You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


ABOUT JAMA
Advanced Search

Welcome   | My Account | E-mail Alerts | Access Rights | Sign In


  Vol. 288 No. 20, November 27, 2002 TABLE OF CONTENTS
  JAMA
  •  Online Features
  Special Communication
 This Article
 •Full text
 •PDF
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Citing articles on ISI (209)
 •Contact me when this article is cited
 Related Content
 •Related letter
 •Similar articles in JAMA
 Topic Collections
 •Neurology
 •Nutritional and Metabolic Disorders
 •Nutritional and Metabolic Disorders, Other
 •Ophthalmology
 •Ophthalmological Disorders
 •Diabetic Retinopathy
 •Endocrine Diseases
 •Diabetes Mellitus
 •Alert me on articles by topic
 Social Bookmarking
  Add to CiteULike Add to Connotea Add to Del.icio.us Add to Digg Add to Reddit Add to Technorati
What's this?

Molecular Understanding of Hyperglycemia's Adverse Effects for Diabetic Complications

Matthew J. Sheetz, MD, PhD; George L. King, MD

JAMA. 2002;288:2579-2588.

Diabetic complications are the major cause of morbidity and mortality in persons with diabetes. Chronic hyperglycemia is a major initiator of diabetic microvascular complications (eg, retinopathy, neuropathy, nephropathy). Glucose processing uses a variety of diverse metabolic pathways; hence, chronic hyperglycemia can induce multiple cellular changes leading to complications. Several predominant well-researched theories have been proposed to explain how hyperglycemia can produce the neural and vascular derangements that are hallmarks of diabetes. These theories can be separated into those that emphasize the toxic effects of hyperglycemia and its pathophysiological derivatives (such as oxidants, hyperosmolarity, or glycation products) on tissues directly and those that ascribe pathophysiological importance to a sustained alteration in cell signaling pathways (such as changes in phospholipids or kinases) induced by the products of glucose metabolism. This article summarizes these theories and the potential therapeutic interventions that may prevent diabetic complications in the presence of hyperglycemia, control of which is often difficult with current therapeutic options.


Author Affiliations: Lilly Research Laboratories, Indianapolis, Ind (Dr Sheetz); Research Division, Joslin Diabetes Center, Harvard Medical School, Boston, Mass (Dr King).



Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati     What's this?

RELATED LETTER

Animal Models of Human Diabetic Polyneuropathy
Colin L. Crawford and Peter Hardwicke
JAMA. 2003;289(14):1779-1780.
EXTRACT | FULL TEXT  


THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Adiponectin Suppresses Pathological Microvessel Formation in Retina Through Modulation of Tumor Necrosis Factor-{alpha} Expression
Higuchi et al.
Circ. Res. 2009;104:1058-1065.
ABSTRACT | FULL TEXT  

Garlic Increases Antioxidant Levels in Diabetic and Hypertensive Rats Determined by a Modified Peroxidase Method
Drobiova et al.
Evid Based Complement Alternat Med 2009;0:nep011v1-nep011.
ABSTRACT | FULL TEXT  

The pathologic continuum of diabetic vascular disease.
Orasanu and Plutzky
J Am Coll Cardiol 2009;53:S35-S42.
ABSTRACT | FULL TEXT  

Prevention of Posterior Capsular Opacification through Aldose Reductase Inhibition
Yadav et al.
IOVS 2009;50:752-759.
ABSTRACT | FULL TEXT  

Endothelial Dysfunction in Mice with Streptozotocin-induced Type 1 Diabetes Is Opposed by Compensatory Overexpression of Cyclooxygenase-2 in the Vasculature
Nacci et al.
Endocrinology 2009;150:849-861.
ABSTRACT | FULL TEXT  

MicroRNA-377 is up-regulated and can lead to increased fibronectin production in diabetic nephropathy
Wang et al.
FASEB J. 2008;22:4126-4135.
ABSTRACT | FULL TEXT  

Inhibition of Protein Kinase C{beta} Prevents Foam Cell Formation by Reducing Scavenger Receptor A Expression in Human Macrophages
Osto et al.
Circulation 2008;118:2174-2182.
ABSTRACT | FULL TEXT  

