Mild peripheral neuropathy prevents both leg muscular ischaemia and activation of exercise-induced coagulation in Type 2 diabetic patients with peripheral artery disease.
OBJECTIVE
To study the influence of peripheral neuropathy on intermittent claudication in patients with Type 2 diabetes (T2DM).


METHODS
Twenty-five patients with T2DM were grouped according to the ankle/brachial index (ABI): 10 with ABI > 0.9 without peripheral artery disease (PAD; group T2DM) and 15 with ABI < 0.9 with PAD (group T2DM + PAD). Twelve individuals without T2DM with PAD (group PAD without T2DM) were also enrolled. Tests for peripheral neuropathy were performed in all patients. ABI, rate pressure product, prothrombin fragments 1 + 2 (F1+2), thrombin-anti-thrombin complex (TAT), and d-dimer were measured before and after a treadmill test. During exercise both initial and absolute claudication distance and electrocardiogram readings were recorded.


RESULTS
We found mild peripheral neuropathy in 20% of group T2DM and 46.7% of group T2DM + PAD (P < 0.01). After exercise, the rate pressure product increased in each group; ABI fell in T2DM + PAD (P < 0.0001) and in PAD without T2DM (P = 0.0005); the fall was greater in the latter group. Initial and absolute claudication distances were similar in PAD patients. In group T2DM + PAD, absolute claudication distance was longer in the subgroup without peripheral neuropathy (P < 0.05), whereas ABI and rate pressure products were similar. F1+2 values at rest were higher in group T2DM + PAD. After exercise, F1+2 values and TAT increased only in group PAD without T2DM.


CONCLUSIONS
Only group PAD without T2DM experienced muscular ischaemia, whereas group T2DM + PAD did not. Mild peripheral neuropathy may have prevented them from reaching the point of muscular ischaemia during the treadmill test, because they stopped exercising with the early onset of pain. Reaching a false absolute claudication distance may induce ischaemic preconditioning. These findings suggest a possible protective role of mild peripheral neuropathy in T2DM patients with intermittent claudication, by preventing further activation of coagulation during treadmill testing.
Piarulli
F
F
Department of Medical and Surgical Science, University of Padova, Padova, Italy. francesco.piarulli@unipd.it
Sambataro
M
M
Minicuci
N
N
Scarano
L
L
Laverda
B
B
Baiocchi
M R
MR
Baldo-Enzi
G
G
Galasso
S
S
Bax
G
G
Fedele
D
D
D001777:Blood Coagulation / Q000502:physiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D003925:Diabetic Angiopathies / Q000150:complications* / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000150:complications* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000209:etiology; D007511:Ischemia / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply*; D017063:Outcome Assessment, Health Care; D010523:Peripheral Nervous System Diseases / Q000209:etiology / Q000503:physiopathology; D012307:Risk Factors; D016138:Walking