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What Is Microangiopathy In Diabetes?

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 >>

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 >>

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 >>

Cd40-mediated Hif-1 Expression Underlying Microangiopathy In Diabetic Nerve Pathology | Disease Models & Mechanisms

Cd40-mediated Hif-1 Expression Underlying Microangiopathy In Diabetic Nerve Pathology | Disease Models & Mechanisms

CD40-mediated HIF-1 expression underlying microangiopathy in diabetic nerve pathology Hung-Wei Kan, Jung-Hsien Hsieh, Hsiung-Fei Chien, Yea-Huey Lin, Ti-Yen Yeh, Chi-Chao Chao, Sung-Tsang Hsieh Disease Models & Mechanisms 2018 : dmm.033647 doi:10.1242/dmm.033647 Published 16 March 2018 Department of Anatomy and Cell Biology, National Taiwan University, Taipei 10051, TaiwanDepartment of Surgery, National Taiwan University Hospital, Taipei 10002, Taiwan Department of Anatomy and Cell Biology, National Taiwan University, Taipei 10051, TaiwanDepartment of Surgery, National Taiwan University Hospital, Taipei 10002, Taiwan For correspondence: [email protected]@ntu.edu.tw Department of Anatomy and Cell Biology, National Taiwan University, Taipei 10051, TaiwanDepartment of Neurology, National Taiwan University Hospital, Taipei 10002, TaiwanDepartment of Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei 10051, Taiwan To understand the pathology and molecular signatures of microangiopathy in diabetic neuropathy, we systemically and quantitatively examined the morphometry of microvascular and nerve pathologies of sural nerves. In the endoneurium of diabetic nerves, prominent microangiopathy evidenced by reduced capillary luminal area, increased capillary basement membrane thickness, and increased proportion of fibrin(+) blood vessels. Furthermore, capillary basement membrane thickness and the proportion of fibrin(+) blood vessels were correlated with small myelinated fiber density in diabetic nerves. In diabetic nerves, there was significant macrophage and T cell infiltration, and cluster of differentiation 40 (CD40) expression was increased. For molecular alterations in diabetic nerves, hypoxia-inducible factor-1 ( 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 >>

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 >>

Common Vitamins And Supplements To Treat Diabetic-microangiopathy

Common Vitamins And Supplements To Treat Diabetic-microangiopathy

Learn about User Reviews and read IMPORTANT information about user generated content Conditions of Use and Important Information: This information is meant to supplement, not replace advice from your doctor or healthcare provider and is not meant to cover all possible uses, precautions, interactions or adverse effects. This information may not fit your specific health circumstances. Never delay or disregard seeking professional medical advice from your doctor or other qualified health care provider because of something you have read on WebMD. You should always speak with your doctor or health care professional before you start, stop, or change any prescribed part of your health care plan or treatment and to determine what course of therapy is right for you. This copyrighted material is provided by Natural Medicines Comprehensive Database Consumer Version. Information from this source is evidence-based and objective, and without commercial influence. For professional medical information on natural medicines, see Natural Medicines Comprehensive Database Professional Version. Therapeutic Research Faculty 2009. Continue reading >>

Diabetic Microangiopathy.

Diabetic Microangiopathy.

Aker Diabetes Research Centre, Paediatric Department, Aker University Hospital, Oslo, Norway. Microvascular complications of diabetes include retinopathy, nephropathy and neuropathy. The first signs of these complications may develop in children and adolescents, particularly if insulin treatment has been inadequate. The mechanisms by which diabetic microangiopathy develop are not known, but probably include genetic influences. Several biochemical changes may interact, one important change being increased protein glycation. Important functional changes are increased organ blood flow, increased vascular permeability, abnormal blood viscosity and abnormal platelet and endothelial function. The structural hallmark of diabetic microangiopathy is the thickening of the capillary basement membrane. These changes may lead to occlusive angiopathy and to tissue hypoxia and damage. Screening for microangiopathy should start in children and adolescents after 5-y duration of the disease and 10y of age. The screening should include retinal examination through a dilated pupil or fundus photography, urinary albumin excretion rate, blood pressure measurement and neurological examination. Several intervention trials have shown that near normoglycaemia may reduce the risk of microangiopathy. There is a curvilinear association between the risk of development and progression of microangiopathy and mean blood glucose. Therefore, optimal insulin treatment is important in children and adolescents. Continue reading >>

