Panvasculopathy in diabetes: concept, status and challenges_Chinese Journal of Evidence-Based Medicine

Authors：

CUI Jing , LI Yiwen , LUO Binyu , WANG Wenting , ZHU Mengmeng , WANG Ziyu , LIU Yanfei , CHEN Keji ,  LIU Yue

National Clinical Research Centre for Chinese Medicine Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, P. R. China;

Corresponding?author：

LIU Yue, Email: liuyueheart@hotmail.com

Keywords：

Diabetes; Panvasculopathy; Microangiopathy; Metabolic disorder; Progress

DOI：

10.7507/1672-2531.202209124

Video：

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Abstract Full text Figures/Tables Video References Cited by

Diabetic panvasculopathy refers to a clinical syndrome in which a wide range of blood vessels (including heart, brain, kidney, eye, peripheral and other large vessels and microvessels) in diabetic patients have atherosclerosis as the common pathological feature, cardiovascular and cerebrovascular events as the main outcome, and active intervention of metabolic abnormalities is helpful to improve the prognosis. Early diagnosis, early prevention and active exploration of clear therapeutic targets are very important to prevent and delay the occurrence and development of diabetic panvasculopathy, but they are also challenges at present. The cardiorenal benefit of new hypoglycemic drugs is independent of blood glucose control, which has attracted increasing academic attention. The concept of panvasculopathy in diabetes plays an important role in improving the comprehensive management of the disease and multidisciplinary collaborative diagnosis and treatment, which is helpful to promote the vigorous development of the subspecialty of panvasculopathy and the continuous improvement of the comprehensive prevention and treatment level.

Citation： CUI Jing, LI Yiwen, LUO Binyu, WANG Wenting, ZHU Mengmeng, WANG Ziyu, LIU Yanfei, CHEN Keji, LIU Yue. Panvasculopathy in diabetes: concept, status and challenges. Chinese Journal of Evidence-Based Medicine, 2023, 23(2): 133-138. doi: 10.7507/1672-2531.202209124 Copy

