Metabolic syndrome defined by IDF and AHA/NHLBI correlates better to carotid intima-media thickness than that defined by NCEP ATP III and WHO

Diabetes mellitus is major cause leading to pathological changes in skin foot plantar area (SFPA) and affected the static standing balance duration (SSBD). Skin resistance level (SRL) is related to skin conductance which changes in the presence of sweat. This study aims to find out the relationship between the SRL and SSBD in type II diabetic patients. Sixty-eight voluntary students, 30 type II diabetic patients and 30 healthy non-diabetic subjects, were participated to the study. The SSBD was measured on dominant and non-dominant legs. SRLs were recorded with two surface electrodes over the metatarsus heads and heel. The SSBD of the healthy young group was found to be higher than the other groups (P < 0.001). The SRL values of the non-dominant leg in the diabetic group was found to be lower than the others (P = 0.014). For dominant and non-dominant legs within each group, only the healthy young group has statistically difference (P = 0.012). A significant correlation was seen to be between the SRL and SSBD for only healthy non-diabetic group for the non-dominant leg. The relation between the SRL and SSBD is poor but very promising. Measurement of the SRL can be used in evaluating the inflammation of the diabetic foot.     

The influence of reactive hyperemia and leg dependency on skin microcirculation in patients with peripheral arterial occlusive disease (PAOD), with and without diabetes

The increase in venous pressure during leg dependency causes a vasoconstriction of the distal vascular bed in healthy subjects, which is due to the so-called veno-arteriolar reflex. The aim of the present study was to investigate if this reflex is disturbed in patients with severe peripheral arterial occlusive disease (PAOD), with and without diabetes. The total skin microcirculation during rest and postocclusive reactive hyperemia (PRH) after a three minute arterial occlusion at the ankle was studied by laser Doppler (LD) fluxmetry. The LD probe was attached to the dorsal region of the foot in 10 legs of healthy control subjects, patients with PAOD, and patients with PAOD and diabetes respectively. No vasoconstriction was seen in the PAOD group when the leg was moved from the supine to the dependent position. The PRH response was also significantly (p less than 0.05-0.01) impaired compared to the controls in both positions. The diabetic PAOD patients had an almost normal reactivity in spite of an equally reduced arterial circulation as the non-diabetic patients. The results show that patients with PAOD have a significantly disturbed reactivity of the skin microcirculation in the ischemic foot, while the reactivity in diabetic PAOD patients is almost normal.     

Transforming growth factor-beta 1, 2, 3 and receptor type I and II in diabetic foot ulcers.

AIMS: To study the distribution of transforming growth factor-beta (TGF-beta) 1, 2 and 3, and TGF-beta receptor types I and II in diabetic foot ulcers, diabetic skin and normal skin by immunohistochemistry, immunofluorescence and Western blotting. We also compared the TGF-betas with those of chronic venous ulcers. METHODS: Skin biopsies were obtained from the leg or the foot of non-diabetic and diabetic subjects, and from the edge of diabetic foot ulcers and chronic venous ulcers. Distribution (by immunofluorescence and immunocytochemistry) of TGF-beta 1, 2 and 3 and TGF-beta receptors (RI and RII) was done by staining 8-microm skin sections using appropriate antibodies. Protein levels of TGF-beta were measured by Western blot analysis. RESULTS: TGF-beta3 expression was increased in the epithelium at the edge of diabetic foot ulcers, being more intense than diabetic and normal skin (P = 0.03, 0.02, respectively), as was its expression in venous ulcers compared with normal skin. However, TGF-beta1 expression was not increased in diabetic foot ulcers and chronic venous ulcers, and was comparable to diabetic and normal skin. There was also no increase for the receptors in diabetic foot ulcers. CONCLUSION: The lack of TGF-beta1 up-regulation in both diabetic foot ulcers and venous ulcers may explain the impaired healing in these chronic wounds, and could represent a general pattern for chronicity.     

Tissue tonometry: a useful tool for assessing filarial lymphedema.

