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Medicina
Special Issues
Type 2 Diabetes and Insulin Resistance
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Type 2 Diabetes and Insulin Resistance

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Endocrinology".

Deadline for manuscript submissions: closed (31 August 2019) | Viewed by 62495

Special Issue Editor

Dr. Domenico Sergi

E-Mail Website
Guest Editor
Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
Interests: nutrition and metabolic health; energy metabolism; obesity; type 2 diabetes; regulation of energy balance by the hypothalamus; Lipotoxicity and fatty acid metabolism; mitochondria dysfunction and insulin resistance; metabolic inflammation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Type 2 diabetes has reached epidemic proportions worldwide and is projected to afflict more than 300 million individuals by the year 2025. Insulin resistance is the hallmark of type 2 diabetes and represents a pivotal metabolic defect in its pathogenesis. Given the importance of insulin resistance as a critical pathogenic factor leading to type 2 diabetes, the journal Medicina is launching a Special Issue entitled “Type 2 Diabetes and Insulin Resistance” with the aim of gathering together accurate and up-to-date scientific information on all aspects of insulin resistance and type 2 diabetes. We are pleased to invite you and your co-workers to submit your original research articles reporting on the biochemical and molecular aspects of insulin resistance including the pathophysiological mechanisms underpinning its development. We also encourage the submission of original manuscripts spanning basic to clinical research and focusing on dietary, lifestyle, and pharmacological interventions to prevent and/or ameliorate insulin resistance. We would also like to invite you to submit review articles aimed at providing a comprehensive overview of the recent advances in understanding the molecular basis of insulin resistance and its treatment and/or prevention.

Dr. Domenico Sergi
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • insulin resistance
  • type 2 diabetes
  • metabolic syndrome
  • carbohydrate metabolism
  • lipid metabolism
  • meta-inflammation
  • lipotoxicity
  • mitochondrial dysfunction

Published Papers (9 papers)

