Features of diagnostics and treatment of the patient with slowly evolving immune-mediated diabetes and multiple complications
https://doi.org/10.14341/DM13383
Abstract
Slowly developing immune-mediated diabetes mellitus in adults combines the phenotypic and immunological characteristics of type 1 and type 2 diabetes mellitus, which often complicates the correct diagnosis and timely initiation of appropriate glucose-lowering therapy. The article presents a clinical case of a 46-year-old patient with slowly evolving immune-mediated diabetes with multiple complications, initially diagnosed as type 2 diabetes mellitus, upon hospitalization in a surgical hospital for phlegmon of the right foot. A feature of the clinical case is the complications, the severity of which did not correspond to the known duration of the disease and was due to a "hidden", long-term course. The correct diagnosis established during the diagnostic search will avoid attempts to prescribe incorrect therapy to the patient in the future, which can lead to decompensation of carbohydrate metabolism and progression of late complications. With this article, we want to draw the attention of endocrinologists and doctors of other specialties to the complexity, diversity of the clinical course of LADA diabetes and the need for differential diagnosis, a detailed collection of the disease history, as well as the importance of determining autoantibodies in the atypical course of type 2 diabetes mellitus.
About the Authors
M. V. Yaroslavceva
Endocrinology Research Centre
Russian Federation
Competing Interests:
Russian Federation
Marianna V. Yaroslavceva, MD, PhD
Moscow
Competing Interests:
Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с содержанием настоящей статьи.
D. A. Kataeva
Endocrinology Research Centre
Russian Federation
Competing Interests:
Russian Federation
Daria A. Kataeva, MD, clinical resident
11 Dm. Ulyanova street, 117036 Moscow
Competing Interests:
Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с содержанием настоящей статьи.
G. R. Galstyan
Endocrinology Research Centre
Russian Federation
Competing Interests:
Russian Federation
Gagik R. Galstyan, MD, PhD, Professor
Moscow
Competing Interests:
Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с содержанием настоящей статьи.
O. N. Bondarenko
Endocrinology Research Centre
Russian Federation
Competing Interests:
Russian Federation
Olga N. Bondarenko, MD, PhD
Moscow
Competing Interests:
Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с содержанием настоящей статьи.
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1. Figure 1. Lower extremities of patient M. (A — wound of the left heel at admission to the Diabetic Foot Department of the Institute of Diabetes, Endocrinology Research Centre; B — appearance of the lower extremities). | |
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2. Figure 2. Phlegmon of the right foot in patient M. (before amputation, June 2024). | |
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3. Figure 3. Fundus appearance in patient M. Optic disc: multiple retinal hemorrhages (indicated by black arrowheads) along the vessels, soft exudates (indicated by white arrows). | |
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4. Figure 4. Posterior tibial artery of the left lower leg. B-mode ultrasound. Relatively uniform increase in vascular wall echogenicity combined with loss of layer differentiation and multiple calcifications (arrow). | |
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5. Figure 5. X-ray of the left foot, lateral view. The arrow indicates a forming focus of osteonecrosis and wound-related soft tissue rarefaction. | |
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6. Figure 6. Left heel region of patient M. two weeks after discharge. | |
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For citations:
Yaroslavceva M.V., Kataeva D.A., Galstyan G.R., Bondarenko O.N. Features of diagnostics and treatment of the patient with slowly evolving immune-mediated diabetes and multiple complications. Diabetes mellitus. 2026;29(1):50-56. (In Russ.) https://doi.org/10.14341/DM13383
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