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Diabetic Microangiopathy Pathogenesis

Pathogenesis Of Diabetic Microangiopathy. The Hemodynamic View.

Pathogenesis Of Diabetic Microangiopathy. The Hemodynamic View.

Pathogenesis of diabetic microangiopathy. The hemodynamic view. Multiple factors, including altered levels of vasoactive substances, altered vasomotor responsiveness, chronic plasma volume expansion, and tissue hypoxia, contribute to a state of generalized microvascular vasodilatation in early insulin-dependent diabetes mellitus. This vasodilatation, with the consequent elevation in capillary pressures and flows, may be the initiating mechanism leading to both renal and extrarenal diabetic microangiopathy. Sustained hemodynamic actions on the microvasculature, besides directly injuring the capillary wall, promote increased permeability to macromolecules and increased capillary wall proliferation, with consequent thickening of basement membranes and luminal narrowing. These changes eventuate in complete microvascular obstruction and further vasodilatation of less damaged capillaries, thereby ensuring their eventual destruction. The ensuing complications depend on the nature of the surrounding tissue, ranging from reduction of functional reserve, as seen in skeletal muscle, to the devastating functional consequences observed in organs with endarterial circulation such as the kidney and retina. Continue reading >>

Diabetic Retinopathy And Endothelin System: Microangiopathy Versus Endothelial Dysfunction

Diabetic Retinopathy And Endothelin System: Microangiopathy Versus Endothelial Dysfunction

Diabetic retinopathy and endothelin system: microangiopathy versus endothelial dysfunction In the face of the global epidemic of diabetes, it is critical that we update our knowledge about the pathogenesis of diabetes and the related micro alterations on the vascular network in the body. This may ultimately lead to early diagnosis and novel treatment options for delaying the progression of diabetic complications. Research has recently revealed the pivotal role of endothelin in the pathogenesis of diabetic complications, particularly in the regulation of the capillary flow, which is affected in the course of retinopathy. Although there are several reviews on various approaches to the treatment of diabetes, including normalization of glucose and fat metabolism, no reviews in literature have focused on the endothelin system as a therapeutic target or early indicator of diabetic microangiopathy. In this review, we summarize some of the experimental and clinical evidence suggesting that current therapeutic approaches to diabetes may include the modulation of the blood concentration of compounds of the endothelin system. In addition, we will briefly discuss the beneficial effects produced by the inhibition of the production of high levels of endothelin in vasculopathy, with focus on diabetic retinopathy. The cutting-edge technology currently widely used in opththalmology, such as the OCT angiography, allows us to detect very early retinal morphological changes alongside alterations in choroidal and retinal vascular network. Combination of such changes with highly sensitive measurements of alterations in serum concentrations of endothelin may lead to more efficient early detection and treatment of diabetes and related macro/microvascular complications. Diabetic retinopathy (D Continue reading >>

An Insight In To The Pathogenesis Of Diabetic Vascular Diseases: Role Ofoxidative Stress And Antioxidants

An Insight In To The Pathogenesis Of Diabetic Vascular Diseases: Role Ofoxidative Stress And Antioxidants

Received date: October 18, 2013; Accepted date: November 25, 2013; Published date: November 27, 2013 Citation: Aditi, Mahajan N, Rawal S, Katare R (2013) An Insight in to the Pathogenesis of Diabetic Vascular Diseases: Role of Oxidative Stress and Antioxidants. Pharmaceut Anal Acta 4:273. doi: 10.4172/2153-2435.1000273 Copyright: 2013 Aditi, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The profound effects of hyperglycaemia on the vascular tree are the major causes of morbidity and mortality among patients suffering from diabetes. Diabetic Vascular Diseases (DVD) includes accelerated forms of atherosclerosis due to endothelial dysfunction and microangiopathy of retinal vessels. A host of several studies indicate that increased oxidative stress play a pivotal role in the development and progression of diabetic vascular diseases. The metabolic abnormalities due to oxidative stress are linked to the structural and functional changes in the vasculature, consequently resulting in atherosclerosis and diabetic retinopathy. Oxidative stress brings alterations in downstream transcription factors which result in changes in gene expression, myocardial substrate utilization, myocyte growth, endothelial function and myocardial compliance. Based on this, an approach towards investigating new and effective antioxidant therapies could serve as potential therapeutic implications in preventing the deleterious effects of oxidative stress on vasculature. This review aims to understand the underlying mechanisms involved in the pathogenesis of vascular complications in diabetes with special empha Continue reading >>

