Possible Complications

Studies in non-HIV-infected people have estimated that type 2 diabetes may have begun up to 12 years before clinical diagnosis.1 At the time of diagnosis, many patients will have one or more diabetes complications. For example 10–39% of patients may have already developed retinopathy,1,2 which is a major cause of visual loss.3

Patients with diabetes should be assessed/monitored for the following potential complications:

  • diabetic retinopathy3–5
  • diabetic neuropathy3–5 
  • renal damage and chronic kidney disease3–5
  • foot ulceration, infection or deformity secondary to peripheral neuropathy/vascular disease3 psychosocial problems3,4
  • resting tachycardia, exercise intolerance, postural hypotension, constipation, gastroparesis, and erectile dysfunction secondary to cardiovascular autonomic neuropathy3,4   
  • coronary heart disease4
  • cerebrovascular disease4
  • peripheral arterial disease4
  • dental disease


Further information, including recommended assessments for complications at diagnosis and during follow-up, and further details on when to refer, can be found in guidelines published by the International Diabetes Federation, the American Diabetes Association and the American Association of Clinical Endocrinologists (2007).


  1. Harris MI, Klein R, Welborn TA, et al. Onset of NIDDM occurs at least 4-7 yr before clinical diagnosis. Diabetes Care. 1992;15: 815–819.
  2. Kohner EM, Aldington SJ, Stratton IM, et al. United Kingdom Prospective Diabetes Study, 30: diabetic retinopathy at diagnosis of non-insulin-dependent diabetes mellitus and associated risk factors. Arch Ophthalmol. 1998;116: 297–303.
  3. International Diabetes Federation. Global Guideline for Type 2 Diabetes, 2005. Accessed 20 February 2011.
  4. American Diabetes Association. Standards of Medical Care in Diabetes 2011. Diabetes Care. 2011;34;Suppl. 1:S11–S61.
  5. European AIDS Clinical Society (EACS). Guidelines. Version 6.0. Accessed 3 July 2012.