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Microangiopathy And Macroangiopathy In Diabetes

Diabetic Microangiopathy Is An Independent Predictor Of Incident Diabetic Foot Ulcer

Diabetic Microangiopathy Is An Independent Predictor Of Incident Diabetic Foot Ulcer

Diabetic Microangiopathy Is an Independent Predictor of Incident Diabetic Foot Ulcer 1Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo 108-0073, Japan 2Division of General Internal Medicine, Department of Internal Medicine, Tokai University Hachioji Hospital, Tokyo, Japan 3Diabetes Center, Eiju General Hospital, Tokyo, Japan 4Saiseikai Shibuya Satellite Clinic, Tokyo, Japan Received 31 October 2015; Accepted 4 February 2016 Copyright 2016 Masuomi Tomita 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. Aim. To determine the diabetic foot ulcer incidence and examine its association with microangiopathy complications, including diabetic retinopathy (DR) and albuminuria (Alb), in type 2 diabetes patients. Methods. This was a retrospective cohort study of 1,305 patients with type 2 diabetes who were assigned to the following groups: Category 1, normoalbuminuria without DR ( ); Category 3, normoalbuminuria with DR ( ). Cox proportional hazard models were used to compare the risks of developing diabetic foot ulcers across the categories. Results. During 14,249 person-years of follow-up, 50 subjects developed diabetic foot ulcers, with incidence rates of 1.6/1,000, 1.5/1,000, 3.4/1,000, and 12.5/1,000 person-years in Categories 1, 2, 3, and 4, respectively. After adjusting for the presence of diabetic neuropathy and macroangiopathy, the hazard ratios and 95% confidence intervals (CIs) for the risk of diabetic foot ulcer development were 0.66 (95% CI, 0.182.36), 1.72 (95% CI, 0.674.42), and 3.17 (95% CI, 1.526.61) in Categories 2, 3, and 4, respectively, compared with Category 1. Con 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 >>

Pathogenesis Of Diabetic Macro- And Microangiopathy.

Pathogenesis Of Diabetic Macro- And Microangiopathy.

Pathogenesis of diabetic macro- and microangiopathy. Department of Pathology, Eberhard Karls University Tbingen, Germany. [email protected] Epidemiological investigations reveal that we must expect a rapid increase in cases of diabetes mellitus in the next few years. As a result, vascular complications in the form of macro- and microangiopathy are also expected to arise more frequently. A classical example of macroangiopathy is coronary arteriosclerosis, microangiopathy is exemplified by diabetic nephropathy. In patients suffering from diabetes, macroangiopathy manifests as atherosclerosis like in nondiabetic patients, characterized by formation of plaques that follows in stages but with an accelerated course due to the different risk factors, especially hyper- and dyslipidemia, with cumulative effects. Thus, atherosclerosis in diabetes begins earlier, is more markedly pronounced and progresses more rapidly. The pathogenetic concept is based on an endothelial lesion that occurs as a result of a diabetes-specific, endothelium-damaging parameters. In case of diabetic microangiopathy histologically characterized by a progressive glomerulosclerosis, arteriolosclerosis and interstitial fibrosis hyperglycemia, along with its consecutive and complex processes that induce matrix increase, is considered to be the primary pathogenetically relevant factor involved. Insulin resistance seems to be the major common denominator at the center of both diabetic macroangiopathy and microangiopathy. Continue reading >>

Get Unlimited Access On Medscape.

Get Unlimited Access On Medscape.

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Dissociation Of Microangiopathy And Macroangiopathy In Patients With Type 2diabetes.

Dissociation Of Microangiopathy And Macroangiopathy In Patients With Type 2diabetes.

