Title:Diabetes, Diabetic Complications, and Phosphate Toxicity: A Scoping Review
Volume: 16
Issue: 7
Author(s): Ronald B. Brown*
Affiliation:
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1,Canada
Keywords:
Diabetes, phosphate toxicity, pancreatic cancer, diabetic nephropathy, diabetic retinopathy, diabetic neuropathy,
vascular calcification, mitochondria dysfunction.
Abstract: This article presents a scoping review and synthesis of research findings investigating the
toxic cellular accumulation of dysregulated inorganic phosphate—phosphate toxicity—as a pathophysiological
determinant of diabetes and diabetic complications. Phosphorus, an essential micronutrient, is
closely linked to the cellular metabolism of glucose for energy production, and serum inorganic phosphate
is often transported into cells along with glucose during insulin therapy. Mitochondrial dysfunction
and apoptosis, endoplasmic reticulum stress, neuronal degeneration, and pancreatic cancer are associated
with dysregulated levels of phosphate in diabetes. Ectopic calcification involving deposition of
calcium-phosphate crystals is prevalent throughout diabetic complications, including vascular calcification,
nephropathy, retinopathy, and bone disorders. A low-glycemic, low-phosphate dietary intervention
is proposed for further investigations in the treatment and prevention of diabetes and related diabetic pathologies.