Pancreas
Diabetes mellitus
Non insulin dependent diabetes mellitus

Author: Deepali Jain, M.D. (see Authors page)

Revised: 8 December 2017, last major update August 2012

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Non insulin dependent diabetes mellitus[TI] pancreas[TIAB]

Cite this page: Jain, D. Non insulin dependent diabetes mellitus. PathologyOutlines.com website. http://pathologyoutlines.com/topic/pancreasNIDDM.html. Accessed December 15th, 2017.
Definition / general
  • Also called adult onset, non insulin dependent diabetes mellitus / NIDDM, type 2
  • 80 - 90% of cases of diabetes (Wikipedia: Diabetes Mellitus Type 2 [Accessed 8 December 2017])
  • 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
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
  • 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
Microscopic (histologic) description
  • Amyloid in the islets of Langerhans is the uniform pathologic feature
Microscopic (histologic) images

Images hosted on other servers:

Amyloid deposition in islets

Islet amyloid
polypeptide and
insulin expressing
cells in islets

Videos

Histopathology pancreas - type 2 diabetes mellitus