1.	Orasanu G, Plutzky J. The pathologic continuum of diabetic vascular disease. J Am Coll Cardiol, 2009, 53(5 Suppl): S35-42.
2.	Hayward RA, Reaven PD, Wiitala WL, et al. Follow-up of glycemic control and cardiovascular outcomes in type 2 diabetes. N Engl J Med, 2015, 372(23): 2197-2206.
3.	Nathan DM, Cleary PA, Backlund JY, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med, 2005, 353(25): 2643-2653.
4.	G?de P, Oellgaard J, Carstensen B, et al. Years of life gained by multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: 21 years follow-up on the Steno-2 randomised trial. Diabetologia, 2016, 59(11): 2298-2307.
5.	Hammes HP, Klinzing I, Wiegand S, et al. Islet transplantation inhibits diabetic retinopathy in the sucrose-fed diabetic Cohen rat. Invest Ophthalmol Vis Sci, 1993, 34(6): 2092-2096.
6.	Roy S, Sala R, Cagliero E, et al. Overexpression of fibronectin induced by diabetes or high glucose: phenomenon with a memory. Proc Natl Acad Sci U S A, 1990, 87(1): 404-408.
7.	Lanzer P, Topol EJ. Pan vascular medicine: integrated clinical management. Heidelberg: Springer Berlin Heidelberg, 2002.
8.	《泛血管疾病綜合防治科學聲明》工作組. 泛血管疾病綜合防治科學聲明. 中國循環雜志, 2019, 34(11): 1041-1046.
9.	An Y, Zhang P, Wang J, et al. Cardiovascular and all-cause mortality over a 23-year period among Chinese with newly diagnosed diabetes in the Da Qing IGT and Diabetes Study. Diabetes Care, 2015, 38(7): 1365-1371.
10.	王亞芳, 付曉麗, 朱曉娟, 等. 合并泛血管疾病的老年冠心病患者介入治療后的遠期預后. 中華老年心腦血管病雜志, 2021, 23(11): 1166-1169.
11.	Cui J, Liu Y, Li Y, et al. Type 2 Diabetes and myocardial infarction: recent clinical evidence and perspective. Front Cardiovasc Med, 2021, 8: 644189.
12.	Warner JJ, Harrington RA, Sacco RL, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke. Stroke, 2019, 50(12): 3331-3332.
13.	班繹娟, 冉興無, 楊川, 等. 中國部分省市糖尿病足病臨床資料和住院費用等比較. 中華糖尿病雜志, 2014, 6(7): 499-503.
14.	Steg PG, Bhatt DL, Wilson PW, et al. One-year cardiovascular event rates in outpatients with atherothrombosis. JAMA, 2007, 297(11): 1197-1206.
15.	Zhang X, Ran X, Xu Z, et al. Epidemiological characteristics of lower extremity arterial disease in Chinese diabetes patients at high risk: a prospective, multicenter, cross-sectional study. J Diabetes Complications, 2018, 32(2): 150-156.
16.	Hendriks EJ, Westerink J, de Jong PA, et al. Association of high ankle brachial index with incident cardiovascular disease and mortality in a high-risk population. Arterioscler Thromb Vasc Biol, 2016, 36(2): 412-417.
17.	Sun J, Deng Q, Wang J, et al. Novel insight into long-term risk of major adverse cardiovascular and cerebrovascular events following lower extremity arteriosclerosis obliterans. Front Cardiovasc Med, 2022, 9: 853583.
18.	畢齊. 多學科融合綜合管理泛血管疾病. 中國腦血管病雜志, 2022, 19(3): 145-147.
19.	Nativel M, Potier L, Alexandre L, et al. Lower extremity arterial disease in patients with diabetes: a contemporary narrative review. Cardiovasc Diabetol, 2018, 17(1): 138.
20.	Hurd MD, Martorell P, Delavande A, et al. Monetary costs of dementia in the United States. N Engl J Med, 2013, 368(14): 1326-1334.
21.	姚蔚, 張倩, 方琦, 等. 2型糖尿病血管并發癥與早期認知障礙臨床相關性研究. 中國全科醫學, 2011, 14(35): 4045-4047.
22.	中華糖尿病雜志指南與共識編寫委員會. 中國糖尿病藥物注射技術指南(2016年版). 中華糖尿病雜志, 2017, 9(2): 79-105.
23.	Keating ST, van Diepen JA, Riksen NP, et al. Epigenetics in diabetic nephropathy, immunity and metabolism. Diabetologia, 2018, 61(1): 6-20.
24.	Remuzzi G, Schieppati A, Ruggenenti P. Clinical practice. Nephropathy in patients with type 2 diabetes. N Engl J Med, 2002, 346(15): 1145-1151.
25.	Fox CS, Coady S, Sorlie PD, et al. Trends in cardiovascular complications of diabetes. JAMA, 2004, 292(20): 2495-2499.
26.	Sasso FC, Chiodini P, Carbonara O, et al. High cardiovascular risk in patients with Type 2 diabetic nephropathy: the predictive role of albuminuria and glomerular filtration rate. The NID-2 Prospective Cohort Study. Nephrol Dial Transplant, 2012, 27(6): 2269-2274.
27.	中華醫學會糖尿病學分會, 中華醫學會感染病學分會, 中華醫學會組織修復與再生分會. 中國糖尿病足防治指南(2019版)(Ⅳ). 中華糖尿病雜志, 2019, 11(5): 316-327.
28.	Thrainsdottir S, Malik RA, Dahlin LB, et al. Endoneurial capillary abnormalities presage deterioration of glucose tolerance and accompany peripheral neuropathy in man. Diabetes, 2003, 52(10): 2615-2622.
29.	Coppey LJ, Gellett JS, Davidson EP, et al. Effect of antioxidant treatment of streptozotocin-induced diabetic rats on endoneurial blood flow, motor nerve conduction velocity, and vascular reactivity of epineurial arterioles of the sciatic nerve. Diabetes, 2001, 50(8): 1927-1937.
30.	Hanff TC, Sharrett AR, Mosley TH, et al. Retinal microvascular abnormalities predict progression of brain microvascular disease: an atherosclerosis risk in communities magnetic resonance imaging study. Stroke, 2014, 45(4): 1012-1017.