Microangiopathic Complications In Type 1 Diabetes Mellitus: Differences In Severity When Isolated Or Associated With Autoimmune Polyendocrinopathies

Microangiopathic Complications In Type 1 Diabetes Mellitus: Differences In Severity When Isolated Or Associated With Autoimmune Polyendocrinopathies

Original Article Patrícia Teófilo Monteagudo, Maria Beatriz Sayeg Freire, Nilva Simeren Bueno de Moraes, Sérgio Atala Dib Endocrinology Unit, Department of Medicine/Universidade Federal de São Paulo/Escola Paulista de Medicina/UNIFESP-EPM, São Paulo, Brazil ABSTRACT CONTEXT: The development and evolution of different chronic diabetic complications may present variations among the different types and conditions of this disease. OBJECTIVE: To evaluate the degree of microangiopathy in Type 1 diabetes mellitus (DM1) associated with autoimmune polyendocrinopathies (OSAD) or isolated DM1 (iDM1). PATIENTS: OSAD (n=17) and iDM1 (n=13) were over 15 years old at diagnosis of DM and were matched for diabetes duration (13.9 ± 8.2 and 13.2 ± 5.9 years, respectively) and metabolic control (HbA1c: 6.4 ± 1.9 and 6.8 ± 1.4%). MAIN OUTCOME MEASURES: Urinary albumin excretion (UAE; ELISA), the inversion of serum creatinine (1/C) level and indirect ophthalmoscopy. RESULTS: Although the prevalence of hypertension was similar in both groups, the OSAD had inferior levels of UAE (7.4 ± 2.5 vs. 17.3 ± 9.2 µg/min; p< 0.05). Nephropathy was detected in 12% of the OSAD (none of them macroproteinuric) and in 39% of the iDM1 . The UAE in the iDM1 correlated negatively with 1/C values (r= -0.7, p< 0.005), but the same did not occur in the OSAD (r= 0.2, ns). Among patients with retinopathy, the severe form was found in 29% of the OSAD and in 46% of the iDM1. CONCLUSIONS: OSAD was associated with a lower degree of microangiopathy, in spite of age at diagnosis, duration of diabetes and the metabolic control. In contrast with the iDM1 , the increase in UAE of OSAD was not associated with reductions in GFR. UNITERMS: Microangiopathy. Type 1 diabetes mellitus. Autoimmune poliendocrinopathies. I 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 >>

Association Between Diabetes Mellitus With Metabolic Syndrome And Diabetic Microangiopathy

Association Between Diabetes Mellitus With Metabolic Syndrome And Diabetic Microangiopathy

Association between diabetes mellitus with metabolic syndrome and diabetic microangiopathy Affiliations: Department of Endocrinology, First Affiliated Hospital, Liaoning Medical College, Jinzhou, Liaoning 121001, P.R. China Published online on: September 29, 2014 Metrics: HTML 0 views | PDF 0 views Cited By (CrossRef): 0 citations The aim of this study was to investigate the association between diabetes mellitus (DM), mainly typeII, with metabolic syndrome (MS) and diabetic nephropathy(DN)/diabetic retinopathy (DR). Based on the analysis of the prevalence of MS, patients with DM were divided into MS and nonMS groups according to the presence or absence of MS. The correlation between DN, DR and certain factors, including gender, age, disease duration and the presence or absence of a family history of MS, were analyzed. The prevalence of MS among the patients with DM was 62.50%. The prevalence of DN was 55.33% in the MS group and that of DR was 26.00%. DN was positively correlated with age, gender, blood pressure, triglyceride (TG), lowdensity lipoprotein cholesterol (LDLC) and blood uric acid. DR was positively correlated with traceable disease duration and LDLC. In conclusion, DM occurred more frequently in concurrence with MS than without MS, and the prevalence of DN/DR in the MS group was higher than that in the nonMS group. Age, gender, blood pressure, TG, LDLC and blood uric acid were risk factors for DN and the traceable disease duration and LDLC were risk factors for DR. At present, diabetes mellitus (DM) is a seriousissue in China, and complications associated with the disease are aserious threat to human health. Diabetic nephropathy (DN) anddiabetic retinopathy (DR) are the main microvascular complications,causing kidney failure and blindness, respectively. Met Continue reading >>

