This review highlights potential mechanisms, including prediabetic metabolic abnormalities and chronic hyperglycemia, that drive the high prevalence and distal distribution of peripheral vascular disease in Type 2 diabetes.
Patients with Type 2 diabetes mellitus frequently have peripheral vascular disease, with a predilection for the lower legs. In this review potential mechanisms for this high prevalence and altered distribution are explored. It is hypothesised that the metabolic abnormalities in the prediabetic phase predispose to a more distal and aggressive atherosclerosis. Once diabetes has developed this process is accelerated due to chronic hyperglycaemia. Furthermore, endothelial damage, non-enzymatic glycosylation and polyneuropathy could lead to impaired vascular remodelling and collateral formation.
Schaper et al. (2000) studied this question.