Diabetic vascular diseases: molecular mechanisms and therapeutic strategies

Abstract

Vascular complications of diabetes pose a severe threat to human health. Prevention and treatment protocols based on a single vascular complication are no longer suitable for the long-term management of patients with diabetes. Diabetic panvascular disease (DPD) is a clinical syndrome in which vessels of various sizes, including macrovessels and microvessels in the cardiac, cerebral, renal, ophthalmic, and peripheral systems of patients with diabetes, develop atherosclerosis as a common pathology. Pathological manifestations of DPDs usually manifest macrovascular atherosclerosis, as well as microvascular endothelial function impairment, basement membrane thickening, and microthrombosis. Cardiac, cerebral, and peripheral microangiopathy coexist with microangiopathy, while renal and retinal are predominantly microangiopathic. The following associations exist between DPDs: numerous similar molecular mechanisms, and risk-predictive relationships between diseases. Aggressive glycemic control combined with early comprehensive vascular intervention is the key to prevention and treatment. In addition to the widely recommended metformin, glucagon-like peptide-1 agonist, and sodium-glucose cotransporter-2 inhibitors, for the latest molecular mechanisms, aldose reductase inhibitors, peroxisome proliferator-activated receptor-γ agonizts, glucokinases agonizts, mitochondrial energy modulators, etc. are under active development. DPDs are proposed for patients to obtain more systematic clinical care requires a comprehensive diabetes care center focusing on panvascular diseases. This would leverage the advantages of a cross-disciplinary approach to achieve better integration of the pathogenesis and therapeutic evidence. Such a strategy would confer more clinical benefits to patients and promote the comprehensive development of DPD as a discipline.

The anti‐inflammatory effect of metformin: The molecular targets

“…This is reasonable but we need much more studies about metformin in other organs: kidney, blood vessels, muscles, and so on, especially the organs related to the insulin resistance. It is well known that the blood vessel in diabetic patients is damaged by chronic inflammation (Kenny & Abel, 2019;Li et al, 2023;Wang et al, 2020). The reduction of inflammation in blood vessel could be the mechanism of cardioprotective effects of metformin.…”

Diabetes as risk factor to severity of dengue in naïve patients

“…Among the leading causes of death, four stand out: cardiovascular disease, cancer, chronic respiratory disease, and diabetes, responsible for 33.3 million deaths in 2019 (34). Diabetes, which was directly responsible for 2 million [1.4-2.7 million] deaths, may require further attention as it elevated association with cardiovascular (35), including heart (coronary artery disease, angina pectoris, heart failure), brain (stroke, encephalopathy), kidney (diabetic kidney disease) and ocular (retinopathy) disorders (21, 36).…”

“…In a similar retrospective case-control study conducted between 2005 and 2008 in Singapore(21), the presence of two or more comorbidities was associated with a higher risk of SDD in patients older than 60 years. When diabetes coexisted with a cardiac disorder the risk was four times higher[8.02; 1.40-45.92] compared to diabetes alone [2.21; 1.10-5.52].…”

Recent advances of hydrogels as smart dressings for diabetic wounds

“…27,48 In addition, patients with diabetes have macrovascular disease, leading to reduced blood flow. 49 At the microvascular level, microvascular dysfunction is caused by abnormal regulation of capillaries and decreased levels of nitric oxide synthase (NOS). 50 A long- term nutrient- and O 2 -deficient wound microenvironment can further delay angiogenesis, epithelial cell growth, and the synthesis of key components of the extracellular matrix.…”