(A) Retinal changes # CHRONIC SYMPTOMS OF DIABETES are due to vascular damage from persistent hyperglycemia.> Vascular damage leads to end-organ damage.> Other conditions associated with diabetes, such as hypertension, dyslipidemia (as well as smoking) accelerate the development of vascular damage and the chronic complications of diabetes, which are the following:# Microvascular complications are a significant cause of morbidity. Persistent hyperglycemia is the major cause for the microvascular complications which are highly specific for diabetes. Retinopathy with potential loss of vision Nephropathy leading to kidney failure Peripheral neuropathy leading to pain, foot ulcers, and limb amputation Autonomic neuropathy causing gastrointestinal, genitourinary, cardiovascular symptoms and sexual dysfunction# Macrovascular complications are the main cause of mortality.> Although persistent hyperglycemia may contribute to macrovascular complications, it is the associated conditions (hypertension, dyslipidemia, smoking) that account for most of the burden of the macrovascular complications. Coronary heart disease which is the major cause of death for patients with diabetes Peripheral vascular disease Cerebrovascular disease> Diabetic retinopathy may be the most common microvascular complication of diabetes. The risk of developing diabetic retinopathy or other microvascular complications of diabetes depends on both the duration and the severity of hyperglycemia. Development of diabetic retinopathy in patients with type 2 diabetes was found to be related to both severity of hyperglycemia and presence of hypertension.> Diabetic nephropathy is the leading cause of renal failure. It is defined by proteinuria > 500 mg in 24 hours in the setting of diabetes, but this is preceded by lower degrees of proteinuria, or "microalbuminuria." Microalbuminuria is albumin excretion of 30-299 mg/24 hours. Without intervention, diabetic patients with microalbuminuria typically progress to proteinuria and overt diabetic nephropathy. This progression occurs in both type 1 and type 2 diabetes.