The vascular complications occurring in diabetes mellitus are reviewed. In addition to the long recognised involvement of large vessels by atheroma and Monckeberg's sclerosis, the more recently described microangiopathy affecting arterioles, venules and, in particular, capillaries is also described. The significance of this microangiopathy in the diabetic syndrome is outlined, and possible pathogenetic mechanisms involved in its development are discussed.
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References
1.
AagenaesA., MoeH. (1961). Light and electron microscopic study of skin capillaries of diabetics. Diabetes, 10, 253
2.
AddisonD. J., GarnerA., AshtonN. (1970). Degeneration of intramural pericytes in diabetic retinopathy. British Medical Journal, 1, 264
3.
AlbrinkM. J. (1964). Diet, diabetes and serum lipids. Diabetes, 13, 425
4.
AngervallL., DotevallG.LehmannK. E. (1961). The gastric mucosa in diabetes mellitus. A functional and histopathological study. Acta medica Scandinavica, 169, 339
5.
AshtonN. (1957). Diabetic retinopathy: Relationship to glomerulosclerosis. British Medical Journal, 1, 1002 (Abstract)
6.
BaranyF. R. (1955). Abnormal vascular reactions in diabetes mellitus; a clinical physiological study. Acta medica Scandinavica Supplement, 304
7.
BeckerD., MillerM. (1960). Presence of diabetic glomerulosclerosis in patients with haemochromatosis. New England Journal of Medicine, 263, 367
8.
BellE. T. (1952). A postmortem study of vascular disease in diabetics. Archives of Pathology, 53, 444
9.
BellE. T. (1953). Renal vascular disease in diabetes mellitus. Diabetes, 2, 376
10.
BencosmeS. A., WestR. O., KerrJ. W., WilsonD. L. (1966). Diabetic capillary angiopathy in human skeletal muscles. American Journal of Medicine, 40, 67
11.
BercoviciE., SolomonL. M., BeermanH. (1964). Microangiopathy in diabetes mellitus and non-diabetic dermatoses. American Journal of the Medical Sciences, 248, 20
12.
BernsA. E., OwensC. T., HirataY., BlumenthalH. T. (1962). The pathogenesis of diabetic glomerulosclerosis. II. A demonstration of insulin-binding capacity of the various histopathological components of the disease by fluorescence microscopy. Diabetes, 11, 308
13.
BloodworthJ. M. B.Jr., EngermanR. L., PowersK. L. (1969). Experimental diabetic microangiopathy. 1. Basement membrane statistics in the dog. Diabetes, 18., 455
14.
BlumenthalH. T. (1968). The relation of micro-angiopathies to arteriosclerosis with special reference to diabetes. Annals of the New York Academy of Sciences, 149, 834
15.
BlumenthalH. T., GoldenbergS., BernsA. W. (1965). Pathology and pathogenesis of the disseminated angiopathy of diabetes mellitus. In On the Nature and Treatment of Diabetes Mellitus (International Diabetes Federation, Fifth Congress), p. 397. Edited by LeibelB. S. and WrenshallG. A.New York: Excerpta Medica Foundation
16.
BlumenthalH. T., HirataY., OwensC. T., BernsA. W. (1964). A histo- and immunologic analysis of the small vessel lesion of diabetes in the human and in the rabbit. In Small Blood Vessel Involvement in Diabetes Mellitus. p. 279. Edited by SipersteinM. D., ColwellA. R.Sr. and MeyerK. Washington, D.C.: American Institute of Biological Sciences
17.
Camerini-DavalosR. A., ReesS. B., CaulfieldJ. B., Lozano-CastanedaO., MarbleA. (1964). Vascular changes in prediabetes. In Small Blood Vessel Involvement in Diabetes Mellitus. p. 107. Edited by SipersteinM. D., ColwellA. R.Sr. and MeyerK. Washington, D.C.: American Institute of Biological Sciences
18.
ClarkeB. F. (1970). The pathogenesis of diabetes mellitus. Scottish Medical Journal, 15, 329
19.
CoganD. G., ToussaintD., KuwabaraT. (1961). Retinal vascular patterns, IV. Diabetic retinopathy. Archives of Ophthalmology, 66, 366
20.
ColemanS. L., BeckerB., CanaanS., RosenbaumL. (1962). Fluorescent insulin staining of the diabetic eye. Diabetes, 11, 375
21.
