Pathophysiology Of Vascular Disease In Diabetes: Effects Of Gliclazide
Abstract Diabetes mellitus is a major risk factor for coronary heart disease, peripheral vascular disease, and cardiovascular disease. The prevalence of these complications is increased about two- to four-fold in people with diabetes in the United States, and they contribute substantially to morbidity, mortality, and healthcare costs. The pathogenesis of macrovascular disease in diabetes is multifactorial. Endothelial injury is an early event, followed by macrophage adherence and uptake of lipids to produce a fatty streak. Platelet adherence, aggregation, and release of thromboxane and platelet-derived growth factors may then occur. Quantitative and qualitative alterations of lipoproteins are seen, particularly in uncontrolled insulin-dependent and non-insulin-dependent diabetes. Hyperinsulinemia may be contributory, as may elevated plasma proinsulin levels. Glycation of plasma proteins and of components of the vascular wall occurs, and altered coagulation and/or fibrinolysis may lead to thrombosis. The process is accelerated by hypertension, smoking, and hypercholesterolemia. Gliclazide is an oral sulfonylurea agent that has been reported to have actions on platelet function and fibrinolysis in addition to its effects on glycemia. The evidence for this is reviewed, and recommendations for future studies are made. Continue reading >>
Peripheral Artery Disease
Peripheral artery disease (PAD) is a narrowing of the arteries other than those that supply the heart or the brain.[4] When narrowing occurs in the heart, it is called coronary artery disease, while, in the brain, it is called cerebrovascular disease. Peripheral artery disease most commonly affects the legs, but other arteries may also be involved.[3] The classic symptom is leg pain when walking which resolves with rest, known as intermittent claudication.[1] Other symptoms including skin ulcers, bluish skin, cold skin, or poor nail and hair growth may occur in the affected leg.[2] Complications may include an infection or tissue death which may require amputation; coronary artery disease, or stroke.[3] Up to 50% of cases of PAD are without symptoms.[1] The main risk factor is cigarette smoking.[3] Other risk factors include diabetes, high blood pressure, and high blood cholesterol.[6] The underlying mechanism is usually atherosclerosis.[5] Other causes include artery spasm.[4] PAD is typically diagnosed by finding an ankle-brachial index (ABI) less than 0.90, which is the systolic blood pressure at the ankle divided by the systolic blood pressure of the arm.[8] Duplex ultrasonography and angiography may also be used.[7] Angiography is more accurate and allows for treatment at the same time; however, it is associated with greater risks.[8] It is unclear if screening for disease is useful as it has not been properly studied.[14][15] In those with intermittent claudication from PAD, stopping smoking and supervised exercise therapy improves outcomes.[10][11] Medications, including statins, ACE inhibitors, and cilostazol also may help.[11][16] Aspirin does not appear to help those with mild disease but is usually recommended in those with more significant disease.[17][18] A Continue reading >>
- Unprocessed Red and Processed Meats and Risk of Coronary Artery Disease and Type 2 Diabetes An Updated Review of the Evidence
- Diagnostic accuracy of resting systolic toe pressure for diagnosis of peripheral arterial disease in people with and without diabetes: a cross-sectional retrospective case-control study
- Treating gum disease may lessen the burden of heart disease, diabetes, other conditions
Inflammation And Peripheral Arterial Disease: The Value Of Circulating Biomarkers (review)
Peripheral arterial disease (PAD) is a manifestation of atherosclerotic vascular disease and is often associated with other comorbidities, such as hypertension, diabetes and dyslipidemia. An increasing body of evidence supports the notion that inflammation plays an important role in the development and progression of PAD. A number of studies have investigated the association of various acute phase proteins, particularly C-reactive protein (CRP), with PAD. Apart from CRP, other circulating biomarkers, such as matrix metalloproteinases (MMPs), selectins and interleukin (IL)-1, IL-2, IL-6, IL-8 and IL-10 have been considered to play a role in the development of PAD. In this review, the role of these circulating biomarkers in PAD is discussed. Current data indicate that the appropriate use of biomarkers in patients with PAD may contribute to an early diagnosis, an enhanced knowledge of the developmental process of the disease, as well as to the subsequent improvement of current therapies and to the development of new ones. 1. Introduction Peripheral arterial disease (PAD), is one of the most common manifestations of atherosclerosis, affecting 27 million individuals in Europe and North America (1). In 1858 Charcot (3) clearly defined and described this syndrome (and he used the term ‘intermittent claudication’) (2,3). Intermittent claudication is reproducibly elicited by walking-induced muscle ischemia and is consistently relieved by rest that allows reperfusion of the affected limb; thus, it may be considered as ‘a leg effort angina.’ Since the 1950s, Stammers (4) and Allen et al (5) independently observed that patients with intermittent claudication have a high risk of mortality due to cardiovascular events (CVs). Subsequent prospective studies on the clinical outc Continue reading >>