31.	張健, 袁戈恒. 糖尿病卒中: 被忽視的大血管并發癥. 中華糖尿病雜志, 2020, 12(11): 864-869.
32.	中國老年醫學學會心血管病分會. 中國多學科微血管疾病診斷與治療專家共識. 中國循環雜志, 2020, 35(12): 1149-1165.
33.	Ikram MK, Cheung CY, Lorenzi M, et al. Retinal vascular caliber as a biomarker for diabetes microvascular complications. Diabetes Care, 2013, 36(3): 750-759.
34.	Xie J, Ikram MK, Cotch MF, et al. Association of diabetic macular edema and proliferative diabetic retinopathy with cardiovascular disease: a systematic review and meta-analysis. JAMA Ophthalmol, 2017, 135(6): 586-593.
35.	Kawasaki R, Cheung N, Islam FM, et al. Is diabetic retinopathy related to subclinical cardiovascular disease. Ophthalmology, 2011, 118(5): 860-865.
36.	Cheung N, Mosley T, Islam A, et al. Retinal microvascular abnormalities and subclinical magnetic resonance imaging brain infarct: a prospective study. Brain, 2010, 133(Pt 7): 1987-1993.
37.	中華醫學會內分泌學分會. 中國成人2型糖尿病患者動脈粥樣硬化性腦心血管疾病分級預防指南. 中華內分泌代謝雜志, 2016, 32(7): 540-545.
38.	Patel A, MacMahon S, et al. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet, 2007, 370(9590): 829-840.
39.	Petrie JR, Guzik TJ, Touyz RM. Diabetes, hypertension, and cardiovascular disease: clinical insights and vascular mechanisms. Can J Cardiol, 2018, 34(5): 575-584.
40.	Bangalore S, Kumar S, Lobach I, et al. Blood pressure targets in subjects with type 2 diabetes mellitus/impaired fasting glucose: observations from traditional and bayesian random-effects meta-analyses of randomized trials. Circulation, 2011, 123(24): 2799-2810.
41.	Meer E, Bavinger JC, Yu Y, et al. Association of fenofibrate use and the risk of progression to vision-threatening diabetic retinopathy. JAMA Ophthalmol, 2022, 140(5): 529-532.
42.	Bhatt DL, Bonaca MP, Bansilal S, et al. Reduction in ischemic events with ticagrelor in diabetic patients with prior myocardial infarction in PEGASUS-TIMI 54. J Am Coll Cardiol, 2016, 67(23): 2732-2740.
43.	Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med, 2015, 373(22): 2117-2128.
44.	Scheen AJ. Sodium-glucose cotransporter type 2 inhibitors for the treatment of type 2 diabetes mellitus. Nat Rev Endocrinol, 2020, 16(10): 556-577.
45.	Wang XX, Levi J, Luo Y, et al. SGLT2 Protein expression is increased in human diabetic nephropathy: SGLT2 protein inhibition decreases renal lipid accumulation, inflammation, and the development of nephropathy in diabetic mice. J Biol Chem, 2017, 292(13): 5335-5348.
46.	Maki T, Maeno S, Maeda Y, et al. Amelioration of diabetic nephropathy by SGLT2 inhibitors independent of its glucose-lowering effect: a possible role of SGLT2 in mesangial cells. Sci Rep, 2019, 9(1): 4703.
47.	Chung YR, Ha KH, Kim HC, et al. Dipeptidyl peptidase-4 inhibitors versus other antidiabetic drugs added to metformin monotherapy in diabetic retinopathy progression: a real world-based cohort study. Diabetes Metab J, 2019, 43(5): 640-648.
48.	Penno G, Garofolo M, Del Prato S. Dipeptidyl peptidase-4 inhibition in chronic kidney disease and potential for protection against diabetes-related renal injury. Nutr Metab Cardiovasc Dis, 2016, 26(5): 361-373.
49.	Takashima S, Fujita H, Fujishima H, et al. Stromal cell-derived factor-1 is upregulated by dipeptidyl peptidase-4 inhibition and has protective roles in progressive diabetic nephropathy. Kidney Int, 2016, 90(4): 783-796.
50.	Shi S, Kanasaki K, Koya D. Linagliptin but not Sitagliptin inhibited transforming growth factor-β2-induced endothelial DPP-4 activity and the endothelial-mesenchymal transition. Biochem Biophys Res Commun, 2016, 471(1): 184-190.
51.	Holman RR, Paul SK, Bethel MA, et al. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med, 2008, 359(15): 1577-1589.
52.	葛均波, 翁建平, 曾強. 2型糖尿病患者泛血管疾病風險評估與管理中國專家共識(2022版). 中國循環雜志, 2022, 37(10): 974-990.
53.	明帥, 姚溪, 謝坤鵬, 等. 糖尿病視網膜病變人工智能自動診斷系統在社區和醫院老年糖尿病患者中的應用效果分析. 中華眼底病雜志, 2022, 38(2): 120-125.
54.	Xie Q, Liu Y, Huang H, et al. An innovative method for screening and evaluating the degree of diabetic retinopathy and drug treatment based on artificial intelligence algorithms. Pharmacol Res, 2020, 159: 104986.
55.	趙亮, 付園坤, 陳涵欣, 等. 基于平行圖像的糖尿病視網膜病變智能診斷. 電子測量技術, 2022, 45(14): 131-139.
56.	Hadoux X, Hui F, Lim JKH, et al. Non-invasive in vivo hyperspectral imaging of the retina for potential biomarker use in Alzheimer's disease. Nat Commun, 2019, 10(1): 4227.
57.	Sade LE, Eroglu S, Bozba? H, et al. Relation between epicardial fat thickness and coronary flow reserve in women with chest pain and angiographically normal coronary arteries. Atherosclerosis, 2009, 204(2): 580-585.
58.	萬仁輝, 魯瑾. 2型糖尿病大血管并發癥的影響因素. 第二軍醫大學學報, 2020, 41(1): 75-80.