A tissue tonometer was used to assess peripheral lymphedema in patients with filariasis in a Bancroftian endemic community. Matched populations of 34 patients with Grade II and 29 patients with Grade III unilateral lower limb edema and 26 healthy subjects were assessed for leg tissue compressibility and circumference. Tonometry was performed at three fixed points on the leg using three weight levels (70, 140, and 210 gms). The mean value of compressibility for each weight level and points measured in the edematous leg were significantly less compared with the contralateral non-edematous leg in the filarial patients and the legs of healthy subjects. Patients with Grade III lymphedema were more resistant to compression than Grade II patients throughout the leg but especially at the foot. The least mean square analyses of circumference and compressibility differential values of edematous compared with non-edematous legs revealed a positive correlation at the foot in Grade II and the proximal and distal parts of Grade III lymphedema; moreover, the slopes were significantly different from zero. These findings support progressive tissue changes of edema and fibrosis first in the foot and later in the more proximal portions of the leg which correspond to progressive volume expansion with protein-rich fluid. Tissue tonometry appears to be a sensitive measure for assessing progression of both edema and fibroplasia in patients with peripheral lymphedema associated with filariasis, and, therefore, may be a useful tool to measure the efficacy of drugs commonly used to treat this condition.     

Persistent Postoperative Complaints After Whole Sural Nerve Biopsies in Diabetic and Non-diabetic Subjects

The postoperative effects of a whole sural nerve biopsy in diabetic (11) and non-diabetic (10 healthy controls, 10 patients with impaired glucose tolerance and 2 patients with polyneuropathy) subjects were investigated by a mailed questionnaire 20–44 months after the surgical procedure (10/11 vs 21/22 answers received). Pain in the biopsy area at follow-up was reported in 4/10 of the diabetic patients (p = 0.01) but in none of the non-diabetic subjects (0/21). An increased number (p = 0.01) of diabetic patients (5/10 vs 1/21) had cold intolerance in their foot or leg whereas 11/31 of all patients had dysaesthesia in the affected skin. Overall 6/31 patients described serious problems at the time of the questionnaire, and 4 of this 6 having diabetes. Loss of sensation was reported in almost all subjects irrespective of diabetes or not; however, a decrease in the area of loss of sensation was reported most often in diabetic patients (8/10 vs 8/21, p = 0.02). It is concluded that whole surval nerve biopsies give rise to persistent problems both in diabetic and non-diabetic subjects. The reason for a sural nerve biopsy has always to be carefully considered before being conducted. © 1997 by John Wiley & Sons, Ltd.     

Skin Capillary Circulation is More Impaired in the Toes of Diabetic Than Non-diabetic Patients with Peripheral Vascular Disease

The aim of the present study was to investigate if diabetes negatively influences the skin microvascular reactivity in the toes of patients with peripheral vascular disease (PVD). Twenty healthy subjects, 20 diabetic, and 20 non-diabetic patients with PVD participated. One foot in each subject was investigated. The patient groups were matched for age, sex, and toe pressure. The capillary blood cell velocity in the nailfold of the great toe was investigated by videophotometric capillaroscopy, and the total skin microcirculation within the same area by laser Doppler fluxmetry. Capillary blood cell velocity and laser Doppler flux were studied during rest, and following a 1 min arterial occlusion at the toe base. The skin microvascular reactivity was impaired in both diabetic and non-diabetic patients. In the diabetic patients the disturbances were mainly seen in the capillaries, and the capillary blood flow was severely reduced during reactive hyperaemia (p<0.01). In contrast, the total skin microcirculation was normal, indicating that sufficient blood reaches the area, but does not come out into the capillaries. The ratio between capillary blood cell velocity and laser Doppler flux, representing the distribution of blood between nutritional and non-nutritional blood compartments, was reduced in the diabetic patients (p<0.05). These findings may contribute to the higher risk for development of chronic foot ulcers in diabetic patients with PVD.     

Microlymphatic aneurysms in patients with lipedema.

