Association between thermal threshold abnormalities and peripheral artery disease in patients with type 2 diabetes

Abstract

Both diabetic peripheral neuropathy and peripheral arterial disease (PAD) cause foot ulcers and often result in non-traumatic amputations in patients with type 2 diabetes. This study aimed to evaluate the association between clinical variables, PAD, and subclinical diabetic small fiber peripheral neuropathy detected by abnormal thermal thresholds of the lower extremities in patients with type 2 diabetes.We investigated 725 consecutive patients with type 2 diabetes (male/female: 372/353; mean age, 67 ± 11 years) who did not have apparent cardiovascular disease (including coronary artery disease, arrhythmia, and stroke) and who underwent the quantitative sensory test for thermal (warm and cold) thresholds of the lower limbs and ankle-brachial index (ABI)/toe-brachial index (TBI) examinations in 2015. The analyses included glycated hemoglobin, estimated glomerular filtration rate, and other characteristics.In total, 539 (74.3%) patients showed an abnormality of at least 1 thermal threshold in their feet. All patients with an abnormal ABI (<0.9) had concurrent impaired thermal thresholds, and 93% (87/94) of patients with an abnormal TBI experienced abnormal thermal thresholds in the lower limbs. Age- and sex-adjusted TBI and estimated glomerular filtration rate were significantly correlated to abnormal thermal thresholds. In the multivariate analysis, fasting plasma glucose, and glycated hemoglobin were independently associated with abnormal thermal thresholds in the lower extremities.Subclinical thermal threshold abnormalities of the feet are significantly associated with PAD and nephropathy in patients who have type 2 diabetes without cardiovascular disease.

Thermal Perception Abnormalities Can Predict Diabetic Kidney Disease in Type 2 Diabetes Mellitus Patients

“…Five seconds elapsed before switching to the next sensory stimuli of the nonpainful modalities. All of the samples were measured twice, and the mean value was used for further statistical analysis [9,27]. Upper limb warmth perception abnormality (ULWPA) was defined as abnormal warmth perception in the right or left upper limbs (0-2 points).…”

“…DPN is characterized by pain, tingling, and numbness, with prevalence rates ranging from 30 to 50% [7]. It is often associated with many comorbidities, including cognitive impairment, depression, autonomic neuropathy, peripheral artery occlusive disease (PAOD), nephropathy, retinopathy, cardiovascular disease, and medial arterial calcification [8,9]. The diagnosis of DPN is most often made based on suggestive clinical symptoms and neurologic tests.…”

“…Previous studies have indicated that DKD is significantly associated with DPN, and that patients with DPN have a higher incidence of albuminuria and lower eGFR than patients without DPN [18,19]. Sheen et al [9] had reported that thermal perception abnormalities of the lower limbs by QST are significantly associated with lower eGFR and higher albuminuria in type 2 diabetes. Given that the chronology of the occurrence of DPN and DKD in patients with T2DM is still unclear, we hypothesized that the severity of thermal perception abnor-mality of the 4 limbs by QST can help to detect patients at risk of kidney failure.…”

Assessment of diabetic small‐fiber neuropathy by using short‐wave infrared hyperspectral imaging

“…Diabetic foot ulcers are mainly attributable to diabetic neuropathy (DN) and peripheral arterial disease. The ankle-brachial index is recommended as a noninvasive screening tool for peripheral arterial disease [9]; however, early diagnosis of DN, especially small fiber dysfunction, remains a challenge [10]. DN is the commonest form of neuropathy [7], and has a higher prevalence among T2DM patients; DN was present at baseline in 26% of youths [7,11], and 42% of adults with T2DM [7,12].…”

“…DN is the commonest form of neuropathy [7], and has a higher prevalence among T2DM patients; DN was present at baseline in 26% of youths [7,11], and 42% of adults with T2DM [7,12]. The evaluation of DN is difficult because of its heterogeneous presentation, involving a combination of subjective symptoms and signs, abnormal neurophysiological examination findings and impaired activities of daily living [10,[13][14][15]. Traditional tools, such as questionnaires and neurological examinations, have a multifactorial bias, such as patients' reaction time and mental concentration [10].…”