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Complicaciones Crónicas de la Diabetes

Complicaciones Crónicas de la Diabetes

La diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus mellitus ( DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus) es un trastorno metabólico crónico caracterizado por hiperglucemia persistente debido a una secreción de insulina deficiente ( DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 1), resistencia a la insulina ( DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 2) o diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus autoinmune de inicio en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la edad adulta ( diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus autoinmune latente del adulto, LADA). El objetivo del control de la diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus es prevenir complicaciones crónicas graves y potencialmente incapacitantes debido al AL Amyloidosis daño en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum varios órganos. El control adecuado a largo plazo de la glucosa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum sangre es crucial en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la prevención de complicaciones. Las complicaciones macrovasculares incluyen enfermedad cardiovascular, accidente cerebrovascular, enfermedad vascular periférica y ERC en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum varias etapas, incluida la enfermedad renal en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum etapa terminal que requiere diálisis. Las complicaciones macrovasculares incluyen la cardiopatía, la enfermedad cerebrovascular y la enfermedad vascular periférica. La enfermedad microvascular puede causar retinopatía, neuropatía, nefropatía o angina microvascular.

Last updated: Dec 15, 2025

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Contents

Descripción General

La diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus mellitus ( DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus) es una enfermedad común que puede conducir a múltiples complicaciones graves. El control glucémico a largo plazo es imperativo para prevenir estas complicaciones.

  • Enfermedad cardiovascular:
    • La enfermedad cardiovascular es la principal causa de muerte en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus.
    • IM:
      • Hombres: 3,7 veces mayor riesgo que los LOS Neisseria individuos no diabéticos
      • Mujeres: 5,9 veces mayor riesgo que los LOS Neisseria individuos no diabéticos
  • Nefropatía diabética/ERC:
    • La causa más común de insuficiencia renal en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria EE.UU.
    • Afecta al AL Amyloidosis 20%–30% de las personas con diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus
  • Retinopatía diabética:
    • Aproximadamente el 90% de los LOS Neisseria casos con diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 1 y el 25% de los LOS Neisseria casos con diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 2 desarrollan retinopatía después de 15 años de la enfermedad.
    • La causa más común de discapacidad visual y ceguera en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum personas de 25–74 años en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria EE.UU.
    • Clasificada como no proliferativa o proliferativa según los LOS Neisseria hallazgos retinianos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la oftalmoscopia
  • Neuropatía:
    • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el momento del diagnóstico, aproximadamente del 10%–20% de los LOS Neisseria casos ya tienen algún grado de neuropatía periférica.
    • Prevalencia a los LOS Neisseria 10 años del diagnóstico: aproximadamente 41%
    • Clasificación:
      • Polineuropatía simétrica distal (más común)
      • Neuropatía autonómica
      • Mononeuropatía
      • Polirradiculopatía
      • Mononeuropatía múltiple

Fisiopatología

Las complicaciones crónicas de la diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tienen procesos fisiopatológicos únicos y dependen del sistema orgánico involucrado.

Cardiovascular

  • Aterosclerosis:
    • Disfunción endotelial:
      • La hiperglucemia conduce a una mayor producción de especies de radicales libres mitocondriales → niveles reducidos de NO
      • El NO bajo conduce a la vasoconstricción y reduce el flujo sanguíneo, lo que provoca daños en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria órganos diana.
    • Aumento de la inflamación: la diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus es un estado proinflamatorio → riesgo conocido de aterosclerosis
  • Arteriopatía periférica: acumulación de lípidos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria vasos sanguíneos → vasoconstricción y reducción del flujo sanguíneo, lo que provoca daños en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria órganos diana
  • Enfermedad macrovascular:
    • Corazón: IM
    • Cerebro: accidente cerebrovascular, demencia multiinfarto
    • Piernas: enfermedad vascular periférica/arteriopatía periférica
  • Enfermedad microvascular:
    • Ojos: retinopatía diabética
    • Pies: neuropatía diabética
    • Estómago: gastroparesia
    • Intestinos: isquemia mesentérica
    • Riñón: nefropatía diabética/ERC
    • Genitales: disfunción eréctil

Renal

Existen varias formas de enfermedad renal en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus, incluidas las lesiones glomerulares no clásicas y la enfermedad tubulointersticial.