"Lipedema," a special form of obesity syndrome, represents swelling of the legs due to an increase of subcutaneous adipose tissue. In 12 patients with lipedema of the legs and in 12 healthy subjects (controls), fluorescence microlymphography was performed to visualize the lymphatic capillary network at the dorsum of the foot, at the medial ankle, and at the thigh. Microaneurysm of a lymphatic capillary was defined as a segment exceeding at least twice the minimal individual diameter of the lymphatic vessel. In patients with lipedema, the propagation of the fluorescent dye into the superficial lymphatic network of the skin was not different from the control group (p > 0.05). In all 8 patients with lipedema of the thigh, microaneurysms were found at this site (7.9 +/- 4.7 aneurysms per depicted network) and in 10 of the 11 patients with excessive fat involvement of the lower leg, multiple microlymphatic aneurysms were found at the ankle region. Two obese patients showed lymphatic microaneurysms in the unaffected thigh and in only 4 patients were microaneurysms found at the foot. None of the healthy controls exhibited microlymphatic aneurysms at the foot and ankle, but in one control subject a single microaneurysm was detected in the thigh. Multiple microlymphatic aneurysms of lymphatic capillaries are a consistent finding in the affected skin regions of patients with lipedema. Its significance remains to be elucidated although its occurrence appears to be unique to these patients.     

Motor dysfunction in diabetes

Neuropathy is a frequent complication in diabetes and most commonly seen as distal symmetrical sensorimotor polyneuropathy (PN). Involvement of the motor system is infrequently seen at the clinical examination. However, with the application of quantitative techniques, that is, isokinetic dynamometry, type 1 and type 2 diabetic patients have been detected to have weakness at the ankle and the knee. Muscle weakness is found only in diabetic patients with PN, while non-neuropathic patients even with long-term diabetes have normal strength. The weakness is closely related to signs and severity of PN. With the use of magnetic resonance imaging, muscle weakness is found to be paralleled by muscular atrophy, which is observed in the feet and at the lower leg. Following diabetic patients for 8-10 years, we have observed accelerated loss of muscle strength in patients with symptomatic PN; similarly, accelerated loss of muscle mass is observed in the feet and lower legs. In large-scale studies of diabetic and non-diabetic subjects, lower muscle quality in diabetic patients is also found. Thus, in addition to PN, diabetes per se leads to lower strength per unit striated muscle. Muscle weakness is related to the slowing of movements, unstable gait, and more frequent falls. Furthermore, motor dysfunction leads to an increased risk of developing a foot ulcer due to due to alterations of the biomechanics of the feet caused by muscle atrophy. This may lead to an increased skin pressure that may lead to foot ulceration and ultimately amputation. Muscle and balance training may improve strength, postural stability, and walking performance; however, this needs to be studied in more detail.     

A comparison of gait patterns between the offspring of people with medial tibiofemoral osteoarthritis and normal controls

OBJECTIVES: The aim of this study was to explore the contribution of biomechanical factors to the development and progression of knee osteoarthritis (OA) by investigating whether the offspring of subjects with medial tibiomfemoral OA demonstrate gait abnormalities in the absence of OA. METHODS: Three-dimensional gait analyses were performed on 9 offspring of people with medial tibiofemoral OA and 9 age, gender and Body Mass Index (BMI) matched individuals with no parental history of knee OA. External knee adduction, extension and flexion moments, as well as the magnitude of foot rotation during early stance were compared between the groups. RESULTS: The offspring of people with medial tibiofemoral OA walked with less external rotation at the foot than control subjects during early stance (4.5 degrees versus 13.5 degrees, p < 0.01). There were no significant differences between groups for the peak knee adduction moments (dominant leg, p = 0.49; non-dominant leg, p = 0.70) or peak knee extension moments (dominant leg, p = 0.46; non-dominant leg, p = 0.48). Moreover, there was no difference between groups for the knee flexion moment occurring when the force adducting the knee was greatest (dominant leg, p = 0.35; non-dominant leg, p = 0.33). CONCLUSIONS: Although the offspring of people with medial tibiofemoral OA walked with less external foot rotation than the control subjects during early stance, whether this increases their risk of developing knee OA is yet to be determined.     

