Diabetes mellitus and its complications - type 2
Description
- Insulin resistance + progressive beta-cell failure
- Beta-cell mass already ~50% lost at diagnosis - hence progressive drug escalation
- Hyperglycaemia is the marker; the disease is cardio-reno-metabolic
- Modern therapy is chosen for organ protection, not only for HbA1c
Complications
- Microvascular - retinopathy, nephropathy, neuropathy (distal symmetric, autonomic, mononeuropathy, amyotrophy)
- Macrovascular - IHD, stroke, PAD
- Other - MASLD/MASH, OSA, foot ulcer/Charcot, infection, cognitive decline
- Microvascular risk tracks glycaemia; macrovascular risk tracks BP, lipids and smoking more than HbA1c
Look-alikes not to miss
| Clue | |
|---|---|
| LADA | Lean, GAD antibody positive, fails orals fast |
| MODY | Onset <25y, 3 generations, non-obese, no antibodies, no ketosis |
| Pancreatogenic (T3c) | Pancreatitis/CF/haemochromatosis; brittle, glucagon also lost |
| Steroid/antipsychotic-induced | Post-prandial predominant |
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