When Does Endothelial Dysfunction Occur In Diabetes

In type 1 diabetes, ED precedes and may cause diabetic microangiopathy, but it is not clear whether hyperglycemia is a sufficient cause of ED (30-36). In our view, it is more likely that hyperglycemia predisposes to the development of ED and that other factors, genetic or environmental, play a role in determining who among type 1 diabetic patients goes on to develop ED, nephropathy and aggressive angiopathy, and who does not. In type 2 diabetes, ED is present from the onset of the disease and is strongly related to adverse outcomes (4,16). Type 2 diabetes mostly occurs in the setting of the metabolic syndrome, but ED in type 2 diabetes is not explained by hypertension, obesity, or dyslip-idemia (37). It is not clear whether this diabetes-specific ED is caused by hyperglycemia or other factors. An important potential determinant is increased inflammatory activity (Fig. 1). In addition, part of the ED in type 2 diabetes may be "primary," i.e., cause of diabetes rather than caused by diabetes (see the following section).

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