The effects of muscle activation on postural stability in diabetes mellitus patients with cutaneous sensory deficit in the foot

Activity of the lower leg muscles in response to an unexpected disturbance to upright standing was studied in diabetic patients and non-diabetic matched controls. The diabetic individuals were classified into two groups: diabetic patients with normal cutaneous sensitivity in the foot (n=27) and patients with cutaneous sensory deficit (n=23). All participants completed twenty trials standing on a force platform that rotated upward 8 deg at 50 deg/s. This movement produced short-latency and medium-latency responses in the gastrocnemius muscle and a single long-latency response in the anterior tibialis. All muscle activity was assessed using electromyography techniques. Results indicated that the average delay of the short-, medium- and long-latency responses produced by the diabetic groups was comparable to control group values. However, the within subject variability associated with activating the anterior tibialis was found to be statistically greater for the cutaneous deficit diabetic group. Additionally, fifty percent of the CD group failed to produce an observable stretch reflex response. The results suggest that the inability to generate a neuromuscular response with consistent temporal patterning is a contributing factor to greater postural sway observed in diabetic patients with cutaneous sensory deficit in the foot.     

Antioxidant status of Mauritian subjects with type II diabetes mellitus

A pilot study involving 30 Type II diabetic subjects with no macrovascular and microvascular complications and 30 healthy subjects from the Republic of Mauritius was conducted to assess the erythrocyte catalase level and the plasma antioxidant activity in diabetic condition. The total antioxidant capacity was determined using the ferric reducing antioxidant power (FRAP) assay and erythrocyte catalase activity by a catalase kit. The mean catalase activity in the diabetic group was significantly lower (8720.3?±?290.7 nmol/min/ml) than the non-diabetic group (13341.5?±?302.4 nmol/min/ml) (P?<?0.001). Ferric reducing antioxidant power was also lower (1241.1?±?210.2 μmolFe²⁺/L) for the diabetic compared to the control (1637.2?±?304.2 μmolFe²⁺/L). These data suggest that the in vivo antioxidant defense is compromised in the subjects with type II diabetes mellitus.     

High Prevalence of Diabetes in Chronic Leg Ulcer Patients: a Cross-sectional Population Study

In a cross-sectional survey, designed to detect all patients with current chronic leg ulcers, 27% of the patients had diabetes mellitus. The outcome for the 104 examined diabetic patients has been evaluated and compared with the 278 nondiabetic patients. The purpose was to establish the prevalence of leg ulcers among diabetic patients and to assess potential causes. The point prevalence was calculated by extrapolating the leg ulcer frequency to the total diabetic population in the studied area. The point prevalence for active leg ulcers (including foot ulcers) in diabetic patients was 3.5% (95% CI 2.8–4.2). Ulcers above the malleoli were almost as common as foot ulcers. Peripheral vascular disease was present in 67% of all ulcerated legs in patients with diabetes compared to 42% in nondiabetic patients (p < 0.001). In 72% of foot ulcers in diabetic patients arterial impairment was judged to be a contributing aetiological factor and in nondiabetic patients 45% (p < 0.001). Ulcers solely attributed to possible neuropathy were less common (15%). Ulcers with multifactorial causes were common above the malleoli. This survey has given the size of the problem and indicates macroangiopathy to be the dominating factor responsible for slow or nonhealing ulcers in diabetic patients. Objective assessment of arterial circulation is mandatory and signs of arterial impairment require consultation with a vascular surgeon.     

Can elderly diabetic patients co-operate with routine foot care?

Foot care education is widely promoted as a preventive strategy for reducing foot ulceration in diabetes. We describe a simple method of assessing the ability of elderly diabetic patients to co-operate with foot care advice. Using small self-adhesive red spots, foot lesions can be simulated and patients advised and prompted to detect and inspect these 'lesions'. Nineteen young non-diabetic volunteers and three groups of 14 elderly patients were assessed: diabetic patients with a foot ulcer, diabetic patients with no history of foot ulceration and non-diabetic patients. Eleven (39%) of the diabetic patients were unable to reach their toes and remove the lesions and only 6 (14%) of all elderly patients could respond to plantar lesions. It is therefore unlikely that unsupported foot care education can be effective in reducing the morbidity of foot problems in the elderly diabetic patient.     

