The Microcirculation in Diabetes Mellitus

Abstract Examination of human microvascular function in the two major forms of diabetes has revealed common abnormalities yet important differences in microvascular behavior. Early microvascular hypertension related to the degree of hyperglycemia appears to be fundamental to the expression of microangiopathy in type 1 diabetes millitus (T1DM), and although plausible biochemical explanations exist for this phenomenon, they remain to be verified in human diabetes. In type 2 diabetes millitus (T2DM) the interplay between preceding insulin resistance, hypertension, and vascular smooth muscle function modifies and confuses the pathophysiological findings, particularly in view of the fact that the emergence of hyperglycemia is difficult to date in this form of the disease. Unraveling of this puzzle may explain the subtle differences in the expression of microangiopathy in T1DM and T2DM, whereas primary manipulation of the hemodynamic and permeability changes may offer real therapeutic potential in the future.