Diabetes Mellitus Pathology

A 52-year-old man with known type 2 diabetes for 8 years presents with progressive fatigue and dyspnea. His HbA1c is 8.2%. Serum creatinine is 2.8 mg/dL (eGFR 22 mL/min/1.73 m²). Which investigation is most appropriate to assess the structural renal pathology and guide prognosis in diabetic nephropathy?

A 38-year-old man with a 15-year history of poorly controlled Type 2 Diabetes Mellitus presents with progressive proteinuria and declining renal function. Kidney biopsy shows nodular glomerulosclerosis with PAS-positive deposits. All of the following pathological changes are expected in diabetic nephropathy EXCEPT:

Which of the following pathological changes in pancreatic islet architecture is most characteristic of Type 2 Diabetes Mellitus?

A 38-year-old woman with type 2 diabetes mellitus for 8 years presents with progressive dyspnea, orthopnea, and lower limb edema. On examination, she has elevated JVP, hepatomegaly, and bilateral ankle edema. Echocardiography reveals left ventricular ejection fraction (LVEF) of 35% with restrictive filling pattern. She is currently on metformin 1000 mg BD and glibenclamide 5 mg BD. Blood pressure is 145/92 mmHg. What is the most appropriate next step in management?

A 38-year-old woman from rural Maharashtra presents with a 6-month history of polyuria, polydipsia, and a 4 kg weight loss. On examination, she is lean (BMI 19 kg/m²), with no acanthosis nigricans. Fasting blood glucose is 156 mg/dL, and HbA1c is 8.2%. C-peptide level is 0.3 ng/mL (normal 0.8–3.1). Anti-GAD65 antibodies are positive. She denies autoimmune thyroid disease or celiac disease. What is the most likely pathological mechanism underlying her diabetes?