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Pancreas

Diabetes mellitus

Non-insulin dependent diabetes mellitus


Reviewer: Deepali Jain, M.D. (see Reviewers page)
Revised: 25 November 2012, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

General
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● Also called adult onset, Non-Insulin Dependent Diabetes Mellitus / NIDDM, type 2
● 80-90% of cases of diabetes (Wikipedia)
● Usually > 30 years old, obese (80% of cases, abdominal obesity more important than subcutaneous obesity), normal or increased blood insulin, rare diabetic ketoacidosis, no anti-islet antibodies

Pathophysiology
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Early:
● Normal insulin secretion and plasma levels, but loss of pulsatile, oscillating pattern of secretion
● Also loss of rapid first phase of insulin secretion triggered by glucose
● NO insulinitis is present

Later:
● Mild/moderate insulin deficiency, may be due to beta cell damage
● Beta cells may be “exhausted” due to chronic hyperglycemia and persistent beta cell stimulation

Amylin:
● 37 amino acid peptide, normally produced by beta cells, packaged and cosecreted with insulin
● In NIDDM patients, tends to accumulate outside beta cells and resembles amyloid

Clinical features
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● 90%+ concordance in twins, apparently due to multiple genetic polymorphisms (no HLA association)
● Due to insulin resistance (associated with obesity and pregnancy) or derangement in beta cell secretion of insulin
● Associated with amyloid deposits in islets (amyloid associated with basement membrane heparan sulfate proteoglycan, Arch Pathol Lab Med 1992;116:951) and pituitary (Arch Pathol Lab Med 1995;119:1055)

Treatment
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● Diet, exercise, and education (eMedicine)
● Lifestyle intervention and metformin delay onset of diabetes (N Engl J Med 2012;367:1177)

Micro description
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● Amyloid in the islets of Langerhans is the uniform pathologic feature

Micro images
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Amyloid deposition in islets


Islet amyloid polypeptide (IAPP; black) and insulin-expressing cells (red) in islets

Videos
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End of Pancreas > Diabetes mellitus > Non-insulin dependent diabetes mellitus


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