management to identify and prevent secondary complications from the disease processMacrovascular and Microvascular Complication Evidence-based assessment amp. management to identify and prevent secondary complications from the diabetes mellitusChronic diseases have been an important issue in various countries around the world. In Australia, there is no exception as many people are affected. This is clear is Nick, Marty, and Sam cases in which the condition is likely to lead to complications.Various complications can arise from individuals that have diabetes mellitus. The complications are listed as macrovascular and microvascular. Hence, Nick, Marty, and Sam are likely to have one of the complications due to the severity of their conditions. The complication may be macrovascular or microvascular. One of the most likely microvascular complications that they are likely to develop is retinopathy commonly known as retinopathy. The complication can be easily identified in individual with type 1 and type 2 diabetes. One can use several features in easy identification of the condition. One of the common characteristics that can be easily used in the identification of the complication is the presence of small haemorrhages in the central part of the retina (Fowler, 2008). Haemorrhages in this section of the eye appear as dots. The other characteristics that can be easily used in the identification of the condition in these individuals is the presence of hard exudates in the skin. The other common attributes are the presence of small vascular dilatations that occur in the retina commonly known as microaneurysms (Fowler, 2008). The location of the small vascular dilations can help in direct identification of the complication as they are usually the first to develop. Moreover, an individual is most likely to have retinal oedema that indicates microvascular leakage. Hence, individual retina is most likely to be greyish in colour. The severity can be easily identified by noting individual visual capability. The management of the disease is crucial in preventing the development of the complication. One of the key things in preventing of complication is by ensuring the three take part in dietary changes (Lewis, Dirksen, Heitkemper amp. Bucher, 2013). Change of diet will involve a reduction of carbohydrate intake and at the same time increase the fibre intake (Australian Indigenous HealthInfoNet. (2007). Another way of reducing complication is ensuring the affected individuals take part in eye screening. Eyes should be regularly checked by ophthalmologist especially on a yearly basis (Australian Indigenous HealthInfoNet. (2007). On the other hand, Nick, Marty, and Sam are likely to develop macrovascular complications. One of the common types of this complication is peripheral artery disease. The complication is characterised by occlusion of the lower arteries (Cade, 2008). In assessment, individuals will mostly complain of claudication and pain especially in strenuous condition. The other characteristic likely to be noted is failure of individuals to be able to carry out routine activities. The other common characteristic that is likely to exhibit during assessment is ulceration in the foot. Moreover, individual’s body is likely to show hyperglycemia that may easily indicate presence of PAD (Cade, 2008). The individuals should also be checked on the presence of hypertension, waist to hip ratio and serum fibrinogen levels. The complication can be easily managed through various initiatives. First, blood pressure should regularly be monitored. For example, it can be done twice in a year. Secondly, there should be screening for fasting blood lipids and carried out after diagnosis of diabetes mellitus in individuals (Donaghue et al., 2009). The other important part of the management is in ensuring there is metabolic control and changes in diet taken by individuals. Individuals should also be encouraged not to take part in activities that can increase the risk such as smoking (Lewis et al., 2013).In conclusion, it is clear that diabetes mellitus can lead to various complications in the body. The complication can affect individuals involved such as Nick, Marty, and Sam. Therefore, assessment and management of the condition in these individuals is crucial in ensuring that they retain a comfortable life.ReferencesAustralian Indigenous HealthInfoNet. (2007). Review of diabetes among Indigenous peoples. Retrieved 12 September 2014 from, T. (2008). Diabetes-Related Microvascular and Macrovascular Diseases in the Physical Therapy Setting. Physical Therapy, 88(11), 1322-1335.Donaghue, K., Chiarelli, F., Trotta, D., Allgrove, J amp. Dahl-Jorgensen, K. (2009). Microvascular and macrovascular complications associated with diabetes in children and adolescents. Paediatric Diabetes, 10(12), 195-203.Fowler, M. (2008). Microvascular and Macrovascular Complications of Diabetes. Clinical Diabetes, 26(2), 77-82.Lewis, S., Dirksen, S., Heitkemper, M amp. Bucher, L. (2013). Medical-Surgical Nursing: Assessment and Management of Clinical Problems. New York: Elsevier Health Sciences.

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