The definitive guide to treating common ailments

No 24: Complications of diabetes

About 2% of people in the UK are known to be diabetic and numbers are growing. Among the possible complications are renal disease, which can cause kidney failure; retinopathy, which can cause blindness; and foot ulcers, which may lead to amputation. Yet these problems can often be prevented with regular health checks and treatment where necessary.

Renal disease

Increased glucose in the blood, a symptom of diabetes, is associated with progressive damage to the kidneys, although symptoms may not show up until the kidneys are on the point of failure. A US study of people with non-insulin dependent (NID) or "type two" diabetes, the most common form, found more than 1% developed renal failure over 10 years. But the problem can be detected in its early stages by urine tests for raised levels of protein.

Researchers, after assessing numerous studies, recommend people with NID should have urine tests at least annually. Surveys suggest less than two-thirds do. Blood pressure and blood glucose levels - added risk factors for renal disease - also need monitoring. Where protein levels are abnormal, ACE inhibitors - normally taken to control blood pressure - can reduce renal disease, according to studies. Intensive treatment programmes, which combine ACE inhibitors, control of blood pressure, blood glucose and lipids (fats), diet advice, exercise and quitting smoking, can significantly reduce renal disease in people with low, but above normal, protein in urine, another major study shows.

Retinopathy

Diabetic retinopathy is the most common cause of acquired blindness in working-age people in industrialised countries. The problem occurs when blood vessels in the retina become blocked, causing new vessels to form. It often goes undetected in early stages. One study has estimated that annual eye tests and treatment with lasers could prevent 260 cases a year.

Foot ulcers

About 15% of people with diabetes develop foot ulcers due to nerve damage or reduced blood supply. These can lead to serious infections and - for up to 15% of sufferers (2% of all diabetics) - amputation. Regular inspections and careful foot care can substantially reduce amputations, a large trial has shown.