  • La “enfermedad renal diabética” es un diagnóstico clínico basado en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la gravedad de la albuminuria Albuminuria The presence of albumin in the urine, an indicator of kidney diseases. Kidney Function Tests, la TFG o ambas, en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum personas con diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus.
  • Riñones: Los LOS Neisseria depósitos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la membrana capilar causan arterioesclerosis hialina.
  • Nefropatía diabética/ERC:
    • Cambios mesangiales: aumento de la permeabilidad e hiperfiltración
    • Lesiones vasculares: arteriolosclerosis, especialmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las arteriolas eferentes
    • Lesiones glomerulares:
      • El engrosamiento difuso de la membrana basal capilar es el hallazgo más temprano y más común.
      • Nodular: Los LOS Neisseria nódulos de Kimmelstiel-Wilson son patognomónicos
    • Lesiones tubulares: depósito de glucógeno tubular

Neurológica

  • La hiperglucemia provoca la glicación de las proteínas del axón con el desarrollo subsiguiente de neuropatía en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria nervios periféricos.
  • Neuropatía:
    • Arteriolosclerosis de arteriolas endoneurales que resultan en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum isquemia y daño neuronal
    • Estrés oxidativo y daño osmótico

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Presentación Clínica

Enfermedad cardiovascular

  • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum personas con diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus, el IM puede presentarse de forma atípica debido a la neuropatía diabética concurrente, en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum lugar de la presentación típica con dolor Dolor Inflammation torácico.
  • Otras enfermedades del corazón:
    • Enfermedad microvascular
    • Miocardiopatía diabética
  • Estenosis carotídea:
    • La arteriosclerosis en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las grandes arterias del cuello puede presentarse con ataques isquémicos transitorios ( TIA TIA Transient ischemic attack (TIA) is a temporary episode of neurologic dysfunction caused by ischemia without infarction that resolves completely when blood supply is restored. Transient ischemic attack is a neurologic emergency that warrants urgent medical attention. Transient Ischemic Attack (TIA), por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés).
    • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el examen físico se pueden escuchar soplos carotídeos.
  • Accidente cerebrovascular/ TIA TIA Transient ischemic attack (TIA) is a temporary episode of neurologic dysfunction caused by ischemia without infarction that resolves completely when blood supply is restored. Transient ischemic attack is a neurologic emergency that warrants urgent medical attention. Transient Ischemic Attack (TIA): La aterosclerosis en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las arterias cerebrales se presenta con déficits neurológicos focales.
  • Enfermedad arterial periférica:
    • Se presenta como claudicación intermitente debido a enfermedad oclusiva vascular en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las piernas.
    • Pulsos pediales disminuidos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el examen físico

Nefropatía diabética/ERC

  • Generalmente asintomáticos
  • Las personas afectadas notan una “orina espumosa”.
  • Pueden tener hipertensión o aumento de la creatinina en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las pruebas de laboratorio

Retinopatía diabética

  • Generalmente, es asintomática y diagnosticada mediante exámenes de rutina.
  • Las personas afectadas pueden quejarse de disminución de la agudeza visual en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum etapas avanzadas.
  • Si se complica, las personas pueden presentar:
    • Pérdida de visión monocular súbita e indolora
    • Miodesopsias
  • Examen del fondo de ojo:
    • Edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema macular
    • Exudados algodonosos
    • Hemorragias puntiformes y en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum mancha
  • Complicaciones oculares adicionales debido a la hiperglucemia:
    • Acumulación de sorbitol Sorbitol A polyhydric alcohol with about half the sweetness of sucrose. Sorbitol occurs naturally and is also produced synthetically from glucose. It was formerly used as a diuretic and may still be used as a laxative and in irrigating solutions for some surgical procedures. It is also used in many manufacturing processes, as a pharmaceutical aid, and in several research applications. Laxatives y aumento de la presión osmótica en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cristalino del ojo
    • Mayor riesgo de cataratas
  • Mujeres con diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus que están planeando un embarazo:
    • Deben ser evaluadas y tratadas integralmente.
    • Se les debe aconsejar sobre el riesgo de progresión de la enfermedad
Fundus photo showing scatter laser surgery for diabetic retinopathy

Imagen del fondo de ojo que muestra la cirugía con láser disperso para la retinopatía diabética

