Handbook of Diabetes. Rudy Bilous

the retinal microvasculature. The endothelial cells...Figure 15.2 Microaneurysms, the earliest sign of diabetic retinopathy appear...Figure 15.3 Fluorescein angiogram, showing microaneurysms as small white dot...Figure 15.4 Retinal haemorrhages: red ‘blots’.Figure 15.5 Focal diabetic maculopathy with circinate (ring‐shaped) exudate....Figure 15.6 Cotton wool spots around the optic disc. Note also flame and blo...Figure 15.7 Intraretinal microvascular abnormalities (IRMAs) appearing as a ...Figure 15.8 Venous irregularity or ‘beading’ (centre of field) and new vesse...Figure 15.9 More extensive new vessels on the disc, occupying more than half...Figure 15.10 Extensive neovascularisation above the disc, with widespread si...Figure 15.11 Preretinal haemorrhage. Note the settling of the uncoagulated b...Figure 15.12 Fibrous bands that are exerting traction on the retina. The ret...Figure 15.13 Rhegmatogenous retinal detachment: a large retinal tear (red le...Figure 15.14 B‐scan ultrasound image of the eye, showing a retinal detachmen...Figure 15.15 Diffuse macular oedema, with a macular ‘star’. This requires la...Figure 15.16 Left eye of a patient with diffuse diabetic macular oedema. (a)...Figure 15.17 New vessels (arrows) on the iris (rubeosis iridis). There is al...Figure 15.18 Diabetic cataract appearing as pale opacification of the lens....Figure 15.19 Recent panretinal (scatter) laser photocoagulation burns for tr...Figure 15.20 Focal laser photocoagulation scars around the macula following ...

      16 Chapter 16Figure 16.1 Classification and prognosis for end stage renal disease based u...Figure 16.2 Hyperfiltration in diabetes and its correction by SGLT‐2 (sodium...Figure 16.3 Relative mortality of patients with diabetes with and without pe...Figure 16.4 Nodular glomerulosclerosis in a patient with type 1 diabetes and...Figure 16.5 Nodular glomerulosclerosis (Kimmelstiel–Wilson lesions) in a pat...Figure 16.6 Electron micrograph of the glomerulus from a patient with diabet...Figure 16.7 Schematic to show how metabolic and haemodynamic factors combine...Figure 16.8 Schematic of changes in selectivity of glomerular capillary to a...Figure 16.9 Prevalence of parental hypertension in type 1 patients with norm...Figure 16.10 (a) Prevalence and (b) cumulative incidence of moderate albumin...Figure 16.11 Effects of antihypertensive treatment on (a) mean arterial bloo...Figure 16.12 Meta‐analysis of the effects of angiotensin‐converting enzyme (...Figure 16.13 (a) Cumulative incidence of death in 160 moderately albuminuric...Figure 16.14 Frequency of monitoring (number of clinic visits per year) base...Figure 16.15 Reciprocal serum creatinine plotted against date for the case h...

      17 Chapter 17Figure 17.1 Diabetic neuropathy is common and associated with a complex mix ...Figure 17.2 Classification of diabetic neuropathy.Figure 17.3 Mechanisms of diabetic neuropathy.Figure 17.4 Clinical pattern of distal symmetrical neuropathies.Figure 17.5 Staging the severity of diabetic neuropathy.Figure 17.6 Positive sensory symptoms; painful neuropathy.Figure 17.7 A 10g monofilament is simple, easy to use in the clinic and is m...Figure 17.8 Increased blood flow (distended veins) on the dorsum of the foot...Figure 17.9 Clinical pattern of pressure palsies in patients with diabetes....Figure 17.10 Generalised wasting of the interossei (and hypothenar eminence)...Figure 17.11 Diabetic amyotrophy, showing marked quadriceps wasting, and cli...Figure 17.12 Histological changes associated with diabetic amyotrophy. In pa...Figure 17.13 Clinical and subclinical features of diabetic autonomic neuropa...Figure 17.14 Effects of intensified insulin therapy and strict glycaemic con...

      18 Chapter 18Figure 18.1 Features of Diabetic dyslipidaemia. In the German PROCAM study, ...Figure 18.2 The pathogenesis of diabetic dyslipidaemia involves increased re...Figure 18.3 Eruptive xanthomata. This young patient with type 1 diabetes pre...Figure 18.4 The MRFIT screening study enrolled >360,000 men in the 1960s‐70s...Figure 18.5 The importance of LDL cholesterol lowering to reduce major vascu...Figure 18.6 Circulating cholesterol is derived from two sources: de novo syn...Figure 18.7 A meta‐analysis of cholesterol‐lowering therapy in 18 686 patien...Figure 18.8 The mechanism of action of statins and PCSK9 monoclonal antibodi...

      19 Chapter 19Figure 19.1 Suggested mechanisms linking insulin resistance to the developme...Figure 19.2 Additive effects of diabetes and hypertension on deaths from cor...Figure 19.3 World Health Organisation/International Society for Hypertension...Figure 19.4 Schematic diagram of the renin‐angiotensin system. Dotted lines ...Figure 19.5 Summary of antihypertensive drug management in people with diabe...