Evaluation of the local effects of vitamin E (E-Mousse) on free radicals in diabetic microangiopathy: a randomized,controlled trial

The aims of the study were to evaluate the short-term effects of a new thermosensitive, vitamin E (V-E) mousse on local free radicals (FR) and skin flux in diabetic microangiopathy. A group of 40 patients with diabetic microangiopathy was included. The variation in measurements of skin FR was evaluated by the D-Rom test. Subjects were between 45 and 65 years with type II diabetes and good metabolic control. E-mousse, a thermoactive preparation of acetate vitamin E (20%), was applied twice daily on the whole surface of the leg (below knee) and foot for 3 weeks. The contralateral leg was untreated acting as control. Subjects with age between 45 and 65 years with type II diabetes (diagnosed at least 5 years before) and good metabolic control (blood sugar < 180 mg/dL) were included after informed consent. Patients with uncontrolled diabetes, peripheral vascular disease, and severe lower limbs infections were excluded. Local free radicals (FR) and laser Doppler flux including the venoarteriolar response (VAR) were evaluated. The tolerability was evaluated by a semiquantitative score. Of the 40 included patients 34 completed the study. The 2 groups were comparable. At 3 weeks there was no decrease in FR in controls; the decrease in the treatment group was 45.3% (p < 0.05). Also in the treatment group RF decreased (p < 0.05) and the VARveno improved from an average of 21% to an average of 38% (p < 0.05). No significant variations were observed in the control group. The variation in symptomatic score was from a total value of 8 to 5 in the control group and from 8 to 1 in the treatment group (p < 0.02). Their tolerability was good. In conclusion local treatment with E-mousse for 3 weeks in diabetic microangiopathy improves skin microcirculation and the metabolic condition as shown by the decrease in FR.     

2型糖尿病肾病患者的Apelin、胱抑素C的变化及其临床意义

目的探讨血清胱抑素C（Cys-C）与Apelin水平在2型糖尿病肾病患者中的相关性及其临床意义。 方法2014年5月至2017年2月期间在广西壮族自治区人民医院老年内分泌病房接受治疗的63例2型糖尿病患者的病例资料,根据24 h尿微量蛋白是否>30 mg/24h,分为糖尿病肾病组（24 h尿微量蛋白>30 mg/24h,31例）和糖尿病非肾病组（24 h尿微量蛋白≤30 mg/24h,32例）,另设30例正常对照组,用酶联免疫吸附法测定空腹血清Apelin水平,同时测定Cys-C。 结果与对照组相比,糖尿病肾病组和糖尿病非肾病组血清Apelin及Cys-C均明显升高（P<0.05）。糖尿病肾病组血清Apelin及Cys-C高于糖尿病非肾病组（P<0.05）。糖尿病肾病组的Apelin与Cys-C水平呈正相关（P<0.05）。 结论血清Cys-C与Apelin水平在2型糖尿病肾病患者中存在正相关,考虑两者通过在肾小球的协同作用调控疾病的发展,可成为反映糖尿病肾病的早期指标发挥重要作用。     

Evaluation of physical fitness in patients with Type 2 diabetes mellitus

Purpose: The aim of this study was to compare functional capacity in 30 Type 2 Diabetic patients with 30 healthy non-diabetic control subjects. Methods: Physical fitness was evaluated using the “EUROFIT Physical Fitness Test Battery”. This battery estimates body composition, cardiopulmonary, musculoskeletal and motor fitness. Results: Percentage of body fat (PBF) was higher in the diabetic compared with control groups (P<0.05) although body mass index (BMI) was similar. Biceps and suprailiac skinfold thickness were also greater in the diabetic group (P<0.05). The 6-min walking distance and VO_2max were significantly lower in the diabetic group (P<0.05). The diabetic patients had lower values of the single leg balance test with eyes opened and closed. Jump-stretch, handgrip and side-bending of trunk tests were also lower in the diabetic patients. Conclusion: Physical functional capacity is lower in Type 2 diabetic patients than in age-matched control subjects.     