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Research

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10 pages, 310 KiB  
Article
Type 2 Diabetes and Cardiovascular Factors Contrasted with Fibrinolysis Disorders in the Blood of Patients with Peripheral Arterial Disease
by Radosław Wieczór, Anna Maria Wieczór, Arleta Kulwas and Danuta Rość
Medicina 2019, 55(7), 395; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina55070395 - 22 Jul 2019
Cited by 8 | Viewed by 2553
Abstract
Background and objectives: Both in the pathogenesis of type 2 diabetes (DM 2) and Peripheral Arterial Disease (PAD), a vital role is played by endothelial dysfunction. Metabolic disorders found in DM 2 (hyperglycemia, insulin resistance), endothelial dysfunction, and increased inflammation lead to intensified [...] Read more.
Background and objectives: Both in the pathogenesis of type 2 diabetes (DM 2) and Peripheral Arterial Disease (PAD), a vital role is played by endothelial dysfunction. Metabolic disorders found in DM 2 (hyperglycemia, insulin resistance), endothelial dysfunction, and increased inflammation lead to intensified atherothrombosis. The fibrinolysis system comprises a natural compensatory mechanism in case of hypercoagulability. The aim of this study was to assess concentrations of selected fibrinolysis parameters in the blood of patients with symptomatic PAD, including in particular concurrent DM 2 and other cardiovascular factors. Materials and Methods: In the group of 80 patients with PAD (27 F/53 M) and 30 healthy volunteers (10 F/20 M), the following parameters were measured: Concentrations of fibrinogen, tissue-Plasminogen Activator (t-PA Ag), Plasminogen Activator Inhibitor-1 (PAI-1 Ag), D-dimer, and platelet (PLT) count. Results: In the blood of patients with PAD and concomitant DM 2 significantly higher concentrations of fibrinogen were found in comparison with patients with PAD and without diabetes (p = 0.044). No significant impact was observed in individuals with atherosclerotic complications (manifested by coronary artery disease, atherosclerosis of cerebral arteries) and selected cardiovascular risk factors (smoking, LDL and triglyceride concentrations, BP values) on the levels of t-PA, PAI-1, D-dimer, and PLT count. It was found that t-PA Ag and PAI-1 Ag values tended to rise along with a BMI increase in the subgroups of subjects (with normal body mass, overweight, and obesity), but no statistically significant differences were observed. However, two significant positive correlations were reported between t-PA Ag and BMI, as well as between PAI-1 Ag and BMI. Conclusions: Type 2 diabetes in peripheral arterial disease affects the concentration of fibrinogen causing its increase, which is connected with the inflammation and prothrombotic process in the course of both conditions. The concurrence of atherosclerosis of coronary or cerebral arteries, smoking, LDL and TG concentrations, and BP value do not have a significant impact on the levels of analyzed fibrinolysis parameters. A positive correlation between BMI and t-PA Ag and PAI-1 Ag concentrations needs to be supported in further studies on a larger number of overweight and obese patients. Full article
(This article belongs to the Special Issue Type 2 Diabetes and Insulin Resistance)
13 pages, 538 KiB  
Article
Evaluation of Dyslipidaemia Using an Algorithm of Lipid Profile Measures among Newly Diagnosed Type II Diabetes Mellitus Patients: A Cross-Sectional Study at Dormaa Presbyterian Hospital, Ghana
by Enoch Odame Anto, Christian Obirikorang, Max Efui Annani-Akollor, Eric Adua, Sampson Donkor, Emmanuel Acheampong and Evans Adu Asamoah
Medicina 2019, 55(7), 392; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina55070392 - 21 Jul 2019
Cited by 4 | Viewed by 3447
Abstract
Background and Objectives: Dyslipidaemia and its associated complications have been reported to increase mortality among type 2 diabetes mellitus (T2DM) patients. However, there is a dearth of data on the incidence of dyslipidemia among Ghanaian patients with T2DM. This study evaluated dyslipidemia [...] Read more.
Background and Objectives: Dyslipidaemia and its associated complications have been reported to increase mortality among type 2 diabetes mellitus (T2DM) patients. However, there is a dearth of data on the incidence of dyslipidemia among Ghanaian patients with T2DM. This study evaluated dyslipidemia among newly diagnosed T2DM patients at Dormaa Presbyterian Hospital, Ghana. Materials and Methods: This cross-sectional study recruited a total of 215 participants at the Presbyterian Hospital, Dormaa-Ghana. A well-structured questionnaire was administered to collect demographic data. Predisposing factors of dyslipidemia such as BMI, hypertension, and family history of diabetes were also obtained. Lipid profile was performed on the serum obtained from each respondent. Dyslipidaemia was defined as total cholesterol (TC) >200 mg/dL, triglyceride (TG) >150 mg/dL, low density lipoprotein cholesterol (LDL-c) >100 mg/dL, and high-density lipoprotein cholesterol (HDL-c) <40 in males and <50 mg/dL in females. Combinations of the individual parameters of dyslipidaemia were further evaluated. Results: Of the total (215) participants, 86 (40%) were males and 129 (60%) were females, representing