- Diagnostic accuracy of resting systolic toe pressure for diagnosis of peripheral arterial disease in people with and without diabetes: a cross-sectional retrospective case-control study
- Identification of novel biomarkers to monitor β-cell function and enable early detection of type 2 diabetes risk
- 92 Alkaline Foods That Fight Cancer, Inflammation, Diabetes and Heart Disease
Diabetes And Vascular Disease: Pathophysiology, Clinical Consequences, And Medical Therapy: Part I
Go to: Introduction The number of people with diabetes mellitus is alarmingly increasing due to the growing prevalence of obesity, genetic susceptibility, urbanization, and ageing.1,2 Type 2 diabetes, the most common form of the disease, may remain undetected for many years and its diagnosis is often made incidentally through an abnormal blood or urine glucose test. Hence, physicians often face this disease at an advanced stage when vascular complications have already occurred in most of patients. Macrovascular complications are mainly represented by atherosclerotic disease and its sequelae. Diabetes-related microvascular disease such as retinopathy and nephropathy are major causes of blindness and renal insufficiency.1 Based on this scenario, a better understanding of the mechanisms underlying diabetic vascular disease is mandatory because it may provide novel approaches to prevent or delay the development of its complications. This review will focus on the most current advances in the pathophysiology of vascular disease (Part I) and will address clinical manifestations and management strategies of patients with diabetes (Part II). Continue reading >>
- The Pathophysiology of Hyperglycemia in Older Adults: Clinical Considerations
- Insulin: Potential Negative Consequences of Early Routine Use in Patients With Type 2 Diabetes
- Xultophy® Reported a Better Option than Basal-Bolus Insulin Therapy to Manage Type 2 Diabetes by Participants in the DUAL VII Clinical Trial
Oxidative Stress And Inflammation: Their Role In The Pathogenesis Of Peripheral Artery Disease With Or Without Type 2 Diabetes Mellitus
Abstract: Peripheral artery disease (PAD), a common vascular disease, has been associated with increased cardiovascular (CV) morbidity and mortality as well as all-cause death. Type 2 diabetes mellitus (T2DM) predisposes to PAD development. In T2DM patients, PAD further increases the risk for CV disease and death as well as foot morbidity and microvascular complications. The present narrative review discusses the role of oxidative stress and inflammation in the pathophysiology of PAD with or without the presence of T2DM. The effects of lifestyle measures (i.e. diet, physical activity and smoking cessation) and drug treatment on markers of oxidative stress and inflammation are also considered. Further research should establish the clinical implications of such effects as well as the clinical use of antioxidants and anti-inflammatory drugs in PAD. Keywords: peripheral artery disease, type 2 diabetes mellitus, oxidative stress, inflammation, antioxidant Rights & PermissionsPrintExport Continue reading >>
- Unprocessed Red and Processed Meats and Risk of Coronary Artery Disease and Type 2 Diabetes An Updated Review of the Evidence
- Diagnostic accuracy of resting systolic toe pressure for diagnosis of peripheral arterial disease in people with and without diabetes: a cross-sectional retrospective case-control study
- Complicated urinary tract infections associated with diabetes mellitus: Pathogenesis, diagnosis and management
Peripheral Artery Disease In Patients With Diabetes: Epidemiology, Mechanisms, And Outcomes
Go to: Peripheral artery disease (PAD) is the atherosclerosis of lower extremity arteries and is also associated with atherothrombosis of other vascular beds, including the cardiovascular and cerebrovascular systems. The presence of diabetes mellitus greatly increases the risk of PAD, as well as accelerates its course, making these patients more susceptible to ischemic events and impaired functional status compared to patients without diabetes. To minimize these cardiovascular risks it is critical to understand the pathophysiology of atherosclerosis in diabetic patients. This, in turn, can offer insights into the therapeutic avenues available for these patients. This article provides an overview of the epidemiology of PAD in diabetic patients, followed by an analysis of the mechanisms by which altered metabolism in diabetes promotes atherosclerosis and plaque instability. Outcomes of PAD in diabetic patients are also discussed, with a focus on diabetic ulcers and critical limb ischemia. Keywords: Peripheral artery disease, Epidemiology, Pathophysiology, Outcomes, Diabetes Core tip: Diabetes mellitus (DM) is a major risk factor of peripheral artery disease (PAD), leading to increased morbidity and mortality as well as an accelerated disease course. As such, a more thorough understanding of the multi-factorial mechanisms underlying disease etiology for both DM and PAD is justified. This review provides clinical insight into the current state of research in the pathophysiology of PAD in diabetic patients, as well as highlights the progress of endovascular interventions for PAD, with a focus on techniques that have shown promise for treatment of critical lower limb ischemia. Go to: INTRODUCTION Over 170 million people worldwide have diabetes mellitus (DM) and the worldwide Continue reading >>
