[Atherosclerosis and cardio-vascular complications of diabetes]

Diabetic macroangiopathy comprises: on one hand, atherosclerosis which seems to appear earlier and to progress more rapidly than in non-diabetic individuals; and, on the other hand, a less well characterised involvement of arteries affecting their structure (diffuse fibrosis) and function (vasomotility). Hyperinsulinaemia is suspected to enhance macroangiopathy, yet the biological and epidemiological facts to support this hypothesis are weak and somewhat discrepant. By contrast, a role for hyperglycaemia, in terms of intensity and duration, is supported by growing evidence. In addition to the correction of classical risk factors for arterial disease, the strict control of hyperglycaemia is likely to become an essential intervention in the prevention of macroangiopathy.