Controversies regarding vascular disease in the patient with diabetes: a review of the literature.

Vascular disease in the patient with diabetes represents a potentially devastating complication. Tri-neuropathy (sensory, motor, and autonomic) often predisposes patients to ulceration and vascular disease leads to delayed healing. Vascular pathology compromises blood flow and oxygen provision, affecting healing, infection, sepsis, amputation, and mortality. Recent research suggests that vascular reconstruction should not be withheld on the basis of arteriolar-capillary involvement and while oxygen levels may provide important prognostic and diagnostic information, no single noninvasive parameter or test can reliably predict healing of existing wounds. Hyperglycemia has been identified as a risk factor for macrovascular disease but evidence to substantiate that improved glucose control affects vascular pathology or wound healing is limited. Similarly, the exact role of vascular endothelial growth factor or nicotine on vascular pathology and healing remains unclear. Although the literature may be mired in discrepancies, vascular health is known to affect healing. Further research to resolve controversy and to better direct care is needed.