SLR - November 2013 - Tyler Silverman
Reference: Tomešová J, Gruberova J, Lacigova S, Cechurova D, Jankovec Z, Rusavy Z. Differences in Skin Microcirculation on the Upper and Lower Extremity in Patients with Diabetes Mellitus: Relationship of Diabetic Neuropathy and Skin Microcirculation. Diabetes Technol Ther. 2013 Aug 21. [Epub ahead of print].
Scientific Literature Review
Reviewed by: Tyler Silverman, DPM
Residency Program: Cambridge Health Alliance
Podiatric Relevance: Many of the patients encountered in a podiatric practice are diabetic. The diabetic patient is complicated in many ways, especially with regard to his or her blood flow. There are clearly established differences between the upper and lower extremities in large vessel circulation. However, the differences in microcirculation are less clearly understood. This article sheds light on some of the differences in the microcirculation between the upper and lower extremities in diabetic patients.
Methods: Fifty-two type II diabetic patients were enrolled. Their microvascular health was measured by reactivity to 1 percent acetylcholine (ACH) and 1 percent sodium nitroprusside (SNP), both of which were delivered via iontophoresis.
Results: There was significantly less increase in perfusion as a result of ACH iontophoresis in the foot compared to the hand. There was no significant difference in increase in perfusion as a result of SNP iontophoresis in the foot compared to the hand. There was also decreased microvascular reactivity in patients with neuropathy compared to those without neuropathy.
Conclusions: The authors concluded that that skin microcirculation of the foot is less than the hand. They also concluded that there is a relationship between neuropathy and impaired skin circulation.
This research may shed light into problems related to wound healing. Without proper regulation of local blood flow, wounds cannot heal well. It is important to look for signs of impaired microcirculation especially in patients with diabetic neuropathy. The endothelium is essential to regulation of blood flow because it releases an endothelium-derived relaxing factor, also known as nitric oxide. Unfortunately, one of the only current clinical applications related to the importance of the endothelium on vasodilation is Viagra. This article may allow us to use this knowledge for assessment of the microcirculation of diabetics.