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Autonomic Neuropathy and Diabetic Foot Ulceration
Author(s) -
Edmonds M. E.,
Nicolaides K. H.,
Watkins P. J.
Publication year - 1986
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.1986.tb00708.x
Subject(s) - medicine , peripheral neuropathy , diabetes mellitus , cardiology , autonomic neuropathy , surgery , endocrinology , biology , genetics , cell culture , neuroblastoma
Autonomic function was studied in three groups of insulin‐dependent diabetic patients. Heart rate changes during deep breathing and on standing were significantly less in 28 patients with a recent history of foot ulceration compared with 40 patients with peripheral neuropathy but without ulceration ( p <0.001) and 54 patients without neuropathy ( p <0.001). Sympathetic function was assessed in 36 of these patients from peripheral arterial diastolic flow patterns obtained by Doppler ultrasound measurements and expressed as the pulsatility index (PI). Patients with a history of ulceration ( n = 10) showed considerably increased diastolic flow (Pl = 4.28 ± 0.53, mean ± S.E.M.) compared with 12 neuropathic patients with no history of ulceration (Pl = 7.80 ± 0.68, p <0.002) and 14 patients without neuropathy (Pl = 9.55 ± 0.89, p <0.002). Severely abnormal autonomic function occurs in association with neuropathic foot ulceration, but patients without ulcers have lesser degrees of autonomic neuropathy, thus a causal relationship has not been established.