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Autonomic neuropathy and toe circulation. A prospective study.

G Sundkvist, L O Almér, B Lilja

    Acta Medica Scandinavica
    |January 1, 1986
    PubMed
    Summary
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    Diabetic patients with autonomic neuropathy (AN) exhibit delayed toe warming after cold exposure, indicating impaired circulation. Parasympathetic neuropathy increases cold sensitivity, while sympathetic neuropathy causes vasodilation and higher toe temperatures.

    Area of Science:

    • Vascular Physiology
    • Diabetic Complications
    • Autonomic Nervous System Function

    Background:

    • Diabetic autonomic neuropathy (AN) affects blood vessel regulation.
    • Peripheral circulation, particularly in the toes, can be compromised in diabetes.
    • Understanding the impact of AN on thermoregulation is crucial for managing diabetic foot complications.

    Purpose of the Study:

    • To evaluate ankle and toe pressure ratios and toe temperature responses to cold and rewarming in diabetic patients with and without AN.
    • To investigate the long-term changes in vascular function over 5-7 years in diabetic patients with AN.
    • To differentiate the effects of parasympathetic versus sympathetic neuropathy on toe vascular responses.

    Main Methods:

    • Longitudinal study involving 23 diabetic patients, assessed in two phases 5-7 years apart.

    Related Experiment Videos

  • Measurement of ankle-brachial index (ABI) and toe-to-brachial index (TBI).
  • Assessment of toe temperature changes following a standardized cold challenge and indirect heating protocol.

    • Main Results:

    • In the initial study, diabetic patients with parasympathetic neuropathy showed significantly delayed toe rewarming despite normal pressure ratios.
    • In the follow-up study, patients with sympathetic neuropathy exhibited higher baseline toe temperatures compared to those without AN.
    • Parasympathetic neuropathy was associated with increased toe cold sensitivity, while sympathetic neuropathy correlated with vasodilation and elevated toe temperatures.

    Conclusions:

    • Diabetic autonomic neuropathy, specifically parasympathetic dysfunction, impairs the normal vascular response to cold, leading to delayed toe warming.
    • Sympathetic neuropathy in diabetic patients is linked to altered baseline toe temperatures and vasodilation.
    • These findings highlight distinct vascular regulatory roles of parasympathetic and sympathetic systems in diabetic neuropathy and have implications for foot care.