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  1. NIDDM – Non-insulin dependent diabetes mellitus (aka, type 2 diabetes).  Traditionally known as “adult-onset diabetes” this form of diabetes is diagnosed most often in adults but increasingly in children or adults under the age of 21.  There are three primary treatments for NIDDM:  a highly-restricted diet and exercise, oral medications (of many types and brands), or insulin injections.  Diet and exercise is generally prescribed for the least severe cases and insulin is prescribed for the most severe cases. 
  2. NIH – National Institutes of Health.  A funding agency of the US government that supports health-related research.
  3. Hx/Dx – History (Hx) or diagnosis (Dx) of a disease.  History indicates symptoms and diagnosis at some previous point in time.  For example a “history of MI” indicates that at some previous time a formal diagnosis of MI was given to a person.  The diagnosis indicates a formal declaration of having a disease or complication.
  4. Death from competing causes – Death from causes unrelated to diabetes (in our case).  For example, death from a train wreck.

Factors associated with NIDDM:

  1. A1C or HbA1C – Hemoglobin A1c.  This is a measure of how well a person’s glucose is under control, i.e., their body’s ability to process sugar.  Too much A1c indicates hyperglycemia (too much sugar in the blood) which leads to complications.  Too little A1C indicates hypoglycemia (too little sugar in the blood) which can lead to impaired neurological function, seizures, or coma (in rare occasions death).  A1C is frequently used as a marker for adequate treatment of diabetes.
  2. SBP/DBP – Systolic and diastolic blood pressure.  Markers of early heart disease.
  3. Hyperlipidemia – Lipid levels that are too high.  There are several types of lipids (fats) that a person’s body produces and/or uses. Commonly reported lipids are LDL (low-density lipoprotein), HDL (high-density lipoprotein), and cholesterol.  In general, HDL is considered a “good” lipid (you want lots of HDL) and the others are considered “bad” (too much is bad for you). Hyperlipidemia increases a person’s risk for heart disease.

Complications of Diabetes Identified in the Michigan Model

  1. Retinopathy – Eye disease.  Diabetes is the leading cause of retinopathy in the US.  Stages of retinopathy in increasing severity are:
    1. Non-proliferative retinopathy – There is some damage but it is not spreading.
    2. Proliferative retinopaty – The damage is spreading.
    3. Macular edema – Thickening of the retina causing vision loss.  Macular edema can occur with or without proliferative and non-proliferative retinopathy.
    4. Blindness – may occur in one or two eyes.
  2. Neuropathy – Disease of nerve endings.  Diabetic neuropathy usually begins in the ends of long nerves and progressively worsens.  For example, neuropathy is usually first observed as a tingling sensation in a person’s feet, followed by loss of sensation in the feet, followed by loss of sensation in the legs and fingers.  Stages of diabetic neuropathy are:
    1. Clinical Neuropathy – Typically indicated by loss of sensation in the toes or soles of feet and with foot ulceration: Loss of sensation in the foot inhibits unconscious protections such as shifting one’s weight or gait when walking.  This causes repetitive pressure on a particular spot of the foot (usually near a pointy bone) and eventually wears an ulcer on the foot in the same way you can wear a hole through a glove or a pair of pants through repetitive use.  The destructive potential of this repetitive pressure is enhanced by microvascular compromise (poor blood flow to the foot) making it difficult for the skin to repair the damage.
    2. Amputation – Amputation in the diabetic patient is usually caused by an infected foot ulcer that becomes gangrenous secondary to poor circulation to the affected area. Although amputation in the general population is not usually thought as a complication of nerve damage, in our diabetes model, we consider it to be the worst outcome of the progression starting with clinical neuropathy.  More than 60 percent of nontraumatic lower-limb amputations occur among people with diabetes.
  3. Nephropathy – Disease of the kidneys. Stages of nephropathy include:
    1. Microalbuminuria – Pre-clinical nephropathy marked by small amounts of albumin protein leaking from the kidney and excreted in the urine.  Microalbuminuria is a very early indicator of kidney disease and is one of the few complications of diabetes that can be reversed if treated early.  The extra glucose in the blood (from hyperglycemia in uncontrolled diabetes) is filtered in the kidneys; but eventually the overloaded kidneys begin to break down and microscopic holes appear in the kidney wall allowing albumin to leak into the urine.
    2. Proteinuria – Otherwise known as macroalbuminuria, proteinuria occurs when large amounts of protein are excreted in a person’s urine.
    3. ESRD – End stage renal disease.  This is when the kidneys actually fail.  There are two treatments described below.  Diabetes is the leading cause of kidney failure, accounting for 44 percent of new cases in 2002.
    4. Dialysis – Filtering of blood by mechanical methods after the kidneys have failed in part or in whole.  This is very expensive and unpleasant. 
    5. Transplant – Transplantation of one or both kidneys.  Again, this is very unpleasant. 
  4. Cardiovascular Disease or Coronary Heart Disease
    1. Angina – Stable angina usually relates to the fact that the patient is stable (heart rhythm is not dangerous, vital signs are stable, etc.). Unstable angina is when the patient is not medically stable. Thus the patient has a much higher risk for heart damage and death.
    2. MI/Cardiac Arrest – Myocardial infarction (a heart attack).  An MI is caused by loss of oxygen to the heart causing the destruction of heart tissue.  The term “heart attack” is a less precise term and is occasionally also used to describe unstable angina.
    3. Hx of MI – Had an MI and survived.
  5. Cerebral Vascular Disease  
    1. TIA – Transient ischemic attack.  This is a temporary loss of oxygen to the brain.  Extended loss of oxygen can cause permanent damage.
    2. Stroke – Destruction of brain tissue due to lack of oxygen.  The loss of oxygen can be caused by blockage of a blood vessel, or by rupture of a blood vessel.
    3. Hx of stroke – Had a stroke and survived.