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Vol. 2 No. 2 (2025)

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September 29, 2026
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December 31, 2025

Copyright (c) 2025 Amani Khamash Hassan Asiri, Saad Mohammed Saad Al Mawwash, Khalid Omar Mohammed Muhanna, Abdullah Ibrahim Mrer, Aisha Dahal Mahnashi, Abdulhakim Aqeel Burayk Alotaibi, Rajaa Abdulmonem Mohammed Fallatah

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This work is licensed under a Creative Commons Attribution 4.0 International License.

Diabetes and Cardiovascular–Microvascular Disease: Pathophysiology, Clinical Recognition, and Therapeutic Strategies-Updated Review.

https://doi.org/10.64483/202522786
Amani Khamash Hassan Asiri
Alharajh General Hospital, Asir Health Cluster, Ministry of health, Saudi Arabia
Saad Mohammed Saad Al Mawwash
King Salman Hospital, Riyadh First Health Cluster, Ministry of health, Saudi Arabia
Khalid Omar Mohammed Muhanna
Farasan General Hospital, Ministry of Health, Saudi Arabia
Abdullah Ibrahim Mrer
Jazan General Hospital, Ministry of Health, Saudi Arabia
Aisha Dahal Mahnashi
Al-Laqiyah Health Center, Jazan, Ministry of Health, Saudi Arabia
Abdulhakim Aqeel Burayk Alotaibi
Hail University, Ministry of Education, Saudi Arabia
Rajaa Abdulmonem Mohammed Fallatah
King Fahd Hospital, Madinah, Ministry of Health, Saudi Arabia

Corresponding Author(s) : Amani Khamash Hassan Asiri

mmkzo00012@gmail.com

Saudi Journal of Medicine and Public Health, Vol. 2 No. 2 (2025)

Abstract

Background: Diabetes mellitus is a major global metabolic disorder associated with progressive vascular injury and substantial morbidity and mortality. Chronic hyperglycemia, oxidative stress, inflammation, endothelial dysfunction, and advanced glycation end products contribute to both microvascular and macrovascular complications. Early recognition and comprehensive management of modifiable risk factors are therefore essential for reducing long-term vascular burden.


Aim: This review aimed to summarize the mechanisms underlying diabetes-associated vascular injury and examine contemporary approaches to prevention and management, with emphasis on lifestyle modification, dietary strategies, pharmacological therapies, and cardiovascular risk reduction.


Methods: A narrative review of published literature addressing diabetes mellitus, endothelial dysfunction, metabolic memory, vascular complications, lifestyle interventions, dietary patterns, and pharmacological management was undertaken. Evidence concerning glycemic control, weight management, physical activity, Mediterranean dietary patterns, intermittent fasting, antihypertensive and lipid-lowering therapies, and newer glucose-lowering agents was synthesized.


Results: Persistent hyperglycemia promotes oxidative stress, inflammation, AGE formation, protein kinase C activation, and endothelial dysfunction, contributing to retinopathy, nephropathy, neuropathy, coronary disease, stroke, and peripheral vascular disease. Metabolic memory may sustain vascular injury despite subsequent improvement in glycemic control. Weight reduction, regular physical activity, Mediterranean dietary patterns, behavioral modification, and structured education support metabolic and cardiovascular risk reduction. Pharmacological management increasingly incorporates cardiovascular and renal outcomes. SGLT2 inhibitors and GLP-1 receptor agonists provide important cardiovascular benefits beyond glucose lowering, while metformin remains a foundational therapy. Blood-pressure and lipid management remain essential components of vascular risk reduction.


Conclusion: Prevention and treatment of diabetes-associated vascular disease require early, sustained, and multifactorial intervention integrating glycemic control, lifestyle modification, cardiovascular risk management, and individualized pharmacotherapy.

Keywords

Diabetes mellitus; vascular disease; endothelial dysfunction; microvascular complications; macrovascular complications; metabolic memory; cardiovascular disease; SGLT2 inhibitors; GLP-1 receptor agonists; lifestyle modification.
Asiri, A. K. H., Al Mawwash, S. M. S., Muhanna, K. O. M., Mrer, A. I., Mahnashi, A. D., Alotaibi, A. A. B., & Fallatah, R. A. M. (2025). Diabetes and Cardiovascular–Microvascular Disease: Pathophysiology, Clinical Recognition, and Therapeutic Strategies-Updated Review. Saudi Journal of Medicine and Public Health, 2(2), 3874–3889. https://doi.org/10.64483/202522786
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