Why the study?
Does autonomic neuropathy influence toe blood pressure in diabetic patients without peripheral vascular disease?
Does autonomic neuropathy influence toe blood pressure in diabetic patients without peripheral vascular disease?
Autonomic neuropathy in diabetic patients without peripheral vascular disease reduces toe blood pressure, indicating it cannot be reliably used as an ischemic index in this population.
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Autonomic neuropathy was associated with lower TBP and TBI in NIDDM without PVD; leaves open whether TBI remains a valid ischemic index.
OBJECTIVE: To assess the influence of autonomic neuropathy on toe blood pressure (TBP), a parameter used currently as an ischemic index. RESEARCH DESIGN AND METHODS: The age-matched study subjects included 20 non-insulin-dependent diabetes mellitus (NIDDM) patients with autonomic neuropathy (DN) and 10 NIDDM patients without autonomic neuropathy (D), assessed by standard cardiovascular tests and galvanic skin response, and 8 control subjects (C). None of the subjects had peripheral vascular disease (PVD) (ankle/brachial index 0.9-1.1. RESULTS: The TBP and toe/brachial index (TBI) were significantly lower in DN than in C and D (P < 0.01). The saturation index (SI), the ratio between foot venous and arterial partial pressure of oxygen (PO2), was significantly higher in DN than in C and D (P < 0.05). An inverse relationship was found between TBI and SI (r = 0.554, P = 0.001). CONCLUSIONS: The autonomic nervous system directly influences peripheral circulation. In diabetic patients without PVD, a failure of sympathetic fibers caused by autonomic neuropathy could lead to a reduction of TBP. Therefore, TBP cannot be used as an ischemic index in diabetic patients.
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Uccioli et al. (1994) studied this question.
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