## 2 Classifications of Microvascular and Macrovascular Complications of Diabetes Mellitus
### Classifications of Microvascular Complications of Diabetes Mellitus
#### 2.1.4 Macrovascular Complications of Diabetes Mellitus  
Diabetes mellitus (DM) macrovascular consequences include coronary artery disease, cerebrovascular disease, and peripheral vascular disease [39; 40]. Macrovascular consequences of diabetes will inevitably emerge in patients with poorly managed glucose levels due to hyperglycemia. Even when treated, these consequences thri in patients who have had the condition for a long time. Over a decade ago, it was discovered that diabetic-associated macrovascular complications share a sped-up development and progression of atherosclerotic conditions, which contribute to the damage and clogging of coronary, carotid, and peripheral arteries, and thus an increased risk of cardiovascular events associated with these vascular conditions [41]. However, whether the aorta was involved in the macrovascular problems of diabetes mellitus and whether atherosclerosis development was linked to this vast central blood channel remain unknown. As a result, it would be quite interesting to investigate the effect and association of diabetes on the aorta and its integrity in order to gain a better understanding of the relationship between diabetes and macrovascular complications and how they are established (that is, what are the underlying mechanisms that occur in the aorta under diabetic conditions, and whether these mechanisms involve only atherosclerosis or whether other processes are occurring either concurrently or predominantly). Other pathways may be involved in vascular injury under these settings. Indeed, high blood pressure influences the development of arteriosclerosis, a disorder that occurs in the arterial wall and is characterized by a loss of vascular compliance due to loss in elasticity. Hypertension and dyslipidemia are two processes connected to diabetes-related macrovascular problems [42]. The ability of diabetes to impact the number and integrity of elastin fibers would be extremely important because it would provide vital insights into the likelihood of additional processes being involved in the link between diabetes and aortic vascular integrity. Endothelial dysfunction has been found to play an important role in the development of diabetic vascular problems, including vasoconstriction [43]. Interestingly, both microvascular and macrovascular illnesses have been proven to co-exist and share comparable risk factors in people with diabetes. However, because it is not well-documented, this relationship of micro- and macrovascular needs further exploration. Alarmingly, it has been estimated that by 2045, the global prevalence of diabetes mellitus will be 629-700 million, which undoubtedly warrants concurrent increases in cases of macrovascular complications of diabetes mellitus (especially in poorly controlled hyperglycemia), such as strokes, cardiovascular diseases, and myocardial infarctions, and that their occurrence may have socioeconomic implications in a given government [39]. Furthermore, the coexistence of the above-mentioned diabetes macrovascular diseases with increased development and progression of atherosclerosis, primarily in the carotid, coronary, and peripheral arteries, and thus strokes and myocardial infarctions [41], could be a possible association. In this regard, persons with diabetes mellitus are 2-4 times more likely than those without diabetes mellitus to suffer from cardiovascular events, and the former is more likely to die from these events than the latter [41]. Approximately 80% of people with diabetes mellitus have cardiovascular problems, and 65% die as a result of these complications [44]. However, it has been observed in the same group that glucose-lowering medications may improve cardiovascular events, hence improving patient outcomes in patients with diabetes mellitus [44]. Notably, the majority of recent data on diabetes complications and trends comes from industrialized countries,not underdeveloped countries [39].