Adeshara, Arundhati G.
Vascular Complications of Diabetes: Current Issues in Pathogenesis and Treatment, 2nd Edition
Diwan and Rashmi S. Journal Name: Current Drug Targets. Volume 17 , Issue 11 , Journal Home Translate in Chinese.
Graphical Abstract: Abstract: Diabetes is a metabolic disorder and over the past decades, it has become a major cause of morbidity and mortality affecting the youth and middle-aged as it is the fourth leading cause of disease related to death. Close Print this page. Content: Citation Only. Citation and Abstract. Cite this article as: Krishna A. Journal Insight. The role of increased level of tumor necrosis factor alpha in the development of IR is well-documented. IR itself has inflammatory action as described above.
The levels of several other inflammatory markers such as C-reactive protein, fibrinogen, plasminogen activator inhibitor I, and interleukine-6 have been shown to increase with the onset of diabetes. The proliferation of vasa vasorum is associated with increased plaque burden, which subsequently promotes atherosclerosis.
Complications of diabetes - Wikipedia
Neovascularization develops by the growth from both adventitial layer outward and arterial lumen inward toward the intima. VEGF, a multifunctional cytokine, also contributes to microvascular complications by increasing the vascular permeability to macromolecules, monocyte chemotaxis, and tissue factor production.
However, contrary to this, VEGF treatment has been shown to restore microcirculation in the vasa nervorum and limit diabetic neuropathy as demonstrated by rodent VEGF gene transfer experiment. Decreased PEDF levels may also likely contribute to diabetic nephropathy.
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Other growth factors such as insulin-like growth factor 1, basic fibroblast growth factor, and hepatocyte growth factor may foster proliferative retinopathy. Atherosclerosis in large arteries as well as cardiomyopathy in diabetes a microvascular component may go hand in hand. Therefore, changes in small arteries and capillaries are not responsible for only microvascular long-term complications in patients with diabetes retinopathy, nephropathy, and neuropathy but also for other manifestations of heart disease in diabetes.
This review highlights the need for implementing programs for early detection, screening, and awareness to mitigate the burden of managing the complications. Good blood glucose control improves microvascular disease and should be implemented early and maintained for the optimum length of time. Appropriate controls of blood pressure as well as dyslipidemia are extremely important in macrovascular disease prevention besides glycemic control.
Patients with microvascular complications appear particularly prone to accelerated atherosclerosis and premature death. Neovascularization arising from the vasa vasorum may interconnect macro-and microangiopathy. A clearer picture on differing responses to therapeutic interventions could lead to better management and improve T2DM outcomes not only regarding microvascular but also macrovascular complications as well.
Further systematic research on the above interlinking hypothesis will help us get more clarity whether microvascular complications precede macrovascular complications or they are two ends of the same spectrum of disease existing in continuum. National Center for Biotechnology Information , U. Indian J Endocrinol Metab. Author information Copyright and License information Disclaimer. Corresponding Author: Dr. E-mail: moc. This article has been cited by other articles in PMC. Abstract Diabetes and related complications are associated with long-term damage and failure of various organ systems.
Keywords: Complications, diabetes, macrovascular, microvascular.
Diabetic neuropathy Diabetic neuropathy, a life-threatening complication involves both peripheral and autonomic nerves, affecting almost half of the diabetic population. Oxidative stress Oxidative stress, caused by the overproduction of ROS plays an important role in the activation of other pathogenic pathways involved in diabetic complications, including elevated polyol pathway activity, nonenzymatic glycation, and PKC levels which in turn lead to the development of micro-and macrovascular complications. Low-grade inflammation Inflammation has been recognized as one of the potent risk factors in both atherosclerosis and T2DM.
Open in a separate window. Figure 1. Insulin resistance and hyperglycemia drive the atherosclerotic process. Neovascularization of vasa vasorum The proliferation of vasa vasorum is associated with increased plaque burden, which subsequently promotes atherosclerosis. Figure 2. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Standards of medical care in diabetes Summary of revisions. Diabetes Care. Orasanu G, Plutzky J. The pathologic continuum of diabetic vascular disease.
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Diabetic Retinopathy – An Update on Pathophysiology, Classification, Investigation and Treatment
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