The expanding spectrum of diabetes

Abstract

The conventional approach views diabetes in binary
terms: as type 1 or type 2 diabetes, with acute or chronic
complications, needing either insulin or non-insulin
agents. This, however, is an over-simplified impression.
Diabetes may be a single eight-letter word, but it packs a
wide spectrum of causative factors, clinical presentations,
comorbid conditions, and complications.¹
This is evident in the article published by Asma Ahmed
et.al.2, who analyzed cases of diabetes ketoacidosis (DKA)
presented to their center in Karachi.2 DKA is usually
thought to be a complication of poorly controlled
diabetes, but the authors highlight the susceptibility of
persons with type 2 diabetes to DKA as well. This
phenomenon, initially described as Flatbush diabetes, is
common in people of South Asia ancestry.³ The patient
may present in ketoacidosis or ketosis and then recover
after the initial glucotoxicity and lipotoxicity have been
corrected. COVID-19 is known to be a pro-diabetogenic
condition, as it is associated with a poorer prognosis in
persons with diabetes.⁴ This is clear from the study results,
which showed the high frequency of DKA and the
relatively poor prognosis of this complication in COVID-19
infected patients.²

Continued....