Endothelial Dysfunction, Inflammation and Diabetes

Dandona P, Aljada A, Chaudhuri A, Mohanty P. Rev Endocr Metab Disord. 2004;5:189-197.

This review addresses the relationship between endothelial dysfunction, inflammation, and type 2 diabetes and describes the anti-inflammatory effects of current diabetes therapies. The endothelium serves a number of functions, the most important of which is to ensure the patency of blood vessels for adequate blood flow through the blood vessels. This effect is achieved by the release of factors involved in vascular relaxation and contraction, thrombogenesis and fibrinolysis, and platelet activation and inhibition, functions that are impaired in response to oxidative and inflammatory stress. Metabolic conditions―including obesity, insulin resistance, and type 2 diabetes―are now thought of as inflammatory conditions. Dandona and colleagues give an extensive overview of the key studies carried out over the past decade that have led to this conclusion as well as the implications in terms of the pathogenesis and treatment of type 2 diabetes.

Some treatments for diabetes have anti-inflammatory effects. This finding is of growing interest because of the dual effects of improved blood glucose control and prevention of cardiovascular outcomes. Both insulin and thiazolidinediones have been shown to have anti-inflammatory effects. Although metformin and α-glucosidase inhibitors do not have known anti-inflammatory properties, both reduce cardiovascular mortality, as shown in the UK Prospective Diabetes Study (UKPDS) and the Study to Prevent Non-Insulin Dependent Diabetes Mellitus (Stop-NIDDM), respectively. Sulfonylureas have not been shown to have an anti-inflammatory effect or an effect on improving cardiovascular outcomes. The recent finding that the use of statins, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin receptor blockers in patients at risk of or with established cardiovascular disease leads to a decrease in the incidence of type 2 diabetes further reinforces the inflammatory nature of both conditions.

The role of inflammation in diabetes and endothelial dysfunction is an emerging area of research, and new findings in this field are eagerly anticipated.