Resolved and unresolved issues of cerebrovascular disease in diabetes mellitus

Abstract

Significant contribution of type 2 diabetes mellitus (T2DM) to the development and progression of cerebrovascular disease (CVD) has been confirmed over the past few decades. The aim of this article is to present the results of many years of research, summarizing generally resolved problems in CVD and T2DM comorbidity, as well as raising several issues that still need to be clarified. Materials and methods. The assessment results of 824 patients with CVD were selected from a large body of data for inclusion in the analysis. Ischaemic stroke was analysed in 250 patients: 128 patients with T2DM (aged 63 [54; 74] years) and 122 patients without T2DM (62 [52; 71] years). The group with chronic CVD consisted of 574 people: 300 patients with T2DM (62 [56; 69] years) and 274 patients without T2DM (63 [57; 68] years). The results of surgery for carotid artery stenosis were evaluated in 170 patients, including 72 patients with T2DM. The control group consisted of 86 persons without CVD (60 [54; 63] years). A wide range of clinical, laboratory and imaging assessments included physical and neurological examinations, neuropsychological tests, blood chemistry, haemorheological and haemostasis tests, as well as neuroimaging studies. Results. T2DM has a significant effect on neurological, neuropsychological, cognitive and functional impairments, as well as on the outcome of acute and chronic CVD, progression of intracranial atherosclerotic lesions, and changes in cerebral and vascular tissue. The impact of the quality of glycaemic control and duration of chronic hyperglycaemia on neurocognitive and structural brain changes has not been completely determined yet. The role of non-glycaemic changes, including influence of several mediators on the vascular and neurodegenerative mechanisms of cerebral tissue damage, warrants further study. Conclusion. The obtained results identify a wide range of unanswered questions and emphasize the need for both possible changes to several clinical algorithms and for ongoing in-depth studies of CVD associated with T2DM.