Imagen: “Fundus photo showing scatter laser surgery for diabetic retinopathy” por National Eye Institute, National Institutes of Health. Licencia: Dominio Público

Neuropatía

  • A menudo asintomática y se encuentra como hallazgo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el examen físico
  • Puede ser focal generalizada, multifocal Multifocal Retinoblastoma o autonómica.
  • Polineuropatía simétrica distal crónica:
    • Se presenta con parestesias en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un patrón de pérdida sensorial en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum “guante de media”
    • Las personas afectadas pueden quejarse de:
      • Adormecimiento
      • Hormigueo
      • Ardor
      • Dolor Dolor Inflammation en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria pies
      • Empeoramiento por la noche
    • Disminución de la sensación al AL Amyloidosis tacto ligero/monofilamento
    • Pérdida de la percepción del dolor Dolor Inflammation, lo que conduce a la posibilidad de heridas
  • Neuropatía autonómica:
    • Manifestaciones cardiovasculares:
      • Taquicardia en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum reposo
      • Hipotensión ortostática
    • Gastroparesia por afectación del nervio vago:
      • Vaciamiento gástrico retardado
      • Riesgo de hipoglucemia posprandial
      • Náuseas
      • Distensión abdominal
      • Pérdida de apetito
      • Puede resultar en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pérdida excesiva de peso
    • La afectación genitourinaria puede conducir a la disfunción eréctil, aunque es más probable que esta condición se deba a una etiología vascular.
    • Nervios craneales:
    • Mononeuropatía periférica: parálisis nerviosas, como el nervio peroneo común que causa caída del pie
    • Mononeuritis múltiple: neuropatía asimétrica que involucra múltiples nervios periféricos y craneales
Lesión del pie diabético

Lesión en el pie en un individuo con neuropatía periférica:
La neuropatía periférica hace que las personas afectadas no sientan pequeñas lesiones en las extremidades, que a menudo quedan desatendidas. Combinadas con la reducción del flujo sanguíneo a las extremidades, estas lesiones pueden provocar úlceras crónicas en los pies que incluso pueden requerir un desbridamiento quirúrgico en personas con diabetes.

Imagen: “Pre-operative view of chronic recurrent ulcer under the fifth MT head” por Department of Orthopaedic Surgery, Assaf HaRofeh Medical Center, Zerrifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Licencia: CC BY 4.0

Manifestaciones cutáneas

  • Acantosis nigricans:
    • Placas oscuras y aterciopeladas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las axilas o el cuello
    • Se observan en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum individuos con resistencia a la insulina
    • A veces pueden ser un signo de malignidad subyacente
  • Necrobiosis lipoídica:
    • Parches indurados, ovalados o irregulares, de atrofia central con pigmentación amarilla y márgenes de color marrón rojizo
    • A menudo asintomática, se encuentran en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las espinillas.
Acantosis nigricans Grado 1

Acantosis nigricans: un hallazgo común en personas con resistencia a la insulina (como en la diabetes). La acantosis nigricans se describe como áreas aterciopeladas, engrosadas y oscurecidas de la piel, que a menudo se ven en la nuca.

Imagen: “Acanthosis nigricans Grade 1” por Department of Clinical Medical Sciences, The University of West Indies, St Augustine, Trinidad & Tobago, WI. Licencia: CC BY 2.0

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Diagnóstico

Enfermedad cardiovascular

Arteriopatía coronaria:

  • Antecedente clínico: indagar sobre factores que inciden en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el riesgo cardiovascular:
    • Dolor Dolor Inflammation torácico o síntomas similares a los LOS Neisseria experimentados en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la angina
    • Antecedentes de enfermedad cardíaca o tratamiento
    • Factores de riesgo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el estilo de vida:
      • Niveles de actividad física y condición física general
      • Opciones dietéticas
      • Tabaquismo
      • Ingesta de alcohol
      • Uso de drogas ilícitas
      • Estrés emocional
  • Pruebas de tamizaje:
    • Pruebas de laboratorio
    • ECG ECG An electrocardiogram (ECG) is a graphic representation of the electrical activity of the heart plotted against time. Adhesive electrodes are affixed to the skin surface allowing measurement of cardiac impulses from many angles. The ECG provides 3-dimensional information about the conduction system of the heart, the myocardium, and other cardiac structures. Electrocardiogram (ECG)
    • Pruebas de estrés
    • Nota: Las pruebas de tamizaje no se recomiendan para personas asintomáticas o con enfermedades cardiovasculares o factores de riesgo establecidos.
  • Las pruebas están indicadas para individuos sintomáticos y dependen del individuo y las circunstancias en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las que se ordena la prueba.
    • Puntaje de calcio coronario: Debido a los LOS Neisseria falsos negativos, la prueba no se recomienda para personas de alto riesgo.
    • Pruebas de estrés: de ejercicio o farmacológicas, según la capacidad del individuo:
      • Con o sin imagenología de medicina nuclear
      • Ecocardiograma de estrés
    • Angiotomografía computarizada
    • Angiografía en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum individuos con resultados anormales en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la prueba de esfuerzo

