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Review
. 2016 Jul-Aug;20(4):546-51.
doi: 10.4103/2230-8210.183480.

Microvasular and macrovascular complications in diabetes mellitus: Distinct or continuum?

Aastha Chawla  1 , Rajeev Chawla  1 , Shalini Jaggi  2
Affiliations
Review

Microvasular and macrovascular complications in diabetes mellitus: Distinct or continuum?

Aastha Chawla et al. Indian J Endocrinol Metab. 2016 Jul-Aug.

Abstract

Diabetes and related complications are associated with long-term damage and failure of various organ systems. The line of demarcation between the pathogenic mechanisms of microvascular and macrovascular complications of diabetes and differing responses to therapeutic interventions is blurred. Diabetes induces changes in the microvasculature, causing extracellular matrix protein synthesis, and capillary basement membrane thickening which are the pathognomic features of diabetic microangiopathy. These changes in conjunction with advanced glycation end products, oxidative stress, low grade inflammation, and neovascularization of vasa vasorum can lead to macrovascular complications. Hyperglycemia is the principal cause of microvasculopathy but also appears to play an important role in causation of macrovasculopathy. There is thought to be an intersection between micro and macro vascular complications, but the two disorders seem to be strongly interconnected, with micro vascular diseases promoting atherosclerosis through processes such as hypoxia and changes in vasa vasorum. It is thus imperative to understand whether microvascular complications distinctly precede macrovascular complications or do both of them progress simultaneously as a continuum. This will allow re-focusing on the clinical issues with a unifying perspective which can improve type 2 diabetes mellitus outcomes.

Keywords: Complications; diabetes; macrovascular; microvascular.

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Figures

Figure 1
Figure 1
Insulin resistance and hyperglycemia drive the atherosclerotic process
Figure 2
Figure 2
The diabetes continuum
See this image and copyright information in PMC

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