Interactions between microvascular and macrovascular disease in diabetes: pathophysiology and therapeutic implications

Diabetes Obes Metab. 2007 Nov;9(6):781-91. doi: 10.1111/j.1463-1326.2007.00670.x.


Convention partitions the complications of diabetes into two main subtypes. First are the diabetes-specific microvascular complications of retinopathy, nephropathy and neuropathy; second are the atherothrombotic macrovascular complications that account for the majority of premature deaths. Pathological interactions between microvascular and macrovascular complications, for example, nephropathy and macrovascular disease, are common. Similar mechanisms and shared risk factors drive the development and progression of both small and large vessel disease. This concept has therapeutic implications. Mounting evidence points to the need for multifactorial strategies to prevent vascular complications in subjects with diabetes and/or the metabolic syndrome. We advocate a combined therapeutic approach that addresses small and large vessel disease. Preferential use should be made of drug regimens that (i) maximize vascular protection, (ii) reduce the risk of iatrogenic vascular damage and (iii) minimize the increasing problem of polypharmacy.

Publication types

  • Review

MeSH terms

  • Atherosclerosis / etiology*
  • Atherosclerosis / therapy
  • Diabetes Mellitus, Type 2 / etiology*
  • Diabetes Mellitus, Type 2 / therapy
  • Diabetic Angiopathies / etiology*
  • Diabetic Angiopathies / therapy
  • Diabetic Nephropathies / etiology*
  • Diabetic Nephropathies / therapy
  • Diabetic Retinopathy / etiology*
  • Diabetic Retinopathy / therapy
  • Female
  • Humans
  • Hypertension / etiology*
  • Hypertension / therapy
  • Insulin / pharmacology
  • Insulin / therapeutic use
  • Male
  • Obesity / complications


  • Insulin