Enfermedad arterial periférica:

  • Prueba de índice tobillo-brazo
  • Ultrasonido
  • Angiograma

Estenosis carotídea: ultrasonido para evaluar la extensión de la enfermedad oclusiva

Nefropatía diabética

La nefropatía diabética generalmente se diagnostica durante una prueba anual de detección de microalbuminuria en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum orina.

  • La microalbuminuria (30–299 mg/24 horas) es el signo más temprano de nefropatía diabética.
  • La ERC se diagnostica mediante pruebas de laboratorio para la creatinina.

Retinopatía diabética

Diagnosticada durante los LOS Neisseria exámenes oculares de tamizaje anual con un especialista en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum ojos (oftalmólogo u optometrista)

  • No proliferativa:
    • Microaneurismas
    • Exudados blandos (exudado algodonoso que representa un infarto)
    • Hemorragia intrarretiniana
    • Vasos ocluidos, dilatados y tortuosos
  • Proliferativa:
    • Neovascularización del disco y/o vasos retinianos
    • Hemorragia perirretiniana y vítrea
    • Fibrosis Fibrosis Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. Bronchiolitis Obliterans posterior y desprendimiento de retina Retina The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outermost layer is pigmented, whereas the inner nine layers are transparent. Eye: Anatomy traccional
  • Edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema macular:
    • Engrosamiento y edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema retinal que involucra la mácula
    • Puede ocurrir durante la retinopatía proliferativa y no proliferativa

Neuropatía diabética

  • Examen físico:
    • Evaluar la sensación utilizando un monofilamento.
    • Evaluar el sentido de vibración utilizando un diapasón de 128 Hz.
    • Reflejos tendinosos profundos
    • Comprobar si existen úlceras o infecciones neuropáticas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la piel
  • La artropatía neuropática diabética (pie de Charcot) es una complicación grave:
    • Deformación de las articulaciones tarsometatarsianas
    • Las úlceras coexistentes son comunes.
    • Se presenta como deformidades óseas con colapso de la parte media del pie

Tratamiento

Todas las complicaciones

Con todas las complicaciones diabéticas, la prevención es clave y el control glucémico es la máxima prioridad.

  • Control de comorbilidades (hipertensión arterial e hiperlipidemia).
  • Modificaciones en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el estilo de vida:
    • Cese del tabaquismo
    • Control agresivo de la presión arterial
    • Tratamiento de la dislipidemia
    • Pérdida de peso si tiene sobrepeso u obesidad
    • Ingesta moderada de alcohol:
      • 1 bebida/día en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum promedio para mujeres
      • 2 bebidas/día en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum promedio para hombres

Enfermedad de las arterias coronarias

  • Aspirina en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum dosis bajas para la prevención secundaria ( en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum personas con diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus que tienen complicaciones macrovasculares conocidas)
  • Colchicina: nueva recomendación para personas con enfermedad coronaria crónica que reciben otras estrategias de prevención secundaria

Nefropatía

  • Control de las comorbilidades:
    • Hipertensión: El objetivo de presión arterial para todas las personas con diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus debe ser < 130/80 mm Hg.
    • Cese del tabaquismo
    • Control de la hiperlipidemia
  • Los LOS Neisseria IECA o ARA actúan sobre las arteriolas eferentes, que son las más afectadas.
  • Medicamentos adicionales de protección renal:
    • Inhibidores del cotransportador sodio-glucosa 2 (SGLT2).
    • Antagonistas selectivos no esteroideos de los LOS Neisseria receptores de mineralocorticoides ( ARM Arm The arm, or “upper arm” in common usage, is the region of the upper limb that extends from the shoulder to the elbow joint and connects inferiorly to the forearm through the cubital fossa. It is divided into 2 fascial compartments (anterior and posterior). Arm: Anatomy)

