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Perspectives in Diabetes

Microvascular Complications of Impaired Glucose Tolerance

  1. J. Robinson Singleton1,
  2. A. Gordon Smith12,
  3. James W. Russell3 and
  4. Eva L. Feldman3
  1. 1Department of Neurology, University of Utah, Salt Lake City, Utah
  2. 2Department of Pathology, University of Utah, Salt Lake City, Utah
  3. 3Department of Neurology, University of Michigan, Ann Arbor, Michigan
  1. Address correspondence and reprint requests to Eva L. Feldman, Professor and Director, JDRF Center for the Study of Complications in Diabetes, University of Michigan, Department of Neurology, 4414 Kresge III 200 Zina Pitcher Place, Ann Arbor, MI 48109. E-mail: efeldman{at}umich.edu
Diabetes 2003 Dec; 52(12): 2867-2873. https://doi.org/10.2337/diabetes.52.12.2867
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Abstract

Impaired glucose tolerance (IGT) serves as a marker for the state of insulin resistance and predicts both large- and small-vessel vascular complications, independent of a patient’s progression to diabetes. Patients with IGT are at significantly increased risk for death and morbidity due to myocardial infarction, stroke, and large-vessel occlusive disease. IGT is more predictive of cardiovascular morbidity than impaired fasting glucose, probably because it is a better surrogate for the state of insulin resistance. IGT is also independently associated with traditional microvascular complications of diabetes, including retinopathy, renal disease, and polyneuropathy, which are the topics of this review. Inhibition of nitric oxide-mediated vasodilation, endothelial injury due to increased release of free fatty acids and adipocytokines from adipocytes, and direct metabolic injury of endothelial and end-organ cells contribute to vascular complications. Early detection of IGT allows intensive diet and exercise modification, which has proven significantly more effective than drug therapy in normalizing postprandial glucose and inhibiting progression to diabetes. To what degree intervention will limit recognized complications is not known.

  • ADA, American Diabetes Association
  • DPP, Diabetes Prevention Project
  • eNOS, endothelial nitric oxide synthase
  • FFA, free fatty acid
  • IGT, impaired glucose tolerance
  • IFG, impaired fasting glucose
  • OGTT, oral glucose tolerance test
  • ROS, reactive oxygen species

Footnotes

    • Accepted August 12, 2003.
    • Received May 14, 2003.
  • DIABETES
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December 2003, 52(12)
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Microvascular Complications of Impaired Glucose Tolerance
J. Robinson Singleton, A. Gordon Smith, James W. Russell, Eva L. Feldman
Diabetes Dec 2003, 52 (12) 2867-2873; DOI: 10.2337/diabetes.52.12.2867

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Microvascular Complications of Impaired Glucose Tolerance
J. Robinson Singleton, A. Gordon Smith, James W. Russell, Eva L. Feldman
Diabetes Dec 2003, 52 (12) 2867-2873; DOI: 10.2337/diabetes.52.12.2867
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  • Article
    • Abstract
    • Recognition and natural history of IGT.
    • Microvascular complications of IGT: neuropathy, retinopathy, and renal microproteinuria.
    • Pathogenesis of IGT complications: general considerations.
    • Hyperglycemia inhibits nitric oxide-mediated vasodilation.
    • Insulin resistance.
    • FFAs and adipocytokines induce endothelial injury.
    • Other metabolic effects of hyperglycemia.
    • Treatment and areas for future study.
    • Acknowledgments
    • Footnotes
    • REFERENCES
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