Payperview: Does Microangiopathy Contribute To The Pathogenesis Of The Diabetic Foot Syndrome? - Karger Publishers

Payperview: Does Microangiopathy Contribute To The Pathogenesis Of The Diabetic Foot Syndrome? - Karger Publishers

Does Microangiopathy Contribute to the Pathogenesis of the Diabetic Foot Syndrome? Coppelli A. Abbruzzese L. Goretti C. Iacopi E. Riitano N. Piaggesi A. Department of Medicine, University of Pisa I have read the Karger Terms and Conditions and agree. Chronic diabetic complications, both micro and macrovascular, have become a serious issue worldwide, and the dramatic rise in the number of patients with diabetes has exacerbated the problem. Hyperglycemia represents the pathologic hallmark of diabetes mellitus and induces vascular damages probably through a common pathway represented by increased intracellular oxidative stress. Among diabetic chronic complications, the pathology related to diabetic foot plays a major role and is the most common reason for hospitalization in diabetic patients. Nearly all components of the lower extremity are involved in the pathological process: skin, subcutaneous cellular tissue, muscles, bones, joints, vessels, nerves. Despite the role of microangiopathic complications in diabetic patients (retinopathy, nephropathy and neuropathy affect most both type 1 and type 2 diabetic patients), the relevance of small vessels damage in the pathogenesis and clinical history of diabetic foot syndrome remains elusive and is still debated. For several years, microangiopathy has not been considered an important pathogenic factor in the development of a diabetic foot ulcer. However, several functional and structural microvascular changes can be detected at the microvascular level in diabetic patients, which might increase the vulnerability of the skin or which can contribute to impaired wound healing. In this review, we highlighted some most exploited pathways involved in the pathogenesis of microangiopathy. We also emphasized the emerging role of microan Continue reading >>

Microangiopathy - Wikipedia

Microangiopathy - Wikipedia

This article has multiple issues. Please help improve it or discuss these issues on the talk page . This article needs additional citations for verification . Please help improve this article by adding citations to reliable sources . Unsourced material may be challenged and removed. This article appears to be a dictionary definition . Please rewrite it to present the subject from an encyclopedic point of view. If it cannot be turned into a full encyclopedia article in the near future, consider moving it to Wiktionary . Check that this article meets Wiktionary's criteria for inclusion . Check that Wiktionary does not have an article on this word or phrase, as verified using the search page . If Wiktionary has a definition already, change this tag to {{ TWCleanup2 }} or else consider a soft redirect to Wiktionary by replacing the text on this page with {{ Wi }}. If Wiktionary does not have the definition yet, consider moving the whole article to Wiktionary by replacing this tag with the template {{ Copy to Wiktionary }}. This template will no longer automatically categorize articles as candidates to move to Wiktionary. Microangiopathy (or microvascular disease, or small vessel disease) is an angiopathy (i.e. disease of blood vessels) affecting small blood vessels in the body. [1] It can be contrasted to macroangiopathy , or large vessel disease. Cerebral small vessel disease refers to a group of diseases that affect the small arteries , arterioles , venules , and capillaries of the brain. Age-related and hypertension -related small vessel diseases and cerebral amyloid angiopathy are the most common forms. Coronary small vessel disease is a type of coronary heart disease (CHD) that affects the arterioles and capillaries of the heart. Coronary small vessel disease is also Continue reading >>

The Pathogenesis Of Diabetic Microangiopathy.

