Protective Factors and the Pathogenesis of Complications in Diabetes

Endocr Rev. 2023 Aug 28:bnad030. doi: 10.1210/endrev/bnad030. Online ahead of print.ABSTRACTChronic complications of diabetes are due to myriad disorders of numerous metabolic pathways, which are responsible for most of the morbidity and mortality associated with the disease. Traditionally, diabetes complications are divided into those of micro- and macrovascular origin. We suggest revising this antiquated classification into diabetes complications of vascular, parenchymal, and hybrid (both vascular and parenchymal) tissue origin, since the profile of diabetes complications ranges from those involving only vascular tissues to those involving mostly parenchymal organs. A major paradigm shift has occurred in recent years regarding the pathogenesis of diabetes complications, in which the focus has shifted from studies on risks to those on the interplay between risk and protective factors. While risk factors are clearly important for the development of chronic complications in diabetes, recent studies have established that protective factors are equally significant in modulating the development and severity of diabetes complications. These protective responses may help explain the differential severity of complications, and even the lack of pathologies, in some tissues. Nevertheless, despite the growing number of studies on this field, comprehensive reviews on protective factors and their mechanisms of action are not available. This review thus focused on the clinical, biochemica...
Source: ENDOCR REV - Category: Endocrinology Authors: Source Type: research