Impaired skin microcirculation in paediatric patients with type 1 diabetes mellitus

Abstract

Aims/hypothesisWe used Laser Doppler Fluximetry (LDF) to define "normal" endothelial function in a large cohort of healthy children and adolescents and to evaluate skin microcirculation in paediatric patients with type 1 diabetes mellitus.MethodsLDF was performed in 102 healthy children (12.8 ± 3.3 years of age; 48 male) and 68 patients (12.9 ± 3.3 years of age; 33 male). Duration of disease was 5.0 ± 3.97 years. Each participant sequentially underwent three stimulation protocols (localized thermal hyperaemia with localized warming to maximum 40°C, iontophoretic delivery of pilocarpine hydrochloride (PCH) and sodium nitroprusside (SNP)). The maximum relative increase in skin blood flow and the total relative response, i.e. the area under the curve (AUC) to each stimulus (AUCheat, AUCPCH, AUCSNP) was determined. In addition, the area of a right-angled triangle summarizing the time to and the amplitude of the first peak, which represents the axon reflex mediated neurogenic vasodilation (ARR) was calculated.ResultsIn healthy controls, AUCheat, AUCPCH, AUCSNP, and ARR turned out to be independent of sex, age, and anthropometric values. Per parameter the 10th percentile generated from data of healthy controls was used as the lower threshold to define normal endothelial function. Diabetic patients showed significantly reduced vasodilatative response to either physical or pharmacological stimulation with SNP, whereas the response to PCH was comparable in both cohorts. In patients compared to controls i) a significantly higher frequency of impaired vasodilatation in response to heat and SNP was noted and ii) vascular response was classified as pathological in more than one of the parameters with significantly higher frequency.Conclusions/interpretationSkin microvascular endothelial dysfunction is already present in about 25% of paediatric type 1 diabetic patients suffering from type 1 diabetes for at least one year. Future studies are needed to assess the predictive value of endothelial dysfunction in the development of long-term (cardio)vascular comorbidity in these patients.

Assessment of heat provocation tests on the human gingiva: the effect of periodontal disease and smoking

“…Heat challenge to the skin is usually applied using a thermostatic heating probe device made of solid metal (13,41,47). But this method is not practical in the case of the gingiva because its surface is curved; in addition, the heating device could mechanically compress the thin gingival tissues including vessels.…”

Impaired Microcirculation in Children After Kidney Transplantation: Everolimus Versus Mycophenolate Based Immunosuppression Regimen

“…As control group for microvascular function we used data from 82 healthy children, which was obtained previously for another study by our workgroup [18]. Furthermore, normal plasma levels for Ang 1 and Ang 2 were obtained from a group of 38 age-matched healthy children for this study.…”

“…Optical assessment of skin microvascular function has been used for diagnostic purposes in adults for more than 20 years [13][14][15][16], and in recent years cutaneous laserDoppler fluximetry (LDF) has become accepted as an easy and noninvasive method to investigate microcirculation and/or the neurogenic vasodilation response secondary to physical or pharmacological stimulation in children [17,18]. A study of both cross-sectional and longitudinal design in adults with end-stage renal disease revealed that an impaired cutaneous local thermal hyperemic response was associated with increased cardiovascular mortality [5].…”

Prospects of Laser Doppler flowmetry application in assessment of skin microcirculation in diabetes

“…Нарушения функций эндотелия приводят к нарушению синтеза NO, что отражается в снижении постокклюзи-онной реактивной гиперемии, по степени выраженно-сти которой исследователи судят об объемах резервов кровотока [21,22]. Для оценки эндотелиальной функ-ции у пациентов с СД могут применяться и другие виды функциональных воздействий: фармакологические и температурные пробы [50]. Дисфункция эндотелия в этих случаях также проявляется снижением вазодила-таторной реакции на стимулы.…”

“…Было показано, что в формировании температурной вазоди-латации участвуют как эндотелий, так и аксональные рефлексы [23]. Оценка с помощью одного вида воздей-ствия сразу нескольких звеньев регуляции микроцирку-ляторной сети, на каждом из которых могут наблюдаться изменения, приводит к увеличению вероятности обнару-жения статистически значимых отклонений микроцир-куляции у пациентов с СД [50,51].…”