Diabetes-Related Microvascular and Macrovascular Diseases in the Physical Therapy Setting

TLDR

Physical therapists frequently treat diabetic patients with vascular complications that arise from shared risk factors such as hyperglycemia, insulin resistance, dyslipidemia, hypertension, tobacco use, and obesity, affecting multiple organs and underscoring the growing importance of PT awareness and exercise interventions. Vascular disease in diabetes results from advanced glycation end‑product accumulation, nitric‑oxide‑mediated vasodilatory impairment, smooth‑muscle dysfunction, excess endothelial growth factors, chronic inflammation, hemodynamic dysregulation, impaired fibrinolysis, and heightened platelet aggregation.

Abstract

Physical therapists commonly treat people with diabetes for a wide variety of diabetes-associated impairments, including those from diabetes-related vascular disease. Diabetes is associated with both microvascular and macrovascular diseases affecting several organs, including muscle, skin, heart, brain, and kidneys. A common etiology links the different types of diabetes-associated vascular disease. Common risk factors for vascular disease in people with diabetes, specifically type 2 diabetes, include hyperglycemia, insulin resistance, dyslipidemia, hypertension, tobacco use, and obesity. Mechanisms for vascular disease in diabetes include the pathologic effects of advanced glycation end product accumulation, impaired vasodilatory response attributable to nitric oxide inhibition, smooth muscle cell dysfunction, overproduction of endothelial growth factors, chronic inflammation, hemodynamic dysregulation, impaired fibrinolytic ability, and enhanced platelet aggregation. It is becoming increasingly important for physical therapists to be aware of diabetes-related vascular complications as more patients present with insulin resistance and diabetes. The opportunities for effective physical therapy interventions (such as exercise) are significant.