1. Orasanu G, Plutzky J. The pathologic continuum of diabetic vascular disease. J Am Coll Cardiol, 2009, 53(5 Suppl): S35-42.
2. Hayward RA, Reaven PD, Wiitala WL, et al. Follow-up of glycemic control and cardiovascular outcomes in type 2 diabetes. N Engl J Med, 2015, 372(23): 2197-2206.
3. Nathan DM, Cleary PA, Backlund JY, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med, 2005, 353(25): 2643-2653.
4. G?de P, Oellgaard J, Carstensen B, et al. Years of life gained by multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: 21 years follow-up on the Steno-2 randomised trial. Diabetologia, 2016, 59(11): 2298-2307.
5. Hammes HP, Klinzing I, Wiegand S, et al. Islet transplantation inhibits diabetic retinopathy in the sucrose-fed diabetic Cohen rat. Invest Ophthalmol Vis Sci, 1993, 34(6): 2092-2096.
6. Roy S, Sala R, Cagliero E, et al. Overexpression of fibronectin induced by diabetes or high glucose: phenomenon with a memory. Proc Natl Acad Sci U S A, 1990, 87(1): 404-408.
7. Lanzer P, Topol EJ. Pan vascular medicine: integrated clinical management. Heidelberg: Springer Berlin Heidelberg, 2002.
8. 《泛血管疾病綜合防治科學聲明》工作組. 泛血管疾病綜合防治科學聲明. 中國循環雜志, 2019, 34(11): 1041-1046.
9. An Y, Zhang P, Wang J, et al. Cardiovascular and all-cause mortality over a 23-year period among Chinese with newly diagnosed diabetes in the Da Qing IGT and Diabetes Study. Diabetes Care, 2015, 38(7): 1365-1371.
10. 王亞芳, 付曉麗, 朱曉娟, 等. 合并泛血管疾病的老年冠心病患者介入治療后的遠期預后. 中華老年心腦血管病雜志, 2021, 23(11): 1166-1169.
11. Cui J, Liu Y, Li Y, et al. Type 2 Diabetes and myocardial infarction: recent clinical evidence and perspective. Front Cardiovasc Med, 2021, 8: 644189.
12. Warner JJ, Harrington RA, Sacco RL, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke. Stroke, 2019, 50(12): 3331-3332.
13. 班繹娟, 冉興無, 楊川, 等. 中國部分省市糖尿病足病臨床資料和住院費用等比較. 中華糖尿病雜志, 2014, 6(7): 499-503.
14. Steg PG, Bhatt DL, Wilson PW, et al. One-year cardiovascular event rates in outpatients with atherothrombosis. JAMA, 2007, 297(11): 1197-1206.
15. Zhang X, Ran X, Xu Z, et al. Epidemiological characteristics of lower extremity arterial disease in Chinese diabetes patients at high risk: a prospective, multicenter, cross-sectional study. J Diabetes Complications, 2018, 32(2): 150-156.
16. Hendriks EJ, Westerink J, de Jong PA, et al. Association of high ankle brachial index with incident cardiovascular disease and mortality in a high-risk population. Arterioscler Thromb Vasc Biol, 2016, 36(2): 412-417.
17. Sun J, Deng Q, Wang J, et al. Novel insight into long-term risk of major adverse cardiovascular and cerebrovascular events following lower extremity arteriosclerosis obliterans. Front Cardiovasc Med, 2022, 9: 853583.
18. 畢齊. 多學科融合綜合管理泛血管疾病. 中國腦血管病雜志, 2022, 19(3): 145-147.
19. Nativel M, Potier L, Alexandre L, et al. Lower extremity arterial disease in patients with diabetes: a contemporary narrative review. Cardiovasc Diabetol, 2018, 17(1): 138.
20. Hurd MD, Martorell P, Delavande A, et al. Monetary costs of dementia in the United States. N Engl J Med, 2013, 368(14): 1326-1334.
21. 姚蔚, 張倩, 方琦, 等. 2型糖尿病血管并發癥與早期認知障礙臨床相關性研究. 中國全科醫學, 2011, 14(35): 4045-4047.
