The pathophysiology of both insulin- and noninsulin-dependent diabetes mellitus centers on chronic untreated hyperglycemia. All individuals with diabetes are at risk for microvascular as well as macrovascular complications. Recent breakthroughs in research mandate an updated understanding of their pathogenesis. Good glycemic control must begin as soon as possible following diabetes onset. Deranged lipid metabolism similarly demands control for quantity of dietary fat. Other complications include sympathetic nervous sensitivity, at least in NIDDM, and neurobehavioral sequelae. These latter are especially evident in childhood IDDM. Pancreatic transplantation, appropriate insulinization, and second-generation hypoglycemic agents offer varied levels of effective diabetic therapy. Immunosuppression is a promising future therapeutic intervention.
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