Dissociation of microangiopathy and macroangiopathy in patients with type 2diabetes. Yamamoto M(1), Egusa G, Okubo M, Yamakido M. (1)Second Department of Internal Medicine, Hiroshima University School of Medicine, Japan. [email protected] OBJECTIVE: Although persistent hyperglycemia contributes greatly to theprogression of diabetic micro- and macroangiopathy, microangiopathy progressesmore rapidly than macroangiopathy in some type 2 diabetic patients, with theopposite being true in others. This study was conducted to identify factorsresponsible for such dissociation.RESEARCH DESIGN AND METHODS: Patients with proliferative diabetic retinopathy anda carotid intima-media thickness (IMT) level < or =1.0 mm were classified as the microangiopathy group (MIG); those with an IMT level >1.1 mm and withoutretinopathy or with background retinopathy were assigned to the macroangiopathygroup (MAG). Only middle-aged patients, 50-69 years old, were included in thisstudy. There were 54 patients in the MIG and 68 patients in the MAG.RESULTS: Patients in the MIG were significantly younger at the onset of diabetes,and those in the MAG had a significantly higher mean ratio of apoprotein (apo) B to apoAI. The percentage of patients with a family history of diabetes wassignificantly higher in the MIG. Maternal inheritance was common among thesepatients. Those with obesity, a family history of diabetes, and younger onset of hypertension were more common in the MAG. In the multiple logistic regressionanalyses, maternal inheritance and early onset of diabetes were independent risk factors for the acceleration of microangiopathy. A personal history of obesityand a family history of hypertension were independently related to thedevelopment of macroangiopathy.CONCLUSIONS: Our result Continue reading >>

Diabetes And Diabetic Complications

Diabetes And Diabetic Complications

The Maillard reaction and diabetes mellitus (Contribution from Dr Alejandro Gugliucci MD, PhD) Diabetes mellitus, a condition characterized mainly by a quantitative deficiency in insulin secretion or a resistance to insulin action, is estimated to afflict 8% of the population. This creates a huge economic burden related for the most part to the management of its complications, which are micro and macroangiopathic in nature. Microangiopathy, the microvessel disease in diabetes, includes retinopathy, nephropathy, and neuropathy and in type 1 patients the first signs of these complications may develop even in adolescence, particularly if insulin treatment has been inadequate. Similar complications occur later in life in type 2 patients and are frequently present at the time of diagnosis. The precise mechanisms by which diabetic microangiopathy develops are not fully understood, but a consensus is emerging pointing to a terrain of genetic influences onto which metabolic and hemodynamic derangements are superimposed. The anatomic hallmark of diabetic microangiopathy is the thickening of capillary basement membranes, which subsequently induces occlusive angiopathy, tissue hypoxia, and damage. The evolution of the numerous long-term complications of diabetes mellitus correlates well, in most cases, with the severity and duration of hyperglycemia. It is known that, for instance, postprandial glucose levels above 200 mg/dL (11 mM) are more frequently associated with renal, retinal, and neurologic complications that can commence 5 to 10 years after the debut of the disease. It is noteworthy to point out here that, at the time of initial diagnosis of type 2 diabetes, many patients have postprandial glucose levels above 200 mg/dL and already display some degree of diabetic complica Continue reading >>

Path Long Term Diabetes

Path Long Term Diabetes

What cells have complications from hyperglycemia cells that don't require insulin for uptake--i.e. cells that aren't msucle or adipose -most at risk are those that can't regulate glucose uptake Endothelial and nurons ,schwann and mesangial How are endothelial cells impacted by diabetes cells that don't require insulin for uptake--i.e. cells that aren't msucle or adipose -most at risk are those that can't regulate glucose uptake How are neurons and schwann celsls impacted by DM AND mesangial cells cells that don't require insulin for uptake--i.e. cells that aren't msucle or adipose -most at risk are those that can't regulate glucose uptake variety of changes/cell death leading to pns and renal complications General mechanism by which cells are injured with high BGL dysregulation of mitochondrial electron transport increase free radicals and decrease their ddepletion(oxidative stress) NORMALLY glucose makes ROS as it is metabolized...but the ROS are degraded in diabetes more glucose so MORE energy production MORE ROS but not enough breakdown of ROS--so too much ROS How does increased ROS impact pathogenesis of diabetes increased ROS inhibits glycolytic enzyme (GAPDH which converts glycraldehyde to 1,3 diphophoglycerate ....so normal glucose metab can't continue...shutns to other pathways that are normally minor pathways What pathways is glucsoe shunted to because of ROS Continue reading >>

