Accelerated complications in Type 2 diabetes mellitus: the need for greater awareness and earlier detection

Persistent hyperglycaemia is the underlying pathogenic factor responsible for chronic diabetic complications in Type 1 and Type 2 diabetes mellitus. In Type 1 diabetes, diagnosis is made soon after the onset of hyperglycaemia and several years are required for the resultant complications to appear clinically. The onset of Type 2 diabetes is insidious and is usually recognized only 5-12 years after hyperglycaemia develops. During this period of undiagnosed diabetes, hyperglycaemia, in combination with lifestyle factors (physical inactivity, alcohol use, smoking), and other metabolic (dyslipidaemia, obesity, insulin resistance) and haemodynamic (hypertension) abnormalities frequently associated with Type 2 diabetes, promote the initiation and progression of micro- and macrovascular complications. Furthermore, when blood glucose levels are increased only slightly and no symptoms are apparent, the physician may be reluctant to diagnose Type 2 diabetes or start treatment. This delay in diagnosing the disease results in a high prevalence of chronic complications at the time of actual diagnosis. Indeed, when Type 2 diabetes is diagnosed, cardiovascular disease and neuropathy are found in approximately 10% of cases, and retinopathy and nephropathy in 15-20%. All healthcare providers should be aware of this phenomenon, which may be termed 'accelerated complications', and should plan thorough screening programmes for these conditions at diagnosis. All reversible risk factors associated with diabetes should be identified and treated. When acute metabolic derangements and infections are not the main causes of morbidity and mortality in diabetes, the costs of diabetes care are related mainly to chronic complications of the disease. Therefore, because of the high frequency of Type 2 diabetes, the most efficient method of reducing costs is to increase awareness and secure earlier detection that leads to fast and aggressive treatment of the accelerated chronic complications often seen in Type 2 diabetes.