La microangiopathie diabétique

Diabetic microangiopathy is morphologically defined as a thickening of the basement membrane of the capillaries. Its clinical manifestations are essentially the retinopathy (the four evolutionary stages of which are described) and the glomerular nephropathy, extending from the diffuse type to the classical nodular one. Various etiopathogenic hypotheses have been proposed, the most important of which are: 1. The diabetic erythrocytes deliver less easily oxygen to the tissues; this is due to a deficiency in organic phosphate compounds (mainly diphosphoglycerate) regulating the hemoglobin dissociation curve, and to an ab normal accumulation of the dysfunctional glycosylated hemoglobin A1c. 2. The diabetic endothelial cell may suffer from an excessive sorbitol accumulation and from inositol (which is a growth factor) deficiency. 3. Basement membrane of diabetics is chemically and functionally altered, particularly in its glycoprotein component. Prolonged hyperglycernia in itself can explain these three alterations. Consequently, the major aim of the treatment of diabetes is to prevent the development of the microangiopathy by ensuring continuously an optimal blood glucose con tro1