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Heat‐washout – an objective method for diagnosing neuropathy and atherosclerosis in diabetic patients
Author(s) -
Midttun M.,
Snorgaard O.
Publication year - 2013
Publication title -
clinical physiology and functional imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.608
H-Index - 67
eISSN - 1475-097X
pISSN - 1475-0961
DOI - 10.1111/cpf.12028
Subject(s) - medicine , forefoot , intermittent claudication , diabetes mellitus , peripheral neuropathy , cardiology , type 2 diabetes , diabetic neuropathy , peripheral , claudication , surgery , vascular disease , arterial disease , complication , endocrinology
Summary Background The heat‐washout method is an objective method that measures cutaneous blood flow rate ( BFR ) in ml (100 g. min) −1 , previously found useful for measuring toe BFR in non‐diabetic patients with claudication. Aim The method is used for evaluating the presence of a veno‐arteriolar reflex ( VAR ) in the forefoot and signs of atherosclerosis in the first toe in type 2 diabetics. Methods Nine type 2 diabetics for +10 years, peripheral neuropathy, median age 62, and 9 healthy subjects without diabetes, median age 52 were examined for the presence of a VAR in the forefoot. A VAR was present when BFR decreased 25% or more with the foot 50 cm below heart level. Examinations for atherosclerosis were made in the pulp of the first toe. An increase in BFR of 50% or more with the foot 50 cm below heart level indicated the presence of atherosclerosis. Results The VAR was significantly attenuated in type 2 diabetics with neuropathy compared to controls, ( P <0·01). Only one patient with known neuropathy and diabetes showed a reflex compared to eight out of nine controls ( P <0·01). The VAR was correlated to the vibration perception threshold measured with biothesiometry ( r = −0·661, P = 0·0003). Two patients with type 2 diabetes and neuropathy without clinical sign of peripheral artery disease (PAD) had an abnormal response similar to that seen in subjects with intermittent claudication. Conclusion The heat‐washout method seems useful as and objective method for evaluating as well the presence of a VAR as atherosclerosis in type 2 diabetics.