Pathogenesis of diabetic microvascular complications

The microvascular complications of diabetes relentlessly progress despite more effective management of glycemic control and the use of agents that target the renin-angiotensin system. This is due in part to our incomplete understanding of compensatory as compared with pathologic events that occur as a result of diabetes. In addition, the temporal sequence of the development and progression of microvascular complications is complex and inconsistent, making targets for therapeutic intervention, which would be widely applicable, difficult to identify. Within this chapter we propose that greater attention should be afforded to examining patterns among diabetic microvascular complications with respect to their response to specific therapies and their pathogenesis. We also suggest that enhancing our understanding of why better glycemic control in the earlier phases of diabetes appears to have such profound effects on the subsequent development of microvascular complications would be of significant benefit.