Type 2 Diabetes Mellitus and Macrovascular Complications

International Journal of Endocrinology
Volume 2017 (2017), Article ID 4301461, 2 pages

Type 2 Diabetes Mellitus and Macrovascular Complications

1Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
TwoResearch Division, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
3Division of Internal Medicine, Rambam Health Care Campus and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
4Institute of Endocrinology, Diabetes & Metabolism, Rambam Health Care Campus, Haifa, Israel
5Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
6Department of Physiology & Biophysics, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA

Copyright © 2017 Peng-Fei Shan et al.. That is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The number of individuals with type 2 diabetes mellitus (T2DM) has been increasing worldwide due to aging, urbanization, dietary, and lifestyle changes. It had been estimated that there were 415 million individuals with diabetes aged 20–79 years in 2015, and the amount was predicted to rise to 642 million by 2040 [1]. With comprehensive control of risk factors of cardiovascular disease (CVD), there’s been a decrease in mortality and prevalence in diabetic macrovascular complications within the past several decades in some western states such as United States of America. Macrovascular complications, chiefly such as cardiovascular and cerebrovascular diseases, are the most typical complications and the significant cause of mortality and morbidity in patients with T2DM.

In recent decades, there are lots of advances in this field. Diabetes patients usually have hyperlipidemia, hyperglycemia, and insulin resistance; all of these are risk factors for macrovascular diseases. PKCs, RAGE, and ROS may mediate the effects of hyperlipidemia and hyperglycemia . Knockout of PKCβ, RAGE, and Nox1 could attenuate the development of atherosclerosis in diabetic mice [2, 3]. To mimic macrophage or esophageal insulin resistance, insulin receptor has been knocked out in endothelial cells or macrophages. The development of atherosclerosis was rapid at endothelial insulin receptor knockout mice, and the plaque was unstable. Look AHEAD trial along with also the Italian Diabetes and Exercise Study imply that lifestyle management significantly improves physical fitness, A1c, and coronary heart disease (CHD) risk factors. Weight reduction surgery, especially bariatric surgery, could lead to weight reduction, A1c improvement [4], and CVD result improvement. Moreover, data are available about the effect of treatments. Additionally, clinic trials have demonstrated that in some nations, like lowering blood glucose, smoking rate, and cholesterol as well as blood pressure metabolic rates out of macrovascular complications factors have been declining using comprehensive control of CVD risk.

Within this problem, T. Hu et al. found that diminished expression of CSE and 3-MST along with the then decreased production of hydrogen sulfide (H2S) led to elevated glucose- (HG-) triggered sFlt-1 production via activating ADAM17 in adipocytes. Exogenous H2S donor NaHS includes a potential therapeutic value for HG-induced sFlt-1 production. S. Ye et al. found that the traditional Oriental medicine Didang Decoction intervention may upregulate the expression of cAMP-1 and PKA and downregulate the expression amount of MLCK and PKC, thus ameliorating vascular endothelium injury in high fat diet followed by the small dose of STZ-induced diabetic animal model.

T2DM is always accompanied by a cluster of risk factors of CVD such as hypertension, dyslipidemia, central obesity, and albuminuria [5]. M.-F. Yao et al. researched the differences in the risks of CHD and stroke between Chinese men and women with T2DM and their association with metabolic syndrome in Hangzhou, China. They found that girls had fatal CHD risk lower CHD risk, stroke risk, and fatal stroke risk compared to men with T2DM. The CHD risk was significantly greater in males with MS than in those without MS; along with the CHD and stroke risks were greater in girls with MS than in those without MS. At a total of 9473 subjects aged over 45 decades, such as 1648 patients with T2DM, X. Ding et al. found that the patients with prediabetes or T2DM were with greater risks to have hypertension. T2DM with nonalcoholic fatty liver disease (NAFLD) had significantly higher rates of blood pressure, triglyceride, uric acid, and more HOMA-IR than those with no NAFLD. Hypertriglyceridemia hyperuricemia, and insulin resistance were associated with a greater prevalence of hypertension independent of other metabolic risk factors in type 2 diabetes. B. Stratmann et al. found that serum phospholipid and serine levels independently discriminated T2D patients with and without CAD. Oxidative stress, which is raised in T2D, leads to changes in composition and the content of degradation that is accelerated and biological membranes, leading to lower metabolite degrees of PCs and serine.

Lower extremity peripheral arterial disease (PAD) is a common type of PAD in patients with T2DM, which can be noninvasively and objectively diagnosed by using the ankle-brachial index (ABI), and is also a marker of arterial atherosclerosis in other websites [6]. J. Ma et al. assessed the concordance between oscillometric ABI and standard Doppler ABI in diabetic patients with or without diabetic foot. They found that the measurement has been demonstrated to be a convenient, reliable, and alternate to Doppler ABI in patients. X.-H. Pang et al. decided that the association between lower extremity peripheral arterial disease (PAD), 10-year CHD, and stroke risks in patients with type 2 diabetes. They found that 88 (7.5%) patients were detected with PAD in 1178 T2DM patients. ABI has been an independent predictor of both 10-year CHD and stroke risks in patients. Compared with those from the T2DM non-PAD group, the odds ratios (ORs) for both CHD and stroke risk were 3.6 (95% confidence interval (CI), 2.2–6.0; P < 0 001) and 6.9 (95% CI, 4.0--11.8; P < 0 001) in those with lower extremity PAD, respectively.

Revascularization is a effective and safe treatment for patients with coronary artery disease. Patients who have diabetes mellitus contribute to about 25 percent of individuals undergoing coronary revascularization [7]. Coronary artery bypass grafting (CABG) surgery is considered a standard of care for individuals with advanced coronary artery disease. The best glycosylated hemoglobin (HbA1C) target might be especially applicable in diabetic patients with coronary artery diseases. J. Zheng et al. made a meta-analysis and systemic evaluation involving 7895 diabetic patients undergoing coronary artery bypass grafting surgery from eight published research. Investigations revealed that HbA1c level was significantly correlated with elevated risks of all-cause mortality, myocardial infarction, and stroke in diabetic subjects.

In conclusion, there is progress in risk factors, glycemia control, and the pathophysiology of diabetic macrovascular complications. Other areas are currently showing progress, such as weight loss surgery, but these aren’t discussed in the present matter. We believe that the issue that is present could bring some latest progress in this field and will be of interest to the readers.


Peng-Fei Shan has received research grants from the National Natural Science Foundation of China (81370968 and 81670744) and Science Technology Department of Zhejiang Province of China (2017C33037). Mogher Khamaisi has received research grants from the Israeli Science Foundation (ISF) (2383/17).

Peng-Fei Shan
Qian Li
Mogher Khamaisi
Gui-fen Qiang


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