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

Persistent hyperglycaemia is the underlying pathogenic factor responsible f or chronic diabetic complications in Type 1 and Type 2 diabetes mellitus. I n Type 1 diabetes, diagnosis is made soon after the onset of hyperglycaemia and several years are required for the resultant complications to appear c linically. The onset of Type 2 diabetes is insidious and is usually recogni zed only 5-12 years after hyperglycaemia develops. During this period of un diagnosed diabetes, hyperglycaemia, in combination with lifestyle factors ( physical inactivity, alcohol use, smoking), and other metabolic (dyslipidae mia, obesity, insulin resistance) and haemodynamic (hypertension) abnormali ties frequently associated with Type 2 diabetes, promote the initiation and progression of micro- and macrovascular complications. Furthermore, when b lood glucose levels are increased only slightly and no symptoms are apparen t, the physician may be reluctant to diagnose Type 2 diabetes or start trea tment. 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 terme d 'accelerated complications', and should plan thorough screening programme s for these conditions at diagnosis. All reversible risk factors associated with diabetes should be identified and treated. When acute metabolic deran gements and infections are not the main causes of morbidity and mortality i n diabetes, the costs of diabetes care are related mainly to chronic compli cations of the disease. Therefore, because of the high frequency of Type 2 diabetes, the most efficient method of reducing costs is to increase awaren ess and secure earlier detection that leads to fast and aggressive treatmen t of the accelerated chronic complications often seen in Type 2 diabetes. ( C) 1998 John Wiley & Sons, Ltd.