The Pathogenesis Of Diabetic Microangiopathy.

The pathogenesis of diabetic microangiopathy If this is your first visit, be sure to check out the FAQ by clicking the link above. You may have to register before you can post: click the register link above to proceed. To start viewing messages, select the forum that you want to visit from the selection below. (Consultant Ophthalmologist at MALAZ MEDICAL GROUP) The pathogenesis of diabetic microangiopathy The pathogenesis of diabetic microangiopathy. Short message on demand of a friend Diabetic microangiopathy occurs at the level of capillaries in 2 stages abnormal RBC with defective oxygen transport stickiness and aggregation of platelets. These capillaries and hematological changes result in microvascular occlusion and leakage and exudates Last edited by Reda Gomah El Garia; 11-21-2017 at 10:47 AM. By Medical Videos in forum Hypertension Books By Medical Videos in forum Glaucoma Books By Medical Videos in forum Surgery and Surgical Subspecialties By Medical Videos in forum Surgery and Surgical Subspecialties By Medical Videos in forum Pharmacology Books Continue reading >>

Get Unlimited Access On Medscape.

Get Unlimited Access On Medscape.

You’ve become the New York Times and the Wall Street Journal of medicine. A must-read every morning. ” Continue reading >>

Pathogenesis Of Diabetic Microangiopathy. The Hemodynamic View

Pathogenesis Of Diabetic Microangiopathy. The Hemodynamic View

Pathogenesis of diabetic microangiopathy. The hemodynamic view Pathogenesis of diabetic microangiopathy. The hemodynamic view Pathogenesis of Diabetic Microangiopathy The Hemodynamic ViewROBERTO ZATZ, M.D. BARRY M. BRENNER, M.D. Boston,MassachusettsFrom the Departments ... Key Concepts in A Modern View of Alzheimer's Pathogenesis Recent research has prompted a welcome evolution of theory in Alzheimer's disease. Old and simplistic concepts are Pathogenesis of Diabetic Microangiopathy The Hemodynamic View ROBERTO ZATZ, M.D. BARRY M. BRENNER, M.D. Boston, From the Departments of Medicine, Brigham and Womens Hospital and Harvard Medical School, Boston, Massachusetts. Requests for reprints should be addressed to Dr. Barry M. Brenner, Renal Division, Brigham and Womens Hospital, 75 Francis Street, Boston, Massachusetts 02115. Manuscript accepted June 4, 1985. Multiple factors, including altered levels of vasoactive substances, altered vasomotor responsiveness, chronic plasma volume expansion, and tissue hypoxia, contribute to a state of generalized microvascular vasodilatation in early insulin-dependent diabetes mellitus. This vasodilatation, with the consequent elevation in capillary pressures and flows, may be the initiating mechanism leading to both renal and extrarenal diabetic microangiopathy. Sustained hemodynamic actions on the microvasculature, besides directly injuring the capillary wall, promote increased permeability to macromolecules and increased capillary wall proliferation, with consequent thickening of basement membranes and luminal narrowing. These changes eventuate in complete microvascular obstruction and further vasodilatation of less damaged capillaries, thereby ensuring their eventual destruction. The ensuing complications depend on the nature of the su Continue reading >>

Review Article Diabetic Microangiopathy A Current Look At The Pathogenesis And The Clinical Implications For Cardiovascular Diseases

Review Article Diabetic Microangiopathy A Current Look At The Pathogenesis And The Clinical Implications For Cardiovascular Diseases

