Are microvascular and macrovascular complications of diabetes distinct pathophysiologic entities? Three experts will debate that question during a Current Issues presentation Tuesday morning at the Scientific Sessions.

The unique, two-hour debate, Microvascular and Macrovascular Complications of Diabetes Are Distinct Pathophysiologic Entities, will begin at 8:00 a.m. CT Tuesday, June 16.

Deborah J. Wexler, MD, MSc, Associate Professor of Medicine at Harvard Medical School, will tackle both sides of the debate from an endocrinologist’s perspective. Jasper Tromp, MD, PhD, a Research Fellow at Duke-NUS Medical School in Singapore, and Sanjiv J. Shah, MD, the Neil J. Stone, MD, Professor of Medicine (Cardiology) at Northwestern University, will present opposing arguments from a cardiologist’s perspective.

ADAMeetingNews.org spoke with Drs. Wexler and Tromp for a preview of this ongoing debate.

Why is it important to understand whether microvascular complications distinctly precede macrovascular complications or happen simultaneously and independently?

Dr. Tromp: Microvascular complications are common in patients with diabetes and represent one of the leading causes of blindness and renal failure in the developed world. Microvascular complications are an important risk factor for heart failure, independent of any macrovascular disease. Hence, a better understanding of the underlying biology is critical to identify new treatment targets and improve preventative measures.

Dr. Wexler, you will address both sides of the debate. How will you argue both?

Dr. Wexler: Hyperglycemia is a fundamental perturbation that impacts both microvascular and macrovascular complications, making them part of a continuum. But clearly, hyperglycemia has a stronger effect on the development of microvascular complications. And non-glycemic risk factors such as hypertension and hyperlipidemia are much stronger contributors to the development of macrovascular complications, consistent with the idea that they are distinct pathophysiologic entities.

Dr. Tromp, how will you make the case that the answer to the debate question is ‘definitely yes?’

Dr. Tromp: My research interest is heart failure, particularly heart failure with preserved ejection fraction. Microvascular disease is a critical pathogenic mechanism in heart failure with preserved ejection fraction, which is one of the leading causes of hospitalization in the U.S. I argue that microvascular disease, independent of the presence of macrovascular disease, is an important risk factor for developing heart failure with preserved ejection fraction and a pathogenic mechanism.

How do the different sides of the debate inform care strategy?

Dr. Tromp: If microvascular disease precedes macrovascular disease, the aim of my care strategy would be to prevent future macrovascular disease. This would inform the choice of drugs I prescribe. If I clearly understand that microvascular disease can lead to complications such as heart failure, independent of macrovascular disease, I would see whether my patients are eligible for certain (novel) drugs that could prevent new-onset heart failure.

Dr. Wexler: Understanding a patient’s baseline level of risk for complications helps guide treatment priorities.