Endocrine and Metabolic Modulation of Vascular Dysfunction in the Diabetic Foot: A Narrative Review
Summary: January 25, 2026 narrative review synthesizes evidence on the endocrine-vascular axis in diabetic foot ulcers (DFUs). Beyond traditional risks (hyperglycemia, dyslipidemia), endocrine alterations (impaired insulin signaling, glucagon excess, adipokine imbalance, stress hormones, thyroid dysfunction) interact with mitochondrial issues and inflammation to impair endothelial function, reduce nitric oxide, promote oxidative stress/pro-ischemic environment, and hinder angiogenesis, ECM remodeling, immune response, and repair. Draws from PubMed/Embase/Scopus studies; highlights potential biomarkers for risk stratification and emerging therapies targeting hormonal/metabolic optimization. Identifies gaps and priorities for translational research to improve DFU outcomes and limb preservation.
Key Highlights:
- Mechanisms: Endocrine dysregulation exacerbates microvascular compromise in diabetes.
- Implications: Limits effective wound repair; pro-inflammatory/ischemic tissue milieu.
- Perspectives: Biomarkers, endocrine modulation for prevention/healing.
- Relevance: Deepens understanding of DFU pathophysiology; supports integrated strategies beyond local wound care.
Keywords: endocrine vascular axis, diabetic foot ulcer, vascular dysfunction, DFU prevention