Diabetic Microvascular Complications: Possible Targets for Improved Macrovascular Outcomes

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Diabetic Microvascular Complications: Possible Targets for Improved Macrovascular Outcomes

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Title: Diabetic Microvascular Complications: Possible Targets for Improved Macrovascular Outcomes
Author: Bayliss, George; D'Elia, John Anthony; Roshan, Bijan; Maski, Manish; Gleason, Ray Edward; Weinrauch, Larry Allan

Note: Order does not necessarily reflect citation order of authors.

Citation: D'Elia, John A, George Bayliss, Bijan Roshan, Manish Maski, Ray E Gleason, and Larry A Weinrauch. 2011. Diabetic microvascular complications: Possible targets for improved macrovascular outcomes. International Journal of Nephrology and Renovascular Disease 4: 1-15.
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Abstract: 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.
Published Version: doi://10.2147/IJNRD.S14716
Other Sources: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108788/pdf/
Terms of Use: This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA
Citable link to this page: http://nrs.harvard.edu/urn-3:HUL.InstRepos:8160877

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