Altered Postural Regulation of Foot Skin Oxygenation and Blood Flow in Patients with Type 2 Diabetes Mellitus
Although skin oxygenation is an important factor in the development and healing of foot ulcers, its regulation was not fully understood. We studied changes in foot skin oxygenation and blood flow during postural changes in patients with type 2 diabetes mellitus.
Skin oxygenation was measured using transcutaneous oxygen pressure (TcPO(2)) and skin blood flow by laser Doppler flowmetry in 40 patients with type 2 diabetes mellitus without evidence of peripheral arterial disease and 13 healthy control subjects.
TcPO(2) in the supine position was significantly lower in patients with type 2 diabetes mellitus compared with control, although skin blood flow was not different. In the sitting position, TcPO(2) significantly increased in control and diabetic patients. The postural change-related increase in TcPO(2) was significantly enhanced in diabetic patients. On the other hand, skin blood blow significantly decreased in the sitting position from the supine position in control subjects but remained stable in diabetic patients. Orthostatic drop in systolic blood pressure correlated negatively with TcPO(2) in the supine position while correlated positively with %change in TcPO(2) and blood flow by postural changes.
The present study demonstrated the dissociated regulation of skin oxygenation and blood flow in response to leg dependency. Impaired postural vasoconstriction was associated with altered regulation of skin oxygenation probably due to sympathetic vascular dysfunction in diabetic patients.
Available from: Wuquan Deng
- "Fig. 3 – ROC curve showing the sensitivity and specificity of TcPO 2 in supine position, sitting position, and sittingsupine position differences for identification of DPN in subclinical DPN group. subjects than the DPN patients, consistent with previous reports  . In healthy subjects, pre-capillary arterioles constrict involves a local sympathetic axon reflex and the veno-arteriolar response when changing from the supine to the sitting position . "
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The assessment of transcutaneous oxygen pressure (TcPO2) may serve as a non-invasive and lower-cost alternative to nerve conduction studies (NCSs) for the diagnosis of diabetic peripheral neuropathy (DPN). The aim of this study was to determine whether the measurement of TcPO2 is useful for evaluating DPN.
We performed a cross-sectional study of 381 consecutive hospitalized diabetic patients classified by clinical examination and NCS as having DPN. Anthropometric and metabolic parameters were assessed. The TcPO2 examination was performed in both supine and sitting positions.
Three hundred and one patients had DPN. The TcPO2 in both the supine and sitting positions was highest in the Non-DPN group and lower in the confirmed DPN group than the other three groups (p < 0.001). The Non-DPN group had the lowest sitting-supine position difference in TcPO2 among the groups (p < 0.001). The risk factors strongly associated with DPN included sitting-supine position difference in TcPO2 (OR =4.971, p < 0.001), diabetic retinopathy (DR) (odds ratio [OR] =3.794, p =0.002), and HbA1c (OR =1.534, p =0.033). The area under the curve (AUC) of the sitting-supine position difference in TcPO2 was 0.722 and revealed an optimal cutoff point for the identification of DPN (19.5 mmHg) that had a sensitivity of 0.611 and a specificity of 0.738 based on AUC analysis.
This large study of diabetic patients confirms that the sitting-supine position difference in TcPO2 is higher in DPN patients than control subjects, indicating that TcPO2 examination is a promising valuable diagnostic tool for DPN.
Available from: Mohammad Kabbani
- "In concordance to these results, we also could not detect significant changes in capillary blood flow in either diabetic patients or in PAOD patients. Iwase et al31 showed that transcutaneous oxygen pressure (TcPO2) at the dorsal foot in patients with diabetes was reduced compared to healthy controls, whereas skin blood flow did not differ significantly. This is also in agreement with our results as we reported deteriorated cutaneous oxygen saturation with equivalent blood perfusion in patients with diabetes mellitus. "
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Plastic and reconstructive surgeons are commonly faced with chronic ulcerations and consecutive wound infections of the feet as complications in patients with diabetes and/or peripheral arterial occlusive disease (PAOD). Microcirculatory changes seem to play an important role. However, the evaluation of functional changes in the soft tissue microcirculation at the plantar foot using combined Laser-Doppler and Photospectrometry System has not yet been performed in patients with DM or PAOD.
A prospective, controlled cohort study was designed consisting of a total of 107 subjects allocated to 1 of 3 groups—group A: healthy subjects (57% males, 63.3 y); group B: patients with diabetes mellitus (DM) (53% males, 59.4 y); and group C: patients with PAOD (81% males, 66.1 y). Microcirculatory data were assessed using a combined Laser-Doppler and Photospectrometry System.
Global cutaneous oxygen saturation microcirculation at the plantar foot of healthy individuals was 8.4% higher than in patients with DM and 8.1% higher than in patients with PAOD (both P = 0.033). Patients with diabetes did not show significant differences in global cutaneous blood flow when compared with either healthy subjects or patients suffering from PAOD.
Functional microcirculation at the plantar foot differs between healthy subjects and patients suffering from diabetes or PAOD of the same age. Patients with either diabetes or PAOD demonstrate deteriorated cutaneous oxygen saturation with equivalent blood perfusion at the plantar foot. More clinical studies have to be conducted to evaluate therapeutical methods that might ameliorate cutaneous oxygen saturation within diabetic foot disease and PAOD.
Available from: Christodoulos Monastiriotis
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ABSTRACT: The aim of this study was to evaluate foot temperature in type 2 diabetic patients with vs. without peripheral neuropathy. The study included 30 patients (group A: 16 men, mean age 63.23+/-7.02 years) with peripheral neuropathy and 30 patients (group B: 17 men, mean age 62.37+/-6.73 years) without peripheral neuropathy. Neuropathy was diagnosed by the Diabetic Neuropathy Index (DNI). Foot temperature was measured with a handheld infrared thermometer (KM 814, Kane-May, UK) on the mid-dorsal aspect of the foot (dorsal temperature) and on the plantar aspect of the foot at the level of the first metatarsal head (plantar temperature). Dorsal temperature was significantly higher in group A than in group B (right foot 32.89+/-1.02 degrees C vs. 31.2+/-1.07 degrees C, p<0.001). The same significant difference was observed for the plantar temperature (32.2+/-0.94 degrees C vs. 30.7+/-1.07 degrees C, p<0.001). In both groups, a significant positive correlation was observed between dorsal and plantar temperature (group A: r (s)=0.913, p<0.001; group B: r (s)=0.956, p<0.001). Finally, in group A, DNI score showed a significant positive correlation with dorsal temperature (r (s)=0.856, p<0.001), as well as plantar temperature (r (s)=0.859, p<0.001). CONCLUSIONS: Foot temperature is significantly higher in type 2 diabetic patients with neuropathy as compared to those without neuropathy. In patients with neuropathy, a significant positive correlation is observed between foot temperature and clinical severity of neuropathy.
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