2017 Volume 60 Issue 4 Pages 301-308
A 60-year-old man with no medical history of diabetes experienced mouth dryness for 9 days, for which he drank high volumes of non-alcoholic beverages. Subsequently, he presented with nocturia and polydipsia. Laboratory data indicated HbA1c 12.5 %, blood glucose 396 mg/dL, CPR 3.00 ng/mL, and GAD antibody<0.3 IU/mL; based on these findings, he was diagnosed with type 2 diabetes mellitus. After starting pharmacotherapy, the laboratory findings improved as follows: fasting blood glucose 127 mg/dL, CPR 2.55 ng/mL, and increased insulin secretion. He did not have diabetic microangiopathy. His ABI was reduced (right: 0.54; left: 0.58). Volume-rendered, multidetector row computed tomography indicated chronic total occlusion of the aorta from the renal artery and both common iliac arteries; thus, Leriche syndrome was diagnosed. Renal artery ultrasonography revealed a severely stenotic lesion in the right renal artery. Coronary angiography revealed significant stenosis, for which Y artificial blood vessel replacement surgery was performed, while pharmacological management was continued. Postoperatively, the ABI improved to 1.05 on the right side and 1.07 on the left. Patients with diabetes should be screened not only for microangiopathy but also for macroangiopathy.
