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Non‐cardiac Autonomic Tests in Diabetes: Use of the Galvanic Skin Response
Author(s) -
Macleod A. F.,
Smith S. A.,
Cowell T.,
Richardson P. R.,
Sonksen P. H.
Publication year - 1991
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.1464-5491.1991.tb02160.x
Subject(s) - medicine , skin conductance , diabetes mellitus , peripheral , sural nerve , nerve conduction velocity , diabetic neuropathy , peripheral neuropathy , cardiology , surgery , endocrinology , biomedical engineering
Diabetic peripheral neuropathy affects both large myelinated and small unmyelinated nerve fibres. It has been proposed that the small unmyelinated fibres, responsible for pain and temperature sense, and autonomic function, are involved early, particularly in subjects with painful symptoms, and may be important in foot ulceration. The sympathetic skin response has been used to investigate the function of small unmyelinated sympathetic fibres in the limbs of diabetic subjects. Changes in skin resistance at the fingers and toes have been measured simultaneously after a sound stimulus. These procedures were controlled using a microcomputer. Data collected from 55 diabetic subjects, randomly selected from the diabetic clinic, have been compared with results from conventional tests of large motor and sensory fibres and autonomic function. The ratio of the change in skin resistance for toes to fingers correlated with sural and posterior tibial nerve conduction velocity (correlation coefficients 0.54 and 0.42, p < 0.001 and p < 0.01, respectively), with the expired to inspired ratio (correlation coefficient 0.51, p < 0.01), and inversely with vibration perception threshold in the feet (correlation coefficient 0.50, p < 0.001). Correlation with the dark adapted pupil diameter, however, only just achieved statistical significance (correlation coefficient 0.27, p = 0.043). We propose that this simple test may elucidate the role of the peripheral autonomic system in diabetic neuropathy.