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?
See also Complication risks and Acute complications.
These resources were last accessed on 1 November 2012. Some of them are in PDF format - see how to access PDF files. They are listed under the following headings.
Cardiovascular
Diabetes UK: Cardiovascular disease
“People with diabetes have an up to fivefold increased risk of CVD compared with those without diabetes”. This section of the Diabetes UK website describes what the risks are and how they can be reduced. A leaflet on the topic can be obtained from Diabetes UK.
JBS 2 (2005) Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice (PDF 848.16KB)
These guidelines have been developed jointly by a number of societies to promote a consistent multidisciplinary approach to the management of people with established atherosclerotic cardiovascular disease (CVD) and those at high risk of developing symptomatic atherosclerotic disease which includes people with diabetes. The guideline is made available as a supplement of the journal 'Heart'.
NHS Diabetes: Areas of care: cardiovascular care
This page is aimed at commissioners and providers of diabetes care. It brings together guidance, policy, commissioning guides, links to care pathways and examples of how services can be improved for people with diabetes.
Eyes (diabetic retinopathy)
Diabetes UK: Your eyes and diabetes
Information from Diabetes UK on retinopathy, its causes and treatment.
Diabeticretinopathy.org.uk
This site has been developed by staff from Good Hope Hospital Eye Department, to help patients and the professionals who care for them. It provides information on many different aspects of retinopathy including prevention, support and rehabilitation.
National Library of Medicine MEDLINEplus service: Diabetes: eye complications
An interactive tutorial which is made available in different formats..
NHS Choices: Diabetic retinopathy
General information on diabetic retinopathy.
NHS Diabetes: Areas of care: Eye services
This page is aimed at commissioners and providers of diabetes care. It brings together guidance, policy, commissioning guides, links to care pathways and examples of how services can be improved for people with diabetes.
NHS Diabetic Eye Screening Programme
The aim of this programme is to reduce the risk of sight loss amongst people with diabetes by prompt identification and treatment of diabetic retinopathy. Resources include a film aimed at improving attendance rates for screening: Don't let the light go out in your sight.
Patient.co.uk: Diabetic retinopathy
Patient information ondiabetic retinopathy.
RNIB/Royal College of Ophthalmologists: Diabetes related eye conditions
General information on diabetic retinopathy from the Royal Institute for the Blind.
Scottish Diabetic Retinopathy Screening Collaborative
The Scottish Diabetic Retinopathy Screening (DRS) collaborative brings together individuals from all NHS Boards in Scotland to facilitate the delivery of the National Diabetic Retinopathy Screening Programme.
Feet
Cochrane Library Database of Systematic Reviews:
- Foam dressings for healing diabetic foot ulcers
The review aimed to evaluate the effects of foam wound dressings on the healing of foot ulcers in people with diabetes. - Granulocyte-colony stimulating factors (G-CSF) as adjunctive therapy for diabetic foot infections
The aim of this review is to examine the effects of adjunctive G-CSF compared with placebo or no growth factor, added to usual care on rates of infection, cure and wound healing in people with diabetes who have a foot infection. - Debridement of diabetic foot ulcers
The aim of this review is to assess the evidence for the effectiveness of debridement which is widely regarded as an effective intervention to speed up ulcer healing, and to assess which is the most effective method. - Patient education for preventing diabetic foot ulceration
This review aimed to assess the effectiveness of patient education on the prevention of foot ulcers one of the key health problems for people with diabetes mellitus. - Pressure relieving interventions for preventing and treating diabetic foot ulcers
This review assesses the effectiveness of pressure relieving interventions in the prevention and treatment of diabetic foot ulcers. - Silver based wound dressings and topical agents for treating diabetic foot ulcers
This review evaluates the effects of silver-containing dressings and topical agents on infection rates and healing of diabetes related foot ulcers.
The above is not necessarily a comprehensive listing of relevant reviews. For further information about Cochrane reviews see How to use the Cochrane Library.
Diabetes UK: Putting feet first
Diabetes UK in partnership with NHS Diabetes have published guidance on commissioning a care pathway for footcare services and commissioning specialist services for the management and prevention of diabetic foot disease in hospitals, along with associated documents. In March 2012 they also launched the Putting Feet First campaign.
