Relationship Between Peripheral Diabetic Neuropathy and Microvascular Reactivity in Patients with Type 1 and Type 2 Diabetes Mellitus

Z. Kasalová; M. Prázný; J. Škrha

doi:10.1055/s-2006-923895

Experimental and Clinical Endocrinology & Diabetes, Inhaltsverzeichnis

Exp Clin Endocrinol Diabetes 2006; 114(2): 52-57
DOI: 10.1055/s-2006-923895

Article

J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Relationship Between Peripheral Diabetic Neuropathy and Microvascular Reactivity in Patients with Type 1 and Type 2 Diabetes Mellitus

Neuropathy and Microcirculation in DiabetesZ. Kasalová¹ , M. Prázný¹ , J. Škrha¹

¹Department of Internal Medicine 3, Faculty of Medicine 1, Charles University, Prague, Czech Republic

Abstract

The aim of the study was to evaluate differences in the relationship between peripheral diabetic neuropathy and microvascular reactivity in type 1 and type 2 diabetic patients. Twenty-eight type 1 and 37 type 2 diabetic patients were included in the study. Control groups consisted of 18 and 25, age and body mass index matched healthy persons. The presence of peripheral neuropathy was estimated by vibration perception threshold higher than 20 V evaluated by biothesiometry. Microvascular reactivity was examined by laser doppler fluxmetry using postocclusive reactive hyperemia and thermal hyperemia. The following variables of vascular reactivity were examined: peak flow after occlusion as a difference between maximal and basal perfusion (PORH_max), mean velocity increase during postocclusive hyperemia (PORH_max/t₁), peak flow during thermal hyperemia (TH_max) and the mean velocity increase in the perfusion during thermal hyperemia (TH_max/t₂). These parameters are expressed in perfusion units (PU) or in perfusion units per second (PU · s^-1). The microvascular reactivity in type 1 diabetic patients without evidence of peripheral neuropathy was comparable with that in healthy persons and it was significantly higher than in type 1 diabetic patients with peripheral neuropathy in all tested parameters (PORH_max: 64 [40; 81] PU vs. 24 [17; 40] PU, p < 0.001, PORH_max/t₁: 5.41 [2.69; 8.18] PU/s vs. 1.21 [0.69; 2.5] PU/s, p < 0.001, TH_max: 105 [77; 156] PU vs. 56 [46; 85] PU, p < 0.001 and TH_max/t₂: 2.48 [1.67; 3.33] PU/s vs. 0.87 [0.73; 1.06] PU/s, p < 0.001). On the contrary, no difference in the microvascular reactivity parameters was found between type 2 diabetic patients with and without neuropathy (PORH_max: 48 [30; 60] PU vs. 49 [36; 57] PU, NS, PORH_max/t₁: 3.46 [2.15; 5.19] PU/s vs. 3.29 [2.45; 4.8] PU/s, NS, TH_max: 95 [78; 156] PU vs. 97 [73; 127] PU, NS and TH_max/t₂: 1.45 [0.95; 2.84] PU/s vs. 1.37 [1.12; 1.95] PU/s, NS). In both these groups microvascular reactivity was comparable with that estimated in the age and BMI matched healthy persons. An inverse relationship was observed between microvascular reactivity and vibratory perception threshold in type 1 diabetic patients, but it was not true in type 2 diabetic patients. We suppose that the pathogenesis of neuropathy and impaired microvascular reactivity may be differently influenced by metabolic factors in type 1 and type 2 diabetic patients.

