Endothelial dysfunction in young people with diabetes mellitus in the absence of clinical vascular disease.

Endothelial dysfunction is an early surrogate of future vasculopathy. Children and adolescents with diabetes have a high future risk of clinical vascular disease and we and others have demonstrated that biophysical abnormalities of endothelial dysfunction and the markers of endothelial cell activation tend to be perturbed early in this group of patients. The endothelial dysfunction is manifest well in advance of clinical vascular disease. The mechanisms of early endothelial dysfunction are complex and many underlying factors act in concert to initiate such dysfunction: with the sustained hyperglycemia acting as a prime mover; the subsequent metabolic derangements as perpetuators; and along with obesity, smoking, and lack of physical exercise, all contribute to a progression of this dysfunction into full angiopathy. Strategies to ameliorate such dysfunction have been explored. This review aims at shedding light on this area that has received much attention in the last two decades.