New Perspectives in the Diagnosis and Treatment of Type 2 Diabetes and Its Complications

Dear Colleagues,

Type 2 diabetes is characterized by a high level of morbidity and mortality. Although there is a trend toward better survival among diabetic and non-diabetic patients, a relevant residual risk is still present among those with diabetes. Therefore, an early diagnosis of diabetes is essential. CGMS, as well as the evaluation of a high quantity of blood glucose data, might help in obtaining an earlier and better diagnosis of carbohydrate disturbances.

Microvascular complications usually precede microvascular complications; both survival and quality of life are related to vascular complications. This way, early and more precise diagnosis of microvascular and macrovascular complications is essential for improving the survival of our patients. Among microvascular complications, neuropathy is of particular importance, which is a complication of diabetes with a poor prognosis. This condition develops over time in more than half of diabetic patients. It is now clear that the prevention of microvascular complications such as neuropathy, near-normoglycemia, close metabolic control, and the management of other risk factors like hypertension, obesity, and hyperlipidemia are also very important. There are two main mechanisms involved in the development of neuropathy: functional and/or structural damage to the vasa nervorum, and the direct effect of hyperglycemia on neurons. The pathogenetic significance of the metabolic pathway is under continuous investigation. Hyperglycemia leads to an increase in the amount of glucose entering nerve cells, which is compensated by the hexokinase capacity for a period of time. However, at the limit of maximum capacity, the alternative metabolic pathways, e.g., the sorbitol and hexosamine pathways, as well as the mechanisms leading to protein kinase C activation and enhanced end-glycation product (AGE) formation, are amplified. In some trials on diabetic patients, intensive metabolic control reduced the progression of diabetic neuropathy without being completely preventable. Progressing neuropathy may occur with a persistently favorable metabolic status in some patients with diabetes mellitus, while in others, though seldom, persistently unfavorable metabolic status is not associated with significant neuropathy. This may be mainly due to genetic differences. Furthermore, the impact of COVID-19 on diabetes and its complications is still uncertain and needs to be defined.

Prof. Dr. Péter Kempler
Dr. Zsuzsanna Putz
Guest Editors

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• type 2 diabetes mellitus
• microvascular complications
• diabetic neuropathy
• diabetic nephropathy
• diabetic retinopathy
• glucose database analysis