Vascular disease is the major cause of morbidity and mortality in diabetes mellitus. Data from the recent comprehensive report from the National Commission on Diabetes suggested that diabetics are two times more prone to heart attacks, five times more prone to gangrene, 17 times more prone to kidney failure, and 25 times more prone to blindness than nondiabetics.1 These sobering statistics reflect the ravages of accelerated atherosclerosis plus a relatively specific form of microvascular disease in multiple organ systems in the diabetic.
Recent progress has been made in the understanding of the mechanisms involved both in large-vessel disease (macrovascular disease) and small-vessel disease (microvascular disease) in patients with diabetes mellitus. With an increased understanding of the mechanisms involved, intelligent decisions about therapy may be more easily made. We briefly review the current thoughts about the pathophysiologic features of diabetic vascular disease and make therapeutic recommendations based on these observations.