Normal glucose levels are an important part of diabetes control, but they do not provide the full picture of the disease or its risk of complications.
Normal glucose levels are an important part of diabetes control, but they do not provide the full picture of the disease or its risk of complications.
Fasting glucose shows the blood sugar level at a specific point in time, while HbA1c reflects the average glucose level over the preceding 2–3 months. However, neither measure provides a complete picture of all the factors that determine the risk of diabetes complications. That is why diabetes monitoring assesses not only glycemia but also the condition of target organs and other risk factors.
Glucose levels can rise and fall noticeably throughout the day. These fluctuations are known as glycemic variability. Their role in the development of diabetes complications is still being studied, so glycemic variability is not currently considered a separate treatment target.
One study involving more than 100,000 people with type 2 diabetes found that greater fluctuations in HbA1c over time were associated with a higher risk of heart attack, stroke, and death from any cause. This association persisted even among people whose average HbA1c remained within the target range — meaning that HbA1c variability itself was associated with a higher risk of cardiovascular complications, independent of average glucose control.
Type 2 diabetes is a progressive disease: over time, pancreatic beta-cell function may gradually decline, and treatment needs may change. Therefore, even after target glucose and HbA1c levels have been reached, the treatment regimen may need to be adjusted later. Normal test results reflect the situation at that point in time; they do not guarantee that treatment needs will remain unchanged.
Prolonged high blood glucose can damage small blood vessels, affecting the retina, kidneys, and nerve fibers.
Diabetes and vision are closely connected, and diabetic retinopathy may cause no symptoms in its early stages. A person may continue to see normally even as changes are developing in the retina. This is why, in people with type 2 diabetes, the first comprehensive eye examination is recommended at the time of diagnosis. The frequency of subsequent examinations depends on the condition of the retina and the level of glycemic control.
Diabetes and kidney health are closely linked among diabetes complications, and kidney damage, too, can develop for a long time without noticeable symptoms. To detect it, doctors assess the urine albumin-to-creatinine ratio and the estimated glomerular filtration rate (eGFR). These measures can help detect kidney damage and monitor its progression before pronounced symptoms appear.
Diabetic peripheral neuropathy is nerve damage that most often affects the nerves responsible for sensation in the feet and legs. It is relatively common, and up to 50% of cases may occur without symptoms. With reduced sensation, a person may not notice a callus, an area of skin irritation, or a minor foot injury. This increases the risk of ulcers and other complications.
Diabetes can accelerate the development of atherosclerosis in large arteries, increasing the risk of heart attack, stroke, and impaired blood flow to the limbs.
Atherosclerosis in Diabetes: Why Cardiovascular Risk Is Higher Than It Seems
Diabetes and heart health are closely connected: type 2 diabetes increases the risk of atherosclerotic cardiovascular disease, including myocardial infarction, stroke, and peripheral artery disease. This risk depends not only on blood glucose levels but also on blood pressure, lipid profile, kidney function, smoking, and other factors. That is why diabetes management includes addressing all major cardiovascular risk factors.
In some people, a heart attack can occur without the typical chest pain and may go unrecognized. Therefore, the absence of characteristic pain does not rule out a previous heart attack, particularly in people with cardiovascular risk factors.
Peripheral artery disease (PAD) is more common in people with type 2 diabetes and may have an atypical or symptom-free course. The classic symptom — pain or discomfort in the legs while walking that improves with rest — is not always present. As a result, the disease may go unnoticed until blood flow becomes significantly impaired.
When arteries become significantly narrowed, the tissues of the lower limbs receive less blood and oxygen. This may cause pain at rest, slow-healing wounds, ulcers, or other signs of ischemia. In severe cases of impaired blood flow, the risk of non-healing ulcers, infection, and amputation increases.
Some diabetes complications develop simultaneously and can worsen each other. This is particularly evident when impaired sensation is combined with inadequate blood flow to the tissues.
Diabetic foot syndrome is associated with a combination of neuropathy, impaired blood flow, foot deformities, and other factors that increase the risk of ulcers and make them harder to heal. Because protective sensation is reduced or lost, a person may not notice a minor injury, while inadequate blood flow can delay wound healing.
Even after an ulcer has healed, the risk of recurrence remains elevated. That is why people with diabetic foot syndrome need regular foot examinations and measures to prevent further injury.
