Quantitative evaluation of the dermal vasculature of diabetics

The dermal microvasculature has been compared in 51 diabetics and 51 matched non-diabetic controls using tissue measurement techniques and functional assessments of blood vessel reactivity. Blood vessel walls were thicker in different groups of diabetics than the controls (p less than 0.01) but the degree of thickness did not differ between patients with insulin-dependent diabetes mellitus and those with non-insulin-dependent diabetes mellitus or between diabetics with and without vascular complications. Vascular lumina were narrower in diabetics than in controls (p less than 0.01) and diabetics with vascular complications had a greater reduction in luminal area than those without such complications (p less than 0.001) but the luminal area did not differ between the insulin-dependent and the non-insulin-dependent groups. The luminal perimeter was also reduced in the diabetic group compared to controls. The weal and flare response to intracutaneous histamine acid phosphate (50 micrograms) was markedly decreased (p less than 0.001) in diabetic subjects compared with controls, as was the response to a topically applied vasodilator (Transvasin). The degree of reduction did not differ between patients with insulin-dependent diabetes mellitus and those with the non-insulin-dependent disease but diabetics with vascular complications show impaired responses as compared to those without. The maximum increase in skin temperature on the volar surface of the right middle finger during a period of reactive hyperaemia following 3 min of cuff-induced ischaemia was also markedly decreased in diabetics compared with control subjects. It did not differ between those with insulin-dependent diabetes mellitus and those with the non-insulin-dependent disease but did between diabetics with vascular complications as compared with those without. This study confirms that the cutaneous vasculature of diabetics differs markedly from that of matched control subjects. The results also indicate that there are significant differences between diabetics with vascular complications and those without. The quantitative approaches adopted may have predictive value.