[What may cause diabetes]

Area of Science:

• Cardiology
• Endocrinology
• Nephrology

Background:

• A 49-year-old male with a history of morbid obesity (BMI 40 kg/m2), arterial hypertension since adolescence, dyslipidemia, and type 2 diabetes mellitus presented with multiple comorbidities.
• The patient had a history of smoking until 2011 and was on multiple medications for his conditions, including insulin therapy for diabetes.

Observation:

• The patient experienced progressive cardiovascular decline, including heart failure (left ventricular ejection fraction 33%), acute coronary syndrome (NSTEMI), and pulmonary hypertension.
• Further complications included resistant hypertension treated with renal denervation, carotid artery stenosis, and diabetic nephropathy (KDIGO stage 3).
• In 2014, he presented with pulmonary edema, cardiogenic shock, and peripheral arterial occlusion, leading to his death despite intensive care.

Findings:

• The case illustrates the severe consequences of combined metabolic and cardiovascular risk factors, including morbid obesity, type 2 diabetes, and hypertension.
• The patient's complex medical history led to multiple organ system involvement and a fatal outcome.

Implications:

• This case emphasizes the critical link between diabetes, hypertension, and ischemic heart disease, highlighting their combined adverse impact on cardiovascular morbidity and mortality.
• It underscores the importance of comprehensive management of cardiovascular risk factors and early screening for diabetes in patients with cardiovascular disease.