- Unprocessed Red and Processed Meats and Risk of Coronary Artery Disease and Type 2 Diabetes An Updated Review of the Evidence
- Medication Adherence and Improved Outcomes Among Patients With Type 2 Diabetes
- Diagnostic accuracy of resting systolic toe pressure for diagnosis of peripheral arterial disease in people with and without diabetes: a cross-sectional retrospective case-control study
Pathophysiology And Burden Of Infection In Patients With Diabetes Mellitus And Peripheral Vascular Disease: Focus On Skin And Soft-tissue Infections.
Clin Microbiol Infect. 2015 Jul 18. pii: S1198-743X(15)00390-0. doi: 10.1016/j.cmi.2015.03.024. [Epub ahead of print] Dryden M, Baguneid M, Eckmann C, Corman S, Stephens J, Solem C, Li J, Charbonneau C, Baillon-Plot N, Haider S. | Infectious and parasitic Diabetes mellitus affects 284 million adults worldwide and is increasing in prevalence. Accelerated atherosclerosis in patients with diabetes mellitus contributes an increased risk of developing cardiovascular diseases including peripheral vascular disease (PVD). Immune dysfunction, diabetic neuropathy and poor circulation in patients with diabetes mellitus, especially those with PVD, place these patients at high risk for many types of typical and atypical infections. Complicated skin and soft-tissue infections (cSSTIs) are of particular concern because skin breakdown in patients with advanced diabetes mellitus and PVD provides a portal of entry for bacteria. Patients with diabetes mellitus are more likely to be hospitalized with cSSTIs and to experience related complications than patients without diabetes mellitus. Patients with PVD requiring lower extremity bypass are also at high risk of surgical site and graft infections. Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent causative pathogen in cSSTIs, and may be a significant contributor to surgical site infections, especially in patients who are colonized with MRSA on hospital admission. Patients with cSSTIs and diabetes mellitus or PVD experience lower clinical success rates than patients without these comorbidities, and may also have a longer length of hospital stay and higher risk of adverse drug events. Clinicians should be vigilant in recognizing the potential for infection with multi-drug-resistant organisms, especially MRSA, in these popula Continue reading >>
Peripheral Artery Disease: Pathophysiology, Diagnosis And Treatment
Francisco J Serrano Hernando a, Antonio Martín Conejero a a Servicio de Cirugía Vascular, Hospital Clínico San Carlos, Madrid, Spain Keywords Peripheral artery disease. Ankle-brachial index. Lower limb revascularization. Cardiovascular risk. Abstract Peripheral artery disease is one of the most prevalent conditions, and it frequently coexists with vascular disease in other parts of the body. Early diagnosis is important for improving the patient's quality of life and for reducing the risk of serious secondary vascular events such as acute myocardial infraction (AMI) or stroke. The best noninvasive measure for identifying the presence of occlusive arterial disease is the ankle-brachial index, which can also be used to indicate the prognosis of the affected extremity and to predict the likelihood of AMI during follow-up. Intermittent claudication in the lower limbs is the most common clinical presentation. The presence of critical ischemia (i.e., with rest pain or trophic changes) indicates the need for prompt revascularization because of the high risk of limb amputation. The more proximal the affected arterial segment, the better the outcome of the procedure. Endovascular treatment is usually reserved for lesions affecting multiple segments. It gives poorer results in occluded arteries. In extensive disease, conventional surgery is usually the best option. Article EPIDEMIOLOGY Peripheral artery disease (PAD) affects 15%-20% of persons older than 70 years of age,1-3 though its prevalence is probably even greater if we include asymptomatic persons. The diagnostic test most used to check the asymptomatic population is the ankle-brachial index (ABI). In asymptomatic persons, an ABI <0.9 has a sensitivity >95% and a specificity approaching 100% as compared with arteriograp Continue reading >>
- Diagnostic accuracy of resting systolic toe pressure for diagnosis of peripheral arterial disease in people with and without diabetes: a cross-sectional retrospective case-control study
- Unprocessed Red and Processed Meats and Risk of Coronary Artery Disease and Type 2 Diabetes An Updated Review of the Evidence
- Diagnosis and treatment of diabetes mellitus in chronic pancreatitis
Type 2 Diabetes And Vascular Complications: A Pathophysiologic View
