Diabetes Complication: Diabetic Vasculopathy

Cutaneous manifestations develop inapproximately 30% of persons withdiabetes. Premature atherosclerosisis a common complication of thedisease and can cause peripheral infarction,ulceration, and necrosis.As seen here on the finger of a64-year-old man who has a 25-yearhistory of diabetes mellitus, ulcerationsecondary to insensible traumacan arise from diabetic neuropathy.Healing of such a lesion may befurther complicated by vascular insufficiencyrelated to the disease.The pathogenic mechanism of vascular disease in diabetes is not clearly understood. Earlydiagnosis and tight glucose control afford the best opportunity to delay disease progression.This patient was referred to a vascular surgeon for evaluation and treatment.(Case and photograph courtesy of Drs Charles E. Crutchfield III, Eric J. Lewis, and Humberto Gallego.)