DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain; Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain; Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Badalona, Spain.
Trends Endocrinol Metab. 2020 Apr;31(4):287-295. doi: 10.1016/j.tem.2020.01.007. Epub 2020 Feb 4.
Chronic-diabetes-related complications simultaneously compromise both the micro- and macrovascular trees, with target organs considered as the paradigm of large vessel injury also entailing microangiopathic changes. However, complications independent or partially independent from vascular damage are often overlooked. This includes neuronal dysfunction (e.g., retinal neurodegeneration), interstitial injury (e.g., tubulointerstitial disease), metabolic damage (e.g., in the heart and liver), and nonclassical conditions such as cognitive decline, impaired pulmonary function, or increased risk of cancer. In this scenario, researchers, endocrinologists and primary care physicians should have a holistic view of the disease and pay further attention to all organs and all potential clinical repercussions, which would certainly contribute to a more rational and integrated patient health care.
慢性糖尿病相关并发症同时损害微血管和大血管树，靶器官被认为是大血管损伤的范例，同时也伴有微血管病变。然而，独立于或部分独立于血管损伤的并发症往往被忽视。这包括神经元功能障碍（例如，视网膜神经退行性变）、间质损伤（例如，肾小管间质性疾病）、代谢损伤（例如，心脏和肝脏）以及非典型情况，如认知能力下降、肺功能受损或癌症风险增加。在这种情况下，研究人员、内分泌学家和初级保健医生应该对疾病有一个全面的认识，并更加关注所有器官和所有潜在的临床影响，这无疑将有助于更合理和综合的患者医疗保健。
