Type 2 Diabetes and Vascular Complications: Current Perspectives on Pathophysiology and Management Strategies

Type 2 diabetes mellitus (T2DM) is a major global public health challenge, currently affecting over 537 million adults, with projections reaching 783 million by 2045. India contributes over 17% of global T2DM cases, significantly adding to the disease burden. Hyperglycemia-induced oxidative stress plays a crucial role in T2DM pathogenesis by disrupting the balance between reactive oxygen species (ROS) production and antioxidant defence mechanisms. This imbalance activates pathological pathways, including polyol and hexosamine biosynthesis, promotes advanced glycation end-products (AGEs) formation, increases protein kinase C (PKC) activity, and triggers inflammation, leading to vascular complications.

This study systematically examines literature reviews published between 2010 and 2024 in peerreviewed journals indexed in databases such as PubMed, Web of Science, Scopus, ScienceDirect, and Google Scholar. The research utilizes search terms about diabetic microvascular and macrovascular complications, their pathogenesis, and therapeutic management.

Microvascular complications, arising from damage to small blood vessels, encompass diabetic nephropathy, retinopathy, neuropathy, and sexual dysfunction. Macrovascular complications, resulting from large blood vessel impairment, increase the risk of cardiovascular diseases, including coronary artery disease, peripheral arterial disease, stroke, and heart failure.

The effective management of vascular complications necessitates a comprehensive approach, incorporating strict glycaemic control, lifestyle modifications, and pharmacological interventions such as Renin- Angiotensin-Aldosterone System (RAAS) blockers, Sodium-Glucose Cotransporter-2 (SGLT2) inhibitors (e.g., dapagliflozin), phosphodiesterase-5 inhibitors (PDE5i) (e.g., sildenafil citrate), glucagon-like peptide-1 receptor agonists, and anti- vascular endothelial growth factor (VEGF) therapies (e.g., aflibercept). Early diagnosis, risk factor management, and targeted treatment strategies are crucial for improving patient outcomes and mitigating disease progression.