Papers, Reference Manager, RefWorks, Zotero Szmit S, Opolski G. Review articleDiabetic microangiopathy a current look at the pathogenesis and the clinical implications for cardiovascular diseases. Przegld Kardiodiabetologiczny/Cardio-Diabetological Review. 2007;1(1):27-34. Szmit, S., & Opolski, G. (2007). Review articleDiabetic microangiopathy a current look at the pathogenesis and the clinical implications for cardiovascular diseases. Przegld Kardiodiabetologiczny/Cardio-Diabetological Review, 1(1), 27-34. Szmit, Sebastian, and Grzegorz Opolski. 2007. "Review articleDiabetic microangiopathy a current look at the pathogenesis and the clinical implications for cardiovascular diseases". Przegld Kardiodiabetologiczny/Cardio-Diabetological Review 1 (1): 27-34. Szmit, S., and Opolski, G. (2007). Review articleDiabetic microangiopathy a current look at the pathogenesis and the clinical implications for cardiovascular diseases. Przegld Kardiodiabetologiczny/Cardio-Diabetological Review, 1(1), pp.27-34. Szmit, Sebastian et al. "Review articleDiabetic microangiopathy a current look at the pathogenesis and the clinical implications for cardiovascular diseases." Przegld Kardiodiabetologiczny/Cardio-Diabetological Review, vol. 1, no. 1, 2007, pp. 27-34. Szmit S, Opolski G. Review articleDiabetic microangiopathy a current look at the pathogenesis and the clinical implications for cardiovascular diseases. Przegld Kardiodiabetologiczny/Cardio-Diabetological Review. 2007;1(1):27-34. Microangiopathy is one of the chronic complications in patients with diabetes mellitus. Morphological and functional changes in vessels below 100 nm are typical for diabetic microangiopathy. There are many genetic, biochemical and haemodynamic factors causing microangiopathy. The most important clinical ch Continue reading >>

Endothelial Dysfunction And Pathogenesis Of Diabetic Angiopathy

Endothelial Dysfunction And Pathogenesis Of Diabetic Angiopathy

Endothelial dysfunction and pathogenesis of diabetic angiopathy aDepartment of Internal Medicine, Free University Hospital, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands bInstitute for Cardiovascular Research, Free University Hospital, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands Corresponding author. Tel. +31 20 4440531; Fax +31 20 4440502. Search for other works by this author on: aDepartment of Internal Medicine, Free University Hospital, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands bInstitute for Cardiovascular Research, Free University Hospital, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands Search for other works by this author on: aDepartment of Internal Medicine, Free University Hospital, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands bInstitute for Cardiovascular Research, Free University Hospital, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands Search for other works by this author on: cGaubius Laboratory, TNO Prevention and Health, 2301 CE Leiden, Netherlands Search for other works by this author on: Cardiovascular Research, Volume 34, Issue 1, 1 April 1997, Pages 5568, Coen D.A Stehouwer, Jan Lambert, A.J.M Donker, Victor W.M van Hinsbergh; Endothelial dysfunction and pathogenesis of diabetic angiopathy, Cardiovascular Research, Volume 34, Issue 1, 1 April 1997, Pages 5568, Objective and Methods: To review, from the clinical perspective, the contribution of dysfunction of the vascular endothelium to the pathogenesis of diabetic micro- and macroangiopathy. Results: Available data indicate that endothelial dysfunction in diabetes complicated by micro- or macroalbuminuria (renal microangiopathy) is generalised. The close linkage between microalbuminuria and endothelial dysfunction is an attractive explanation for the fact that microalbumi Continue reading >>

