Neural and endothelial control of the microcirculation in diabetic peripheral neuropathy

To examine the role played by endothelium-dependent and endothelium-independent vasodilation of the cutaneous microcirculation and their relationship to neural microcirculatory control in type 1 and type 2 diabetic patients. Acetylcholine and sodium nitroprusside were iontophoresed using a dose-resp...

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Bibliographic Details
Published in:Neurology Vol. 54; no. 6; p. 1246
Main Authors: Kilo, S, Berghoff, M, Hilz, M, Freeman, R
Format: Journal Article
Language:English
Published: United States 28.03.2000
Subjects:
Adult
Analysis of Variance
Diabetic Neuropathies - physiopathology
Endothelium, Vascular - physiopathology
Female
Humans
Male
Microcirculation
Middle Aged
Peripheral Nerves - physiopathology
Peripheral Nervous System Diseases - physiopathology
Regional Blood Flow
Sensation - physiology
Skin - blood supply
ISSN:0028-3878
Online Access:Get more information
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Summary:To examine the role played by endothelium-dependent and endothelium-independent vasodilation of the cutaneous microcirculation and their relationship to neural microcirculatory control in type 1 and type 2 diabetic patients. Acetylcholine and sodium nitroprusside were iontophoresed using a dose-response technique. Endothelium-dependent, endothelium-independent, and C-fiber-mediated vasodilation were measured with a laser Doppler device. Endothelium-dependent vasodilation of the forearm cutaneous microcirculation was attenuated in diabetic subjects. The response was less in type 2 diabetic subjects than in controls (p < 0.005). In contrast, there was no significant difference between type 1 diabetic subjects and controls. There was no significant abnormality in endothelium-independent vasodilation in either diabetic group. The C-fiber-mediated axon reflex in the forearm was impaired in both type 1 and type 2 diabetics, which is consistent with a small-fiber neuropathy (p < 0.005). The duration of diabetes in type 2 diabetics was a significant predictor of the maximum endothelium-mediated vasodilation. Changes in cutaneous blood flow are seen relatively early in the course of diabetic peripheral neuropathy and are characterized by endothelial and neural but not smooth muscle dysfunction. The presence of significant C-fiber impairment in both diabetic groups, together with significantly greater dysfunction in endothelium-dependent vasodilation in type 2 diabetics, suggests that the endothelial function and nitric oxide may play a greater role in the pathogenesis of diabetic peripheral neuropathy in type 2 diabetic patients.
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ISSN:0028-3878
DOI:10.1212/WNL.54.6.1246