a ratio of 1:1.5. High total cholesterol was more prevalent in females (69.0%) than males (53.5%). Generally, dyslipidaemia was predominant among those aged >40 years, with the exception of increased LDL-c (25.1%), which was higher among the 20–40 years age group. The male participants exhibited significantly (p < 0.001) higher percentages of all combined measures of dyslipidaemia—such as high TG and reduced HDL-c (77.9%), high TG and elevated LDL-c (75.6%) and high LDL and low HDL (65.1%). BMI was significantly associated with HDL levels (p = 0.02), whereas family history of diabetes was associated with TC (p = 0.004) and TG levels (p = 0.019). Conclusion: Combined dyslipidaemia is relatively high among newly diagnosed T2DM patients in Ghana, and in those >40 years. Gender is significantly associated with combined dyslipidaemia in T2DM, and males may be at a higher risk than females. BMI and family history of diabetes are potential risk factors of dyslipidaemia in T2DM. Full article
(This article belongs to the Special Issue Type 2 Diabetes and Insulin Resistance)
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9 pages, 322 KiB  
Article
High HOMA-IR Index in Healthcare Shift Workers
by Caterina Ledda, Diana Cinà, Serena Matera, Nicola Mucci, Massimo Bracci and Venerando Rapisarda
Medicina 2019, 55(5), 186; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina55050186 - 22 May 2019
Cited by 28 | Viewed by 3615
Abstract
Background and objectives: Evidence shows that shift work may be correlated with insulin resistance (IR). Therefore its estimation in clinical and prevention practice is of great significance. A cross-sectional study was performed to examine the Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) Index among healthcare [...] Read more.
Background and objectives: Evidence shows that shift work may be correlated with insulin resistance (IR). Therefore its estimation in clinical and prevention practice is of great significance. A cross-sectional study was performed to examine the Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) Index among healthcare shift workers (HCSW). Materials and Methods: A total of 272 healthcare workers (HCWs) were invited to participate in the study within an occupational surveillance framework, 137 were HCSW while 135 were healthcare non-shift workers (HCNSW). Fasting glucose, insulin, and HOMA-IR Index were evaluated in each participant and correlated with shift workers. Results: Indicators of glucose metabolism were significantly higher in HCSW p < 0.001, and logistic regression analysis confirmed a significant positive association between increased values of HOMA-IR Index and shift workers (p < 0.05). Conclusions: Shift work could be a risk factor in developing insulin resistance and metabolic syndrome. Full article
(This article belongs to the Special Issue Type 2 Diabetes and Insulin Resistance)
11 pages, 918 KiB  
Article
Predominant Complications of Type 2 Diabetes in Kumasi: A 4-Year Retrospective Cross-Sectional Study at a Teaching Hospital in Ghana
by Max Efui Annani-Akollor, Otchere Addai-Mensah, Linda Ahenkorah Fondjo, Lorraine Sallah, Eddie-Williams Owiredu, Emmanuel Acheampong and Solomon Akamugri
Medicina 2019, 55(5), 125; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina55050125 - 09 May 2019
Cited by 11 | Viewed by 3493
Abstract
Background and objectives: Diabetes mellitus type 2 (T2DM) has been associated with several microvascular and macrovascular complications. However, studies regarding the predominant complications of T2DM in Ghana have not been conducted. This study evaluated the prevalence and predominant complications of T2DM and [...] Read more.
Background and objectives: Diabetes mellitus type 2 (T2DM) has been associated with several microvascular and macrovascular complications. However, studies regarding the predominant complications of T2DM in Ghana have not been conducted. This study evaluated the prevalence and predominant complications of T2DM and assessed the sociodemographic factors associated with the development of diabetes-related complications in Kumasi, Ghana. Materials and Methods: This was a retrospective cross-sectional study conducted at Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. A total of 1600 Ghanaian T2DM adults were included in this study. Patients’ clinical data from 2012 to 2016 were retrieved from the hospital’s archive. Results: The prevalence of macrovascular and microvascular complications of T2DM was 31.8% and 35.3% respectively. The prevalence of neuropathy, nephropathy, retinopathy, sexual dysfunction, diabetic keto-acidosis (DKA), and hypoglycemia were 20.8%, 12.5%, 6.5%, 3.8%, 2.0%, and 0.8% respectively. Sexual dysfunction was significantly associated with the male gender compared to females. Being employed: Informal (aOR = 0.479, p < 0.0001), and Formal (aOR = 0.475, p = 0.0008) was associated with lower age- and sex-adjusted odds of developing T2DM-related complications while having T2DM for 5–10 years (aOR = 1.550, p = 0.0009) and more than 10 years (aOR = 2.755, p < 0.0001) was associated with increased odds of developing complications. Conclusions: Microvascular complication is the most predominant among T2DM in Kumasi, Ghana. The most prevalent T2DM-related microvascular complication in Kumasi, Ghana is neuropathy. Sexual dysfunction is associated with male compared to female T2DM patients. Being employed reduces the chance of developing T2DM-related complications while increasing DM duration increases the risk of complications. Full article
