[Advanced microangiopathic complications at the diagnosis of diabetes mellitus]

A case of a 59-year-old male patient with advanced microangiopathic complications at the diagnosis of diabetes mellitus is reported. The patient was referred to ophthalmological investigation due to progressive loss of visual acuity. Although diabetes mellitus was not known, proliferative diabetic retinopathy with significant visual loss was found at fundus examination. Not only newly diagnosed diabetes mellitus (initial fasting blood glucose 19.0 mmol/, HbA1c: 11.6%) but the presence of advanced sensory, motor and autonomic diabetic neuropathy (nervus peroneus motor conduction velocity: 32.1 m/s, nervus suralis sensory conduction velocity could not be detected, postural decrease in systolic blood pressure: 20 mmHg, beat-to-beat variation 6 beats/min, 30:15 ratio 1.03) as well as signs of advanced diabetic nephropathy (daily urinary protein excretion: 1.2-5.7 g, serum creatinine value: 101 mumol/l, sitting blood pressure: 150/100-180/100 mmHg) could be documented by further investigations at Medical Department. Avoiding short-term strict metabolic control insulin therapy was initiated and adequate long-term diabetic control was achieved later (HbA1c: 6.5-6.2%). In order to classify the diabetes, repeated measurements of serum C-peptide, ICA, GADA and IA2-antibodies were performed and type 2 diabetes was diagnosed. After a transient deterioration the proliferative retinopathy remained unchanged. Although laser photocoagulation was performed, no improvement in the visual acuity could be achieved. Only a minor improvement of neurological alterations was documented by repeated electrophysiological investigation at follow-up. Although the antihypertensive treatment (ACE-inhibitor drug in combination with calcium channel blocker) resulted in a significant decrease of elevated blood pressure, only a transient improvement of proteinuria could be achieved. Despite regular control, the advanced microangiopathic complications of diabetes mellitus carry poor prognosis.