22. 中華糖尿病雜志指南與共識編寫委員會. 中國糖尿病藥物注射技術指南(2016年版). 中華糖尿病雜志, 2017, 9(2): 79-105.
23. Keating ST, van Diepen JA, Riksen NP, et al. Epigenetics in diabetic nephropathy, immunity and metabolism. Diabetologia, 2018, 61(1): 6-20.
24. Remuzzi G, Schieppati A, Ruggenenti P. Clinical practice. Nephropathy in patients with type 2 diabetes. N Engl J Med, 2002, 346(15): 1145-1151.
25. Fox CS, Coady S, Sorlie PD, et al. Trends in cardiovascular complications of diabetes. JAMA, 2004, 292(20): 2495-2499.
26. Sasso FC, Chiodini P, Carbonara O, et al. High cardiovascular risk in patients with Type 2 diabetic nephropathy: the predictive role of albuminuria and glomerular filtration rate. The NID-2 Prospective Cohort Study. Nephrol Dial Transplant, 2012, 27(6): 2269-2274.
27. 中華醫學會糖尿病學分會, 中華醫學會感染病學分會, 中華醫學會組織修復與再生分會. 中國糖尿病足防治指南(2019版)(Ⅳ). 中華糖尿病雜志, 2019, 11(5): 316-327.
28. Thrainsdottir S, Malik RA, Dahlin LB, et al. Endoneurial capillary abnormalities presage deterioration of glucose tolerance and accompany peripheral neuropathy in man. Diabetes, 2003, 52(10): 2615-2622.
29. Coppey LJ, Gellett JS, Davidson EP, et al. Effect of antioxidant treatment of streptozotocin-induced diabetic rats on endoneurial blood flow, motor nerve conduction velocity, and vascular reactivity of epineurial arterioles of the sciatic nerve. Diabetes, 2001, 50(8): 1927-1937.
30. Hanff TC, Sharrett AR, Mosley TH, et al. Retinal microvascular abnormalities predict progression of brain microvascular disease: an atherosclerosis risk in communities magnetic resonance imaging study. Stroke, 2014, 45(4): 1012-1017.
31. 張健, 袁戈恒. 糖尿病卒中: 被忽視的大血管并發癥. 中華糖尿病雜志, 2020, 12(11): 864-869.
32. 中國老年醫學學會心血管病分會. 中國多學科微血管疾病診斷與治療專家共識. 中國循環雜志, 2020, 35(12): 1149-1165.
33. Ikram MK, Cheung CY, Lorenzi M, et al. Retinal vascular caliber as a biomarker for diabetes microvascular complications. Diabetes Care, 2013, 36(3): 750-759.
34. Xie J, Ikram MK, Cotch MF, et al. Association of diabetic macular edema and proliferative diabetic retinopathy with cardiovascular disease: a systematic review and meta-analysis. JAMA Ophthalmol, 2017, 135(6): 586-593.
35. Kawasaki R, Cheung N, Islam FM, et al. Is diabetic retinopathy related to subclinical cardiovascular disease. Ophthalmology, 2011, 118(5): 860-865.
36. Cheung N, Mosley T, Islam A, et al. Retinal microvascular abnormalities and subclinical magnetic resonance imaging brain infarct: a prospective study. Brain, 2010, 133(Pt 7): 1987-1993.
37. 中華醫學會內分泌學分會. 中國成人2型糖尿病患者動脈粥樣硬化性腦心血管疾病分級預防指南. 中華內分泌代謝雜志, 2016, 32(7): 540-545.
38. Patel A, MacMahon S, et al. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet, 2007, 370(9590): 829-840.
39. Petrie JR, Guzik TJ, Touyz RM. Diabetes, hypertension, and cardiovascular disease: clinical insights and vascular mechanisms. Can J Cardiol, 2018, 34(5): 575-584.
40. Bangalore S, Kumar S, Lobach I, et al. Blood pressure targets in subjects with type 2 diabetes mellitus/impaired fasting glucose: observations from traditional and bayesian random-effects meta-analyses of randomized trials. Circulation, 2011, 123(24): 2799-2810.
