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Peripheral vascular disease and type 2 diabetes mellitus
N C Schaper1, M H Nabuurs-Franssen, M S Huijberts
1Division of Endocrinology, Department of Internal Medicine, Academic Hospital Maastricht and Cardiovascular Institute Maastricht (CARIM), The Netherlands. nsc@sint.azm.nl
Diabetes/Metabolism Research and Reviews
|October 31, 2000
Summary
Type 2 diabetes mellitus often leads to peripheral vascular disease, particularly in the lower legs. Prediabetic metabolic issues and chronic hyperglycemia in diabetes accelerate atherosclerosis, impairing vascular repair.
Area of Science:
- Vascular Medicine
- Endocrinology
- Diabetology
Background:
- Type 2 diabetes mellitus (T2DM) is commonly associated with peripheral vascular disease (PVD).
- PVD in T2DM patients often presents with a predilection for the lower extremities.
- The mechanisms underlying this specific distribution and high prevalence require detailed exploration.
Purpose of the Study:
- To review and explore potential mechanisms contributing to the high prevalence and altered distribution of PVD in T2DM patients.
- To investigate the role of prediabetic metabolic abnormalities in initiating distal and aggressive atherosclerosis.
- To examine how chronic hyperglycemia and associated complications accelerate PVD progression in established T2DM.
Main Methods:
- Literature review of existing studies on T2DM, PVD, and atherosclerosis.
- Analysis of proposed pathophysiological mechanisms including metabolic derangements, endothelial dysfunction, and neuropathy.
- Hypothesizing the contribution of prediabetic metabolic state to disease initiation and progression.
Main Results:
- Metabolic abnormalities during the prediabetic phase may predispose to more distal and aggressive atherosclerosis.
- Chronic hyperglycemia in T2DM accelerates the atherosclerotic process.
- Endothelial damage, non-enzymatic glycosylation, and polyneuropathy contribute to impaired vascular remodeling and collateral formation.
Conclusions:
- Prediabetic metabolic changes are hypothesized to initiate a more aggressive, distal PVD.
- Established T2DM, driven by hyperglycemia, exacerbates PVD through multiple pathways.
- Understanding these mechanisms is crucial for developing targeted interventions for PVD in T2DM patients.