Diabetes-Related Microvascular and Macrovascular Diseases in the Physical Therapy Setting
Cade
ptjournal 2008;88:1322-1335.
ABSTRACT | FULL TEXT  

Circulating Endothelial Progenitor Cells as a New Marker of Endothelial Dysfunction or Repair in Acute Stroke * Supplemental Methods
Chu et al.
Stroke 2008;39:1441-1447.
ABSTRACT | FULL TEXT  

Demonstration of the Essential Role of Protein Kinase C Isoforms in Hyperglycemia-Induced Embryonic Malformations
Zhiyong Zhao et al.
Reproductive Sciences 2008;15:349-356.
ABSTRACT  

Inhibition of NADPH Oxidase Prevents Advanced Glycation End Product-Mediated Damage in Diabetic Nephropathy Through a Protein Kinase C-{alpha}-Dependent Pathway
Thallas-Bonke et al.
Diabetes 2008;57:460-469.
ABSTRACT | FULL TEXT  

Oral Hypoglycemics and Diabetic Nephropathy
Hadler
CJASN 2008;3:159-162.
FULL TEXT  

Does Lowering of Blood Glucose Improve Cardiovascular Morbidity and Mortality?
Iqbal and Rubenstein
CJASN 2008;3:163-167.
FULL TEXT  

Dynamic blood pressure load and nephropathy in the ZSF1 (fa/facp) model of type 2 diabetes
Griffin et al.
Am. J. Physiol. Renal Physiol. 2007;293:F1605-F1613.
ABSTRACT | FULL TEXT  

Akt activation and augmented fibronectin production in hyperhexosemia
Xin et al.
Am. J. Physiol. Endocrinol. Metab. 2007;293:E1036-E1044.
ABSTRACT | FULL TEXT  

Relationship Between Gilbert Syndrome and Prevalence of Vascular Complications in Patients With Diabetes
Inoguchi et al.
JAMA 2007;298:1398-1400.
FULL TEXT  

Painful Diabetic Peripheral Neuropathy
Smith
J. Am. Podiatr. Med. Assoc. 2007;97:394-401.
ABSTRACT | FULL TEXT  

Aldose Reductase-Regulated Tumor Necrosis Factor-{alpha} Production Is Essential for High Glucose-Induced Vascular Smooth Muscle Cell Growth
Ramana et al.
Endocrinology 2007;148:4371-4384.
ABSTRACT | FULL TEXT  

Etiology and natural history of diabetic retinopathy: An overview
Morello
Am J Health Syst Pharm 2007;64:S3-S7.
ABSTRACT | FULL TEXT  

Screening for and managing diabetic retinopathy: Current approaches
Bloomgarden
Am J Health Syst Pharm 2007;64:S8-S14.
ABSTRACT | FULL TEXT  

New pharmacologic approachesto treating diabetic retinopathy
Ryan
Am J Health Syst Pharm 2007;64:S15-S21.
ABSTRACT | FULL TEXT  

Phosphorylation of Pleckstrin Increases Proinflammatory Cytokine Secretion by Mononuclear Phagocytes in Diabetes Mellitus
Ding et al.
J. Immunol. 2007;179:647-654.
ABSTRACT | FULL TEXT  

Kidney Outcomes in Long-Term Studies of Ruboxistaurin for Diabetic Eye Disease
Tuttle et al.
CJASN 2007;2:631-636.
ABSTRACT | FULL TEXT  

High Glucose Impairs Early and Late Endothelial Progenitor Cells by Modifying Nitric Oxide-Related but Not Oxidative Stress-Mediated Mechanisms
Chen et al.
Diabetes 2007;56:1559-1568.
ABSTRACT | FULL TEXT  

CAN WE OVERCOME THE PREDESTINED POOR SURVIVAL OF DIABETIC PATIENTS? PERSPECTIVES FROM PRE- AND POST-DIALYSIS
Kim
pdi 2007;27:S171-S175.
ABSTRACT | FULL TEXT  

Etiology and effect on outcomes of hyperglycemia in hospitalized patients
Campbell
Am J Health Syst Pharm 2007;64:S4-S8.
ABSTRACT | FULL TEXT  

