Diabetes mellitus and cerebrovascular disease

In the past several years, a substantial amount of new information on the e pidemiology and pathophysiology of diabetes and vascular disease has become available. Autopsy studies suggest that diabetic patients are susceptible to cerebral small-artery disease a nd lacunar infarction and may be at risk for large-artery atherosclerotic occlusive disease. Epidemiological studie s show that diabetes is a risk factor for ischemic stroke. The pathogenesis of diabetes-associated stroke appears to be linked to excessive glycation and oxidation, endothelial dysfunction, increased platelet aggregation, imp aired fibrinolysis and insulin resistance. Macrovascular complications may be prevented by simple primary prevention measures including exercise, weig ht loss and treatment of dyslipidemia. The role of tight glycemic control i n reducing the risk of stroke is still uncertain. Many new insights and tre atment strategies are expected in the future.