VEGFA and Hyperglycemia: 2019). The increased production of reactive oxygen species and the direct toxic effects of hyperglycemia in the diabetic state may lead to reduced release of stromal cell–derived factor 1 (SDF1) and vascular endothelial growth factor (VEGF), suppressed activation of their downstream signaling molecules, and reduced nitric oxide bioavailability, resulting in vasodilatory dysfunction, accelerating endothelial cell apoptosis, and suppressing proliferation and migration (Catrina et al. 2004; Jarajapu 2020).