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Autonomic function in neuropathic diabetic patients with foot ulceration
J E Gilmore1, J A Allen, J R Hayes
1School of Basic Medical Sciences, Queen's University of Belfast, Northern Ireland.
Diabetes Care
|January 1, 1993
Summary
Diabetic subjects with foot ulcers show significantly impaired peripheral autonomic function compared to those without. This suggests peripheral autonomic neuropathy is linked to diabetic foot ulcer development.
Area of Science:
- Diabetology
- Neurology
- Cardiology
Background:
- Diabetic neuropathy is a common complication.
- Foot ulceration is a severe consequence of diabetic neuropathy.
- Autonomic dysfunction may play a role in ulcer development.
Purpose of the Study:
- To compare peripheral autonomic function in diabetic patients with and without foot ulcers.
- To investigate the relationship between autonomic dysfunction and diabetic foot ulceration.
Main Methods:
- Studied 57 diabetic subjects: 35 with neuropathy (14 with prior ulcers), 22 without neuropathy.
- Assessed motor/sensory nerve conduction and autonomic function using cardiovascular reflex tests.
- Measured foot blood flow variability and vasoconstrictor responses to deep breathing and body cooling.
Main Results:
- Diabetic subjects with foot ulcers (DU group) had significantly worse peripheral sympathetic function.
- The DU group exhibited diminished vasoconstrictor responses to deep breathing and body cooling compared to neuropathic subjects without ulcers (DN group).
- Cardiac autonomic function and nerve conduction were similar between neuropathic groups.
Conclusions:
- Peripheral autonomic neuropathy is associated with the development of foot ulceration in diabetic patients.
- Impaired peripheral sympathetic function may increase the risk of foot ulceration in diabetes.