(This article belongs to the Special Issue Type 2 Diabetes and Insulin Resistance)
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8 pages, 326 KiB  
Communication
Common Polymorphisms Linked to Obesity and Cardiovascular Disease in Europeans and Asians are Associated with Type 2 Diabetes in Mexican Mestizos
by Angélica Saraí Jiménez-Osorio, Claudette Musalem-Younes, Helios Cárdenas-Hernández, Jacqueline Solares-Tlapechco, Paula Costa-Urrutia, Oscar Medina-Contreras, Julio Granados, Catalina López-Saucedo, Teresa Estrada-Garcia and Martha Eunice Rodríguez-Arellano
Medicina 2019, 55(2), 40; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina55020040 - 05 Feb 2019
Cited by 9 | Viewed by 2633
Abstract
Background and objectives: Type 2 diabetes (T2D) is a major problem of public health in Mexico. We investigated the influence of five polymorphisms, previously associated with obesity and cardiovascular disease in Europeans and Asians, on T2D in Mexican Mestizos. Materials and Methods [...] Read more.
Background and objectives: Type 2 diabetes (T2D) is a major problem of public health in Mexico. We investigated the influence of five polymorphisms, previously associated with obesity and cardiovascular disease in Europeans and Asians, on T2D in Mexican Mestizos. Materials and Methods: A total of 1358 subjects from 30 to 85 years old were genotyped for five loci: CXCL12 rs501120; CDNK2A/B rs1333049; HNF-1α rs2259816; FTO rs9939609; and LEP rs7799039. We used logistic regressions to test the effect of each locus on T2D in two case–control groups with obesity and without obesity. Also, linear regression models on glucose and glycated hemoglobin (HbA1c) were carried out on the whole sample, adjusted by age, gender, and body mass index. Results: The CXCL12 rs501120 C allele (OR = 1.96, p = 0.02), the FTO rs9939609 A allele (OR = 2.20, p = 0.04) and the LEP rs7799039 A allele (OR = 0.6, p = 0.03) were significantly associated with T2D in obesity case–control group. No significant association was found in the non-obesity case–control group. The linear regression model showed that CDNK2A/B rs1333049 C allele (β = 0.4, p = 0.03) and FTO rs9939609 A allele (β = 0.5, p = 0.03), were significantly associated with HbA1c, but no association was found among the loci with the glucose levels. Conclusions: Polymorphisms previously linked with obesity and cardiovascular events were also associated with T2D and high levels of HbA1c. Furthermore, we must point at the fact that this is the first report where polymorphisms CXCL12 rs501120 and LEP rs7799039 are associated with T2D in subjects with obesity. Full article
(This article belongs to the Special Issue Type 2 Diabetes and Insulin Resistance)
9 pages, 1072 KiB  
Article
Comparison of Carotid Ultrasound Indices and the Triglyceride Glucose Index in Hypertensive and Normotensive Community-Dwelling Individuals: A Case Control Study for Evaluating Atherosclerosis
by Javad Alizargar and Chyi-Huey Bai
Medicina 2018, 54(5), 71; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina54050071 - 11 Oct 2018
Cited by 17 | Viewed by 3295
Abstract
Background and objectives: Hypertension (HTN) is an important risk factor for cardiovascular diseases. High blood pressure is a major cause of atherosclerosis which leads to myocardial infarction and stroke. Insulin resistance (IR) is correlated with HTN and atherosclerosis. To determine differences between [...] Read more.
Background and objectives: Hypertension (HTN) is an important risk factor for cardiovascular diseases. High blood pressure is a major cause of atherosclerosis which leads to myocardial infarction and stroke. Insulin resistance (IR) is correlated with HTN and atherosclerosis. To determine differences between the effects of HTN on the intima media thicknesses (IMTs) of the internal (ICA), external (ECA), and common carotid arteries (CCA), and evaluate the carotid plaque presence between hypertensive and normotensive individuals, a case-control study was designed among community-dwelling individuals. The relationship between the triglyceride glucose (TyG) index and atherosclerosis was also investigated in this study. Materials and Methods: Data from 77 hypertensive and 199 normotensive individuals were analyzed in this study. Results: The IMTs of the CCA, ICA, and ECA, and the TyG index were all higher in hypertensive individuals compared to the control group (all p < 0.05). After controlling for age, sex, the body-mass index, and TyG index, HTN was an independent predictor of a high CCA IMT (odds ratio (OR) = 2.48; 95% confidence interval (CI) = 1.24–4.93) and presence of plaque (OR = 2.36; CI = 1.15–4.85) in the carotid artery. Conclusions: HTN was an independent risk of carotid IMT thickening and atherosclerosis. TyG index could only predict the CCA IMT independent of other risk factors (OR = 2.09; CI = 1.07–4.09). Full article
(This article belongs to the Special Issue Type 2 Diabetes and Insulin Resistance)
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Review

