title: Differences in skin microcirculation on the upper and lower extremities in patients with diabetes mellitus: relationship of diabetic neuropathy and skin microcirculation.
abstract: BACKGROUND
  During recent years, the role of microcirculation has received increasing attention especially for its potential pathogenic role in the development of diabetes complications, particularly diabetic foot syndrome. The aim of this study was to evaluate the differences in the skin microcirculatory reactivity on the upper and lower extremities (UE and LE, respectively) in the patient with type 2 diabetes mellitus (T2DM). We also evaluated the changes in the skin microcirculation independently of the individual test for peripheral diabetic neuropathy (DN) diagnosis (Semmes-Weinstein monofilaments, Bio-Thesiometer [Bio-Medical Instrument Co., Newbury, OH], and Neuropad(®) [TRIGOcare International GmbH, Wiehl, Germany]).
  
  
  METHODS
  Fifty-two patients with T2DM were enrolled. Microvascular reactivity was measured by laser Doppler iontophoresis, using 1% acetylcholine chloride (ACH) and 1% sodium nitroprusside.
  
  
  RESULTS
  Significant reduction of perfusion was found in LE compared with UE when using ACH. In patients with DN skin microvascular reactivity on LE and UE was reduced, compared with patients without DN. Impaired skin microvascular reactivity to ACH (dominant on LE) was demonstrated in all patients who were positive in at least one of the tests for the presence of DN.
  
  
  CONCLUSIONS
  Reactivity of the skin microcirculation is worse on the foot than on the hand. This study confirmed a close relationship of DN and impaired skin microcirculation. It seems that autonomous neuropathy (assessed using the Neuropad) precedes the manifestation of somatosensory neuropathy.
authors: The Faculty of Medicine in Pilsen, Charles University in Prague , Pilsen, Czech Republic .
authors: Jitka
authors: J
authors: Tomešová
authors: Jitka
authors: J
authors: Gruberova
authors: Silvie
authors: S
authors: Lacigova
authors: Daniela
authors: D
authors: Cechurova
authors: Zdenek
authors: Z
authors: Jankovec
authors: Zdenek
authors: Z
authors: Rusavy
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000503:physiopathology*; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008833:Microcirculation; D012016:Reference Values; D012867:Skin / Q000098:blood supply*; D034941:Upper Extremity / Q000098:blood supply*