When neuropathy is combined with impaired blood flow, treatment requires several underlying factors to be assessed at the same time. The doctor needs not only to treat the ulcer itself but also to control infection, assess blood flow to the limb, and determine whether a vascular procedure is needed. Continued follow-up is important after healing because the risk of recurrent ulcers remains elevated.
Type 2 diabetes affects the body more broadly than its usual list of complications might suggest. Some conditions associated with diabetes are considered comorbidities rather than direct complications, but they still need to be taken into account when monitoring a person with diabetes.
Metabolic dysfunction–associated steatotic liver disease (MASLD) is often associated with type 2 diabetes and insulin resistance. In this condition, excess fat accumulates in the liver, and in some people this can progress to metabolic dysfunction–associated steatohepatitis (MASH), which may involve liver inflammation and fibrosis.
MASLD may cause no specific symptoms, so its assessment is based not only on symptoms but also on risk factors and laboratory findings. The ADA’s 2026 Standards of Care recommend considering MASLD and MASH as part of the comprehensive evaluation of people with diabetes.
Prolonged hyperglycemia can impair immune function and reduce the body’s ability to fight infection. As a result, skin injuries may take longer to heal, and the risk of infection increases.
Type 2 diabetes is associated with an increased risk of cognitive impairment and vascular dementia. Prolonged hyperglycemia, high blood pressure, and vascular damage can impair blood flow to the brain and contribute to damage to brain tissue. The risk is further increased by other cardiovascular risk factors and a history of vascular events, including stroke.
Controlling diabetes is not just about reaching a target glucose level. It also means regularly monitoring how the disease is progressing and assessing the risk of its complications.
Diabetes management is not limited to a single measure, such as fasting glucose. A person may have no symptoms of damage to the eyes, kidneys, nervous system, or peripheral arteries, which is why these complications require dedicated screening. The ADA’s 2026 Standards of Care consider glycemic control one part of comprehensive diabetes management, alongside assessment of cardiovascular risk, kidney function, eye health, the nervous system, and the feet.
For risk assessment, it is important to monitor blood pressure, lipid profile, kidney function (eGFR and the urine albumin-to-creatinine ratio), the condition of the retina, and sensation and blood flow in the feet. Each of these assessments may seem unnecessary on its own when blood sugar is “normal.” However, taken together, they can reveal what a single fasting glucose test cannot show.
Cell therapy is being studied as one promising approach to treating diabetes complications, particularly those associated with impaired blood flow and nerve damage. At the same time, its potential and long-term effectiveness continue to be investigated.
Mesenchymal stem cells are being studied as a potential approach for targeting processes involved in ischemia and tissue repair. In preclinical studies, their effects have been linked to paracrine activity — the release of signaling molecules that can influence inflammation, new blood vessel formation, and other repair processes. For more information about how cell therapy is used in the treatment of type 2 diabetes and its complications, see the page on treating type 2 diabetes with stem cells.
In a randomized, placebo-controlled study involving 40 patients with type 2 diabetes complicated by lower-limb angiopathy, administration of mesenchymal stem cells in addition to standard treatment was associated with better outcomes than standard treatment alone: pain decreased, foot sensation improved, trophic ulcers healed faster, and patients’ quality of life improved. No adverse effects requiring discontinuation of therapy were recorded.
This approach is not a replacement for basic treatment, including weight management, blood pressure and blood glucose control, and regular foot examinations. Rather, it may be considered an addition to standard care in cases where vascular and neuropathic complications are already pronounced. Long-term data remain limited, so the decision about whether this therapy is appropriate in an individual case is made by the treating physician.
What makes type 2 diabetes dangerous? It is a disease whose course can change over time and affect multiple organs and systems. Looking at glucose levels alone does not provide a complete picture of a person’s condition or allow all risks to be assessed independently.
Regular monitoring of glycemia, blood pressure, lipid profile, kidney function, and the condition of the eyes, nervous system, and feet can help detect abnormal changes in time. It is equally important to take comorbid conditions into account, as they can affect quality of life and overall prognosis.
The consequences of type 2 diabetes can remain unnoticed for a long time. That is why treatment requires regular assessment of the patient’s condition and adjustment of therapy when necessary. Promising approaches, including cell therapy, continue to be studied as potential additions to standard treatment for individual complications.
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