title: Peripheral nerve functions may deteriorate parallel to the progression of microangiopathy in diabetic patients.
abstract: Our aim was to obtain information to help in the early detection of impaired nerve function and to assess the severity of diabetic symmetric polyneuropathy (DPN). Various somatic and autonomic nerve functions in 40 diabetics and 20 age-matched healthy volunteers were evaluated using six objective examinations: nerve conduction study, quantitative vibratory perception threshold, heart rate variability, Valsalva test, head-up tilt and quantitative sudomotor axonal reflex test (QSART). The diabetics were divided into three groups according to the severity of their microangiopathy. The nerve function data and level of impairment were compared between a healthy control and three diabetic groups. The relationships between nerve function data and clinical background were also examined using multivariate analysis. Results were as follows: (1) all nerve dysfunctions seemed to develop parallel to the progression of microangiopathy, (2) reduced nerve conduction velocity and elevated vibratory perception thresholds in the feet might be early detectable signs of DPN, (3) vasomotor and sudomotor sympathetic functions and cardiovagal functions seemed to deteriorate with the appearance of microangiopathy, (4) lowered compound muscle action potential seemed to appear at the advanced microangiopathic condition, (5) hypohydrosis was closely related to diabetic foot ulcers. In conclusion, nerve dysfunction in diabetics might generally progress with microangiopathy from somatic sensory nerve dysfunction to autonomic nerve dysfunction and then to somatic motor nerve dysfunction. Sympathetic sudomotor dysfunction might be a sensitive predictor of diabetic foot ulcer.
authors.affiliation: The First Department of Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, PO Box 641-8509, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Ogawa
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Sasaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamasaki
authors.forename: Kunihisa
authors.initials: K
authors.lastname: Okamoto
authors.forename: Shohei
authors.initials: S
authors.lastname: Matsuno
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shono
authors.forename: Takuya
authors.initials: T
authors.lastname: Doi
authors.forename: Keiko
authors.initials: K
authors.lastname: Arimoto
authors.forename: Hiroto
authors.initials: H
authors.lastname: Furuta
authors.forename: Masahiro
authors.initials: M
authors.lastname: Nishi
authors.forename: Taisei
authors.initials: T
authors.lastname: Nakao
authors.forename: Kishio
authors.initials: K
authors.lastname: Nanjo
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000473:pathology*; D003929:Diabetic Neuropathies / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009460:Neurologic Examination; D010525:Peripheral Nerves / Q000502:physiology* / Q000503:physiopathology*; D012720:Severity of Illness Index