Diabetes Mellitus (DM) is a chronic systemic disease characterized by disorders in metabolism of insulin, carbohydrate, fat and protein and impairment of structure and function of blood vessels; the early manifestations are metabolic and the complications result from vascular disease. Vascular changes may precede several years overt DM. Both type 1 and type 2 DM are vulnerable to microvascular and macrovascular complications. The relation of glucose and coronary artery disease is continuous and graded across the range of nondiabetic glucose values, independent of traditional and nontraditional risk factors with no gender difference.
Several epidemiological studies have confirmed excess morbidity/mortality due to cardiovascular disease (CVD) in patients with DM. Proposed mechanisms linking DM to CVD are uniformly targeted to endothelial cell dysfunction.
The rationale to institute primary prevention of vascular damage in patients with DM is compelling to reduce morbidity/mortality. Type 1 or 2 DM are at high risk for CVD: coronary artery disease, stroke, peripheral arterial disease, cardiomyopathy and congestive heart failure. Therefore, it becomes imperative that physicians who take care of clinically diabetic patients or nondiabetics with genetic evidence of diabetes in the family history should search for evidence of impaired glucose tolerance, hyperinsulinemia and lipidemia. Treating a patient with impaired glucose tolerance and overt DM must be a â€žshared responsibilityâ€° among specialists of vascular beds involved.
The intimately incriminating connection between DM and CVD is real. The vascular manifestation of DM affect more vascular beds than any other disease. None of the presently known risk factors inflicts more morbidity and mortality in the cardiovascular system than DM. Indeed, DM is not only a major risk factor for CVD but in reality DM is CVD that destroys the vascular beds of several target organs.