Microangiopathy - An Overview | Sciencedirect Topics

Microangiopathy - An Overview | Sciencedirect Topics

Andrew R. Gennery, in Stiehm's Immune Deficiencies , 2014 Microangiopathy following allogeneic hematopoietic stem cell transplantation is a well-recognized but poorly defined group of syndromes, occurring in up to 15% of patients and characterized by generalized endothelial dysfunction occurring within 150 days of transplant. A number of terms have been used to describe this entity, including thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, thrombotic microangiopathy, transplant-associated microangiopathy, and microangiopathic hemolytic anemia. The pathogenesis is poorly understood; endothelial toxicity caused by chemoradiotherapy, infection, immunosuppressive drugs (particularly calcineurin inhibitors), and GvHD is implicated. The most effective treatment is cessation of calcineurin inhibitors; defibrotide has been used with some success.8183 Maria Cecilia Ziadi, ... Rob S. Beanlands, in Clinical Nuclear Cardiology (Fourth Edition) , 2010 Significance of Endothelial and Microvessel Dysfunction Microvascular disease underlies the involvement of the small coronary arteries in early phases of several cardiovascular conditions that usually precede the onset of symptoms. Microvascular disease or dysfunction is considered to be an independent prognostic value.120 Coronary endothelial vasodilator dysfunction has been observed in patients with traditional cardiovascular risk factors. Endothelial cells protect the coronary artery as mechanical barriers and produce vasoactive substances, cytokines, and other active biological compounds to maintain vascular homeostasis.121 The biochemical hallmark of coronary endothelial dysfunction is a reduction in the synthesis or bioactivity of NO, with reduced endothelium-dependent vasodilatation. R.A. Malik12*, in Handbook o Continue reading >>

Is Microalbuminuria A Marker For Microangiopathy Or Macroangiopathy?

Is Microalbuminuria A Marker For Microangiopathy Or Macroangiopathy?

Is microalbuminuria a marker for microangiopathy or macroangiopathy? 10. J.-G. Wang, Y. Li, and C.-S. Sheng, China The presence of a low concentration of albumin in the urine (microalbuminuria) was originally considered a marker of renal microangiopathy, thus confining its clinical usefulness mainly to the early detection of patients at higher risk of diabetic nephropathy. In the last 10 years, this concept has been challenged in several respects. Microalbuminuria was found in nondiabetic patients and in the general population, where the risk of nephropathy is extremely low. Several large epidemiological studies, eg, the Prevention of REnal and Vascular ENdstage Disease (PREVEND) and European Prospective Investigation of Cancer-Norfolk (EPICNorfolk) studies, showed that microalbuminuria was associated with a higher risk of cardiovascular complications, such as coronary artery disease or death from a cardiovascular event, in unselected populations. As such, microalbuminuria probably reflects an alternative mechanism of cardiovascular pathogenicity. It is now generally considered a surrogate marker of endothelial dysfunction present in most patients with cardiovascular complications. Large clinical studies, such as the Heart Outcomes Prevention Evaluation (HOPE) and the Losartan Intervention For Endpoint reduction in hypertension (LIFE), provided further confirmation of the association between microalbuminuria and macroangiopathy. The prevalence of cardiovascular problems, such as coronary artery disease, peripheral vascular disease, and cerebrovascular disease, was significantly and dose-dependently associated with the intensity of proteinuria, as was the risk of cardiovascular death. Most interestingly, post-hoc analysis showed that the ability to lower microalbuminuri 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 >>

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 >>

Micro And Macrovascular Complications Of Diabetes Mellitus In Cameroon: Risk Factors And Effect Of Diabetic Check-up - A Monocentric Observational Study

Micro And Macrovascular Complications Of Diabetes Mellitus In Cameroon: Risk Factors And Effect Of Diabetic Check-up - A Monocentric Observational Study

Stéphane Moumbe Tamba1, Marielle Epacka Ewane1,2, Aimé Bonny1, Claudine Nkidiaka Muisi3, Emmanuel Nana2, Augustin Ellong2, Côme Ebana Mvogo1,2, Samuel Honoré Mandengue1,& 1University of Douala, Cameroon, 2General Hospital of Douala, Cameroon, 3Essos Hospital Center, Yaounde, Cameroon &Corresponding author Samuel Honoré Mandengue, University of Douala, BP: 7064, Cameroun Introduction: The objective of this study was to evaluate the prevalence of vascular complications among diabetes patients (DP), to find out the relationship with risk factors and to assess the effect of diabetic check-up (DC) in the onset of these complications. Methods: Clinical and laboratory data of DP followed between 2000 and 2009 were retrospectively analyzed. Those with at least one DC were selected (140 out of 538). Risk factors were checked and listed. Prospectively, an electrocardiogram (ECG) was recorded for 121 of them. Results: The sample was constituted of 78 (56%) men and 62 (44%) females; mean age was 55 ± 12 years. Type 2 Diabetes accounted for 94.3%. Microangiopathy distribution was: retinopathy = 23.6%, nephropathy = 25% and neuropathy = 40%. Within macroangiopathy prevalence was: 5% for stroke, 17.1% for limbs ischemic disease and 23.6% for coronary heart disease. Occurrence of complications was associated with hypertension, duration of diabetes, dyslipidemia, microalbuminuria, 24-hour proteinuria, body mass index and HbA1c. Diabetic neuropathy was neither associated to HbA1c nor microalbuminuria.. HbA1c was conversely but not significantly associated with the number of DC realized. Conclusion: Conclusion: Vascular complications are considerably present in diabetes patients in the studied center, especially among those practicing less glycemic controls. Normalizing the level of 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 >>