      20 Chapter 20Figure 20.1 Relationships between systolic BP (a) and serum cholesterol (b) ...Figure 20.2 Among patients with diabetes, those who develop nephropathy and ...Figure 20.3 Arteriolar changes in diabetes in the myocardium of a woman who ...Figure 20.4 Medial calcification of the digital arteries in a diabetic patie...Figure 20.5 New Zealand cohort study showing the relationship between CVD mo...Figure 20.6 DAG‐mediated activation of protein Kinase C‐β results in phospho...Figure 20.7 Advanced glycation end products (AGEs) have a number of unwanted...Figure 20.8 A meta‐analysis of five prospective randomised controlled trials...Figure 20.9 Cardiovascular and death from any course with Empagliflozin comp...Figure 20.10 Primary and exploratory outcomes with Liraglutide vs Placebo in...Figure 20.11 The ADVANCE study randomised approximately 20,000 high‐risk pat...Figure 20.12 Age‐adjusted prevalence of previous stroke among type 2 diabete...Figure 20.13 From the Antithrombotic Trialists Collaboration, there is no cl...Figure 20.14 Age‐adjusted prevalence of intermittent claudication in patient...Figure 20.15 Diffuse coronary artery disease in a 49‐year‐old woman with typ...

      21 Chapter 21Figure 21.1 The ‘diabetic foot’ refers to a mix of pathologies.Figure 21.2 Major components in the aetiology of foot ulceration.Figure 21.3 Risk factors for diabetic foot complications.Figure 21.4 Annual foot review for everyone with diabetes above 12 years old...Figure 21.5 Typical neuropathic ulcer with surrounding callus.Figure 21.6 Neuroischaemic damage caused by tightly fitting shoes.Figure 21.7 Principles of ulcer treatment, in addition to providing educatio...Figure 21.8 Critical ischaemia, ulceration and gangrene affecting the extrem...Figure 21.9 Bilateral Charcot neuroarthropathy in the cuneiform‐metatarsal a...Figure 21.10 Plain X‐ray of a Charcot foot demonstrates gross destruction, d...Figure 21.11 Total contact plaster cast for ‘offloading’ a neuropathic ulcer...Figure 21.12 The following clinical scenario and anti‐microbial agents that ...

      22 Chapter 22Figure 22.1 The most common symptoms of sexual dysfunction in men and women ...Figure 22.2 Sexual Health Inventory for Men (SHIM).Figure 22.3 Pathways that lead to the relaxation of vascular and corpus cave...Figure 22.4 Major pathways contributing to ED in diabetic men.Figure 22.5 Treatment options for diabetic men with ED.Figure 22.6 Intracavernosal injection of alprostadil, self‐injected.Figure 22.7 A vacuum device with constriction rings.Figure 22.8 Gynaecological factors relevant to women with diabetes or IGT.Figure 22.9 Genitourinary infections in diabetic women.Figure 22.10 Patterns of contraceptive use in women with type 1 diabetes in ...

      23 Chapter 23Figure 23.1 Motility disorders associated with diabetes at various levels of...Figure 23.2 Dose‐dependent effect of hyperglycaemia on postprandial gallblad...Figure 23.3 Effect of insulin‐induced hypoglycaemia on gastric emptying (50%...Figure 23.4 Wet swallow‐induced oesophageal peristalsis in a healthy subject...Figure 23.5 Effect of gut microbiota in liver disease, insulin resistance, a...

      24 Chapter 24Figure 24.1 Child‐Pugh score.Figure 24.2 Multiple hit model in the pathogenesis of NAFD, NASH and cirrhos...Figure 24.3 Simple non‐invasive tests for fibrosis.

      25 Chapter 25Figure 25.1 Global cancer cases in 2012 due to diabetes and BMI ≥ 25 kg/m² s...Figure 25.2 Immortality bias with metformin treatment. Cancer rates recorded...

      26 Chapter 26Figure 26.1 Diabetic dermopathy or ‘shin spots’.Figure 26.2 Necrobiosis lipoidica diabeticorum (NLD). (a) An early lesion on...Figure 26.3 In children, acanthosis nigricans is associated with obesity (+ ...Figure 26.4 Diabetic bullae – blistering of the foot.Figure 26.5 Granuloma annulare. Taken from http://healthool.com/granuloma‐an...Figure 26.6 Garrod’s knuckle pads.Figure 26.7 The ‘prayer sign’, another feature of cheiroarthropathy.Figure 26.8 Dupuytren’s contractors.Figure 26.9 Trigger finger in a diabetic patient.Figure 26.10 Tinea manus, showing the characteristic erythematous, scaly mar...Figure 26.11 Chronic paronychia caused by Candida albicans.

      27 Chapter 27Figure 27.1 The impairment of cognitive ability in 125 adolescents with type...

      28 Chapter 28Figure 28.1 Changes in plasma glucose and insulin concentrations during prol...Figure 28.2 Progressive resistance exercise training, supervised over 12 wee...Figure