Microvascular damage of diabetes: what to know and how to act

Answer: Diabetes can also cause damage to small blood vessels, leading to complications known as microvascular complications, which mainly affect the eyes, kidneys and nerves. These complications are among the most feared because, if not recognised and treated in time, they can seriously impair quality of life.

Diabetic retinopathy is one of the most frequent eye complications. It is caused by damage to the small blood vessels in the retina, the part of the eye responsible for vision. Over time, hyperglycaemia damages these vessels, causing microhaemorrhages, swelling and, in severe cases, the growth of new abnormal vessels that can lead to retinal detachment and loss of vision. For this reason, it is essential to undergo regular ophthalmic check-ups, with specific examinations such as fundoscopy or fundus photography, to detect the first signs of retinopathy and intervene promptly.

Diabetic kidney disease, or nephropathy, is another important risk for people living with diabetes. Prolonged hyperglycaemia damages the kidney structures responsible for 'filtering' blood called glomeruli, which are responsible for blood purification. This results in excessive protein loss with urine and/or a progressive loss of kidney function, which can evolve to renal failure and even dialysis. In order to prevent or slow down this evolution, it is necessary to regularly monitor two basic parameters: the glomerular filtration rate (Vfg), which measures how well the kidneys filter the blood, and the presence of protein or albumin in the urine, which indicates early kidney damage. In patients with type 1 diabetes, kidney checks should start about five years after diagnosis and be repeated at least once a year. In type 2 diabetes, on the other hand, since the disease is asymptomatic and the complication may already be present at onset, screening should start immediately and continue annually. In addition to these tests, it is also important to assess other factors such as blood pressure, which if elevated can accelerate kidney damage, and cholesterol.

Diabetic neuropathy is a complication that affects nerves, both peripheral and autonomic. It affects up to one third of people with diabetes and can manifest itself with various symptoms: tingling in the lower extremities, pain, burning sensations, loss of sensation especially in the feet, night cramps and balance problems when walking. In more advanced cases, neuropathy can cause foot ulcers and infections that are difficult to heal, even leading, in extreme cases, to amputation. It is therefore crucial to recognise these signs early in order to intervene with appropriate treatment and prevent serious complications.

To diagnose neuropathy, the doctor performs a careful collection of symptoms and a specific physical examination. Particular attention is paid to the feet, checking their skin, nails, the presence of calluses, deformities and lesions. The peripheral wrists are also assessed to check blood circulation. One of the simplest and most useful tests is with the 10-gram monofilament, a small filament that is applied at various points on the sole of the foot. If the patient does not feel stimulation in at least three places, there is likely to be neuropathy. In cases where autonomic neuropathy is suspected, blood pressure measurements in different positions (supine and standing) and tests assessing heart rate variability during deep breathing or the Valsalva manoeuvre are performed. Information is also collected on gastrointestinal, urinary or sexual disorders that may indicate autonomic nerve involvement.

It is essential that screening for these complications be carried out regularly, at least once a year, in order to identify any problems early and intervene early with treatment or lifestyle changes. Careful management of diabetes, with glycaemic, blood pressure and cholesterol control, together with regular specialist visits, is the most effective strategy to prevent or slow down the onset and progression of microvascular complications.