Diabetes UK: Fast track for a foot attack: reducing amputations
The majority of diabetes-related amputations are caused by a 'foot attack' (a foot ulcer or infection failing to heal). People who have rapid access to treatment by a specialist multi-disciplinary team have experienced faster healing and fewer amputations, saving money and lives. This report recommends the promotion of the commissioning of an integrated footcare pathway through the Putting Feet First campaign. It also sets out recommendations for CCGs and health and wellbeing boards on how to achieve this.
Diabetic Foot
This resource is designed to assist health care professionals who look after the foot problems of diabetic patients. It includes information on footcare, footwear, hosiery, casting, sensory testing, monofilaments and circulation tests. The website has foot care advice leaflets in 31 languages.
Foot in Diabetes UK
FDUK is an international, independent, multi-professional, group of people who are involved in the care, management and research of people with diabetic foot disease. The group is closely associated with Diabetes UK and has links with other diabetes organisations throughout the world.
NHS diabetes: Areas of care: Footcare
This page is aimed at commissioners and providers of diabetes care. It brings together guidance, policy, commissioning guides, links to care pathways and examples of how services can be improved for people with diabetes.
NICE (2011) Diabetic foot - inpatient management of people with diabetic foot ulcers and infection
This short clinical guideline (CG119) offers evidence-based advice on the inpatient care of people with diabetic foot problems from hospital admission onwards. See also NICE: Foot care services for people with diabetes
This area of the Nice website links to a commissioning guide for foot care services and related guidance.
NICE quality standard: Diabetes in adults
NICE quality standards are a concise set of statements designed to drive and measure priority quality improvements within a particular area of care.
Quality statement 10: ‘At risk’ foot
Quality statement 11: Foot problems requiring urgent medical attention.
Nursing Standard article:
Holt P (2013) Assessment and management of patients with diabetic foot ulcers. Nursing Standard 27(27) 6 March pp.49-55.
You can access the full text through the RCN e-Library at e-journals.
Kidneys
Cochrane Library Database of Systematic Reviews
- Angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists for preventing the progression of diabetic kidney disease
This review evaluates the benefits and harms ACEi and AIIRA in patients with DKD. - Protein restriction for diabetic renal disease
This review assesses the effects of dietary protein restriction on the progression of diabetic nephropathy in patients with diabetes. - Antihypertensive agents for preventing diabetic kidney disease
This review aimed to evaluate the comparative effects of antihypertensive agents in patients with diabetes and normoalbuminuria.
The above is not necessarily a comprehensive listing of relevant reviews. For further information about Cochrane reviews see How to use the Cochrane Library.
Diabetes UK: Kidneys (nephropathy)
This webpage in the Diabetes UK website describes how kidney disease might develop in people with diabetes and links to related information and websites.
Guidelines and Audit Implementation Network (GAIN) (2010) Northern Ireland guidelines for management of chronic kidney disease
These guidelines were developed by GAIN and the Northern Ireland Nephrology Forum. The changes reflect current NICE guidance and include advice on assessment of chronic kidney disease, appropriate referral of patients with declining kidney function for specialist help and the use of quantitative measures of proteinuria. The guidelines are listed by year of publication.
International Diabetes Federation: Fact sheet - Diabetes and kidney disease
This fact sheet discusses diabetes and kidney disease, its prevention and treatment.
National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK): Kidney disease of diabetes
This American website describes how kidney disease can develop in diabetes, how it is diagnosed and how it can be prevented or slowed down.
NHS Diabetes: Areas of care: Kidney care
NHS Diabetes is collaborating with many organisations to develop a comprehensive model of care for the emotional and psychological support for people with diabetes.
NHS Kidney Care (2011) Diabetes with kidney disease: key facts 2011
This booklet from NHS Diabetes provides key information about the impact of kidney disease in diabetes, in particular what puts people at risk of developing kidney disease and what can be done about it.
NICE Quality standard (2011) Chronic kidney disease
This quality standard includes a section on 'Chronic kidney disease: identification and testing in people with diabetes'. See also the NICE chronic kidney disease pathway which provides quick access to NICE guidance.
Patient.co.uk: Diabetic kidney disease
This web page provides information on diabetic kidney disease, risk factors and complications.
RCN Nephrology Nursing Forum
An RCN nursing community which provides links to news, events, featured articles and a community discussion area.
