Hemorheologic therapy to control diabetic vascular disease

Abstract

Chronic diabetes mellitus is associated with difficulties that have in common a disturbance of the circulation. A clearly defined hemorheologic burden antedates and is cross-sectionally related to the diabetic circulatory complications, suggesting that blood flow plays a role in damaging diabetic blood vessels. This concept has led to the development of hemorheologic models for both micro- and macroangiopathy. Intensive insulin therapy appears to benefit the diabetic hemorheologic burden, but it has limits that make it unable to normalize blood's flow properties. Other interventions can be identified, based both on drugs and on changes in health habits. They have little or no effect on blood glucose levels but decrease the hemorheologic burden; fourteen means to improve diabetic blood flow are identified and discussed. Four non-drug managements are already often used in treatment. Ten types of pharmacologic agent have clear potential for reducing or preventing diabetic vascular problems. The strength of evidence for their effects and their possible mechanisms of action are discussed. Establishing a more effective role for these agents in diabetes management will require more sophisticated interventional studies that incorporate modern hemorheologic assessment into their design. Such evaluations are important in examlnlng both established and new drugs if we are to further improve the prognosis for individuals with established diabetes.