Pathogenesis Of Diabetic Microangiopathy. The Hemodynamic View

Pathogenesis Of Diabetic Microangiopathy. The Hemodynamic View

Volume 80, Issue 3 , March 1986, Pages 443-453 Pathogenesis of diabetic microangiopathy. The hemodynamic view Author links open overlay panel RobertoZatzM.D. Barry M.BrennerM.D. Get rights and content Multiple factors, including altered levels of vasoactive substances, altered vasomotor responsiveness, chronic plasma volume expansion, and tissue hypoxia, contribute to a state of generalized microvascular vasodilatation in early insulin-dependent diabetes mellitus. This vasodilatation, with the consequent elevation in capillary pressures and flows, may be the initiating mechanism leading to both renal and extrarenal diabetic microangiopathy. Sustained hemodynamic actions on the microvasculature, besides directly injuring the capillary wall, promote increased permeability to macromolecules and increased capillary wall proliferation, with consequent thickening of basement membranes and luminal narrowing. These changes eventuate in complete microvascular obstruction and further vasodilatation of less damaged capillaries, thereby ensuring their eventual destruction. The ensuing complications depend on the nature of the surrounding tissue, ranging from reduction of functional reserve, as seen in skeletal muscle, to the devastating functional consequences observed in organs with endarterial circulation such as the kidney and retina. Continue reading >>

Diabetic Skin Microangiopathy : Studies On Pathogenesis And Treatment

Diabetic Skin Microangiopathy : Studies On Pathogenesis And Treatment

Diabetic skin microangiopathy : Studies on pathogenesis and treatment Location: Thoraxklinikens aula, Karolinska Sjukhuset Department: Institutionen fr medicin / Department of Medicine Background: Most of late diabetic complications have their basis in adisturbed microcirculation, i.e. diabetic microangiopathy. This alongwith peripheral arterial occlusive disease (PAOD) and neuropathycontribute to the development of chronic diabetic foot ulcers, a severeand expensive complication often leading to lower-limb amputations and anincreased death rate. Hypercoagulation and impaired fibrinolysisassociated with diabetes mellitus might contribute to the pathogenesis ofdiabetic microangiopathy.Aims: 1. To study the effects of the low molecular weight heparincompound dalteparin (Fragmin, Pharmacia Corporation/Pfizer) on a) ulceroutcome, b) peripheral macro- and microcirculation, and c) haemostaticfunction, in patients with diabetes, PAOD and chronic foot ulcers.2. To evaluate the predictive values of macro- (toe blood pressure, TBP)and microcirculatory (transcutaneous oxygen tension, TcP02) measurementsfor ulcer outcome in patients with diabetes.Methods: 1. Prospective, randomised, double-blind and placebo-controlledmulticenter study. The patients were randomised to treatment with dailyinjections of 5000 U dalteparin or placebo, until ulcer healing or for amaximum of six months. Ulcer healing was evaluated every fourth week, andperipheral circulation and haemostatic function at baseline, after 3 and6 months, or earlier in case of discontinuation of treatment. Foot skinmicrocirculation was evaluated by TcP02 and laser Doppler fluxmetry(LDF), and haemostatic function by analysis of plasma fibrinogenconcentration, fibrin gel structure (permeability coefficient, Ks; fibermass/length Continue reading >>

Diabetic Nephropathy

Diabetic Nephropathy

Author: Vecihi Batuman, MD, FASN; Chief Editor: Romesh Khardori, MD, PhD, FACP more... Diabetic nephropathy is a clinical syndrome characterized by the following [ 1 ] : Persistent albuminuria (>300 mg/d or >200 g/min) that is confirmed on at least 2 occasions 3-6 months apart Progressive decline in the glomerular filtration rate (GFR) Elevated arterial blood pressure (see Workup) Proteinuria was first recognized in diabetes mellitus in the late 18th century. In the 1930s, Kimmelstiel and Wilson described the classic lesions of nodular glomerulosclerosis in diabetes associated with proteinuria and hypertension. (See Pathophysiology.) By the 1950s, kidney disease was clearly recognized as a common complication of diabetes, with as many as 50% of patients with diabetes of more than 20 years having this complication. (See Epidemiology.) Currently, diabetic nephropathy is the leading cause of chronic kidney disease in the United States and other Western societies. It is also one of the most significant long-term complications in terms of morbidity and mortality for individual patients with diabetes. Diabetes is responsible for 30-40% of all end-stage renal disease (ESRD) cases in the United States. (See Prognosis.) Generally, diabetic nephropathy is considered after a routine urinalysis and screening for microalbuminuria in the setting of diabetes. Patients may have physical findings associated with long-standing diabetes mellitus. (See Clinical Presentation.) Good evidence suggests that early treatment delays or prevents the onset of diabetic nephropathy or diabetic kidney disease. This has consistently been shown in both type1 and type 2 diabetes mellitus. (See Treatment and Management). Regular outpatient follow-up is key in managing diabetic nephropathy successfully. ( Continue reading >>

