Vol 5, No 3 (2004): Practical Diabetology
Other materials agreed with the Editors
Published online: 2004-05-20
Microvascular complications of impaired glucose tolerance. Perspectives in diabetes
Diabetologia Praktyczna 2004;5(3):161-169.
Abstract
Impaired glucose tolerance (IGT) serves as a marker
for the state of insulin resistance and predicts both
largeand 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.
Keywords: microvascular complicationsimpaired glucose toleranceinsulin resistancediabetes