Autonomic Neuropathy Influences Great Toe Blood Pressure

Uccioli, Luigi; Monticone, Giovanna; Durola, Laura; Russo, Francesco; Mormile, F.; Mennuni, G; Menzinger, G.

doi:10.2337/diacare.17.4.284

Cited by 33 publications

(32 citation statements)

References 11 publications

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“…A reduction in sensory neurons for substance P and calcitonin gene-related peptide has been shown in diabetic patients [32,33]. The nerve axon reflex-related vasodilation has also been reported to be impaired in patients with diabetic peripheral neuropathy [34,35] or even to be virtually absent in severe cases [36,37].…”

Section: Blood Vessel Dilationmentioning

confidence: 94%

Microvascular dysfunction in diabetic foot disease and ulceration

Chao

Cheing

2009

Diabetes Metabolism Res

170

129

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Diabetic foot disease and ulceration is a major complication that may lead to the amputation of the lower limbs. Microangiopathy may play a significant role in the pathogenesis of tissue breakdown in the diabetic foot. However, the precise mechanisms of this process remain unclear and poorly understood. Microvasculature in the skin is comprised of nutritive capillaries and thermoregulatory arteriovenous shunt flow. It is regulated through the complex interaction of neurogenic and neurovascular control. The interplay among endothelial dysfunction, impaired nerve axon reflex activities, and microvascular regulation in the diabetic patient results in the poor healing of wounds. Skin microvasculature undergoes both morphologic changes as well as functional deficits when parts of the body come under stress or injury. Two important theories that have been put forward to explain the abnormalities that have been observed are the haemodynamic hypothesis and capillary steal syndrome. With advances in medical technology, microvasculature can now be measured quantitatively. This article reviews the development of microvascular dysfunction in the diabetic foot and discusses how it may relate to the pathogenesis of diabetic foot problems and ulceration. Common methods for measuring skin microcirculation are also discussed.

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Section: Blood Vessel Dilationmentioning

confidence: 94%

Microvascular dysfunction in diabetic foot disease and ulceration

Chao

Cheing

2009

Diabetes Metabolism Res

170

129

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“…It also increases blood flow (in the absence of large vessel PVD), with arteriovenous shunting leading to the warm foot. It can also markedly reduce toe blood pressure (19). The insensitive foot is, therefore, often warm, which results in a false sense of security as the patient believes that because the circulation is intact, the risk is minimal.…”

Section: Diabetic Neuropathymentioning

confidence: 98%

The Pathogenesis of Diabetic Foot Problems: An Overview

1997

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Foot ulceration and lower limb amputation are still common complications of diabetes. Diabetic peripheral neuropathy and peripheral vascular disease are the most important etiologic factors, but there is a complex interplay between these abnormalities and a number of other contributory factors, such as altered foot pressures, limited joint mobility, glycemic control, ethnic background, and cardiovascular parameters. Identification of patients at high risk of ulceration is nevertheless simple, and education of such patients can achieve a major reduction in amputation and ulceration rates.

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“…However, toe pressures measured with pulse-volume recordings are thought to have poor reproducibility (137), especially in the presence of autonomic neuropathy (146). The impact of MAC on the accuracy of blood pressure measurements and the preferred vascular assessment measured in the person with diabetes remains controversial.…”

Section: Peripheral Vascular Diseasementioning

confidence: 99%