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How can controlling blood glucose slow small-blood-vessel complications of diabetes mellitus?

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An anatomical illustration of the human pancreas shows its location near the stomach and intestines, a detailed cross-section highlighting ducts and the islet of Langerhans, and an inset of pancreatic tissue histology with labeled alpha, beta, and delta cells. — diabetes mellitus The islets of Langerhans are responsible for the endocrine function of the pancreas. Each islet contains beta, alpha, delta, and pancreatic polypeptide (PP) cells that are responsible for the secretion of pancreatic hormones. Beta cells secrete insulin, a well-characterized hormone that plays an important role in regulating glucose metabolism.

Controlling blood glucose levels is a primary strategy for slowing or preventing the development and progression of small-vessel complications in diabetes mellitus, such as diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy.

High blood sugar, or hyperglycemia, contributes to the formation of advanced glycation end products (AGEs). These harmful substances are created when glucose binds with components like hemoglobin in the blood, and they can inflict significant damage on the walls of small arteries and capillaries. By managing blood glucose through diet, exercise, insulin, or oral medications, patients can limit the production of these damaging substances, thereby protecting the integrity of small blood vessels.12

Additionally, because hypertension often exacerbates these vascular issues, controlling blood pressure—frequently with ACE inhibitors—is also essential for delaying the onset and progression of these complications.12