Advances in Integrative and Complementary Medicine
Case Report Volume: 1 & Issue: 1
Abstract
Type 2 diabetes mellitus (T2DM) has become a major global health challenge, with its prevalence increasing substantially since 1990. The burden is particularly pronounced among South Asian populations, who develop T2DM at younger ages and at lower body mass indices than many other ethnic groups. The South Asian phenotype is characterized by visceral adiposity, insulin resistance, dyslipidemia, and a heightened susceptibility to cardiometabolic disease. Despite increasing recognition of these risks, current clinical strategies remain largely focused on identifying and treating established risk factors and maintaining glycemic targets, particularly HbA1c, rather than detecting early microvascular dysfunction and preventing progressive end-organ injury. We describe the longitudinal clinical profile of an 89-year-old South Asian individual with longstanding hypertension, left ventricular hypertrophy, and T2DM. Contemporary diagnostic modalities, including ambulatory cardiac rhythm monitoring, stress electrocardiography/echocardiography, and technetium-99 myocardial perfusion imaging, were used to evaluate cardiovascular function and ischemic risk. Although transient ST-segment depressions were observed during ambulatory and stress ECG monitoring, myocardial perfusion imaging demonstrated no inducible ischemia but revealed a fixed perfusion defect consistent with myocardial scar. The patient subsequently developed persistent foot discomfort for which conventional podiatric evaluation did not adequately distinguish among impaired peripheral circulation, neuropathic or inflammatory mechanisms, and immune-mediated processes. This case illustrates an important gap in the current management of diabetes and its complications. HbA1c provides an important measure of glycemic exposure but does not adequately characterize tissue-level microvascular perfusion, inflammation, immune activation, or the evolving mechanisms responsible for end-organ injury. In particular, the absence of readily available methods for assessing peripheral microvascular flow dynamics makes it difficult to determine whether symptoms such as foot pain reflect vascular insufficiency, inflammation, neuropathy, or a combination of these processes. The case highlights the need to move beyond HbA1c-centered diabetes management toward an integrated approach incorporating early detection of microvascular dysfunction, assessment of peripheral microcirculation, and identification of inflammatory and immune biomarkers. Development and clinical validation of accessible tools for monitoring microvascular flow and tissue-level inflammatory responses may improve risk stratification, enable earlier intervention, and reduce progressive microvascular and end-organ complications in South Asian individuals with T2DM
Keywords: Type 2 diabetes, metabolic diseases, microvascular diseases, peripheral artery disease.