Macroangiopathy in diabetes mellitus

Macroangiopathy in diabetes mellitus In patients with diabetic angiopathy u ntil today, no histological nor histochemical evidence has been found to de fine a specific type of diabetic arteriopathy. Consequenty, diabetic arteri osclerosis is considered as a more serious form of atherosclerosis characte rized by its premature onset. Hyperglycemia is assumed to be the crucial pa thophysiological cause of the development of macro- and microangiopathy in diabetes mellititus. Apparently, hyperglycemia has a direct toxic influence on the arterial wall by increased accumulation of irreversible glycosylati on end products, and secondly, it provokes endothelial dysfunction. The frequently occurring ulcerations of the diabetic foot are primarily cau sed by neuropathy; however; peripheral vascular disease (PVD) is often asso ciated. The risk of suffering from PVD in diabetic patients is approximatel y four-fold. Usually, the distal segments of the lower leg arteries are con cerned, where reconstructive intervention is complicated or even impossible . Diabetes is considered as an independent risk factor for cardio- and cerebr ovascular diseases with almost twice as high rates for recurrent myocardial infarction, and a 3.7 fold higher relative risk for stroke in diabetic, co mpared to non-diabetic patients. This review looks at the correlations betw een hyperglycemia and arteriosclerosis, but also the treatment options in d iabetic patients. Until now, there is no evidence for an association between an optimal contr ol of blood glucose levels and a decrease in the risk of coronary heart dis ease, stroke, or PVD. In contrast, an attenuation of microvascular lesions is achieved by stringent control of blood glucose levels. Thus, although th e development of macroangiopathy may not be significantly influenced, the c onduction of a stringent control regimen of plasmatic glucose levels is adv isable.