Beyond the Triad: Uncommon Initial Presentations in Newly Diagnosed Type 2 Diabetes Mellitus

Abstract

Background Type 2 diabetes mellitus (T2DM) often presents with a range of symptoms, many of which are under-recognized, leading to delayed diagnosis. Objective To analyze the range of initial presenting symptoms in newly diagnosed patients with T2DM in an outpatient setting. Methods A retrospective study of 50 newly diagnosed patients with T2DM aged 30-65 years was conducted at Aster DM Healthcare, Dubai. Their presenting symptoms and laboratory results were recorded. Symptoms were categorized as classical (polyuria, polydipsia, fatigue, and weight loss) and atypical (blurred vision, pruritus, skin infections, and delayed wound healing). Laboratory parameters such as fasting blood sugar (FBS), random blood sugar (RBS), glycated hemoglobin (HbA1c) and urine routine were analyzed. Results Classic presenting symptoms were polyuria (n=30; 60%), polydipsia (n=28; 56%), fatigue (n=25; 50%), and weight loss (n=19;38%). Atypical initial presenting symptoms included blurred vision (n=13; 26%), pruritus (n=10; 20%), recurrent vaginal infections (n=6; 24% of females), and delayed wound healing (n=8; 16%). Obese patients were significantly more likely to present with atypical symptoms. Females were more likely to report fatigue, pruritus, and candidiasis. Conclusion This case series of 50 newly diagnosed patients with T2DM reveals a high prevalence of atypical symptoms, especially in women and in those with obesity. Fatigue, pruritus, and visual disturbances were common non-classical features. These findings support expanding screening criteria to include atypical presentations, promoting earlier diagnosis and intervention, particularly in high-risk populations.

Keywords: atypical symptoms; diabetes; fatigue; newly diagnosed type 2 diabetes; polydipsia; polyuria; presenting symptoms; weight loss.