Influence of autonomic neuropathy on leg circulation and toe temperature in diabetes mellitus.
The relationship between neuropathy and peripheral circulation was assessed in 26 patients with a short to moderate duration (less than 20 years, mean 11 years) and in 26 patients with a long duration (greater than 20 years, mean 35 years) of diabetes mellitus. Peripheral nervous function was evaluated from measurements of vibration thresholds and ankle reflexes and autonomic nervous function from deep breathing, Valsalva, and tilt table tests. Peripheral circulatory tests included plethysmography, systolic blood pressure ratios, and thermography. A markedly delayed toe temperature increase after cooling followed by indirect heating occurred in diabetics of short duration with autonomic neuropathy (AN). Judging from blood flows and pressure ratios, functional vasospasm caused abnormal toe temperature reactions in short duration diabetics. No correlation existed between AN and abnormal toe temperature reactions in diabetics of long duration. Macroangiopathy rather than AN seemed to be responsible for abnormal toe temperature reactions in long duration diabetics. Thus, an abnormal toe temperature reaction indicates AN in patients with a short duration and macroangiopathy in patients with a long duration of diabetes.
D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis / Q000503:physiopathology*; D001831:Body Temperature; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D013997:Time Factors; D014034:Toes / Q000503:physiopathology*