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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...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove Medical Press
2010
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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 |
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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 |
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