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30 pages, 1402 KiB  
Review
From Pre-Diabetes to Diabetes: Diagnosis, Treatments and Translational Research
by Radia Marium Modhumi Khan, Zoey Jia Yu Chua, Jia Chi Tan, Yingying Yang, Zehuan Liao and Yan Zhao
Medicina 2019, 55(9), 546; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina55090546 - 29 Aug 2019
Cited by 171 | Viewed by 32726
Abstract
Diabetes, a silent killer, is one of the most widely prevalent conditions of the present time. According to the 2017 International Diabetes Federation (IDF) statistics, the global prevalence of diabetes among the age group of 20–79 years is 8.8%. In addition, 1 in [...] Read more.
Diabetes, a silent killer, is one of the most widely prevalent conditions of the present time. According to the 2017 International Diabetes Federation (IDF) statistics, the global prevalence of diabetes among the age group of 20–79 years is 8.8%. In addition, 1 in every 2 persons is unaware of the condition. This unawareness and ignorance lead to further complications. Pre-diabetes is the preceding condition of diabetes, and in most of the cases, this ultimately leads to the development of diabetes. Diabetes can be classified into three types, namely type 1 diabetes, type 2 diabetes mellitus (T2DM) and gestational diabetes. The diagnosis of both pre-diabetes and diabetes is based on glucose criteria; the common modalities used are fasting plasma glucose (FPG) test and oral glucose tolerance test (OGTT). A glucometer is commonly used by diabetic patients to measure blood glucose levels with fast and rather accurate measurements. A few of the more advanced and minimally invasive modalities include the glucose-sensing patch, SwEatch, eyeglass biosensor, breath analysis, etc. Despite a considerable amount of data being collected and analyzed regarding diabetes, the actual molecular mechanism of developing type 2 diabetes mellitus (T2DM) is still unknown. Both genetic and epigenetic factors are associated with T2DM. The complications of diabetes can predominantly be classified into two categories: microvascular and macrovascular. Retinopathy, nephropathy, and neuropathy are grouped under microvascular complications, whereas stroke, cardiovascular disease, and peripheral artery disease (PAD) belong to macrovascular complications. Unfortunately, until now, no complete cure for diabetes has been found. However, the treatment of pre-diabetes has shown significant success in preventing the further progression of diabetes. To prevent pre-diabetes from developing into T2DM, lifestyle intervention has been found to be very promising. Various aspects of diabetes, including the aforementioned topics, have been reviewed in this paper. Full article
(This article belongs to the Special Issue Type 2 Diabetes and Insulin Resistance)
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18 pages, 547 KiB  
Review
Effects of the Consumption of Prickly Pear Cacti (Opuntia spp.) and its Products on Blood Glucose Levels and Insulin: A Systematic Review
by Caroline A. Gouws, Ekavi N. Georgousopoulou, Duane D. Mellor, Andrew McKune and Nenad Naumovski
Medicina 2019, 55(5), 138; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina55050138 - 15 May 2019
Cited by 32 | Viewed by 5873
Abstract
Background and Objectives: There is confusion as to which component of the Opuntia spp. cacti has demonstrated anti-hyperglycemic effects or anti-diabetic properties. It is important to clarify these health benefits due to the increasing need for prevention and treatment of chronic diseases. [...] Read more.
Background and Objectives: There is confusion as to which component of the Opuntia spp. cacti has demonstrated anti-hyperglycemic effects or anti-diabetic properties. It is important to clarify these health benefits due to the increasing need for prevention and treatment of chronic diseases. The aim of this review is to identify the effects of Opuntia spp. cacti consumption on biomedical measures; glucose and insulin with consideration of its’ components; fruit, leaf and combined or unidentified Opuntia spp. products. Materials and Methods: Prior to commencing the searches, this systematic review was registered with PROSPERO (CRD42018108765). Following the PRISMA 2009 guidelines, six electronic databases (Food Science and Technology Abstracts (EBSCO), Medline, Scopus, CINAHL, Web of Science and Cochrane) were searched for articles investigating the effect of Opuntia spp. consumption on glucose and insulin in humans. Results: Initially, 335 articles were sourced and filtered by exclusion criteria (human interventions, control trials and articles published in English) resulting in 20 relevant articles. The included studies were characterized by such plant components as fruit (n = 4), cladode (n = 12), and other Opuntia spp. products (n = 4), further separated by clinical populations (‘healthy’, hyperlipidemic, hypercholesterolemic, Type 2 Diabetes Mellitus). The findings of this review indicate variations in effects between cacti components and products. Cladode and select Opuntia spp. products predominately demonstrated significant reductions in serum glucose and insulin, indicating potential as a functional food candidate. Prickly Pear fruit was predominately reported to have no significant effects on glucose or insulin. The quality of evidence appeared to vary based on the type of Opuntia spp. product used. Studies that used specifically the fruit or cladode had high risk of bias, whereas studies which used combined Opuntia spp. products had a lower risk of bias. Numerous mechanisms of action were proposed where positive findings were reported, with emphasis on dualistic glucose-dependent and independent actions, however, mechanisms require further elucidation. Conclusion: Currently, there is a lack of evidence to support the recommendation of using Opuntia spp. fruit products as an alternative or complementary therapy in the reduction of risk or management of Type 2 Diabetes Mellitus. The Cladode does however show promise in potential glucose-lowering effects which warrant further investigation. Full article
(This article belongs to the Special Issue Type 2 Diabetes and Insulin Resistance)
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Other

