Vasculitis in Maturity-Onset Diabetes Mellitus FREE

Hendrick B. Barner, MD

[+] Author Affiliations

Reprint requests to the Department of Surgery, St Louis University, 1325 S Grand Blvd, St Louis, MO 63104 (Dr Barner).

JAMA. 1976;235(23):2495-2495. doi:10.1001/jama.1976.03260490013010

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ABSTRACT

ABSTRACT | REFERENCES

THE MICROANGIOPATHY that frequently causes death in individuals with juvenile diabetes mellitus is so well recognized and ingrained in our thinking that patients with maturity-onset diabetes are commonly assumed to have similar vascular abnormalities. This misconception is widely held by practicing physicians and is perpetuated in our medical schools, so that emerging physicians continue to believe that microangiopathy precludes vascular reconstruction of larger vessels in the patient with adult-onset diabetes.

Basement membrane thickening at the capillary level is associated with aging and, to a greater degree, with maturity-onset diabetes.^1,2 This, however, is a segmental lesion that does not obstruct flow but may limit nutrient exchange across the capillary wall. Occlusive disease at the level of the small arteries and arterioles was not found to be more prevalent in adult diabetics than in nondiabetics by two careful studies.^3,4

Combined with this anatomic evidence^1-4 indicating lack of obliterative diabetic

REFERENCES

ABSTRACT | REFERENCES

Siperstein MD, Unger RH, Madison LL: Studies of muscle capillary basement membranes in normal subjects, diabetic, and prediabetic patients . J Clin Invest 47:1973-1999, 1968;.

Williamson JR, Vogler NJ, Kilo C: Estimation of vascular basement membrane thickness . Diabetes 18:567-578, 1969;.

Conrad MC: Large and small artery occlusion in diabetics and nondiabetics with severe vascular disease . Circulation 36:83-89, 1967;.

Strandness DE, Priest RE, Gibbons GE: Combined clinical and pathological study of diabetic and nondiabetic peripheral arterial disease . Diabetes 13:366-372, 1964;.

Barner HB, Kaiser GC, Willman VL: Blood flow in the diabetic leg . Circulation 43:391-394, 1971;.

Barner HB, Kaiser GC, Codd JE, et al: Coronary graft flow and glucose tolerance: Evidence against the existence of myocardial microvascular disease . Vasc Surg 9:220-227, 1975;.

Wheelock FC Jr, Filtzer HS: Femoral grafts in diabetic . Arch Surg 99:776-780, 1969;.

Stipa S, Wheelock FC Jr: A comparison of femoral artery grafts in diabetic and nondiabetic patients . Am J Surg 121:223-228, 1971;.

Verska JJ, Walker WJ: Aortocoronary bypass in the diabetic patient . Am J Cardiol 35:774-777, 1975;.

Blumenthal HT, Alex M, Goldenberg S: A study of lesions of the intramural coronary artery branches in diabetes mellitus . Arch Pathol 70:27-42, 1960;.

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