Clinical Manifestations

There are five stages in the natural history of DM:

First stage: susceptibility based on a combination of (1) genetic risk factors; (2) physiological states such as obesity for type II diabetes; (3) and environmental factors including diet, climate, activity, and other life-style patterns. Second stage: glucose intolerance, which is recognized as a phase preceding both insulin-dependent and non-insulin-dependent diabetes. Not all individuals having impaired glucose tolerance progress to symptomatic diabetes. Third stage: chronic hyperglycemia without complications.

Fourth stage: frank diabetes with complications but without disability. Fifth stage: disability due to functional impairment from the complications of diabetes, which involve primarily the vascular system. Common complications include renal disease, blindness due to retinopathy, neuropathy, cerebral vascular disease, cardiac disease, and peripheral vascular disease often leading to lower limb amputation.

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