1Department of Molecular Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia. 2Faculty of Dentistry, Ibb University, P.O.Box 70627, Ibb, Yemen. 3Department of Medicine, University of Malaya Medical Center, University of Malaya, 50603 Kuala Lumpur, Malaysia. *Corresponding Author: Department of Molecular Medicine Faculty of Medicine, University of Malaya 50603 Kuala Lumpur Malaysia Tel: +603 7697 4717 Fax: +603 7967 4957 E-mail: [email protected] Abstract Diabetes mellitus (DM) represents a range of metabolic disorders characterized by hypergly-cemia resulting from insulin deficiency or insulin resistance or both. Hyperglycemia, the pri-mary clinical manifestation of diabetes, is strongly associated with development of the diabetic complications. Complications caused by hyperglycaemia involve damage to the small vessels such as in neuropathy, nephropathy, and retinopathy, and large blood vessels as in cardiovas-cular diseases. It is well known established that in diabetes, long-term complications ensue from abnormal regulation of glucose metabolism. In fact, all manifestations of cardiovascular disease, coronary heart disease, stroke and peripheral vascular disease are substantially more common in patients with type 2 diabetes than in non-diabetic individuals. For example, pa-tients with type 2 diabetes (T2DM) have a two- to fourfold increased risk of fatal and non-fatal coronary events. Diabetes can lead to microvascular and macrovascular damage through a number of mechanisms, each of which may worsen or accelerate the others. The present re-view summarizes the information on the mechanisms of how vascular complications will de-velop in type 2 diabetes and this might be useful as a direction for further research to provide new strategies for Continue reading >>
Pathophysiology And Burden Of Infection In Patients With Diabetes Mellitus And Peripheral Vascular Disease: Focus On Skin And Soft-tissue Infections
Jump to Section Abstract Diabetes mellitus affects 284 million adults worldwide and is increasing in prevalence. Accelerated atherosclerosis in patients with diabetes mellitus contributes an increased risk of developing cardiovascular diseases including peripheral vascular disease (PVD). Immune dysfunction, diabetic neuropathy and poor circulation in patients with diabetes mellitus, especially those with PVD, place these patients at high risk for many types of typical and atypical infections. Complicated skin and soft-tissue infections (cSSTIs) are of particular concern because skin breakdown in patients with advanced diabetes mellitus and PVD provides a portal of entry for bacteria. Patients with diabetes mellitus are more likely to be hospitalized with cSSTIs and to experience related complications than patients without diabetes mellitus. Patients with PVD requiring lower extremity bypass are also at high risk of surgical site and graft infections. Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent causative pathogen in cSSTIs, and may be a significant contributor to surgical site infections, especially in patients who are colonized with MRSA on hospital admission. Patients with cSSTIs and diabetes mellitus or PVD experience lower clinical success rates than patients without these comorbidities, and may also have a longer length of hospital stay and higher risk of adverse drug events. Clinicians should be vigilant in recognizing the potential for infection with multi-drug-resistant organisms, especially MRSA, in these populations and initiating therapy with appropriate antibiotics. Continue reading >>
Impact Of Diabetes On Cardiovascular Disease: An Update
Copyright © 2013 Alessandra Saldanha de Mattos Matheus et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Cardiovascular diseases are the most prevalent cause of morbidity and mortality among patients with type 1 or type 2 diabetes. The proposed mechanisms that can link accelerated atherosclerosis and increased cardiovascular risk in this population are poorly understood. It has been suggested that an association between hyperglycemia and intracellular metabolic changes can result in oxidative stress, low-grade inflammation, and endothelial dysfunction. Recently, epigenetic factors by different types of reactions are known to be responsible for the interaction between genes and environment and for this reason can also account for the association between diabetes and cardiovascular disease. The impact of clinical factors that may coexist with diabetes such as obesity, dyslipidemia, and hypertension are also discussed. Furthermore, evidence that justify screening for subclinical atherosclerosis in asymptomatic patients is controversial and is also matter of this review. The purpose of this paper is to describe the association between poor glycemic control, oxidative stress, markers of insulin resistance, and of low-grade inflammation that have been suggested as putative factors linking diabetes and cardiovascular disease. 1. Introduction Diabetes is an important chronic disease which incidence is globally increasing and though considered as an epidemic [1]. The World Health Organization (WHO) estimated there were 30 million people who had diabetes worldwide in 1985. This number increased to 135 Continue reading >>
- Impact of metformin on cardiovascular disease: a meta-analysis of randomised trials among people with type 2 diabetes
- Impact of menopause and diabetes on atherogenic lipid profile: is it worth to analyse lipoprotein subfractions to assess cardiovascular risk in women?
