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How does diabetes mellitus damage large blood vessels over time?

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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.

In patients with diabetes mellitus, damage to large blood vessels primarily manifests as atherosclerosis, a condition characterized by the hardening and narrowing of the arteries. While this process is similar to that seen in individuals without diabetes, it often occurs at an earlier age and progresses more rapidly in those with the disorder.1

This vascular damage affects critical areas, including the coronary arteries, the cerebral arteries, and the large vessels supplying the legs. By restricting blood flow to the heart, brain, and limbs, this disease significantly increases the risk of myocardial infarction (heart attack), stroke, and peripheral artery disease. In the lower extremities, severe reductions in blood flow can lead to ulceration, gangrene, and, in some cases, the necessity for amputation. These complications are further exacerbated by hypertension and high levels of lipids in the blood.12