Influence of Glucose Control and Improvement of Insulin Resistance on Microvascular Blood Flow and Endothelial Function in Patients with Diabetes Mellitus Type 2

Forst, Thomas; Lübben, G.; Hohberg, Clothilde; Kann, Peter Herbert; Sachara, C.; Gottschall, V.; Friedrich, Christiane; Roßkopf, Reiner; Pfützner, Andreas

doi:10.1080/10739680500253402

Cited by 54 publications

(27 citation statements)

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“…[26][27][28][29][30][31][32] Retinal vasculature is morphologically and functionally related to cerebral vessels because of their common origin from the internal carotid artery. An increased arterial retinal WLR has been described in patients with a history of cerebrovascular events.…”

Section: Discussionmentioning

confidence: 99%

Pilot Study for the Evaluation of Morphological and Functional Changes in Retinal Blood Flow in Patients with Insulin Resistance and/or Type 2 Diabetes Mellitus

Forst

Weber

Mitry³

et al. 2012

J Diabetes Sci Technol

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Section: Discussionmentioning

confidence: 99%

Pilot Study for the Evaluation of Morphological and Functional Changes in Retinal Blood Flow in Patients with Insulin Resistance and/or Type 2 Diabetes Mellitus

Forst

Weber

Mitry³

et al. 2012

J Diabetes Sci Technol

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“…82,83 Given the high prevalence of diabetes mellitus in patients with PAD, it is interesting to note that studies have also suggested that pioglitazone could improve vascular function. [84][85][86] The relevance of these changes to functional status in patients with PAD remains unknown.…”

Section: Endothelial and Microcirculatory Dysfunctionmentioning

confidence: 99%

Pathogenesis of the Limb Manifestations and Exercise Limitations in Peripheral Artery Disease

Hiatt¹,

Armstrong²,

Larson³

et al. 2015

Circulation Research

137

118

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P eripheral artery disease (PAD) is initiated by atherogenic mechanisms common to all major vascular territories but encompasses several distinctly important clinical sequelae.1 The global burden of PAD is large and rising, with substantial morbidity and mortality found in high-, middle-, and low-income countries. 2 The atherosclerotic occlusive disease underlying PAD is associated with an exercise limitation in the majority of patients, whereas the classic symptoms of intermittent claudication, ischemic rest pain, and ischemic ulceration are less common manifestations. 3 Patients with PAD are also at increased risk of myocardial infarction, ischemic stroke, heart failure, renovascular hypertension, and vascular death reflecting the systemic atherosclerotic burden. [4][5][6] The epidemiology of Peripheral Artery Disease Compendium© 2015 American Heart Association, Inc. The diagnosis of PAD can be ascertained by simple hemodynamic measurements, in particular, the ankle-brachial index (ABI), a test performed by measuring the systolic blood pressure in each arm and the dorsalis pedis and posterior tibial arteries of each ankle. The highest of the dorsalis pedis or posterior tibial artery pressures is the numerator of the ABI specific to each leg, whereas the highest arm pressure on either side is the denominator. A ratio of <0.90 in either leg is considered hemodynamic evidence of PAD. 16 When imaged, PAD can be characterized as one or more arterial stenoses or occlusions involving the distal aorta, iliac, femoral, popliteal, or tibial arteries. 17The underlying mechanisms responsible for the functional limitations in PAD are hemodynamic in origin, which affects the supply of oxygen and substrates to metabolically active tissue: skeletal muscle in the case of intermittent claudication and skin and subcutaneous tissues in the case of critical leg ischemia. However, additional pathophysiologic mechanisms contribute to the limb manifestations, where a reduction in blood flow alone does not fully account for the exercise limitation. Recent research into the pathophysiology of this exercise limitation has identified several important sequelae resultant from the chronic hemodynamic deficit. These changes affecting the vasculature and skeletal muscle distal to the primary hemodynamic lesions likely contribute to the mechanisms of exercise limitation in PAD. These advances are reviewed here with an additional focus on identifying possible future therapeutic strategies. Symptomatic Manifestations and Exercise Limitations in PADIn the coronary circulation, plaque rupture leading to acute ischemic events is a common clinical presentation; in PAD, progressive atherosclerosis leading to chronic stenosis and occlusion, often in series, in the arteries supplying the lower extremities dominates the symptomatic manifestations.6 Limb SymptomsPatients with PAD may present with a range of limb symptoms. Most patients are either asymptomatic or have atypical limb symptoms during exercise, whereas only a third have typical symptoms of c...

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“…The thiazolidinediones favorably affect peripheral and coronary endothelial dysfunction [37][38][39] and modestly improve blood pressure. 40 Proposed mechanisms for these effects include improved endothelium-dependent vasodilation via restoration of insulin-dependent endothelial nitric oxide release 41 and improved vasomotor tone via increased expression of vascular endothelial growth factor and reduced expression of endothelin-1.…”

Section: Endothelial Function and Hypertensionmentioning

confidence: 99%

New Drugs for the Treatment of Diabetes Mellitus

2008

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Influence of Glucose Control and Improvement of Insulin Resistance on Microvascular Blood Flow and Endothelial Function in Patients with Diabetes Mellitus Type 2

Abstract: Improving metabolic control has beneficial effects in microvascular function in type 2 diabetic patients. Treatment of type 2 diabetic patients with pioglitazone exerts additional effects on endothelial function beyond metabolic control.

Cited by 54 publications

References 50 publications

Pilot Study for the Evaluation of Morphological and Functional Changes in Retinal Blood Flow in Patients with Insulin Resistance and/or Type 2 Diabetes Mellitus

Pilot Study for the Evaluation of Morphological and Functional Changes in Retinal Blood Flow in Patients with Insulin Resistance and/or Type 2 Diabetes Mellitus

Pathogenesis of the Limb Manifestations and Exercise Limitations in Peripheral Artery Disease

New Drugs for the Treatment of Diabetes Mellitus

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