A 6-Month, Randomized, Double-Masked, Placebo-Controlled Study Evaluating the Effects of the Protein Kinase C-{beta} Inhibitor Ruboxistaurin on Skin Microvascular Blood Flow and Other Measures of Diabetic Peripheral Neuropathy
Casellini et al.
Diabetes Care 2007;30:896-902.
ABSTRACT | FULL TEXT  

Effect of Ruboxistaurin on Urinary Transforming Growth Factor-{beta} in Patients With Diabetic Nephropathy and Type 2 Diabetes
Gilbert et al.
Diabetes Care 2007;30:995-996.
FULL TEXT  

Effect of Ruboxistaurin in Patients With Diabetic Macular Edema: Thirty-Month Results of the Randomized PKC-DMES Clinical Trial
The PKC-DMES Study Group
Arch Ophthalmol 2007;125:318-324.
ABSTRACT | FULL TEXT  

Glycosylation Mediates Up-regulation of a Potent Antiangiogenic and Proatherogenic Protein, Thrombospondin-1, by Glucose in Vascular Smooth Muscle Cells
Raman et al.
J. Biol. Chem. 2007;282:5704-5714.
ABSTRACT | FULL TEXT  

Spontaneously reduced blood pressure load in the rat streptozotocin-induced diabetes model: potential pathogenetic relevance
Bidani et al.
Am. J. Physiol. Renal Physiol. 2007;292:F647-F654.
ABSTRACT | FULL TEXT  

Role of Nitric Oxide in High Glucose-Induced Mitogenic Response in Renal Fibroblasts
Chuang et al.
Mol. Endocrinol. 2006;20:2548-2558.
ABSTRACT | FULL TEXT  

New-onset diabetes and risk of all-cause and cardiovascular mortality: the cardiovascular health study.
Smith et al.
Diabetes Care 2006;29:2012-2017.
ABSTRACT | FULL TEXT  

Folate and Vitamin B6 Rapidly Normalize Endothelial Dysfunction In Children With Type 1 Diabetes Mellitus
MacKenzie et al.
Pediatrics 2006;118:242-253.
ABSTRACT | FULL TEXT  

Reexamining the hyperglycemic pseudohypoxia hypothesis of diabetic oculopathy.
Diederen et al.
IOVS 2006;47:2726-2731.
ABSTRACT | FULL TEXT  

Endothelins: regulators of extracellular matrix protein production in diabetes.
Khan et al.
Exp. Biol. Med. 2006;231:1022-1029.
ABSTRACT | FULL TEXT  

Temporal expression profile and distribution pattern indicate a role of connective tissue growth factor (CTGF/CCN-2) in diabetic nephropathy in mice
Roestenberg et al.
Am. J. Physiol. Renal Physiol. 2006;290:F1344-F1354.
ABSTRACT | FULL TEXT  

Contribution of aldose reductase to diabetic hyperproliferation of vascular smooth muscle cells.
Srivastava et al.
Diabetes 2006;55:901-910.
ABSTRACT | FULL TEXT  

Angiotensin II Type 1 Receptor Blockers Reduce Urinary Oxidative Stress Markers in Hypertensive Diabetic Nephropathy
Ogawa et al.
Hypertension 2006;47:699-705.
ABSTRACT | FULL TEXT  

Effects of a Single Administration of Acarbose on Postprandial Glucose Excursion and Endothelial Dysfunction in Type 2 Diabetic Patients: A Randomized Crossover Study
Shimabukuro et al.
J. Clin. Endocrinol. Metab. 2006;91:837-842.
ABSTRACT | FULL TEXT  

Orally Active Neurotrophin-Enhancing Agent Protects Against Dysfunctions of the Peripheral Nerves in Hyperglycemic Animals
Kakinoki et al.
Diabetes 2006;55:616-621.
ABSTRACT | FULL TEXT  

De novo emergence of insulin-stimulated glucose uptake in human aortic endothelial cells incubated with high glucose
Gosmanov et al.
Am. J. Physiol. Endocrinol. Metab. 2006;290:E516-E522.
ABSTRACT | FULL TEXT  

Diabetic Microangiopathy in Ischemic Limb Is a Disease of Disturbance of the Platelet-Derived Growth Factor-BB/Protein Kinase C Axis but Not of Impaired Expression of Angiogenic Factors
Tanii et al.
Circ. Res. 2006;98:55-62.
ABSTRACT | FULL TEXT  