- American Diabetes Association® Releases 2018 Standards of Medical Care in Diabetes, with Notable New Recommendations for People with Cardiovascular Disease and Diabetes
The Pathophysiology Of Cardiovascular Disease And Diabetes: Beyond Blood Pressure And Lipids
In Brief The pathophysiology of the link between diabetes and cardiovascular disease (CVD) is complex and multifactorial. Understanding these profound mechanisms of disease can help clinicians identify and treat CVD in patients with diabetes, as well as help patients prevent these potentially devastating complications. This article reviews the biological basis of the link between diabetes and CVD, from defects in the vasculature to the cellular and molecular mechanisms specific to insulin-resistant states and hyperglycemia. It concludes with a discussion of heart failure in diabetes, a clinical entity that demonstrates many of the mechanisms discussed. Diabetes is a prime risk factor for cardiovascular disease (CVD). Vascular disorders include retinopathy and nephropathy, peripheral vascular disease (PVD), stroke, and coronary artery disease (CAD). Diabetes also affects the heart muscle, causing both systolic and diastolic heart failure. The etiology of this excess cardiovascular morbidity and mortality is not completely clear. Evidence suggests that although hyperglycemia, the hallmark of diabetes, contributes to myocardial damage after ischemic events, it is clearly not the only factor, because both pre-diabetes and the presence of the metabolic syndrome, even in normoglycemic patients, increase the risk of most types of CVD.1–4 In 2002, a survey of people in the United States with diagnosed diabetes found that, surprisingly, 68% of patients did not consider themselves at risk for heart attack or stroke.5 In addition, only about half of patients surveyed reported that their health care providers discussed the high risk of CVD in diabetes and what steps they could take to reduce that risk.5 Fortunately, we are now making the link. Health care providers are now focuse Continue reading >>
- American Diabetes Association® Releases 2018 Standards of Medical Care in Diabetes, with Notable New Recommendations for People with Cardiovascular Disease and Diabetes
- Conjoint Associations of Gestational Diabetes and Hypertension With Diabetes, Hypertension, and Cardiovascular Disease in Parents: A Retrospective Cohort Study
- Postprandial Blood Glucose Is a Stronger Predictor of Cardiovascular Events Than Fasting Blood Glucose in Type 2 Diabetes Mellitus, Particularly in Women: Lessons from the San Luigi Gonzaga Diabetes Study
2. Learning Objectives
4.1. Diabetic Ketoacidosis (DKA) Diabetic ketoacidosis results from lack of insulin and it is considered a medical emergency as it has a mortality rate of approximately 5 percent, mostly because of late recognition and frequently suboptimal management. Diabetic ketoacidosis can be the first manifestation of type 1 diabetes in a previously undiagnosed patient or can occur in a patient with type 1 diabetes when insulin requirements rise during medical stress. Noncompliance with insulin administration is another common cause of DKA. Although DKA is much more common in type 1 diabetes, it can also occur in patients with type 2 diabetes who have a predominant insulin secretory defect under severe medical stress. 4.1.1. Pathophysiology Diabetes is often referred to as "starvation in the midst of plenty" and the progression of events that results from acute insulin deficiency holds this concept to be valid. Insulin deficiency leads to impaired peripheral glucose uptake. In the presence of inadequate insulin, energy stores in fat and muscle are rapidly broken down into fatty acids and amino acids, which are then transported to the liver for conversion to glucose and ketones (beta-hydroxybutyrate and acetoacetate). Counter-regulatory hormones such as glucagon, catecholamines, cortisol and growth hormone rise in an attempt to correct the perceived low glucose levels, further contributing to hyperglycemia and ketonemia. The combination of increased production of glucose and ketones with decreased utilization (due to insulin deficiency) results in high levels of these substances. Hyperglycemia causes osmotic diuresis with an ensuing reduction of intravascular volume, which in turn causes an impairment of renal blood flow and an inability to excrete glucose which worsens the hypergl Continue reading >>
