Microcirculation and diabetes

Many late complications of diabetes stem from damage to the microcirculation. Changes in the microvascular wall, haemodynamic control and circulating blood may all contribute to impairment of capillary transfer function although the relative importance of the various possible mechanisms is unclear. Early functional disturbance appears more responsive to optimal diabetic control than established disease, and as microangiopathy becomes clinically apparent organ tissue damage is compounded by secondary mechanisms. Until more is learnt of the biochemical and cellular basis of the component pathogenetic mechanisms optimal diabetic control early in the disease remains the sole available primary prevention strategy, although evidence is emerging that manipulation of microvascular haemodynamics may have therapeutic potential.