ABSTRACT
Damage to the microcirculation plays a central role in the development of the long-term complications of diabetes, leading to a specific microangiopathy characterized by basement membrane thickening in capillaries, arterioles, and venules. It has been proposed that diabetic microangiopathy may be the end result of long-standing functional changes in the microcirculation, such as increased pressure, blood flow, and permeability, which eventually lead to microvascular sclerosis perhaps via an injury response to repetitive endothelial damage. Hemodynamic changes have been extensively characterized in the skin microcirculation, which is easily accessible to investigation using noninvasive techniques. Increased microvascular blood flow is present in the skin at an early stage after diagnosis in patients with insulin-dependent diabetes mellitus. There are considerable differences in the normal structure of the individual microvascular beds in the different tissues, allowing specialization of function, e.g., filtration in the glomerulus.