[pathogenesis Of Diabetic Microangiopathy. Fluoroangioretinal Observations During Monocomponent... - Abstract - Europe Pmc

[pathogenesis Of Diabetic Microangiopathy. Fluoroangioretinal Observations During Monocomponent... - Abstract - Europe Pmc

Type: English Abstract, Journal Article(lang: ita) Current theories on the pathogenesis of diabetic microangiopathy and their effective therapeutical implications are reviewed. The possible role of insulin antibody production in insulin-treated diabetics concerning development and progression of retinopathy is particularly discussed. Thus the opportunity of a monocomponent (MC) insulin treatment in all newly diagnosed insulin-dependent diabetics is considered. The authors have carried out fluorescein angiography in two groups of subjects with JOD comparable for age, sex, diabetes duration (5-7 years), insulin requirement, metabolic control, absence of diabetic heredity as well as of clinical (ophtalmoscopic) signs of microangiopathy (retinopathy). The first group had been treated from the beginning with MC porcine insulin (Monotard) only; the second one with conventional Lente only. Early fluoroangiographic signs of retinopathy ("pre-retinopathy") as increased capillary filling, ischaemic areas, alterations in capillary permeability, microangioaneurysms, "primary exudation" had to be detected. In 2 out of 10 cases in the first group one isolated sign was found; one or more signs were found in the second group. In the first group the insulin antibody titer (IB) was under or nearly above the detection limit; in the second group insulin antibody titer was significantly positive. These preliminary findings suggest a larger prospective study. Continue reading >>

Role And Limits Of Glycemic Regulation In The Pathogenesis Of Diabetic Microangiopathy

Role And Limits Of Glycemic Regulation In The Pathogenesis Of Diabetic Microangiopathy

Role and limits of glycemic regulation in the pathogenesis of diabetic microangiopathy Authors: Le Dvhat, C. ; | Khodabandehlou, T. | Zhao, H. ; | Vimeux, M. Affiliations: Service DiabtologieEndocrinologieNutrition, Centre Hospitalier, 58000 Nevers, France | Unit de Recherches dHmorhologie Clinique, Centre Hospitalier, 58000 Nevers, France | Research Institute, ChinaJapan Friendship Hospital, Beijing, China Abstract: The relationship between either an acute or a chronic hyperglycemia and functional microcirculatory disturbances was studied in insulindependent diabetic (IDD) patients in comparison to healthy volunteers. Acute hyperglycemia, provoked in 10 IDD patients, was accompanied by an increase in laser doppler skin blood flux while transcutaneous oxygen pressure (TcPO_2) decreased. These changes, accompanied by that in the concentration of moving blood cells indicate that acute hyperglycemia results in a vasodilation in favour of nonnutritive microvascular shunts. The effect of chronic hyperglycemia was studied in 36 IDD patients who had a duration of diabetes of less than 5 years and had no clinical signs of micro and macroangiopathy. In these patients, erythrocyte aggregation, plasma viscosity and fibrinogen concentration were increased and transcutaneous oxygen pressure reduced, compared with the levels seen in healthy subjects. More marked impairments were observed in patients with poor glycemic control. This suggests that chronic hyperglycemia involves functional disturbances which will contribute to the development of the vascular complications of diabetes. In 34 patients with poorly controlled diabetes who received intensive insulin therapy for 36 months, these changes were reversed in patients in whom good glycemic control was achieved within 2 months, but Continue reading >>

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