Topical methyl nicotinate-induced skin vasodilation in diabetic neuropathy

OBJECTIVE: To evaluate the vasodilation induced by topical application of methyl nicotinate (MN) and to compare it with the vasodilatory response to acetylcholine (ACh) and sodium nitroprusside (SNP) in healthy subjects and diabetic neuropathic patients. RESEARCH DESIGN AND METHODS: Ten diabetic patients with peripheral neuropathy (DN) and 10 age- and sex-matched healthy control subjects (C) were enrolled. The vasodilatory response to topical application of 1% MN and a placebo emulsion at the forearm and dorsum of the foot skin at 5, 15, 30, 60 and 120 min was measured using Laser Doppler Perfusion Imaging. The vasodilatory response to iontophoresis of 1% ACh and 1% SNP solutions was also evaluated. RESULTS: The maximal vasodilatory response to ACh, SNP and MN was similar at the forearm and foot level in the diabetic patients. In the control group, the responses to MN, ACh and SNP were similar on the forearm but in the foot, the MN vasodilatory response was higher when compared to the ACh and SNP responses. MN-related vasodilation was present 5 min after the application, reached its peak at 15-30 min and declined to pre-application levels 120 min afterward. CONCLUSIONS: Topical application of MN at the forearm and foot levels of diabetic neuropathic patients results in skin vasodilation that is comparable to the maximal vasodilation that can be induced by iontophoresis of ACh or SNP and lasts for less than 2 h. Further studies will be required to explore the potential of MN to increase blood flow and to prevent diabetic foot problems in clinical practice.     

Differences in Joint Mobility and Foot Pressures Between Black and White Diabetic Patients

Limited joint mobility is common in diabetes and is related to high foot pressures and foot ulceration. We have examined the differences in joint mobility and foot pressures in four groups matched for age, sex, and duration of diabetes: 31 white diabetic, 33 white non-diabetic, 24 black diabetic, and 22 non-diabetic black subjects. Joint mobility was assessed using a goniometer at the fifth metacarpal, first metatarsal, and subtalar joints. In-shoe and without shoes foot pressures were measured using an F-Scan system. Neuropathy was evaluated using clinical symptoms (Neuropathy Symptom Score), signs (Neuropathy Disability Score), and Vibration Perception Threshold. There was no difference between white and black diabetic patients in Neuropathy Symptom Score, Neuropathy Disability Score, and Vibration Perception Threshold. Subtalar joint mobility was significantly reduced in white diabetic patients (22 ± 7°) compared to white controls (26 ± 4°, black diabetic patients (25 ± 5°), and black controls (29 ± 7°), and increased in black controls compared to white controls and black diabetic patients (level of statistical significance p < 0.05). Without shoes foot pressures were higher in white diabetic patients (8.31 ± 400 kg cm^?2) compared to white controls (6.81 ± 2.31 kg cm^a2), black diabetic patients (6.2 ± 2.53 kg cm^?2) and black controls (5.00 ± 1.24 kg cm^?2) and lower in black controls compared to white and black diabetic patients (p < 0.05 in all cases). We conclude that racial differences exist in joint mobility and foot pressures between black and white subjects. Thus, in black diabetic patients the joint mobility, although reduced compared to black healthy subjects, is increased when compared to white diabetic patients. This contributes to lower foot pressures, comparable to non-diabetic white subjects and probably reduces the risk of foot ulceration in black diabetic patients.     

Cutaneous Blood Flow and Peripheral Resistance in Type II Diabetes as Compared to Intermittent Claudication Patients