Posttranslational, Reversible O-Glycosylation Is Stimulated by High Glucose and Mediates Plasminogen Activator Inhibitor-1 Gene Expression and Sp1 Transcriptional Activity in Glomerular Mesangial Cells
Goldberg et al.
Endocrinology 2006;147:222-231.
ABSTRACT | FULL TEXT  

Regulation of the Caenorhabditis elegans oxidative stress defense protein SKN-1 by glycogen synthase kinase-3
An et al.
Proc. Natl. Acad. Sci. USA 2005;102:16275-16280.
ABSTRACT | FULL TEXT  

Can Protein Kinase C {beta}-Selective Inhibitor, Ruboxistaurin, Stop Vascular Complications in Diabetic Patients?
He and King
Diabetes Care 2005;28:2803-2805.
FULL TEXT  

Glycation and Carboxymethyllysine Levels in Skin Collagen Predict the Risk of Future 10-Year Progression of Diabetic Retinopathy and Nephropathy in the Diabetes Control and Complications Trial and Epidemiology of Diabetes Interventions and Complications Participants With Type 1 Diabetes
Genuth et al.
Diabetes 2005;54:3103-3111.
ABSTRACT | FULL TEXT  

Diabetes causes inhibition of glucose-6-phosphate dehydrogenase via activation of PKA, which contributes to oxidative stress in rat kidney cortex
Xu et al.
Am. J. Physiol. Renal Physiol. 2005;289:F1040-F1047.
ABSTRACT | FULL TEXT  

Activation of the Sphingosine Kinase-Signaling Pathway by High Glucose Mediates the Proinflammatory Phenotype of Endothelial Cells
Wang et al.
Circ. Res. 2005;97:891-899.
ABSTRACT | FULL TEXT  

Enhanced superoxide release and elevated protein kinase C activity in neutrophils from diabetic patients: association with periodontitis
Karima et al.
J. Leukoc. Biol. 2005;78:862-870.
ABSTRACT | FULL TEXT  

Ruboxistaurin, a Protein Kinase C {beta} Inhibitor, as an Emerging Treatment for Diabetes Microvascular Complications
Joy et al.
The Annals of Pharmacotherapy 2005;39:1693-1699.
ABSTRACT | FULL TEXT  

Angiogenic Pathways in Diabetic Retinopathy
Aiello
NEJM 2005;353:839-841.
FULL TEXT  

Effect of Hepatic Lipase -514C->T Polymorphism and Its Interactions With Apolipoprotein C3 -482C->T and Apolipoprotein E Exon 4 Polymorphisms on the Risk of Nephropathy in Chinese Type 2 Diabetic Patients
Baum et al.
Diabetes Care 2005;28:1704-1709.
ABSTRACT | FULL TEXT  

The Effect of Ruboxistaurin on Visual Loss in Patients With Moderately Severe to Very Severe Nonproliferative Diabetic Retinopathy: Initial Results of the Protein Kinase C {beta} Inhibitor Diabetic Retinopathy Study (PKC-DRS) Multicenter Randomized Clinical Trial
The PKC-DRS Study Group
Diabetes 2005;54:2188-2197.
ABSTRACT | FULL TEXT  

Activation of p38 Has Opposing Effects on the Proliferation and Migration of Endothelial Cells
McMullen et al.
J. Biol. Chem. 2005;280:20995-21003.
ABSTRACT | FULL TEXT  

Elevated release of sCD40L from platelets of diabetic patients by thrombin, glucose and advanced glycation end products
Varo et al.
Diabetes and Vascular Disease Research 2005;2:81-87.
ABSTRACT  

Role of Aldose Reductase and Oxidative Damage in Diabetes and the Consequent Potential for Therapeutic Options
Srivastava et al.
Endocr. Rev. 2005;26:380-392.
ABSTRACT | FULL TEXT  

Isolation of transcriptomal changes attributable to LHON mutations and the cybridization process
Danielson et al.
Brain 2005;128:1026-1037.
ABSTRACT | FULL TEXT  

Placental Dysfunction in Suramin-Treated Rats: Impact of Maternal Diabetes and Effects of Antioxidative Treatment
Nash et al.
Reproductive Sciences 2005;12:174-184.
ABSTRACT  