Hyperglycaemia, Microangiopathy, Diabetes And Dementia Risk - Em|consulte

Hyperglycaemia, Microangiopathy, Diabetes And Dementia Risk - Em|consulte

Hyperglycaemia, microangiopathy, diabetes and dementia risk Hyperglycmie microangiopathie crbrale, diabte et dmence aCHU of Bordeaux, Department of Gerontology, Bordeaux, France UMR 5536 CNRS/University Victor Segalen Bordeaux 2, Bordeaux, France bUMR 5536 CNRS/University Victor Segalen Bordeaux 2, Bordeaux, France cINSERM, U987, F-33076 Bordeaux, France; Universit Victor Segalen Bordeaux 2, F-33076 Bordeaux, France Brain microangiopathy increases in frequency and severity with older age, with the presence of hypertension and to a lesser extent with diabetes. Magnetic resonance imaging is used to provide anatomical descriptions, but at this time only clinical examination and neuropsychological testing can assess white matter functioning. Clinical correlates of microangiopathy appear as subcortical cognitive alterations, but data are controversial about dementia risk. Brain microangiopathy seems to be however a complication of chronic hyperglycaemia, probably due to similar mechanisms occurring in retinopathy and other microvascular complications. To date, many questions have been raised: How can brain microangiopathy progression be monitored? Is there a reversible stage of brain microangiopathy? Which preventive actions should be implemented in aging patients with diabetes? Finally, what type of care should be provided for people with diabetes and mild cognitive impairment or overt dementia to slow down cognitive worsening? The full text of this article is available in PDF format. La micro-angiopathie crbrale augmente en frquence et en svrit avec lge, lhypertension artrielle et plus discrtement avec le diabte. Limagerie de rsonnance magntique fournit une description anatomique, mais pour lheure, seule la clinique et la psychomtrie permet dvaluer le fonctionnement de la 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 >>

Pathogenetic Mechanisms Of Diabetic Microangiopathy

Pathogenetic Mechanisms Of Diabetic Microangiopathy

Pathogenetic mechanisms of diabetic microangiopathy Author links open overlay panel UmbertoDi Mario Get rights and content Hyperglycaemia has been shown to play a central role in diabetic microangiopathy, together with the individual background. The pathogenetic sequence is initiated by a series of interrelated biochemical abnormalities associated with hyperglycaemia, including increased flux through the polyol and hexosamine pathways, oxidative stress, AGE formation and protein kinase C (PKC) activation. These abnormalities are capable of modifying the production pattern of several autocrine/paracrine factors by resident and nonresident cells of the tissues. These changes impair the vessel wall turnover, thus leading to an abnormal vascular remodelling, characterised by altered cell and matrix turnover and contacts, vascular tone and permeability and coagulation pattern, with distinct features depending on the target tissue. The hallmark of nephropathy is an abnormal extracellular matrix (ECM) accumulation within the mesangium, sustained by an upregulation of TGF-, possibly triggered by a local activation of the reninangiotensin system, whereas the characteristic alteration of retinopathy is retinal ischaemia due to the formation of acellular capillaries and triggering of a process of vascular endothelial growth factor (VEGF)-dependent neovascularization. This response is very active, but leads to the formation of noncompetent vessels, at variance with macrovascular disease, characterised by an impaired angiogenic response, with generation of competent vessels, potentially compensating for reduced flow. Continue reading >>

Toward Prevention Of Diabetic Microangiopathy

Toward Prevention Of Diabetic Microangiopathy

Toward Prevention of Diabetic Microangiopathy Unlike atheromatous deposits in the larger vessels, the thickening of the basement membrane in the renal and retinal microvasculature of diabetic patients has no readymade metabolic explanation. Ashton1 attributed these changes to tissue hypoxia caused by reduced blood flow. Spiro2 ascribed them to deposition of protein-bound carbohydrate, formed in excess by the diversion of glucose to glycoprotein synthesis. Impressed by the beneficial effect of pituitary ablation on diabetic retinopathy, Lundbaek et al3 sought to implicate the excessive secretion of growth hormone. Incorporating some aspects of these theories into a "three-in-one" concept, Ditzel4 hypothesizes that diabetic microangiopathy is a result of diminished tissue oxygenation, which is due less to reduced blood flow than to diminished release of oxygen from the hemoglobin molecule, as reflected in the right shift of the oxygen dissociation curve. This unloading defect could be explained by an increase in hemoglobin A1a-c ("fast" hemoglobin), Continue reading >>

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