Retinopatía

  • Tipo no proliferativa:
    • Generalmente, no se trata a menos que sea grave
    • La fotocoagulación con láser panretiniano es el tratamiento de elección.
  • Tipo proliferativa:
    • Fotocoagulación con láser panretinal
    • Medicamento: bevacizumab Bevacizumab An anti-vegf humanized murine monoclonal antibody. It inhibits vegf receptors and helps to prevent pathologic angiogenesis. Targeted and Other Nontraditional Antineoplastic Therapy:
      • Anticuerpo monoclonal que funciona como inhibidor de la angiogénesis
      • Se dirige al AL Amyloidosis factor de crecimiento endotelial vascular (VEGF)-A
      • Considerar la vitrectomía.
  • Edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema macular:
  • Complicaciones potenciales graves:
    • Desprendimiento de retina Retina The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outermost layer is pigmented, whereas the inner nine layers are transparent. Eye: Anatomy
    • Hemorragia vítrea
    • Pérdida de la visión

Neuropatía

  • Indicar a las personas afectadas que se revisen diariamente los LOS Neisseria pies
  • Medicamentos para aliviar el dolor Dolor Inflammation neuropático:
    • Anticonvulsivos: gabapentina o pregabalina
    • Antidepresivos tricíclicos: amitriptilina
    • Inhibidores de la recaptación de serotonina y norepinefrina: duloxetina
    • Los LOS Neisseria opioides son el último recurso, pero pueden ser necesarios para el alivio del dolor Dolor Inflammation crónico.
  • Gastroparesia:
    • Comidas pequeñas y frecuentes
    • Medicamento procinético: metoclopramida

Enfermedad arterial periférica

  • Examen periódico de los LOS Neisseria pies
  • Cuidado de no causar heridas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las extremidades, ya que se retrasa la cicatrización
  • Revascularización quirúrgica en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum casos seleccionados
  • La amputación puede ser necesaria para algunas personas con enfermedad arterial periférica.

Manifestaciones de la piel

  • La acantosis nigricans no requiere tratamiento y, a menudo, se resuelve con el control de la glucemia.
  • La necrobiosis lipoídica se trata con esteroides tópicos.

Referencias

  1. Smith, S. C., Jr, Benjamin, E. J., Bonow, R. O., Braun, L. T., Creager, M. A., Franklin, B. A., Gibbons, R. J., Grundy, S. M., Hiratzka, L. F., Jones, D. W., Lloyd-Jones, D. M., Minissian, M., Mosca, L., Peterson, E. D., Sacco, R. L., Spertus, J., Stein, J. H., & Taubert, K. A. (2011). AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association. Journal of the American College of Cardiology, 58(23), 2432–2446. https://doi.org/10.1016/j.jacc.2011.10.824
  2. Ismail-Beigi, F., et al., ACCORD trial group. (2010). Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomised trial. Lancet 376, 419-30. doi: 10.1016/S0140-6736(10)60576-4. Erratum in: Lancet. (2010). 376, 1466. https://pubmed.ncbi.nlm.nih.gov/20594588/
  3. Matoori S. (2022). Diabetes and its Complications. ACS pharmacology & translational science, 5(8), 513–515. https://doi.org/10.1021/acsptsci.2c00122
  4. Yang, T., Qi, F., Guo, F., Shao, M., Song, Y., Ren, G., Linlin, Z., Qin, G., & Zhao, Y. (2024). An update on chronic complications of diabetes mellitus: from molecular mechanisms to therapeutic strategies with a focus on metabolic memory. Molecular medicine (Cambridge, Mass.), 30(1), 71. https://doi.org/10.1186/s10020-024-00824-9
  5. Andarge, B. D., Hayelom, D. H., Degualem, S. M., Bezie, H. E., Wondmagegn, H., Habtegiorgis, Y., Sorrie, M. B., & Chisha, Y. (2025). Chronic complications among patients with type 2 diabetes in Southern Ethiopia. PloS one, 20(11), e0336666. https://doi.org/10.1371/journal.pone.0336666
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