The Pathophysiology of Diabetes Mellitus: An Update

Both IDDM and NIDDM are multifaceted diseases whose pathophysiologies share two important characteristics. When not clinically treated, both involve chronic hyperglycemia. Further, all individuals with diabetes are at risk for developing the complications of the disease. These complications include neuropathies, retinopathies, and nephropathies. Other complications less often cited include sympathetic nervous sensitivity (at least in NIDDM), as well as neurobehavioral sequelae, especially in very young children whose IDDM treatment/response leads to two or more profound hypoglycemic episodes before age five. The future is bright--improved and appropriate insulinization, effective second-generation oral hypoglycemic agents, pancreatic transplantation, and immunosuppression offer hope in the management of diabetes.