Insulin deficient, type I diabetic patients have reduced skin blood flow reserve. It is not known whether these skin perfusion abnormalities also exist in non-insulin dependent (type II) diabetic patients. An additional open question is whether the reduced skin blood flow is due to increased resistance of the cutaneous microvasculature or to decreased peripheral perfusion pressure due to increased atherosclerosis in the diabetic population. We measured skin blood flow by laser Doppler flowmetry in patients with type II non-insulin treated diabetes. Limb systolic blood pressure was measured distally using a sensitive sonar Doppler device at the finger and toe. The ratio of pressure to flow was computed as an index of peripheral blood flow resistance. To assess the effect of cutaneous blood flow resistance, we elicited maximal vasodilation by increasing local skin temperature directly at the site of the laser Doppler probe. We compared blood flow and pressure in diabetic patients with the values in non-diabetic control patients. As a further control population, we also assessed these same parameters in non-diabetic patients with peripheral vascular disease, which may be expected to decrease large arterial blood flow pressure without directly affecting the microvasculature. There were 68 type II diabetic patients, 18 non-diabetic control subjects, and 25 non-diabetic patients with intermittent claudication. We measured skin blood flow at the dorsal surfaces of the finger and toe, sites with primarily nutritive capillary perfusion, and at the plantar surfaces of the finger and toe, where arteriovenous shunt perfusion predominates. Heat stimulated flow was markedly lower for the diabetic patients at the finger dorsal surface (16.5 ± 1.4 ml/min/100 g vs 29.8 ± 4.4 ml/min/100 g in the non-diabetic group (p < 0.05). The resistance index was 13.2 ± 1.9 in the diabetic patients and 6.8 ± 1.7 in the controls (p < 0.05). At the toe dorsum, basal temperature flow was significantly lower in the diabetic group (0.6 ± 0.1 ml/min/100 g) than in the non diabetic group (1.1 ± 0.2 ml/min/100 gm) with resistance index almost twice as high (379 ± 32) in the diabetic group versus non-diabetic controls (208 ± 36) [p < 0.01 for both comparisons]. With the local application of heat, there was a much larger increase in flow in the non-diabetic subjects than in the diabetic group. The resistance index dropped much more with heat stimulation for the non-diabetic patients (10.8 ± 3.3) than for the diabetic patients (50.6 ± 10.4) [p < 0.01] There was a lesser rise in flow at the toe pulp surface with heat in the diabetic patients (31.3 ± 3.0 ml/min/199 gm) than in the control subjects (45.4 ± 5.9 ml/min/100 gm; p < 0.05) with a higher resistance index (13 ± 4) than in the non-diabetic subjects (4 ± 1) [p < 0.05]. The claudication patients had substantially greater flow at the toe dorsal surface at basal temperature (2.2 ± 0.4 ml/min/100 gm) with significantly lower resistance index (126 ± 24) than the non-diabetic controls (p < 0.05). At 44°C, toe dorsum flow was significantly higher (17.8 ± 3.7 ml/min/100 gm) than in the diabetic patients with lower resistance index (17.0 ± 6.6) [p < 0.05]. Toe pulp flow at basal temperature was significantly higher (10.1 ± 2.0 ml/min/100 gm) than in either the diabetic (3.8 ± 0.6) or non-diabetic control groups (3.5 ± 1.4) [p < 0.05]. Skin blood flow is impaired in diabetes. The reduction is due to increased resistance in the capillary bed rather than to reduced perfusion pressure. The increased resistance was found only in the diabetic patients, not in the non-diabetic patients with peripheral vascular disease. To the contrary, there appeared to be a compensatory decrease in skin flow resistance in the patients with peripheral vascular disease. Thus, there is a small vessel disease which impairs cutaneous perfusion in diabetes, but there is no such effect on skin blood flow in non-diabetic patients with large vessel disease.     

Evaluation of Achilles tendon thickening in type 2 diabetes mellitus.

AIM: To investigate the effect of diabetes mellitus on the Achilles tendon, which may contribute to the long-term complications in the foot-ankle complex and to investigate the factors relating to its thickening. METHODS: The study group included 55 patients (26 female and 29 male) with type 2 DM, while the control group included 34 non-diabetic people (13 female and 21 male). We matched the female and male DM patients with their respective control groups in terms of age, BMI, height and body weight. Clinical and biochemical tests, as well as ultrasonographic evaluations of the internal carotid artery and the Achilles tendon, were carried out to evaluate the complications of diabetes mellitus, and to compare the Achilles tendon thickness (ATT) between the study and the control groups. RESULTS: In the female groups the Achilles tendon was significantly thicker in the diabetic patients than in their healthy controls (p<0.001). However, no difference was found in the ATT between the male diabetic patients and their male controls (p=0.74). The ATT correlated with the body mass index (BMI) (r=0.47, p=0.015) and body weight in diabetic female group (r=0.56, p=0.003). We also observed that the ATT values were higher in male DM patients with retinopathy (p=0.034) or neuropathy (p=0.019) compared to the male DM patients without these complications. CONCLUSIONS: The ATT in type 2 female diabetic patients was found to be higher than their non-diabetic controls, but no significant difference could be found between type 2 diabetic male patients and their non-diabetic controls by US. Our results might indicate a possible impact of diabetes on the ATT depending upon gender, but other mechanisms may also contribute to thickening of Achilles tendon.