Diabetes is often defined a "vascular disease" because of the early and extensive involvement of the vascular tree observed in patients with diabetes and even in those at risk of developing diabetes. Both the micro- and macrocirculation are affected, though the pathophysiology, histology, clinical history, and clinical sequelae at the two vascular levels appear to be quite different. It is recently believed that a common pathway causes precocious vascular damage at both vascular districts in diabetes leading to the development of diabetic chronic complications, if not of diabetes itself. Chronic diabetic complications are mostly ascribed to small vessel disease. Diabetic microangiopathy has been considered the main anatomic alteration leading to the development of retinopathy, nephropathy, and neuropathy. Nevertheless, macroangiopathy, i.e., atherosclerosis of peripheral arteries, is also a peculiar feature of long-lasting diabetes and is characterized for being precocious, involving predominantly distal arteries and having inadequate collateral development. The possible links between diabetic micro- and macrovascular alterations and nerve damage will be the focus of this chapter.
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