Diabetes Mellitus Type 2

Pathogenesis of Chronic Complications

 Pancreas

1. Type 1 diabetes:
• Reduction in the number and size of islets.
• Leukocytes infiltration (insulitis)
2. Type 2 diabetes:
• Reduction in islet cell mass
• Amyloid deposition, fibrosis
 Complications:

• Macroangiopathy:
Affects large and medium blood vessels
(atherosclerosis, IHD, lower extremity
ischemia and arteriosclerosis)
• Microangiopathy:
Affects small blood vessels (retinopathy,
nephropathy and neuropathy)
 Atherosclerosis

• Endothelial dysfunction.
• Targets large and medium blood
vessels.
• Consequences:
1. Myocardial infarction
2. Cerebral infarction (stroke)
3. Aortic aneurysms
4. Peripheral vascular disease
Gangrene
 Hyaline arteriosclerosis

• Plasma protein leakage + increased

smooth muscle matrix synthesis.
• Associated with hypertension
(more severe in diabetic patients)
• Amorphous, hyaline thickening of the
walls of the arterioles.
Microangiopathy:

• Diffuse thickening of basement membranes.

• Leads to the development of nephropathy, neuropathy and retinopathy.
 Nephropathy:

• Three lesions are encountered:

1. Glomerular lesions
• Capillary basement membrane thickening
• Diffuse mesangial sclerosis
• Nodular glomerulosclerosis
2. Renal vascular lesions - Arteriolosclerosis
3. Pyelonephritis including necrotizing papillitis
Nephropathy- Glomerular Lesions:

Capillary basement membrane thickening Kimmelstiel-Wilson nodules

Glomerular Lesions

• Glomerular and arteriolar lesions →

ischemia → fine scarring of the
kidney with granular cortical surface
Renal vascular lesions
Pyelonephritis

• Acute/chronic inflammation of the kidneys.

Papillary necrosis Acute pyelonephritis

Ocular Complications

• Cataract
• Glaucoma
• Proliferative/non-proliferative retinopathy
Neuropathy

• Central:
Strokes & hemorrhages.
• Peripheral:
Autonomic neuropathy & distal symmetric neuropathy