Vascular disease is the most important complication of both type 1 and type 2 diabetes, with both micro- and macrovascular disease underlying most of the death and disability observed in diabetic patients. Endothelial dysfunction is a cardinal feature of both types of diabetes, and is believed to be involved in the aetiology and pathophysiology of diabetic vasculopathy. Therefore, measures which improve endothelial dysfunction in diabetes are currently the subject of much interest and research. In this article, we review both drug and non-drug therapies for endothelial dysfunction, along with evidence of their effectiveness in diabetes. We suggest that those therapies for which good evidence of endothelial benefit exists should be more widely used in diabetic patients, and that the maximum benefit will be derived by using multiple such therapies in combination.
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