Hyperglycemia, Diabetes and Vascular Disease

It is estimated that 1-5% ofthe world's population is affected by some form of diabetes. Patients with these disorders are highly likely to develop microvas­ cular pathology in the retina and glomerulus and they are at a 2--6-fold greater risk for atherosclerotic vascular disease than individuals without diabetes. In addition, hypertension is far more prevalent in patients with diabetes than in the general population. As a consequence of these complications, diabetes is a leading cause of blindness and renal failure in young and middle-aged adults and it is a major risk factor for coronary heart disease, stroke and peripheral vascular disease in the Western world. An understanding of the relationship of these vascular complications to diabetic hyperglycemia has become a critical issue for clinicians in recent years, since the prevalence of diabetes appears to be increasing dramatically world-wide. In addition, it is now possible to achieve improved glycemic control in many patients-although not without incurring other risks. This volume explores two principal hypotheses concerning these complications. One is that hyperglycemia underlies or at least contributes to the pathogenesis of both micro- and macrovascular disease in patients with diabetes. The other is that it does so by producing specific metabolic and biochemical alterations in the vascular wall that lead to abnormalities in its function and ultimately its structure.