The vascular endothelium in diabetes - A therapeutic target?

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Insulin resistance affects the vascular endothelium, and contributes to systemic insulin resistance by directly impairing the actions of insulin to redistribute blood flow as part of its normal actions driving muscle glucose uptake. Impaired vascular function is a component of the insulin resistance syndrome, and is a feature of type 2 diabetes. On this basis, the vascular endothelium has emerged as a therapeutic target where the intent is to improve systemic metabolic state by improving vascular function. We review the available literature presenting studies in humans, evaluating the effects of metabolically targeted and vascular targeted therapies on insulin action and systemic metabolism. Therapies that improve systemic insulin resistance exert strong concurrent effects to improve vascular function and vascular insulin action. RAS-acting agents and statins have widely recognized beneficial effects on vascular function but have not uniformly produced the hoped-for metabolic benefits. These observations support the notion that systemic metabolic benefits can arise from therapies targeted at the endothelium, but improving vascular insulin action does not result from all treatments that improve endothelium-dependent vasodilation. A better understanding of the mechanisms of insulin's actions in the vascular wall will advance our understanding of the specificity of these responses, and allow us to better target the vasculature for metabolic benefits.

Original languageEnglish
Pages (from-to)87-99
Number of pages13
JournalReviews in Endocrine and Metabolic Disorders
Volume14
Issue number1
DOIs
StatePublished - Mar 2013

Fingerprint

Vascular Endothelium
Blood Vessels
Insulin Resistance
Insulin
Therapeutics
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Vasodilation
Type 2 Diabetes Mellitus
Endothelium
Glucose
Muscles

Keywords

  • Endothelin
  • Endothelium
  • Insulin
  • Nitric oxide
  • Therapy
  • Vasodilation

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

Cite this

The vascular endothelium in diabetes - A therapeutic target? / Mather, Kieren.

In: Reviews in Endocrine and Metabolic Disorders, Vol. 14, No. 1, 03.2013, p. 87-99.

Research output: Contribution to journalArticle

@article{fa9538ce34db449b81b39e8219edb91d,
title = "The vascular endothelium in diabetes - A therapeutic target?",
abstract = "Insulin resistance affects the vascular endothelium, and contributes to systemic insulin resistance by directly impairing the actions of insulin to redistribute blood flow as part of its normal actions driving muscle glucose uptake. Impaired vascular function is a component of the insulin resistance syndrome, and is a feature of type 2 diabetes. On this basis, the vascular endothelium has emerged as a therapeutic target where the intent is to improve systemic metabolic state by improving vascular function. We review the available literature presenting studies in humans, evaluating the effects of metabolically targeted and vascular targeted therapies on insulin action and systemic metabolism. Therapies that improve systemic insulin resistance exert strong concurrent effects to improve vascular function and vascular insulin action. RAS-acting agents and statins have widely recognized beneficial effects on vascular function but have not uniformly produced the hoped-for metabolic benefits. These observations support the notion that systemic metabolic benefits can arise from therapies targeted at the endothelium, but improving vascular insulin action does not result from all treatments that improve endothelium-dependent vasodilation. A better understanding of the mechanisms of insulin's actions in the vascular wall will advance our understanding of the specificity of these responses, and allow us to better target the vasculature for metabolic benefits.",
keywords = "Endothelin, Endothelium, Insulin, Nitric oxide, Therapy, Vasodilation",
author = "Kieren Mather",
year = "2013",
month = "3",
doi = "10.1007/s11154-013-9237-9",
language = "English",
volume = "14",
pages = "87--99",
journal = "Reviews in Endocrine and Metabolic Disorders",
issn = "1389-9155",
publisher = "Springer Netherlands",
number = "1",

}

TY - JOUR

T1 - The vascular endothelium in diabetes - A therapeutic target?

AU - Mather, Kieren

PY - 2013/3

Y1 - 2013/3

N2 - Insulin resistance affects the vascular endothelium, and contributes to systemic insulin resistance by directly impairing the actions of insulin to redistribute blood flow as part of its normal actions driving muscle glucose uptake. Impaired vascular function is a component of the insulin resistance syndrome, and is a feature of type 2 diabetes. On this basis, the vascular endothelium has emerged as a therapeutic target where the intent is to improve systemic metabolic state by improving vascular function. We review the available literature presenting studies in humans, evaluating the effects of metabolically targeted and vascular targeted therapies on insulin action and systemic metabolism. Therapies that improve systemic insulin resistance exert strong concurrent effects to improve vascular function and vascular insulin action. RAS-acting agents and statins have widely recognized beneficial effects on vascular function but have not uniformly produced the hoped-for metabolic benefits. These observations support the notion that systemic metabolic benefits can arise from therapies targeted at the endothelium, but improving vascular insulin action does not result from all treatments that improve endothelium-dependent vasodilation. A better understanding of the mechanisms of insulin's actions in the vascular wall will advance our understanding of the specificity of these responses, and allow us to better target the vasculature for metabolic benefits.

AB - Insulin resistance affects the vascular endothelium, and contributes to systemic insulin resistance by directly impairing the actions of insulin to redistribute blood flow as part of its normal actions driving muscle glucose uptake. Impaired vascular function is a component of the insulin resistance syndrome, and is a feature of type 2 diabetes. On this basis, the vascular endothelium has emerged as a therapeutic target where the intent is to improve systemic metabolic state by improving vascular function. We review the available literature presenting studies in humans, evaluating the effects of metabolically targeted and vascular targeted therapies on insulin action and systemic metabolism. Therapies that improve systemic insulin resistance exert strong concurrent effects to improve vascular function and vascular insulin action. RAS-acting agents and statins have widely recognized beneficial effects on vascular function but have not uniformly produced the hoped-for metabolic benefits. These observations support the notion that systemic metabolic benefits can arise from therapies targeted at the endothelium, but improving vascular insulin action does not result from all treatments that improve endothelium-dependent vasodilation. A better understanding of the mechanisms of insulin's actions in the vascular wall will advance our understanding of the specificity of these responses, and allow us to better target the vasculature for metabolic benefits.

KW - Endothelin

KW - Endothelium

KW - Insulin

KW - Nitric oxide

KW - Therapy

KW - Vasodilation

UR - http://www.scopus.com/inward/record.url?scp=84874662738&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84874662738&partnerID=8YFLogxK

U2 - 10.1007/s11154-013-9237-9

DO - 10.1007/s11154-013-9237-9

M3 - Article

C2 - 23397462

AN - SCOPUS:84874662738

VL - 14

SP - 87

EP - 99

JO - Reviews in Endocrine and Metabolic Disorders

JF - Reviews in Endocrine and Metabolic Disorders

SN - 1389-9155

IS - 1

ER -