Aim
The study investigated changes in microvascular perfusion during post-exercise recovery in those with type 2 diabetes, with or without peripheral neuropathy, as well as in healthy controls and those with obesity.
Methods
Skin blood perfusion was assessed in each group using laser doppler flowmetry and laser speckle contrast imaging before and immediately after a six-minute walking test. Laser doppler flowmetry recordings underwent wavelet transformation to allow specific control mechanisms of blood perfusion to be studied (e.g. endothelial nitric oxide independent and dependent, neurogenic, myogenic, respiratory and cardiac mechanisms).
Results
Skin blood perfusion increased after exercise in all groups (22.3±28.1% with Laser speckle contrast imaging and 22.1±52.5% with laser doppler flowmetry). Throughout post-exercise recovery, the decrease was blunted in those with subclinical peripheral neuropathy and confirmed peripheral neuropathy when compared to the other three groups. After exercise, total spectral power increased in all groups. The relative contributions of each endothelial band was lower in those with confirmed peripheral neuropathy than in the healthy controls and those with obesity (nitric oxide-dependent function: 23.6±8.9% versus 35.5±5.8% and 29.3±8.8%, respectively; nitric oxide-independent function: 49.1±23.7% versus 53.3±10.4% and 64.6±11.4%, respectively). The neurogenic contribution decreased less in those with confirmed peripheral neuropathy and in those with type 2 diabetes alone, compared to those with subclinical peripheral neuropathy and those with obesity (-14.5±9.9% and -12.2±6.1% versus -26.5±4.7% and -21.7±9.4%, respectively).
Conclusion
Peripheral neuropathy, whatever the stage, altered the microvascular response to exercise via impaired endothelial and neurogenic mechanisms.