Vascular disease in diabetes: pathophysiological mechanisms and therapy

Abstract

Vascular disease is the major cause of morbidity and mortality in diabetes mellitus. Diabetics are twice as prone to heart attacks, 5 times more prone to gangrene, 17 times more prone to kidney failure and 25 times more prone to blindness than nondiabetics. This reflects the effects of accelerated atherosclerosis, plus a relatively specific form of microvascular disease in multiple organ systems in the diabetic. Recent progress has been made in the understanding of the mechanisms involved both in large-vessel disease (macrovascular disease) and small-vessel disease (microvascular disease) in patients with diabetes mellitus. With an increased understanding of the mechanisms involved, intelligent decisions about therapy may be more easily made. Current thoughts about the pathophysiologic features of diabetic vascular disease are reviewed and therapeutic recommendations are made.