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The Forgotten Complications – What You Should Know

Heart disease, chronic kidney disease, and nerve damage tend to dominate the conversation around diabetes-related complications. However, there are several overlooked complications relating to bone health, the brain, and the skin. Experts discuss these complications and more at the 82nd ADA scientific sessions.  

People with diabetes are at an increased risk for complications including heart disease and kidney disease, to vision problems and nerve damage.

Avoiding these complications is a major priority for both people with diabetes and their healthcare teams, but these conversations often stop at the major complications related to the heart, kidneys, eyes, nerves, and more recently, the liver.

In a fascinating session on the third day of the 82nd ADA Scientific Sessions, four experts presented on some of the lesser known or forgotten complications that can impact people with diabetes – the risks they pose, how they may be identified or diagnosed, and available treatment options.

Osteoporosis and diabetes

Dr. Rodrigo Valderrabano, medical director, Research Program in Men’s Health, Aging, and Metabolism at Brigham and Women’s Hospital in Boston, began the session by discussing the connection between diabetes and osteoporosis.

Osteoporosis is a bone disease in which bones deteriorate, becoming weak and brittle, which makes them more fragile and more likely to fracture. Both type 1 and type 2 diabetes are associated with an increased risk for bone fractures. After a person experiences a fracture, they also face increased rates of disability – such as needing a wheelchair or walker and mortality, especially in older adults.

Especially if you are an older adult, discuss your risk for osteoporosis and bone fractures with your healthcare team – including being screened. Know that your healthcare provider may avoid prescribing you a TZD, SFU, or SGLT-2 inhibitor if you are at an increased risk for fracture, as data has shown an association with bone fractures when taking these medications.

Cognitive impairment and diabetes

One can think of cognitive dysfunction almost like an iceberg,” said Dr. Tali Cukierman-Yaffe, endocrinologist, Clinical Epidemiology at Sheba Medical Center in Israel. At the bottom of the iceberg is normal cognitive (brain) function, which can deteriorate to cognitive dysfunction or mild cognitive impairment, which can then progress to dementia.

The research shows that “people with diabetes have more cognitive dysfunction, more dementia, and an accelerated rate of cognitive decline,” she said. 

Cukierman-Yaffe emphasized the importance of screening all people with diabetes over the age of 65 for cognitive function, adapting treatment accordingly. This is important because early detection could help identify if secondary causes that can be treated directly (such as hearing loss or depression) are contributing to cognitive impairment. Additionally, strategies need to be discussed to help with self-care and management in those who are experiencing cognitive decline should discuss building a support system that can assist when necessary.

Skin disorders and diabetes

There are a number of common skin disorders that can appear in people with diabetes including rashes, blisters, scaliness, itching, and fungal infections. Dr. Ellen Roh, a dermatologist and assistant professor of Dermatology at Harvard Medical School, walked through a number of these disorders in her presentation at the ADA conference as well as treatment strategies.

If you notice any strange rashes, colored marks, bumps, or sores, discuss these with your healthcare professional. In some cases, they may refer you to a dermatologist who can better identify the condition and the available treatment options. 

Roh stressed the importance of managing expectations. Many skin disorders can be difficult or expensive to treat, even those with numerous treatment options ranging from medications to laser therapy to surgery. Ask questions in your healthcare appointment and be honest about what kind of results you are hoping for.

Learn more about taking care of your skin as a person with diabetes here.