Glucose metabolism, diabetes and the arterial wall
Preclinical large artery changes, specifically endothelial dysfunction and greater arterial stiffness and wall thickness, represent possible markers of increased cardiovascular risk in diabetic patients. Glycemic exposure and metabolic abnormalities related to insulin resistance affect arterial properties inducing altered vasomotor tone, increased collagen deposition, smooth muscle cell proliferation, inflammatory changes, and lipid infiltration. From an etiologic perspective, the association between arterial stiffness, carotid intima-media thickness (cIMT), and diabetes should be evaluated after adjustment for age, sex, and other risk factors such as hypertension, obesity, and dyslipidemia. Despite the amount of available literature, further studies are warranted to characterize: (i) the atherosclerotic versus (mal)adaptive mechanisms underlying arterial remodeling in different diabetic patients; (ii) the prognostic significance of cIMT and arterial stiffness on top of established risk factors; and (iii) the clinical usefulness of "tissue biomarkers" in individual patients in tracking disease progression. Answering these questions would allow a personalized approach to vascular disease in diabetes.