Endocrine Abstracts

Background: Type 1 diabetes mellitus is an autoimmune disorder caused by the destruction of the pancreatic beta cells which produce insulin. People with type 1 diabetes usually require at least 3-5 years to develop microvascular complications in comparison to those with type 2 diabetes, who may develop such complications even before the diagnosis of diabetes due to its insidious onset and the delay in diagnosis. We discuss a patient who initially presented with proliferative diabetic retinopathy and later diagnosed with type 1 diabetes. Microvascular complications including diabetic retinopathy as the presenting feature of Type 1 diabetes in rarely known or reported in the literature.

Case presentation: A 33-year-old male was seen by the opticians due to one week history of blurred vision. The ophthalmology assessment confirmed proliferative retinopathy of right eye and severe non proliferative retinopathy of left eye with bilateral clinically significant macular oedema. He denied any osmotic symptoms or weight loss. His BMI was 24.9 kg/m2 and random glucose of 24.9 mmol/l. The plasma ketones was 0.7 mmol/l and HBA1c was 177 mmol/mol. The nervous system examination revealed bilateral stocking type of peripheral neuropathy. His Anti Glutamic acid decarboxylase (GAD) antibody was positive confirming the diagnosis of type 1 diabetes mellitus. He was started on basal bolus regimen for blood glucose control and was started on Aflibercept injection to both eyes followed by pan-retinal photocoagulation. Later Nerve conduction studies confirmed the presence of large fiber sensory more than motor, axonal, length dependent peripheral neuropathy suggestive of diabetic symmetric polyneuropathy

Conclusions: The pathogenesis of the development of microvascular complications of type 1 diabetes mellitus is multifactorial. Usually, the development of complications is seen at least few years after the diagnosis. Occurrence of microvascular complication at presentation is rare and makes the management challenging and extremely important to prevent the progression of the disease.