Overview Of Lower Extremity Peripheral Artery Disease
INTRODUCTION Atherosclerosis results in the accumulation of lipid and fibrous material between the layers of the arterial wall and causes disease of the coronary, cerebral, and peripheral arteries. Atherosclerotic disease often involves the arteries providing flow to the lower extremities, referred to as lower extremity peripheral artery disease (PAD). Atherosclerosis can lead to acute or chronic symptoms due to embolism from more proximal disease, or due to thrombosis of an artery that has been progressively narrowed. Management of patients with lower extremity PAD should include medical therapies aimed at reducing the risk for future cardiovascular events related to atherosclerosis, such as myocardial infarction, stroke, and peripheral arterial events. These therapies are also particularly important for reducing the risk of events at the time of intervention (surgical or endovascular), when indicated, and for improving long-term survival. An overview of atherosclerotic occlusive disease affecting the lower extremities is provided here. Disease affecting the upper extremity is reviewed separately. (See "Overview of upper extremity peripheral artery disease".) ANATOMY AND PATHOPHYSIOLOGY The subintimal accumulation of lipid and fibrous material can narrow the vessel lumen, or the plaque can rupture causing embolism. Multiple factors contribute to the pathogenesis of atherosclerosis, including endothelial dysfunction, dyslipidemia, inflammatory and immunologic factors, plaque rupture, and tobacco use. (See "Pathogenesis of atherosclerosis".) The symptoms related to atherosclerotic narrowing of the aorta or lower extremity arteries depend upon the location and severity of disease. Atherosclerotic disease tends to be well localized and usually occurs in the proximal or mid Continue reading >>
- Unprocessed Red and Processed Meats and Risk of Coronary Artery Disease and Type 2 Diabetes An Updated Review of the Evidence
- Diagnostic accuracy of resting systolic toe pressure for diagnosis of peripheral arterial disease in people with and without diabetes: a cross-sectional retrospective case-control study
- Dietary magnesium tied to lower risk of heart disease and diabetes
Diabetes And Peripheral Vascular Disease☆☆☆★★★
Diabetes mellitus is found in as many as 13 million people nationally, or 5.2% of the US population, and more than 650,000 new cases are diagnosed annually.1 Clinical data that link diabetes to vascular disease are derived from several large epidemiologic studies. The Framingham Study of more than 5000 subjects showed that diabetes is a powerful risk factor for atherosclerotic coronary and peripheral arterial disease, independent of other atherogenic risk factors, with a relative risk averaging two fold for men and three fold for women.2 The Framingham Study results also confirmed that the risk of stroke is at least 2.5-fold higher in patients with diabetes,3 a finding that has been confirmed in other large epidemiologic studies.4, 5 Moreover, diabetes is strongly associated with atherosclerosis of the extracranial internal carotid artery and thus imparts an additional independent risk of stroke.6 Jump to Section PATHOPHYSIOLOGY OF VASCULAR DISEASE AND COMPLICATIONS OF DIABETES MELLITUS Jump to Section Overview Many of the clinical complications of diabetes may be ascribed to alterations in vascular structure and function, with subsequent end-organ damage and death. Specifically, two types of vascular disease are seen in patients with diabetes: a nonocclusive microcirculatory dysfunction involving the capillaries and arterioles of the kidneys, retina, and peripheral nerves, and a macroangiopathy characterized by atherosclerotic lesions of the coronary and peripheral arterial circulation.7, 8, 9, 10 The former is relatively unique to diabetes, whereas the latter lesions are morphologically similar in both patients with and without diabetes. Retinopathy is the most characteristic microvascular complication of diabetes, and population-based study results have identified a Continue reading >>
- Diagnostic accuracy of resting systolic toe pressure for diagnosis of peripheral arterial disease in people with and without diabetes: a cross-sectional retrospective case-control study
- Prevalence of and Risk Factors for Diabetic Peripheral Neuropathy in Youth With Type 1 and Type 2 Diabetes: SEARCH for Diabetes in Youth Study
- Peripheral Edema and Diabetes