DaysogA., DobsonH. L., BrennanJ. C. (1961). Renal glomerular and vascular lesions in prediabetes and diabetes mellitus; a study based on renal biopsies. Annals of Internal Medicine, 54, 672
DitzelJ. (1956). Angioscopic changes in the smaller blood vessels in diabetes mellitus and their relationship to ageing. Circulation, 14, 386
24.
DitzelJ. (1967). Conjunctival vascular changes in relation to retinopathy and nephropathy of diabetes mellitus. Acta medica Scandinavica, 182, 213
25.
DrewesV. M., OlsenS. (1965). Histological changes in the small bowel in diabetes mellitus. Acta pathologica et microbiologica Scandinavica, 63, 478
26.
EllenbergM. (1962). Diabetic nephropathy without manifest diabetes, Diabetes, 11, 197
27.
EnnisG., MillerM., UngerF. M., UngerL. (1969). Intercapillary glomerulosclerosis in diabetes secondary to chronic relapsing pancreatitis. Diabetes, 18, 333 (Abstract)
28.
FarquharM. G. (1964). Glomerular permeability investigated by electron microscopy. In Small Blood Vessel Involvement in Diabetes Mellitus. p. 31. Edited by SipersteinM. D., ColwellA. R.Sr. and MeyerK. Washington, D.C.: American Institute of Biological Sciences
29.
FerrierT. M. (1964). Radiologically demonstrable arterial calcification in diabetes mellitus. Australasian Annals of Medicine, 13, 222
30.
FunkH. U. (1965). Veranderungen an Pankreaskapillaren bei Diabetikern. Diabetologia, 1, 228
31.
GoldenbergS., AlexM., BlumenthalH. T. (1958). Sequelae of arteriosclerosis of the aorta and coronary arteries: A statistical study in diabetes mellitus. Diabetes, 7, 98
32.
GordonA. (1968). Clinical aspects of diabetic nephropathy. In Diabetes Mellitus: Current Concepts and Vascular Lesions (Renal and Retinal). The U.C.L.A. Interdepartmental Conference. Annals of Internal Medicine, 68, 634
33.
HandelsmanM. B., LevittL. M., ConradH.Jr. (1952). Small vessel dysfunction in patients with diabetes mellitus; the skin temperature response to priscoline in toes of diabetics. American Journal of the Medical Sciences, 224, 34
34.
HeptinstallR. H. (1966). Pathology of the Kidney, p. 465. London: Churchill
35.
IrelandJ. T., PatnaikB. K., DuncanL. J. P. (1967). Glomerular ultrastructure in secondary diabetics and normal subjects. Diabetes, 16, 628
36.
JorgensenM. B. (1961). The inner ear in diabetes mellitus; histological studies. Archives of Otolaryngology, 74, 373
37.
KimmelsteilP. (1966). Diabetic nephropathy. In The Kidney, p. 226. Edited by MostofiF. K. and SmithD. E.Baltimore: The Williams and Wilkins Co.
38.
LattaH. (1968). Diabetic nephropathy. In Diabetes Mellitus: Current Concepts and Vascular Lesions (Renal and Retinal). The U.C.L.A. Interdepartmental Conference. Annals of Internal Medicine, 68, 634
39.
LendrumA. C. (1963). The hypertensive diabetic kidney as a model of the so-called collagen diseases. Canadian Medical Association Journal, 88, 442
40.
LendrumA. C. (1969). The validation of fibrin and its significance in the story of hyalin. In Trends in Clinical Pathology. Essays in Honour of Gordon Signy. p. 159. London: British Medical Association
41.
LendrumA. D., FraserD. S., SliddersW., HendersonR. (1962). Studies on the character and staining of fibrin. Journal of Clinical Pathology, 15, 401
42.
LundbaekK. (1954). Diabetic angiopathy: A specific vascular disease. Lancet, 1, 337
LundbaekK., Posborg-PetersenV. (1953). Lipid composition of diabetic and non-diabetic coronary arteries. Acta medica Scandinavica, 144, 354
45.
MacDonaldM. K. (1966). Glomerular lesions in diabetes. In Diabetes Mellitus. p. 94. Edited by DuncanL. J. P., University of Edinburgh Pfizer Medical Monographs, No. 1. Edinburgh: Edinburgh University Press
46.
ManciniA. M., ZampaG. A., GeminianiG. D., VecchiA. (1969). Experimental nodular ‘diabeticlike’ glomerulosclerosis in guinea pigs following long-acting, heterologous insulin immunization. Diabetologia, 5, 155
47.
MarbleA. (1955). Coronary artery disease in the diabetic. Diabetes, 4, 290
48.
MarbleA. (1957). The future of the child with diabetes. Journal of the American Dietetic Association, 33, 569
49.
