Smooth muscle cells (SMC) and endothelial cells are the major cell types in blood
vessels. The principal function of vascular SMC in the body is to regulate blood flow and
pressure through contraction and relaxation. The endothelium performs a crucial role in
maintaining vascular integrity by achieving whole-organ metabolic homeostasis via the
production of factors associated with vasoconstriction or vasorelaxation. In this review,
we have focused on the production of nitric oxide (NO), a vasorelaxation factor. The
extent of NO production represents a key marker in vascular health. A decrease in NO is
capable of inducing pathological conditions associated with endothelial dysfunction, such
as obesity, diabetes, cardiovascular disease, and atherosclerosis. Recent studies have
strongly implicated the involvement of G-protein-coupled receptor kinase 2 (GRK2) in the
progression of cardiovascular disease. Vasculature which is affected by insulin resistance
and type 2 diabetes expresses high levels of GRK2, which may induce endothelial
dysfunction by reducing intracellular NO. GRK2 activation also induces changes in the
subcellular localization of GRK2 itself and also of β-arrestin 2, a downstream protein. In
this review, we describe the pathophysiological mechanisms of insulin resistance and
diabetes, focusing on the signal transduction for NO production via GRK2 and β-arrestin 2,
providing novel insights into the potential field of translational investigation in the
treatment of diabetic complications.