Diagnosis, Pathophysiology and Management of Microvascular Dysfunction in Diabetes Mellitus
Microcirculation is an essential system that regulates oxygen and nutrients to cells and tissues in response to various environmental stimuli and pathophysiological conditions. Diabetes mellitus can cause microvascular complications including nephropathy, neuropathy, and retinopathy. The pathogenesi...
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2024-12-01
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| author | Yih-Kuen Jan Nicolas Kelhofer Tony Tu Owaise Mansuri Kingsley Onyemere Shruti Dave Suguna Pappu |
| author_facet | Yih-Kuen Jan Nicolas Kelhofer Tony Tu Owaise Mansuri Kingsley Onyemere Shruti Dave Suguna Pappu |
| author_sort | Yih-Kuen Jan |
| collection | DOAJ |
| description | Microcirculation is an essential system that regulates oxygen and nutrients to cells and tissues in response to various environmental stimuli and pathophysiological conditions. Diabetes mellitus can cause microvascular complications including nephropathy, neuropathy, and retinopathy. The pathogenesis of microvascular dysfunction in diabetes is associated with hyperglycemia and the result of an interplay of various factors. Research studies have demonstrated that functional microvascular dysfunction appears much earlier than structural alterations in vasculature in diabetes. This finding of the progression from microvascular dysfunction to macrovascular disease establishes a foundation for the screening and early diagnosis of diabetes by assessing the microvascular function. This comprehensive review discusses technologies (laser Doppler, transcutaneous oximetry, infrared thermography and near-infrared spectroscopy) with computational methods (linear (time and frequency domains), nonlinear and machine learning approaches) for diagnosing microvascular dysfunction in diabetes. Pathophysiological changes of microvascular dysfunction leading to impaired vasomotion and blood flow oscillations in diabetes are reviewed. Recent findings in managing microvascular dysfunction using lifestyle modifications and force-based modulations are evaluated. A consensus endorsed by the American Diabetes Association has been reached that an effective exercise program would greatly slow down the progression of microvascular dysfunction and its impact on diabetic foot ulcers, muscle fatigue and weakness and peripheral neuropathy. However, it is imperative to determine the dose–response relationship of exercise and microvascular responses in patients with diabetes. Research studies have demonstrated that local vibration and whole-body vibration can improve microcirculation in various pathological conditions, including diabetes. Due to the complex nature of microvascular regulation, various computational methods have been developed to shed light on the influence of diabetes on microvascular dysfunction. This comprehensive review will contribute to the diagnosis and management of microvascular dysfunction in diabetes. |
| format | Article |
| id | doaj-art-a53b815d0b9e4c9abd4b6956151d9a98 |
| institution | Kabale University |
| issn | 2075-4418 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj-art-a53b815d0b9e4c9abd4b6956151d9a982024-12-27T14:20:53ZengMDPI AGDiagnostics2075-44182024-12-011424283010.3390/diagnostics14242830Diagnosis, Pathophysiology and Management of Microvascular Dysfunction in Diabetes MellitusYih-Kuen Jan0Nicolas Kelhofer1Tony Tu2Owaise Mansuri3Kingsley Onyemere4Shruti Dave5Suguna Pappu6Department of Health and Kinesiology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USACarle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USACarle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USADepartment of Endocrinology, Carle Foundation Hospital, Urbana, IL 61801, USADepartment of Endocrinology, Carle Foundation Hospital, Urbana, IL 61801, USADepartment of Endocrinology, Carle Foundation Hospital, Urbana, IL 61801, USADepartment of Neurosurgery, Carle Foundation Hospital, Urbana, IL 61801, USAMicrocirculation is an essential system that regulates oxygen and nutrients to cells and tissues in response to various environmental stimuli and pathophysiological conditions. Diabetes mellitus can cause microvascular complications including nephropathy, neuropathy, and retinopathy. The pathogenesis of microvascular dysfunction in diabetes is associated with hyperglycemia and the result of an interplay of various factors. Research studies have demonstrated that functional microvascular dysfunction appears much earlier than structural alterations in vasculature in diabetes. This finding of the progression from microvascular dysfunction to macrovascular disease establishes a foundation for the screening and early diagnosis of diabetes by assessing the microvascular function. This comprehensive review discusses technologies (laser Doppler, transcutaneous oximetry, infrared thermography and near-infrared spectroscopy) with computational methods (linear (time and frequency domains), nonlinear and machine learning approaches) for diagnosing microvascular dysfunction in diabetes. Pathophysiological changes of microvascular dysfunction leading to impaired vasomotion and blood flow oscillations in diabetes are reviewed. Recent findings in managing microvascular dysfunction using lifestyle modifications and force-based modulations are evaluated. A consensus endorsed by the American Diabetes Association has been reached that an effective exercise program would greatly slow down the progression of microvascular dysfunction and its impact on diabetic foot ulcers, muscle fatigue and weakness and peripheral neuropathy. However, it is imperative to determine the dose–response relationship of exercise and microvascular responses in patients with diabetes. Research studies have demonstrated that local vibration and whole-body vibration can improve microcirculation in various pathological conditions, including diabetes. Due to the complex nature of microvascular regulation, various computational methods have been developed to shed light on the influence of diabetes on microvascular dysfunction. This comprehensive review will contribute to the diagnosis and management of microvascular dysfunction in diabetes.https://www.mdpi.com/2075-4418/14/24/2830diabetic foot ulcersdiabetic peripheral neuropathyendothelialexerciselaser Dopplernear-infrared spectroscopy |
| spellingShingle | Yih-Kuen Jan Nicolas Kelhofer Tony Tu Owaise Mansuri Kingsley Onyemere Shruti Dave Suguna Pappu Diagnosis, Pathophysiology and Management of Microvascular Dysfunction in Diabetes Mellitus Diagnostics diabetic foot ulcers diabetic peripheral neuropathy endothelial exercise laser Doppler near-infrared spectroscopy |
| title | Diagnosis, Pathophysiology and Management of Microvascular Dysfunction in Diabetes Mellitus |
| title_full | Diagnosis, Pathophysiology and Management of Microvascular Dysfunction in Diabetes Mellitus |
| title_fullStr | Diagnosis, Pathophysiology and Management of Microvascular Dysfunction in Diabetes Mellitus |
| title_full_unstemmed | Diagnosis, Pathophysiology and Management of Microvascular Dysfunction in Diabetes Mellitus |
| title_short | Diagnosis, Pathophysiology and Management of Microvascular Dysfunction in Diabetes Mellitus |
| title_sort | diagnosis pathophysiology and management of microvascular dysfunction in diabetes mellitus |
| topic | diabetic foot ulcers diabetic peripheral neuropathy endothelial exercise laser Doppler near-infrared spectroscopy |
| url | https://www.mdpi.com/2075-4418/14/24/2830 |
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