41. Meer E, Bavinger JC, Yu Y, et al. Association of fenofibrate use and the risk of progression to vision-threatening diabetic retinopathy. JAMA Ophthalmol, 2022, 140(5): 529-532.
42. Bhatt DL, Bonaca MP, Bansilal S, et al. Reduction in ischemic events with ticagrelor in diabetic patients with prior myocardial infarction in PEGASUS-TIMI 54. J Am Coll Cardiol, 2016, 67(23): 2732-2740.
43. Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med, 2015, 373(22): 2117-2128.
44. Scheen AJ. Sodium-glucose cotransporter type 2 inhibitors for the treatment of type 2 diabetes mellitus. Nat Rev Endocrinol, 2020, 16(10): 556-577.
45. Wang XX, Levi J, Luo Y, et al. SGLT2 Protein expression is increased in human diabetic nephropathy: SGLT2 protein inhibition decreases renal lipid accumulation, inflammation, and the development of nephropathy in diabetic mice. J Biol Chem, 2017, 292(13): 5335-5348.
46. Maki T, Maeno S, Maeda Y, et al. Amelioration of diabetic nephropathy by SGLT2 inhibitors independent of its glucose-lowering effect: a possible role of SGLT2 in mesangial cells. Sci Rep, 2019, 9(1): 4703.
47. Chung YR, Ha KH, Kim HC, et al. Dipeptidyl peptidase-4 inhibitors versus other antidiabetic drugs added to metformin monotherapy in diabetic retinopathy progression: a real world-based cohort study. Diabetes Metab J, 2019, 43(5): 640-648.
48. Penno G, Garofolo M, Del Prato S. Dipeptidyl peptidase-4 inhibition in chronic kidney disease and potential for protection against diabetes-related renal injury. Nutr Metab Cardiovasc Dis, 2016, 26(5): 361-373.
49. Takashima S, Fujita H, Fujishima H, et al. Stromal cell-derived factor-1 is upregulated by dipeptidyl peptidase-4 inhibition and has protective roles in progressive diabetic nephropathy. Kidney Int, 2016, 90(4): 783-796.
50. Shi S, Kanasaki K, Koya D. Linagliptin but not Sitagliptin inhibited transforming growth factor-β2-induced endothelial DPP-4 activity and the endothelial-mesenchymal transition. Biochem Biophys Res Commun, 2016, 471(1): 184-190.
51. Holman RR, Paul SK, Bethel MA, et al. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med, 2008, 359(15): 1577-1589.
52. 葛均波, 翁建平, 曾強. 2型糖尿病患者泛血管疾病風險評估與管理中國專家共識(2022版). 中國循環雜志, 2022, 37(10): 974-990.
53. 明帥, 姚溪, 謝坤鵬, 等. 糖尿病視網膜病變人工智能自動診斷系統在社區和醫院老年糖尿病患者中的應用效果分析. 中華眼底病雜志, 2022, 38(2): 120-125.
54. Xie Q, Liu Y, Huang H, et al. An innovative method for screening and evaluating the degree of diabetic retinopathy and drug treatment based on artificial intelligence algorithms. Pharmacol Res, 2020, 159: 104986.
55. 趙亮, 付園坤, 陳涵欣, 等. 基于平行圖像的糖尿病視網膜病變智能診斷. 電子測量技術, 2022, 45(14): 131-139.
56. Hadoux X, Hui F, Lim JKH, et al. Non-invasive in vivo hyperspectral imaging of the retina for potential biomarker use in Alzheimer's disease. Nat Commun, 2019, 10(1): 4227.
57. Sade LE, Eroglu S, Bozba? H, et al. Relation between epicardial fat thickness and coronary flow reserve in women with chest pain and angiographically normal coronary arteries. Atherosclerosis, 2009, 204(2): 580-585.
58. 萬仁輝, 魯瑾. 2型糖尿病大血管并發癥的影響因素. 第二軍醫大學學報, 2020, 41(1): 75-80.

Chinese Journal of Evidence-Based Medicine

Panvasculopathy in diabetes: concept, status and challenges

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