title: Sensitive detection of hemodynamic failure during orthostatic stress in patients with diabetic polyneuropathy using a mini laser Doppler blood flowmeter.
abstract: Autonomic dysfunction in diabetes is serious but often underestimated. The purpose of this study was to evaluate hemodynamics within the important initial phase just after standing, which cannot be evaluated by conventional instruments for orthostatic hypotension. Earlobe blood flow (EBF), which indirectly reflects the blood pressure response on standing, was evaluated using a mini laser Doppler flowmeter during standing from the sitting position in 58 healthy controls and 56 diabetic patients categorized as without (11), mild (27), and advanced diabetic polyneuropathy (18). The response area of the EBF waveform within 30 seconds after standing was calculated. An increased response area indicates poor recovery of EBF. Response area increased significantly with the degree of neuropathy (P < .001 for linear trend). Orthostatic hypotension was detected in two patients in the mild neuropathy group. The present approach may be sensitive and practical for detecting autonomic dysfunction not detected with the conventional orthostatic test.
authors.affiliation: Third Department of Internal Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo-shi, Yamanashi, Japan; Research & Development Division, Pioneer Corporation, Kawagoe-shi, Saitama, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Goma
authors.affiliation: Third Department of Internal Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo-shi, Yamanashi, Japan. Electronic address: mkane@yamanashi.ac.jp.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kaneshige
authors.affiliation: Third Department of Internal Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo-shi, Yamanashi, Japan.
authors.forename: Sayaka
authors.initials: S
authors.lastname: Ichijo
authors.affiliation: Third Department of Internal Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo-shi, Yamanashi, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Ichijo
authors.affiliation: Department of Metabolism and Endocrinology, Kofu Municipal Hospital, Kofu-shi, Yamanashi, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Shindo
authors.affiliation: Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Terada
authors.affiliation: Department of Health Sciences, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo-shi, Yamanashi, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yokomichi
authors.affiliation: Department of Health Sciences, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo-shi, Yamanashi, Japan.
authors.forename: Zentaro
authors.initials: Z
authors.lastname: Yamagata
authors.affiliation: Third Department of Internal Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo-shi, Yamanashi, Japan.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Kitamura
authors.affiliation: Department of Laboratory Medicine, School of Medicine, Fukushima Medical University, Fukushima-shi, Fukushima, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Shimura
authors.affiliation: Third Department of Internal Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo-shi, Yamanashi, Japan; Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Kobayashi
mesh_terms: D001795:Blood Pressure Determination / Q000379:methods; D003929:Diabetic Neuropathies / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007024:Hypotension, Orthostatic / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D017078:Laser-Doppler Flowmetry / Q000379:methods; D008297:Male; D008875:Middle Aged; D011187:Posture / Q000502:physiology*; D015203:Reproducibility of Results; D013223:Statistics as Topic
keywords: Autonomic dysfunction; blood flow; blood pressure regulation; orthostatic hypotension