Identification of Amadori-Modified Plasma Proteins in Type 2 Diabetes and the Effect of Short-Term Intensive Insulin Treatment
Jaleel et al.
Diabetes Care 2005;28:645-652.
ABSTRACT | FULL TEXT  

Requirement of Aldose Reductase for the Hyperglycemic Activation of Protein Kinase C and Formation of Diacylglycerol in Vascular Smooth Muscle Cells
Ramana et al.
Diabetes 2005;54:818-829.
ABSTRACT | FULL TEXT  

Hyperglycemia Induces Monocytic Release of Interleukin-6 via Induction of Protein Kinase C-{alpha} and -{beta}
Devaraj et al.
Diabetes 2005;54:85-91.
ABSTRACT | FULL TEXT  

Activation of Nulcear Factor-{kappa}B by Hyperglycemia in Vascular Smooth Muscle Cells Is Regulated by Aldose Reductase
Ramana et al.
Diabetes 2004;53:2910-2920.
ABSTRACT | FULL TEXT  

Meta-Analysis: Glycosylated Hemoglobin and Cardiovascular Disease in Diabetes Mellitus
Selvin et al.
ANN INTERN MED 2004;141:421-431.
ABSTRACT | FULL TEXT  

Accelerated Nephropathy in Diabetic Apolipoprotein E-Knockout Mouse: Role of Advanced Glycation End Products
Lassila et al.
J. Am. Soc. Nephrol. 2004;15:2125-2138.
ABSTRACT | FULL TEXT  

Diabetes Mellitus Non-Glucose Monitoring: Point-of-Care Testing
Armor and Britton
The Annals of Pharmacotherapy 2004;38:1039-1047.
ABSTRACT | FULL TEXT  

Connective Tissue Growth Factor Is Increased in Plasma of Type 1 Diabetic Patients With Nephropathy
Roestenberg et al.
Diabetes Care 2004;27:1164-1170.
ABSTRACT | FULL TEXT  

Multifocal Electroretinogram Delays Predict Sites of Subsequent Diabetic Retinopathy
Han et al.
IOVS 2004;45:948-954.
ABSTRACT | FULL TEXT  

Management of Diabetes and Hyperglycemia in Hospitals
Clement et al.
Diabetes Care 2004;27:553-591.
FULL TEXT  

Amadori-configurated albumin induces nitric oxide-dependent apoptosis of endothelial cells: a possible mechanism of diabetic vasculopathy
Amore et al.
Nephrol Dial Transplant 2004;19:53-60.
ABSTRACT | FULL TEXT  

Endothelial Progenitor Cell Dysfunction: A Novel Concept in the Pathogenesis of Vascular Complications of Type 1 Diabetes
Loomans et al.
Diabetes 2004;53:195-199.
ABSTRACT | FULL TEXT  

Biochemical Pathways for Microvascular Complications of Diabetes Mellitus
Setter et al.
The Annals of Pharmacotherapy 2003;37:1858-1866.
ABSTRACT | FULL TEXT  

High Glucose-suppressed Endothelin-1 Ca2+ Signaling via NADPH Oxidase and Diacylglycerol-sensitive Protein Kinase C Isozymes in Mesangial Cells
Hua et al.
J. Biol. Chem. 2003;278:33951-33962.
ABSTRACT | FULL TEXT  

Protein Kinase C-Dependent Increase in Reactive Oxygen Species (ROS) Production in Vascular Tissues of Diabetes: Role of Vascular NAD(P)H Oxidase
Inoguchi et al.
J. Am. Soc. Nephrol. 2003;14:S227-232.
ABSTRACT | FULL TEXT  

Extracellular Matrix Metabolism in Diabetic Nephropathy
Mason and Wahab
J. Am. Soc. Nephrol. 2003;14:1358-1373.
ABSTRACT | FULL TEXT  

Glucose, Glycation, and RAGE: Implications for Amplification of Cellular Dysfunction in Diabetic Nephropathy
Wendt et al.
J. Am. Soc. Nephrol. 2003;14:1383-1395.
ABSTRACT | FULL TEXT  

Animal Models of Human Diabetic Polyneuropathy
Crawford and Hardwicke
JAMA 2003;289:1779-1780.
FULL TEXT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 2002 American Medical Association. All Rights Reserved.