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7 pages, 1107 KiB  
Case Report
Diabetic Ketoacidosis Associated with Thyroxine (T4) Toxicosis and Thyrotoxic Cardiomyopathy
by Edinson Dante Meregildo Rodriguez, Luis Iván Gordillo Velásquez and José Gustavo Alvarado Moreno
Medicina 2018, 54(6), 93; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina54060093 - 26 Nov 2018
Cited by 3 | Viewed by 3524
Abstract
Thyrotoxicosis and diabetic ketoacidosis (DKA) both may present as endocrine emergencies and may have devastating consequences if not diagnosed and managed promptly and effectively. The combination of diabetes mellitus (DM) with thyrotoxicosis is well known, and one condition usually precedes the other. Furthermore, [...] Read more.
Thyrotoxicosis and diabetic ketoacidosis (DKA) both may present as endocrine emergencies and may have devastating consequences if not diagnosed and managed promptly and effectively. The combination of diabetes mellitus (DM) with thyrotoxicosis is well known, and one condition usually precedes the other. Furthermore, thyrotoxicosis is complicated by some degree of cardiomyopathy in at least 5% de patients; but the coexistence of DKA, thyroxin (T4) toxicosis, and acute cardiomyopathy is extremely rare. We describe a case of a man, previously diagnosed with DM but with no past history of thyroid disease, who presented with shock and severe DKA that did not improve despite optimal therapy. The patient evolved with acute pulmonary edema, elevated troponin levels, severe left ventricular systolic dysfunction, and clinical and laboratory evidence of thyroxin (T4) toxicosis and thyrotoxic cardiomyopathy. Subsequently, the patient evolved favorably with general support and appropriate therapy for DKA and thyrotoxicosis (hydrocortisone, methimazole, Lugol’s solution) and was discharged a few days later. Full article
(This article belongs to the Special Issue Type 2 Diabetes and Insulin Resistance)
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