Case history notes designed as an aid to professional education. Advanced diabetic microvascular disease secondary to impaired glucose tolerance

A case of advanced diabetic microvascular disease secondary to impaired glucose tolerance (IGT) with server proliferative retinopathy, end‐stage diabetic nephropathy and chronic peripheral neuropathy is described. There was concomitant large vessel disease with Fournier's gangrene and left below‐knee amputation. The diabetic patient had been informed some 20 years earlier that he had a ‘tendency to diabetes’ but no formal treatment was given and no follow‐up arranged. It is important to avoid the term ‘mild diabetes’ and recognise that patients with IGT require proper dietary advice and follow‐up assessment so that the severe microangiopathy (and macroangiopathy) seen in this case may be prevented.