Functional Microcirculatory Impairment: A Possible Source of Reduced Skin Oxygen Tension in Human Diabetes Mellitus

Mayrovitz, Harvey N.; Larsen, Parry B.

doi:10.1006/mvre.1996.0048

Cited by 41 publications

(23 citation statements)

References 18 publications

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“…Impairment of microvascular function is accompanied by a decrease in transcutaneous skin oxygen tension [45]. A recent study has further shown impaired transcutaneous oxygen tension in the feet of neuropathic diabetic patients [46].…”

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confidence: 99%

The influence of isolated small nerve fibre dysfunction on microvascular control in patients with diabetes mellitus

et al. 2001

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Section: Discussionmentioning

confidence: 99%

The influence of isolated small nerve fibre dysfunction on microvascular control in patients with diabetes mellitus

et al. 2001

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“…It has been suggested that the impaired injury response explains the propensity to foot ulceration in patients with diabetes and development of foot ulceration in the absence of large-vessel disease. Finally, it has been demonstrated that in diabetic subjects, transcutaneous oxygen tension (TcpO 2 ) of Ͻ30 mmHg in the foot when the skin is heated to 44°C is an independent predictor for foot ulceration (32) and that, in the absence of macrovascular disease, TcpO 2 reflects microvascular dysfunction (33). Although, readily demonstrable and increasingly suggested to be involved in the development of diabetic foot ulceration, there have been no studies specifically examining the role of microvascular dysfunction in foot ulceration and the value of such tests in identifying those at risk.…”

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confidence: 99%

Comparative Roles of Microvascular and Nerve Function in Foot Ulceration in Type 2 Diabetes

et al. 2004

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OBJECTIVE -To determine the relative roles of different modalities of sensory nerve function (large and small fiber) and the role of microvascular dysfunction in foot ulceration in type 2 diabetic subjects. RESEARCH DESIGN AND METHODS-A total of 20 control subjects and 18 type 2 diabetic subjects with foot ulceration and 20 without were studied. None of the subjects had clinical features of peripheral vascular disease. The Computer-Aided Sensory Evaluator IV (CASE IV) was used to determine vibration detection threshold (VDT), cold detection threshold (CDT), warm detection threshold (WDT), and heat pain onset threshold (HPO). Vibration perception threshold (VPT) was also assessed by a neurothesiometer. Microvascular function (maximum hyperemia to skin heating to 44°C) was assessed using laser Doppler flowmetry (mean maximum hyperemia using laser Doppler flowmeter [LDF max ]), laser Doppler imaging (mean maximum hyperemia using laser Doppler imager [LDI max ]), and skin oxygenation with transcutaneous oxygen tension (TcpO 2 ).RESULTS -VPT, VDT, CDT, and HPO were all significantly higher in individuals with ulceration than in those without (VPT and VDT: P Ͻ 0.0001) (CDT and HPO: P ϭ 0.01). LDF max , LDI max , and TcpO 2 were significantly lower in the two diabetic groups than in the control subjects, but there was no difference between individuals with and without ulceration. CONCLUSIONS -This study found that there was no additional value in measuring smallfiber function with the CASE IV over measuring vibration by either CASE IV or the inexpensive neurothesiometer in discriminating between individuals with and without ulceration. Furthermore, none of the tests of microvascular function including the TcpO 2 were able to discriminate between individuals with and without ulceration, suggesting that such tests may not be of benefit in identifying subjects at greater risk of foot ulceration. Diabetes Care 27:1343-1348, 2004T he incidence of diabetes-related lower-extremity amputations continues to increase in the developed and developing world; in the U.S., it has been estimated to cost nearly $2 billion and account for 2,600 patient-years of hospital stays per year (1). Up to 80% of these amputations are preceded by foot ulceration (2). Furthermore, between 1995 and 1996, the Medicare costs for patients with foot ulcers were on an average three times higher than those of Medicare patients in general (3). Thus, there is a pressing need for a better understanding of the etiopathogenic factors involved in foot ulceration so that robust screening and preventative measures can be developed.In the absence of macrovascular disease, impaired nerve function and deranged microvascular function have been implicated as important etiological factors (4 -10). With regard to neuropathy, clinical assessment using simple clinical tools such as the neuropathy disability score, neuropathy symptom score, pressure perception using Semmes-Weinstein monofilaments, and vibration sensation with the neurothesiometer (Horwell Scientific Labora...

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“…In general, increased aortic PWV is associated with increased cardiovascular risk factors and events (18). Other noninvasive tests, such as measurement of transcutaneous oxygen tension, have been proposed to evaluate PAD (19).…”

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Increased Arterial Wall Stiffness Limits Flow Volume in the Lower Extremities in Type 2 Diabetic Patients

et al. 2001

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OBJECTIVE—To document an association between arterial wall stiffness and reduced flow volume in the lower-extremity arteries of diabetic patients. RESEARCH DESIGN AND METHODS—We recruited 60 consecutive type 2 diabetic patients who had no history or symptoms of peripheral arterial disease (PAD) in the lower extremities and normal ankle/brachial systolic blood pressure index at the time of the study (non-PAD group) and 20 age-matched nondiabetic subjects (control group). We used an automatic device to measure pulse wave velocity (PWV) in the lower extremities as an index of arterial wall stiffness. At the popliteal artery, we evaluated flow volume and the resistive index as an index of arterial resistance to blood flow using gated two-dimensional cine-mode phase-contrast magnetic resonance imaging. RESULTS—Consistent with previous reports, we confirmed that the non-PAD group had an abnormally higher PWV compared with that of the control group (P < 0.001). To further demonstrate decreased flow volume and abnormal flow pattern at the popliteal artery in patients with a higher degree of arterial wall stiffness, we assigned the 60 non-PAD patients to tertiles based on their levels of PWV. In the highest group, magnetic resonance angiograms of the calf and foot arteries showed decreased intravascular signal intensity, indicating the decreased arterial inflow in those arteries. The highest group was also characterized by the lowest late diastolic and total flow volumes as well as the highest resistive index among the groups. From stepwise multiple regression analysis, PWV and autonomic function were identified as independent determinants for late diastolic flow volume (r2 = 0.300; P < 0.001). CONCLUSIONS—Arterial wall stiffness was associated with reduced arterial flow volume in the lower extremities of diabetic patients.

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Functional Microcirculatory Impairment: A Possible Source of Reduced Skin Oxygen Tension in Human Diabetes Mellitus

Cited by 41 publications

References 18 publications

The influence of isolated small nerve fibre dysfunction on microvascular control in patients with diabetes mellitus

The influence of isolated small nerve fibre dysfunction on microvascular control in patients with diabetes mellitus

Comparative Roles of Microvascular and Nerve Function in Foot Ulceration in Type 2 Diabetes

Increased Arterial Wall Stiffness Limits Flow Volume in the Lower Extremities in Type 2 Diabetic Patients

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