graph LR
PDX1["PDX1"]
Exogenous_triggers_of_islet_autoimmunity_in_type_1_diabetes_pathways["Exogenous triggers of islet autoimmunity in type 1 diabetes pathways"]
Monogenic_Beta_Cell_Dysfunction["Monogenic Beta-Cell Dysfunction"]
SLC19A2["SLC19A2"]
HNF4A["HNF4A"]
Diabetogenic_pharmacotherapy_exposure["Diabetogenic pharmacotherapy exposure"]
Environmental_determinants_of_diabetes_susceptibility_and_progression["Environmental determinants of diabetes susceptibility and progression"]
HNF1B["HNF1B"]
ABCC8["ABCC8"]
Chronic_Hyperglycemia_shared_diabetic_complication_cascade["Chronic Hyperglycemia (shared diabetic complication cascade)"]
EIF2AK3["EIF2AK3"]
Early_dietary_exposures["Early dietary exposures"]
Immune_checkpoint_inhibitor_exposure["Immune checkpoint inhibitor exposure"]
NEUROD1["NEUROD1"]
Sedentary_lifestyle["Sedentary lifestyle"]
GCK["GCK"]
HNF1A["HNF1A"]
CEL["CEL"]
ALMS1["ALMS1"]
KCNJ11["KCNJ11"]
Obesogenic_environment["Obesogenic environment"]
WFS1["WFS1"]
RFX6["RFX6"]
CISD2["CISD2"]
High_calorie_diet["High-calorie diet"]
Viral_infection_exposure["Viral infection exposure"]
Monogenic_Beta_Cell_Dysfunction --> Chronic_Hyperglycemia_shared_diabetic_complication_cascade
Environmental_determinants_of_diabetes_susceptibility_and_progression --> Chronic_Hyperglycemia_shared_diabetic_complication_cascade
Exogenous_triggers_of_islet_autoimmunity_in_type_1_diabetes_pathways --> Chronic_Hyperglycemia_shared_diabetic_complication_cascade
Diabetogenic_pharmacotherapy_exposure --> Chronic_Hyperglycemia_shared_diabetic_complication_cascade
Immune_checkpoint_inhibitor_exposure --> Chronic_Hyperglycemia_shared_diabetic_complication_cascade
Viral_infection_exposure --> Chronic_Hyperglycemia_shared_diabetic_complication_cascade
Early_dietary_exposures --> Chronic_Hyperglycemia_shared_diabetic_complication_cascade
Sedentary_lifestyle --> Chronic_Hyperglycemia_shared_diabetic_complication_cascade
High_calorie_diet --> Chronic_Hyperglycemia_shared_diabetic_complication_cascade
Obesogenic_environment --> Chronic_Hyperglycemia_shared_diabetic_complication_cascade
KCNJ11 --> Monogenic_Beta_Cell_Dysfunction
HNF1A --> Monogenic_Beta_Cell_Dysfunction
HNF4A --> Monogenic_Beta_Cell_Dysfunction
HNF1B --> Monogenic_Beta_Cell_Dysfunction
ABCC8 --> Monogenic_Beta_Cell_Dysfunction
GCK --> Monogenic_Beta_Cell_Dysfunction
EIF2AK3 --> Monogenic_Beta_Cell_Dysfunction
WFS1 --> Monogenic_Beta_Cell_Dysfunction
ALMS1 --> Monogenic_Beta_Cell_Dysfunction
CISD2 --> Monogenic_Beta_Cell_Dysfunction
SLC19A2 --> Monogenic_Beta_Cell_Dysfunction
PDX1 --> Monogenic_Beta_Cell_Dysfunction
NEUROD1 --> Monogenic_Beta_Cell_Dysfunction
CEL --> Monogenic_Beta_Cell_Dysfunction
RFX6 --> Monogenic_Beta_Cell_Dysfunction
style PDX1 fill:#f3e8ff
style Exogenous_triggers_of_islet_autoimmunity_in_type_1_diabetes_pathways fill:#dcfce7
style Monogenic_Beta_Cell_Dysfunction fill:#dbeafe
style SLC19A2 fill:#f3e8ff
style HNF4A fill:#f3e8ff
style Diabetogenic_pharmacotherapy_exposure fill:#dcfce7
style Environmental_determinants_of_diabetes_susceptibility_and_progression fill:#dcfce7
style HNF1B fill:#f3e8ff
style ABCC8 fill:#f3e8ff
style Chronic_Hyperglycemia_shared_diabetic_complication_cascade fill:#dbeafe
style EIF2AK3 fill:#f3e8ff
style Early_dietary_exposures fill:#dcfce7
style Immune_checkpoint_inhibitor_exposure fill:#dcfce7
style NEUROD1 fill:#f3e8ff
style Sedentary_lifestyle fill:#dcfce7
style GCK fill:#f3e8ff
style HNF1A fill:#f3e8ff
style CEL fill:#f3e8ff
style ALMS1 fill:#f3e8ff
style KCNJ11 fill:#f3e8ff
style Obesogenic_environment fill:#dcfce7
style WFS1 fill:#f3e8ff
style RFX6 fill:#f3e8ff
style CISD2 fill:#f3e8ff
style High_calorie_diet fill:#dcfce7
style Viral_infection_exposure fill:#dcfce7
