The changing picture of Type diabetes E Standl International Diabetes Research Institute Munich Case report – Mr K., 56 Yrs Case report – Mr K., 56 Yrs • First visit: Dyslipidemia • Triglycerides 786 mg/dl • Total Cholesterol 318 mg/dl • LDL-Chol: not measurable • HDL-Chol 26 mg/dl • Preprandial BG 178 mg/dl • HbA1c 8.8 % • Blood pressure 168/92 mmHg Case report – Mr K., 56 Yrs Diagnoses: • Metabolic Syndrome • Type Diabetes mellitus • Obesity • Hypertension • Dyslipidemia • Coronary heart disease Indication for a potentially fatal constellation Pathogenetic key organs and hormones in Type diabetes Pancreas Adipose tissue Leptin & Adiponectin Insulin Glucagon Food Muscle Liver Artery Fuel Glucose Seeley et al, Nature Medicine (2004) 10 :454 Metabolic syndrome / Insulin resistance: causes and associated disease L o w b ir th w e ig h t A d ip o s ity a n d p h y s ic a l in a c tiv ity D ru g s G e n e tic s G lu c o s e to x ic ity Age L ip a tr o p h y INSULIN RESISTANCE METABOLIC SYNDROME c h r o n ic lo w g d e in fla m m a tio n Typ e d ia b e te s H y p e r te n s io n E n d o th e lia l d y s fu n c tio n P r o c o a g u la to r y s ta te D y s lip id e m ia C A R D I O -/M A C R O -V A S C U L A R D I S E A S E IRIS II: Insulin Resistance and Chemical Profile Parameter N Insulin [uU/ml] Intact Proinsulin [pmol/l] Resistin [ng/ml] PAI-1 [AU/ml] Glucose [mg/dl] HbA1c[%] Triglycerides [mg/dl] HDL [mg/dl] LDL [mg/dl] CRP [mg/dl] Fibrinogen [g/l] Adiponectin [mg/mi] HOMA sensitive 1146 6±2 5±4 0,7 ± 3,6 160 ± 95 95 ± 22 6,4 ± 1,0 148 ± 160 52 ± 14 125 ± 33 1,7 ± 1,4 2,8 ± 1,0 13 ± HOMA resistant (>2.0) 3119 17 ± 11 14 ± 14 0,3 ± 0,4 202 ± 99 120 ± 35 7,0 ± 1,3 210 ± 163 46 ± 12 128 ± 33 1,9 ± 2,4 2,9 ± 1,0 8±5 Significance p