MendlowitzM., GrossmanE. B., AlpertS. (1953) Decreased hallucal circulation, an early manifestation of vascular disease in diabetes mellitus. American Journal of Medicine, 15, 316
50.
MohosS. C., HenniganG. R., FogelmanJ. A. (1963). Insulin-induced glomerulosclerosis in the rabbit. Journal of Experimental Medicine, 188, 667
51.
OkudairaY., HirotaK., CohenS., StraussL. (1966). Ultrastructure of the human placenta in maternal diabetes mellitus. Laboratory Investigation, 15, 910
52.
OlsenJ. S. (1969). Diabetic glomerulosclerosis: A comparison between human and experimental lesions. International Review of Experimental Pathology, 7, 271
53.
Osterby-HansenR. O. (1965). A quantitative estimate of the peripheral basement membrane in recent juvenile diabetes. Diabetologia, 1, 97
54.
Osterby-HansenR. O. (1970). Electron microscopic study of glomeruli from young patients with short duration of diabetes: The mesangial region. Diabetologia, 6, 59 (Abstract)
55.
RickettsH. T. (1965), The influence of diabetic control on angiopathy. In Nature and Treatment of Diabetes. p. 588. (International Diabetes Federation, Fifth Congress). Edited by LeibelB. S. and WrenshallG. A.New York: Excerpta Medica Foundation
56.
RobertsonW. B., StrongJ. P. (1968). Atherosclerosis in persons with hypertension and diabetes mellitus. Laboratory Investigation, 18, 538
57.
RosenbaumP., KatrineA. A., GottsegenW. L. (1963). Diabetic and prediabetic nephropathy in childhood. American Journal of Diseases of Children106, 83
58.
SabourM. S., MacDonaldM. K., RobsonJ. S. (1962). An electron microscopic study of the human kidney in young diabetic patients with normal renal function. Diabetes, 11, 291
59.
ScottD. J., DolleryC. T., HillD. W., HodgeJ. V., FraserR. (1964). Fluorescein studies of diabetic retinopathy. British Medical Journal, 1, 811
60.
SieversJ., BlomquistG., BjorkG. (1961). Studies of myocardial infarction in Malmo, 1935 to 1954. Acta medica Scandinavica, 169, 95
61.
SipersteinM. D., UngerR. H., MadisonL. L. (1968). Studies of muscle capillary basement membranes in normal subjects, diabetic and prediabetic patients. Journal of Clinical Investigation, 47, 1973
62.
SpiroR. G. (1959). Role of insulin in two pathways of glucose metabolism: in vivo glucosamine and glycogen synthesis. Annals of the New York Academy of Sciences, 82, 366
63.
SpiroR. G. (1969). Glycoproteins. New England Journal of Medicine, 281, 1049
64.
SpiroR. G., SpiroM. J. (1968). The carbohydrate of the glomerular basement membrane: Structure and enzymatic assembly. Diabetes, 17, 311 (Abstract)
65.
StrandnessD. E.Jr., PriestR. E., GibbonsG. E. (1964). Combined clinical and pathologic study of diabetic and non-diabetic peripheral arterial disease. Diabetes, 13, 366
66.
ThomsenA. C. (1965). The Kidneys in Diabetes Mellitus. Copenhagen: Munksgaard
67.
WarrenS., Le CompteP. M., LeggM. A. (1966). The Pathology of Diabetes Mellitus, 6th edition. Philadelphia: Lea and Febiger
68.
WhiteP. (1932). Diabetes in Childhood and Adolescence. Philadelphia: Lea and Febiger
69.
WhiteP. (1956). Natural course and prognosis of juvenile diabetes. Diabetes, 5, 445
70.
WinzlerR. J. (1964). Plasma glycoproteins and mucopolysaccharides. In Small Blood Vessel Involvement in Diabetes Mellitus. p. 235. Edited by SipersteinM. D., ColwellA. R.Sr. and MeyerK. Washington, D.C.: American Institute of Biological Sciences
71.
YanoffM. (1969). Ocular pathology of diabetes mellitus. American Journal of Ophthalmology, 67, 21
72.
YodaikenR. E., SeftelH. C., KewM. C., LillensteinM., IppE. (1969). Ultrastructure of capillaries in South African diabetics. II. Muscle capillaries. Diabetes, 18, 164
73.
ZacksS. I., PraguesJ. S., ElliottF. A. (1962). Interstitial muscle capillaries in patients with diabetes mellitus: A light and electron microscopic study. Metabolism, 11, 381