name: com_Diabetes_Mellitus__Dieulafoy_Lesion
creation_date: "2026-08-16T00:00:00Z"
curation_status: CANDIDATE
notes: >-
Split out of `kb/disorders/Dieulafoy_Lesion.yaml`'s `environmental:` block
(dismech#8302, one of the four "environmental block asserts something the
pathophysiology block cannot receive" instances tracked there): diabetes
mellitus was listed as an "exposure" with no route to either of the entry's
two pathophysiology nodes (both describe the congenital vascular anomaly
itself, not its acquisition or triggering). It is a comorbidity/host-attribute
state, the same category error #8185 tracks, and is a first-class `Disease`
entry in its own right (`kb/disorders/Diabetes_Mellitus.yaml`).
Directionality is UNKNOWN rather than A_BEFORE_B/RISK: the only source is a
within-case comorbidity proportion from a 101-case systematic review of
rectal Dieulafoy lesion (mean age 66±17), with no comparison population.
That is consistent with diabetes simply reflecting the age/comorbidity
profile of patients who present with GI bleeding, and the source itself
proposes no mechanism connecting diabetes to submucosal-artery caliber
persistence or mucosal erosion. Recording an inferred `RISK` direction or a
mechanistic hypothesis would assert more than the evidence supports (per
the dismech#8195 review precedent on over-claiming from within-case
prevalence). The source paper does not specify diabetes type; the generic
`Diabetes_Mellitus` umbrella entry is used rather than guessing a specific
type.
Supersedes the `review_notes:` no-link waiver dismech#10980 recorded on the
removed `environmental:` entry under dismech#8085. That waiver answered a
different question — whether to run an `influences_mechanisms` edge from the
exposure to a pathophysiology node — and answered it no, on the reasoning
that the cited sentence "reports what patients had rather than what it did."
That reasoning is the case for this entry: a within-case comorbidity
proportion is a co-occurrence observation, which is what a comorbidity
record models and what an environmental exposure does not. The no-link
decision is preserved here as `directionality: UNKNOWN` with no mechanistic
hypothesis, so nothing #8085 settled is reopened by the move.
disease_a:
slug: Diabetes_Mellitus
preferred_term: diabetes mellitus
term:
id: MONDO:0005015
label: diabetes mellitus
disease_b:
slug: Dieulafoy_Lesion
preferred_term: Dieulafoy lesion
term:
id: MONDO:0001427
label: Dieulafoy lesion
directionality: UNKNOWN
effect_direction: UNKNOWN
association_signals:
- source: LITERATURE
method: LITERATURE_ASSOCIATION
population: >-
Systematic review of 101 published adult rectal Dieulafoy's lesion cases
(MEDLINE, Cochrane, Embase, Scopus), mean age at presentation 66±17
years; within-case comorbidity proportion, no comparison/control
population.
directionality: UNKNOWN
statistics:
metrics:
- metric_type: PREVALENCE
metric_value: 0.21
notes: >-
Proportion of the 101-case rectal Dieulafoy lesion series reporting
diabetes mellitus as a major underlying disorder. Unadjusted for age
and with no comparison population, so this corroborates co-occurrence
in an elderly bleeding-presentation cohort rather than establishing
an elevated risk relative to the general population.
evidence:
- reference: PMID:35243119
reference_title: "Rectal Dieulafoy's lesion: a comprehensive review of patient characteristics, presentation patterns, diagnosis, management, and clinical outcomes."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Major underlying disorders were hypertension 29%, diabetes mellitus 21%, and chronic kidney disease 16%."
explanation: >-
Reports diabetes mellitus as an underlying comorbidity among a
systematic review cohort of rectal Dieulafoy lesion cases.