Cargando…

Diabetic microvascular complications: possible targets for improved macrovascular outcomes

The results of recent outcome trials challenge hypotheses that tight control of both glycohemoglobin and blood pressure diminishes macrovascular events and survival among type 2 diabetic patients. Relevant questions exist regarding the adequacy of glycohemoglobin alone as a measure of diabetes contr...

Descripción completa

Detalles Bibliográficos
Autores principales: D’Elia, John A, Bayliss, George, Roshan, Bijan, Maski, Manish, Gleason, Ray E, Weinrauch, Larry A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108788/
https://www.ncbi.nlm.nih.gov/pubmed/21694944
http://dx.doi.org/10.2147/IJNRD.S14716
_version_ 1782205375506808832
author D’Elia, John A
Bayliss, George
Roshan, Bijan
Maski, Manish
Gleason, Ray E
Weinrauch, Larry A
author_facet D’Elia, John A
Bayliss, George
Roshan, Bijan
Maski, Manish
Gleason, Ray E
Weinrauch, Larry A
author_sort D’Elia, John A
collection PubMed
description The results of recent outcome trials challenge hypotheses that tight control of both glycohemoglobin and blood pressure diminishes macrovascular events and survival among type 2 diabetic patients. Relevant questions exist regarding the adequacy of glycohemoglobin alone as a measure of diabetes control. Are we ignoring mechanisms of vasculotoxicity (profibrosis, altered angiogenesis, hypertrophy, hyperplasia, and endothelial injury) inherent in current antihyperglycemic medications? Is the polypharmacy for lowering cholesterol, triglyceride, glucose, and systolic blood pressure producing drug interactions that are too complex to be clinically identified? We review angiotensin–aldosterone mechanisms of tissue injury that magnify microvascular damage caused by hyperglycemia and hypertension. Many studies describe interruption of these mechanisms, without hemodynamic consequence, in the preservation of function in type 1 diabetes. Possible interactions between the renin–angiotensin–aldosterone system and physiologic glycemic control (through pulsatile insulin release) suggest opportunities for further clinical investigation.
format Online
Article
Text
id pubmed-3108788
institution National Center for Biotechnology Information
language English
publishDate 2010
publisher Dove Medical Press
record_format MEDLINE/PubMed
spelling pubmed-31087882011-06-21 Diabetic microvascular complications: possible targets for improved macrovascular outcomes D’Elia, John A Bayliss, George Roshan, Bijan Maski, Manish Gleason, Ray E Weinrauch, Larry A Int J Nephrol Renovasc Dis Review The results of recent outcome trials challenge hypotheses that tight control of both glycohemoglobin and blood pressure diminishes macrovascular events and survival among type 2 diabetic patients. Relevant questions exist regarding the adequacy of glycohemoglobin alone as a measure of diabetes control. Are we ignoring mechanisms of vasculotoxicity (profibrosis, altered angiogenesis, hypertrophy, hyperplasia, and endothelial injury) inherent in current antihyperglycemic medications? Is the polypharmacy for lowering cholesterol, triglyceride, glucose, and systolic blood pressure producing drug interactions that are too complex to be clinically identified? We review angiotensin–aldosterone mechanisms of tissue injury that magnify microvascular damage caused by hyperglycemia and hypertension. Many studies describe interruption of these mechanisms, without hemodynamic consequence, in the preservation of function in type 1 diabetes. Possible interactions between the renin–angiotensin–aldosterone system and physiologic glycemic control (through pulsatile insulin release) suggest opportunities for further clinical investigation. Dove Medical Press 2010-12-22 /pmc/articles/PMC3108788/ /pubmed/21694944 http://dx.doi.org/10.2147/IJNRD.S14716 Text en © 2011 D’Elia et al, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.
spellingShingle Review
D’Elia, John A
Bayliss, George
Roshan, Bijan
Maski, Manish
Gleason, Ray E
Weinrauch, Larry A
Diabetic microvascular complications: possible targets for improved macrovascular outcomes
title Diabetic microvascular complications: possible targets for improved macrovascular outcomes
title_full Diabetic microvascular complications: possible targets for improved macrovascular outcomes
title_fullStr Diabetic microvascular complications: possible targets for improved macrovascular outcomes
title_full_unstemmed Diabetic microvascular complications: possible targets for improved macrovascular outcomes
title_short Diabetic microvascular complications: possible targets for improved macrovascular outcomes
title_sort diabetic microvascular complications: possible targets for improved macrovascular outcomes
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108788/
https://www.ncbi.nlm.nih.gov/pubmed/21694944
http://dx.doi.org/10.2147/IJNRD.S14716
work_keys_str_mv AT deliajohna diabeticmicrovascularcomplicationspossibletargetsforimprovedmacrovascularoutcomes
AT baylissgeorge diabeticmicrovascularcomplicationspossibletargetsforimprovedmacrovascularoutcomes
AT roshanbijan diabeticmicrovascularcomplicationspossibletargetsforimprovedmacrovascularoutcomes
AT maskimanish diabeticmicrovascularcomplicationspossibletargetsforimprovedmacrovascularoutcomes
AT gleasonraye diabeticmicrovascularcomplicationspossibletargetsforimprovedmacrovascularoutcomes
AT weinrauchlarrya diabeticmicrovascularcomplicationspossibletargetsforimprovedmacrovascularoutcomes