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, Table of Contents

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

Full Text

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Zdislava Kasalová

Departement of Internal Medicine 3
Medical Faculty 1, Charles University

U nemocnice 2

12028, Prague 2

Czech Republic

Phone: + 420602881817

Fax: + 420 224 923 852

Email: zkasa@lf1.cuni.cz