Early-onset type 2 diabetes: not a benign condition

Abstract

Case history J.T. is a 39-year-old non-smoking female with type 2 diabetes. She was referred to a diabetes clinic because of poor glycaemic control, despite being on maximal doses of metformin and gliclazide. She was diagnosed with type 2 diabetes at 35 years of age and has a medical history of hypertension and a family history of ischaemic heart disease. Her parents suffered myocardial infarctions in their 60s. Her medications included metformin 1 g twice daily, gliclazide 160 mg twice daily, bendrofluazide 2.5 mg daily and felodipine MR 5 mg daily. When seen at the diabetes clinic, J.T. was obese (body mass index 35.8 kg/m) with a HbA1c of 9% and total cholesterol level of 6.2 mmol/L. She was also hypertensive, with a blood pressure reading of 159/103 mmHg, but showed no signs of overt diabetic microvascular or macrovascular complications. J.T. was started on insulin treatment and her glycaemic control improved to a HbA1c level of 7.8%. Within 15 months of her first attendance at the diabetes clinic, she was admitted with chest pains. Her electrocardiogram showed abnormal ST segment changes in the anterior leads. The troponin I level was significantly raised at 6.8 ng/ml and she was diagnosed with non-ST elevation myocardial infarction. Coronary angiography showed occlusive atherosclerotic disease in the left anterior descending artery (figure 1). She underwent coronary angioplasty and stenting. Echocardiogram showed impaired left ventricular systolic function. Following this episode, J.T. made a satisfactory recovery and atorvastatin treatment was commenced to reduce her cholesterol level.