Diabetes Mellitus: Beyond the Triopathy

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When diabetes mellitus comes into question, the most common thing that strikes the mind of a physician is triopathy, cardiovascular status and secondary infections due to the immunosupressive state. Attention also needs to be paid to the examination of the oral cavity, auditory, complete ophthalmic, skin, pulmonary, gastrointestinal and muscular system in such patients, so that the work up of a diabetic patient becomes complete in all its aspects. A few noteworthy manifestations are discussed below.

An elevated blood glucose level is associated with dysfunction, damage and failure of various organs, especially the eyes, kidneys, nerves, heart and blood vessels. The five classic complications associated with diabetes mellitus (DM) include retinopathy, neuropathy, nephropathy, cardiovascular complications (coronary arterial disease, stroke and peripheral vascular disease) and delayed wound healing. Periodontal disease has recently been recognized as the “sixth complication” of DM. Oral involvement is in the form of periodontal disease, dental caries, fissured tongue, irritation fibroma, traumatic ulcers, lichen planus, recurrent aphthous stomatitis, xerostomia and burning mouth syndrome. Taste impairment has also been associated with the development of obesity and it has been reported during the course of diabetes.

Besides the diabetic retinopathy changes known to occur in DM, other significant ocular findings may be in the form of anterior ischemic optic neuropathy, diabetic papillopathy, cranial nerve palsy, ocular ischemic syndrome, retinal vein occlusion, retinal artery occlusion, glaucoma, dry eye and hence a complete ocular workup is mandatory. Diabetic retinopathy changes in pregnancy need a special mention. In patients who had nonproliferative diabetic retinopathy, studies demonstrated that as many as 50% of them may show an increase in their nonproliferative retinopathy during pregnancy. Approximately 5-20 % of these patients develop proliferative changes.