Scottish Intercollegiate Guidelines Network (SIGN) (2008) Diagnosis and management of chronic kidney disease
This guideline makes recommendations on best practice in the recognition and management of chronic kidney disease in adults aged 18 years and above.
Nerves
Clinical Resource Efficiency and Support Team (2008) Guidelines on the management of neuropathic pain
This guideline from Crest in Northern Ireland covers diagnosis, initial treatment options, treatment options available in specialist pain clinics. Crest , along with a number of related bodies became the Guidelines and Audit Implementation Network and the guideline is made available as part of the Gain website. Guidelines are listed by date of publication.
Cochrane Library Database of Systematic Reviews:
- Systematic administration of local anaesthetic agents to relieve neuropathic pain
The aim of this study was to evaluate pain relief and adverse effect rates between systemic local anaesthetic-type drugs and other control interventions. - Aldose reductase inhibitors for the treatment of diabetic polyneuropathy
The aim of this review was to assess the effects of aldose reductase inhibitors on the progression of symptoms, signs or functional disability in diabetic polyneuropathy which causes pain and sensory and motor deficits in the limbs. - Opioids for neuropathic pain
This review aimed to assess the efficacy and safety of opioid agonists for the treatment of neuropathic pain. - Vitamin B for treating peripheral neuropathy
This review sought to assess the effects of vitamin B for treating generalised peripheral neuropathy.
The above is not necessarily a comprehensive listing of relevant reviews. For further information about Cochrane reviews see How to use the Cochrane Library.
Diabetes UK: Nerves (neuropathy)
This section of the Diabetes UK website describes what nerve damage is and what effects it has on the body.
NHS Diabetes: Areas of care: neuropathy care
This page is aimed at commissioners and providers of diabetes care. It brings together guidance, policy, commissioning guides, links to care pathways and examples of how services can be improved for people with diabetes.
NICE (2010) Neuropathic pain: the pharmacological management of neuropathic pain in adults in non-specialist settings (CG96)
This clinical guideline updates and replaces recommendations made in previous Nice clinical guidelines for type 1 and type 2 diabetes.
Psychological problems and mental health
See also resources at Lifestyle: Emotional health and wellbeing.
NICE quality standard: Diabetes in adults: Quality statement 9: Psychological problems
NICE quality standards are a concise set of statements designed to drive and measure priority quality improvements within a particular area of care.
Nursing Standard articles:
Weaver K (2012) Eating disorders in people with type 1 diabetes. Nursing Standard 26(43) 27 June pp.43-47.
Wilson V (2012) Cognitive impairment in patients with diabetes. Nursing Standard 27(15-17) 12 December pp.44-49.
You can access the full text through the RCN e-Library at e-journals.
Sexual dysfunction
Diabetes UK: Sex and diabetes
These pages are designed to provide a wide range of information on diabetes and sexual health, focusing on erectile dysfunction (ED) and female sexual dysfunction (FSD). There is also a sub section on surveys and studies relating to diabetes and sexual problems, information for health care professionals, advice on getting support, and stories from people in similar situations revealing their own experiences.
NHS Diabetes factsheets (2011) Erectile dysfunction ‘ED is a marker of ill health'
This factsheet discusses erectile dysfunction (ED), its diagnosis, management, investigations, modifiable risk factors and consequences of untreated ED. A bibliography and supporting information is also available. The factsheet is available under the neuropathy heading.
Nursing Standard article:
Stenhouse E (2012) Effects of diabetes on women's reproductive health. Nursing Standard 26(38) 23 May pp.35-40.
You can access the full text through the RCN e-Library at e-journals.
RCN CPD online learning: Sexual health for non-experts
This is one of the learning areas developed by the RCN Learning Zone will help users to increase their knowledge about sexual health issues, and to develop the skills and attitudes needed to help patients and clients.
Sexual Advice Association
The Sexual Advice Association, (formerly the Sexual Dysfunction Association), is a charitable organisation which helps sufferers of male and female sexual problems. Originally the charity focused on helping individuals with erectile dysfunction (impotence) but now it covers all forms of male and female sexual problems.
Skin
Diabetes UK: Skin necrobiosis
This page describes the skin disorder, Necrobiosis lipoidica diabeticorum which is a very uncommon condition but can occur however well the diabetes is controlled. The cause is unknown.