Macroangiopathy - An Overview | Sciencedirect Topics

Macroangiopathy - An Overview | Sciencedirect Topics

Simerpreet Bal, ... Andrew M. Demchuk*, in Handbook of Clinical Neurology , 2014 Imaging small vessel abnormalities in diabetes mellitus Use of transcranial Doppler in diabetic patients with chronic cerebrovascular disease In contrast to macroangiopathy, assessed with many invasive and noninvasive investigations discussed above, cerebral microangiopathy involving small perforating arteries contributes to lacunar infarction but has no specific diagnostic tool. TCD may provide indirect assessment of the microvasculature by the pulsatility index (PI), which is calculated from the difference between peak systolic velocity and end-diastolic velocity. Increased PI has been associated with the duration of DM, old age (>60 years), hypertension, intracranial atherosclerosis, vascular dementia, and small vessel disease (Hassler et al., 1988; Foerstl et al., 1989; Cho et al., 1997; Lee et al., 2000; Kidwell et al., 2001). The PI is postulated to reflect the vascular resistance distal to the examined artery. Therefore, disease or dysfunction of distal small intracranial perforating arteries may alter the PI of upstream larger intracranial artery such as the MCA. Indirect findings of increased PI is more relevant when there is other evidence of DM-related microangiopathic disease such as retinopathy or nephropathy (Lippera et al., 1997; Lee et al., 2000). In a TCD study comparing cerebral hemodynamics in type 2 diabetic patients of disease duration greater than 5 years, flow velocities (Vm) and PI was higher in comparison to age-matched controls. Lacunar infarcts in an otherwise asymptomatic diabetic population have revealed increased PI in intracranial vessels shown on TCD (Tkac et al., 2001). Further studies using long-term serial follow-up TCD exams may clarify the temporal chan Continue reading >>

Irocket Learning Module: Pathological Complications Of Diabetes Mellitus

Irocket Learning Module: Pathological Complications Of Diabetes Mellitus

Pathological Complications of Diabetes Mellitus The most important long-term effects of diabetes mellitus are manifested principally in the cardiovascular system in the form of accelerated atherosclerosis and hyaline arteriosclerosis (diabetic macroangiopathy) and of specific capillary lesions (diabetic microangiopathy). Cardiovascular disease is the underlying cause of death of nearly 60 percent of deaths among people with diabetes. Manifested by increased incidence and severity of: Coronary artery disease: myocardial infarction Cerebrovascular accidents: strokes (infarcts and intracerebral hemorrhage) Peripheral ischemic arterial disease: especially, lower extremities Arteriolar nephrosclerosis: decreased renal function Diabetic microangiopathy develops after 10-15 years of the disease. Lesions occur at the level of capillaries and consist of increased accumulation of capillary basement membrane material, causing distortion, abnormal permeability, and eventually occlusion of the capillaries. The exact mechanism for hyperglycemic induced extracellular matrix protein synthesis leading to basement membrane thickening is presently unclear. The exact role of nonenzymatic glycosylation of proteins and basement membrane thickening in chronic diabetic states is also unclear. Click on an image below to view a larger version, in a new browser window. Characterized by diffuse thickening of glomerular capillary basement membranes and increased amount of mesangial matrix with mild mesangial cell proliferation (mesangial enlargement). Glomerular changes always begin in the vascular stalk. The affected glomeruli eventually develop obliterative diabetic glomerulosclerosis. These changes are seen in at least 40% of diabetic patients after more than 10 to 20 years. Nodular Glomeroscle Continue reading >>

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