SSCI 2005 Meeting Highlights
A Lethal Tetrad in Diabetes: Hyperglycemia, Dyslipidemia, Oxidative Stress, and Endothelial Dysfunction

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ABSTRACT:

This paper addresses the consequences of diabetes and obesity, diseases that have become epidemic in our society, particularly in the past 20 years. Specifically, it summarizes current knowledge about some of the risk factors and mechanisms for the vascular complications of diabetes. These complications can be broadly divided into microvascular disease, such as diabetic retinopathy and diabetic nephropathy, and macrovascular disease, such as accelerated atherosclerosis, and they are the main cause for morbidity and premature mortality among diabetic patients. The roles of hyperglycemia, dyslipidemia and dyslipoproteinemia, oxidative stress, and endothelial dysfunction will be considered. Finally, the “treatment gap” will be addressed. This gap refers to our failure to achieve currently accepted goals to reduce established risk factors for complications in the clinical management of diabetic patients.

Section snippets

Epidemiology of Diabetes and Its Complications

After the discovery of insulin by Frederick Banting and Charles Best in Toronto in 1921, there was much optimism that the major problems associated with diabetes had been solved. Patients with type 1 diabetes, most of whom were children or teenagers, no longer faced certain death within a matter of months and instead could hope for a normal life expectancy. Unfortunately, although the availability of insulin was indeed a revolution for diabetic patients, it became clear over the ensuing decades

Hyperglycemia and Oxidative Stress

The most extensive study addressing the role of hyperglycemia and the complications of type 1 diabetes is the DCCT.14 In this study, 1441 type 1 diabetic subjects were randomized to “intensive” or “standard” glycemic control between 1984 and 1987. The primary endpoint was new appearance (primary prevention group) or progression (secondary prevention group) of diabetic retinopathy. This study was prematurely terminated in 1993 because of a salutatory effect on retinopathy and secondary

Treating Risk Factors for the Complications of Diabetes: The Treatment Gap

There is now widespread concern in the diabetes community about the failure of diabetes specialists, health care providers, and the health care “industry” to apply existing knowledge for the prevention of complications in the systematic community-based manner that is essential to address an epidemic disease. Pearson et al. showed that although 95% of physicians are aware of national cholesterol education panel guidelines, only 18% of patients are treated to goal.43 This problem exists not only

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