Two Diabetes Complications to Watch for

Type 2 diabetes, which is experiencing epidemic-like growth, carries the usual risk of complications if the blood sugar is not controlled – eye problems, arterial disease (causing coronary heart disease and peripheral vascular disease), kidney problems, and peripheral neuropathy. These are so-called major complications, but there are a couple more that should be watched for.

First, a large study reported in the European Heart Journal examined the frequency of atrial fibrillation in type 2 diabetics who were having their raised blood pressure lowered with medication. [Atrial fibrillation (or A-Fib) is the uncoordinated beating of the heart's two upper chambers (the atria) with the two lower chambers (the ventricles). There is an irregular and often rapid heart rate, felt as palpitations.]

Among 11,000-odd patients with type 2 diabetes, half were given a combination medication containing an ACE-inhibitor and a water-pill (diuretic). In the entire collective, 7.5% had A-Fib at baseline. After 4½ years, the risk of all-cause death, cardiovascular death, stroke, or heart failure was 61% more likely in the patients with A-Fib at baseline than in the others. The blood pressure-lowering treatment reduced the likelihood of these outcomes, but they were still much more frequent in the patients with A-Fib than in those without. This shows that A-Fib is relatively common in type 2 diabetes, and needs prompt aggressive management if a bad outcome is to be avoided.

The other relatively ‘silent’ complication of type 2 diabetes is testosterone deficiency in men. As reported at the Diabetes UK Annual Conference, the Testosterone Deficiency Syndrome, also known as hypogonadism, is found in over half of men with diabetes, more than double the rate in non-diabetic men. Symptoms include erectile dysfunction, infertility, reduced body hair, decreased muscle mass, and fatigue. It’s associated with other diabetic signs – insulin resistance, a raised HbA1c, increased belly fat, and a raised body mass index (BMI). A blood test gives the diagnosis – the serum testosterone level is below 12 nanomol/L – and treatment with testosterone therapy is generally successful.