The effect of polyneuropathy on foot microcirculation in Type II diabetes.
OBJECTIVE
The aim of this study was to investigate the influence of peripheral polyneuropathy (PNP) on skin microcirculation and foot swelling rate in the feet of patients with Type II (non-insulin-dependent) diabetes mellitus.


METHODS
38 Type II diabetic patients, 24 with PNP (PNP+), 14 without PNP (PNP-), and 16 healthy control subjects were studied, first supine and subsequently sitting with the foot dependent for 50 mn.


RESULTS
In patients with PNP, foot skin temperature was higher, (p<0.04) and capillary blood cell velocity (CBV, nailfold capillary microscopy), was lower compared to patients without PNP (222 vs 313 micro m/s respectively, p<0.03). Compared to the control subjects, the percentage reduction in skin blood flux, (LDF, laser-Doppler fluxmetry), after 10 min was higher in the PNP- and PNP+ patients (3% vs 18% and 26% respectively, p<0.02). These disturbances were most pronounced in PNP+ patients with a history of a foot ulcer. Foot swelling rate (mercury strain gauge plethysmography) in the first 10 min of dependency, was lower in patients with PNP+ compared to the control subjects (0.00165 vs 0.00286 ml.100 ml(-1)s respectively, p<0.01). In addition, we found a negative correlation (r=-0.41; p<0.01) between Valk-score (severity of PNP) and FSR.


CONCLUSIONS
Type II diabetes PNP is associated with multiple abnormalities in the (skin) microcirculation of the foot, characterised by reduced capillary blood flow, an enhanced reduction in skin blood flux and impaired fluid filtration after sitting up. The most severe abnormalities were observed in patients with a history of foot ulceration.
Department of Internal Medicine, University Hospital Maastricht and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands.
M H
MH
Nabuurs-Franssen
A J H M
AJ
Houben
J E
JE
Tooke
N C
NC
Schaper
D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology*; D017719:Diabetic Foot / Q000209:etiology; D003929:Diabetic Neuropathies / Q000150:complications / Q000503:physiopathology*; D004487:Edema / Q000209:etiology; D005260:Female; D005528:Foot / Q000098:blood supply*; D005534:Foot Diseases / Q000209:etiology; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D015999:Multivariate Analysis; D011115:Polyneuropathies / Q000150:complications / Q000503:physiopathology*; D011187:Posture / Q000502:physiology; D012720:Severity of Illness Index; D012867:Skin / Q000098:blood supply; D016683:Supine Position