New Insights on Vascular and Metabolic Diabetic Complications

Diabetes is a complex and chronic metabolic disorder that is predicted to affect 1.3 billion people worldwide by 2050. This disease is characterized by elevated blood glucose levels resulting from either insufficient insulin production (Type 1 diabetes) or the body's inability to use insulin effectively (Type 2 diabetes). Diabetic complications including micro- and macro-vascular complications such as cardiovascular complications, neuropathy, nephropathy, and retinopathy often arise due to prolonged exposure to high levels of blood glucose and other metabolic changes. Our topic focuses on vascular and metabolic perspectives, which are crucial for managing diabetic complications effectively.

Diabetes significantly increases the risk of vascular complications due to its adverse effects on blood vessels. The chronic elevation of blood glucose levels damages the endothelial lining of blood vessels, leading to a condition known as endothelial dysfunction. Endothelial dysfunction impairs the normal function of blood vessels, resulting in decreased vasodilation, increased vasoconstriction, and enhanced permeability. These alterations contribute to various vascular complications seen in diabetes, such as peripheral artery disease (PAD), coronary artery disease (CAD), and cerebrovascular disease. Due to the narrowing or blockage of arteries, and/ or atherosclerosis, and impaired blood flow to the brain; the risk of gout, heart attacks, angina, stroke, transient ischemic attacks (TIAs), and many other diseases is highly increased.

Diabetes also disrupts various metabolic processes in the body, leading to a cascade of biochemical imbalances that contribute to the development of complications. Insulin resistance, a hallmark of type 2 diabetes, results in impaired glucose uptake by cells, leading to hyperglycemia. Persistent hyperglycemia exacerbates metabolic disturbances, including dyslipidemia, oxidative stress, and advanced glycation end products (AGEs). Elevated triglycerides decrease high-density lipoprotein (HDL) cholesterol, and increase low-density lipoprotein (LDL) cholesterol levels leading to atherosclerosis and cardiovascular complications. Plus, persistent hyperglycemia damages cells and tissues, causing excessive production of reactive oxygen species (ROS) and promoting inflammation and endothelial dysfunction. Low-grade inflammation, which disrupts the body's response to insulin and causes the release of pro-inflammatory molecules, is identified as a significant factor influencing cardiometabolic syndrome and diabetic complications. Management strategies targeting the vascular and metabolic angles of diabetic complications involve strict glycemic control, blood pressure management, lipid-lowering therapy, smoking cessation, weight management, medications, and lifestyle modifications such as regular exercise and a healthy diet.

In summary, diabetic complications encompass both vascular and metabolic angles, each contributing to the multifaceted nature of the disease. A comprehensive approach that addresses both aspects through lifestyle modifications, pharmacotherapy, and targeted interventions is essential for mitigating the burden of diabetic complications and improving patient outcomes. The objective of this topic is not only to elucidate prior discoveries through review articles but also to show recent scientific papers that focus on diabetic complications. We aim to attract submissions (original research papers and review articles) focusing on the diverse field of diabetes, and we welcome contributions (basic researchers, clinical doctors, clinicians, and other scientists) covering various aspects of those above fields.

The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Keywords: diabetes, metabolic diseases, molecular mechanisms, inflammation

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.