Glycated hemoglobin and subsequent risk of microvascular and macrovascular complications

Abstract

Diabetes mellitus (DM) is a global health problem and its prevalence is constantly increasing over the past several decades. Measurement of glycated hemoglobin (HbA1c) is widely accepted as indicator of long-term glycemic exposure and used as tool for the diagnosis and management of DM. Patients with DM are at heightened risk of both microvascular and macrovascular complications which affect the several organs including skin, heart, brain, eyes, and kidneys. There is a common etiology between hyperglycemia and vascular diseases. The mechanism of pathogenesis starts with formation and accumulation of advanced glycation end product, impaired vasodilatory response, smooth muscle cell dysfunction, overproduction of endothelial growth factors, chronic inflammation, hemodynamic dysregulation, impaired fibrinolytic activity, and enhanced platelet aggregation. These events decrease the diameter of the vessel and initiate the lesion of the vessel wall followed by local ischemia and tissue damage.