Structural remodeling in the limb circulation: impact of obesity and diabetes.

Obesity is an emerging epidemic worldwide and threatens cardiovascular health due to the complications of accompanying metabolic dysfunction. One potential mechanism by which these complications are advanced is structural alteration in the microcirculation perfusing target organs. In this brief review, the authors focus on the structural adaptations that occur in the microcirculation, with specific focus on changes in basement membrane thickness and vascular structure. By delineating changes in end-stage disease and recent insights from animal studies, they hope to convince the reader (1) that diabetic disease in the limb is associated with profound changes in arteriolar structure and (2) that parallel changes in microvascular architecture precede the onset of frank type II diabetes.