Key words

Type 1 and type 2 diabetes mellitus - microvascular reactivity - neuropathy

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References

1 Arora S, Smakowski P, Frykberg R G, Simeone L R, Freeman R, LoGerfo F W, Veves A. Differences in foot and forearm skin microcirculation in diabetic patients with and without neuropathy. Diabetes Care. 1998; 21 1339-1344
2 Aso Y, Inukai T, Takemura Y. Evaluation of skin vasomotor reflexes in response to deep inspiration in diabetic patients by laser doppler flowmetry. Diabetes Care. 1997; 20 1324-1328
3 Bartoš V, Pelikánová T. et al .Prakticka diabetologie. 2nd edition. Prague; Maxdorf Jessenius 2000: 147-152
4 Belcaro G, Nicolaides A N. The venoarteriolar response in diabetics. Angiology. 1991; 42 827-835
5 Benbow S J, Pryce D W, Noblett K, MacFarlane I A, Friedmann P S. Flow motion in peripheral diabetic neuropathy. Clin Sci (London). 1995; 88 191-196
6 Bornmyr S, Svensson H, Lilija B, Sundkvist G. Cutaneous vasomotor responses in type I diabetic patients. J Diabetes Complications. 1997; 11 21-26
7 Bouskela E, Cyrino F Z, Wiernsperger N. Effects of insulin and the combination of insulin plus metformin (glucophage) on vascular reactivity in control and diabetic hamsters. Angiology. 1997; 48 503-514
8 Brownlee M. Biochemistry and molecular cell biology of diabetic complications. Nature. 2001; 414 813-820
9 Dyck P J. et al .Diabetic neuropathy. Sixth edition. New York, London, Tokyo; W.B. Saunders Company 1999
10 Flynn M D, Edmonds M E, Tooke J E, Watkinsd P J. Direct measurement of capillary blood flow in the diabetic neuropathic foot. Diabetologia. 1988; 3 652-656
11 Kasalová Z. Biothesiometry in diagnosis of peripheral neuropathies. Cas Lek Cesk. 2002; 141 223-225
12 Kilo S, Berghoff M, Hilz M, Freeman R. Neural and endothelial control of the microcirculation in diabetic neuropathy. Neurology. 2000; 54 1246-1252
13 Koltringer P, Langsteger W, Lind P, Riesecker F, Eber O. A new design for autonomic dysfunction of kin neuropathies: hyperthermal laser-doppler flowmetry. Acta Neurol Scand. 1989; 80 589-592
14 Nabuurs-Franssen M H, Houben A JHM, Tooke J E, Schaper N C. The effect of polyneuropathy on foot microcirculation in type 2 diabetes. Diabetologia. 2002; 45 1164-1171
15 Natali A, Baldeweg S, Toschi E, Capaldo B, Barbaro D, Gastaldelli A, Yudkin J S, Ferrannini E. Vascular effects of improving metabolic control with metformin or rosiglitazone in type 2 diabetes. Diabetes Care. 2004; 27 1349-1357
16 Netten P M, Wollersheim H, Thien T, Lutterman J A. Skin microcirculation of the foot in diabetic neuropathy. Clin Sci (London). 1996; 91 559-565
17 Newrick P G, Cochrane T, Betts R P, Ward J D, Boulton A J. Reduced hyperemic response under the diabetic neuropathic foot. Diabet Med. 1988; 5 570-573
18 Pfutzner A, Forst T, Engelbach M, Margin T, Goitom K, Lobig M, Beyer J, Kunt T. The influence of isolated small nerve fiber dysfunction on microvascular control in patients with diabetes mellitus. Diabet Med. 2001; 18 489-494
19 Prázný M, Škrha J. Microcirculation in the skin of the upper extremities in type 1 diabetes using laser doppler method. Cas Lek Cesk. 2000; 139 309-312
20 Rendell M, Bergman T, O'Donnell G, Drobny E, Borgos J, Bonner R F. Microvascular blood flow, volume and velocity measured by laser doppler techniques in IDDM. Diabetes. 1989; 38 819-824
21 Rendell M, Bamisedun O. Diabetic cutaneous microangiopathy. Am J Med. 1992; 93 611-618
22 Stansberry K B, Hill M A, Shapiro S A, McNitt P M, Bhatt B A, Vinik A I. Impairment of peripheral blood flow responses in diabetes resembles and enhanced aging effect. Diabetes Care. 1997; 20 1711-1716
23 Stevens M J, Edmonds M E, Douglas S L, Watkins P J. Influence of neuropathy on the microvascular response to local heating in the human diabetic foot. Clin Sci (Lond). 1991; 80 249-256
24 Stevens M J, Edmonds M J, Foster A VM, Douglas S LE, Watkins P J. Paradoxical blood flow responses in the diabetic naturopathic foot: an assessment of the contribution of vascular denervation and microangiopathy. Diabet Med. 1992; 9 49-54
25 Stevens M J, Dananberg J, Feldman E L, Lattimer S A, Kamijo M, Thomas T P, Shindo H, Sima A A, Greene D A. The linked roles of nitric oxide, aldose reductase and Na-K‐ATP‐ase in the slowing of nerve conduction in the streptozotocin diabetic rat. J Clin Invest. 1994; 94 853-919
26 Stevens M J, Feldman E L, Greene D A. The etiology of diabetic neuropathy: the combined roles of metabolic and vascular defects. Diabet Med. 1995; 12 566-579
27 Škrha J, Prázný M, Haas T, Kvasnička J, Kalvodová B. Comparison of laser-doppler flowmetry with biochemical indicators of endothelial dysfunction related to early microangiopathy in type 1 diabetic patients. J Diabetes Complications. 2001; 15 234-240
28 Valk G D, Grootenhuis P A, van Eijk J TM, Bouter L M, Bertelsmann F W. Methods for assessing diabetic polyneuropathy: validity and reproducibility of the measurement of sensory symptom severity and nerve function tests. Diab Res Clin Pract. 2000; 47 87-95
29 Verma S, Bhanot S, McNeill J H. Decreased vascular reactivity in metformin-treated fructose-hypertensive rats. Metabolism. 1996; 45 1053-1055
30 Vinik A I, Park T S, Stansberry K B, Pittenger G L. Diabetic neuropathies. Diabetologia. 2000; 43 957-973
31 Vinik A I, Erbas T, Park T S, Pierce K K, Stansberry K B. Methods for evaluation of peripheral neurovascular dysfunction. Diabetes Technol Ther. 2001; 3 29-50
32 Vinik A I, Erbas T, Park T S, Stansberry K B, Scanelli J A, Pittenger G L. Dermal neurovascular dysfunction in type 2 diabetes. Diabetes Care. 2001; 24 1468-1475
33 Young M J, Veves A, Walker M G, Boulton A J. Correlation between nerve function and tissue oxygenation in diabetic patients: further clue to the etiology of diabetic neuropathy. Diabetologia. 1992; 35 1146-1150
34 Young M J, Bennett J L, Liderth S A, Veves A, Boulton A J, Douglas J T. Rheological and microvascular parameters in diabetic peripheral neuropathy. Clin Sci (Lond). 1996; 90 183-187

Zdislava Kasalová

Departement of Internal Medicine 3
Medical Faculty 1, Charles University

U nemocnice 2

12028, Prague 2

Czech Republic

Telefon: + 420602881817

Fax: + 420 224 923 852

eMail: zkasa@lf1.cuni.cz