Relation of Skin Capillary Pressure in Patients with Insulin-Dependent Diabetes Mellitus to Complications and Metabolic Control

Sandeman, Derek D.; Shore, Angela C.; Tooke, John E.

doi:10.1056/nejm199209103271103

Cited by 177 publications

(122 citation statements)

References 30 publications

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“…Reduction of hydrostatic pressure in the microcirculation has been suggested as a likely factor. Direct [48] and indirect evidence suggest that capillary hydrostatic pressure is elevated in IDDM patients [47,49], while normal capillary pressure (finger nail fold) has been reported in normotensive NIDDM patients [50]. However, increased capillary pressure has been documented in essential hypertension [51] and hypertension was prominent in our NIDDM patients with (83 %) and without (30 %) diabetic nephropathy.…”

Section: Discussionmentioning

confidence: 64%

Macro-microangiopathy and endothelial dysfunction in NIDDM patients with and without diabetic nephropathy

et al. 1996

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Insulin-dependent diabetic (IDDM) patients with incipient and overt diabetic nephropathy are characterized by a higher incidence and prevalence of retinopathy and cardiovascular diseases than normoalbuminuric IDDM patients [1,2]. The relative cardiovascular mortality is approximately 40 times higher in diabetic nephropathy as compared to the age-matched population [1]. Furthermore, the prevalence of

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Section: Discussionmentioning

confidence: 64%

Macro-microangiopathy and endothelial dysfunction in NIDDM patients with and without diabetic nephropathy

et al. 1996

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“…31,32 Reduced net capillary fluid absorption during hypovolaemic circulatory stress has earlier been found in type 1 diabetes patients without microvascular complications, 16 and seemed linked to a reduction in capillary filtration coefficient (CFC) rather than differences in the regulation of capillary hydrostatic pressure or changed metabolic milieu caused by changes in insulin and glucose concentrations, as discussed in Olsen and Lanne 14 and Olsen et al 15 Furthermore, there are indications of reduced precapillary resistance in type 1 diabetes patients, possibly reducing transcapillary driving force. 33 The attenuated FVR response in DMR+ during hypovolaemia could thus further aggravate the reduction in fluid absorption ( Table 1).…”

Section: Discussionmentioning

confidence: 99%

Impaired compensatory response to hypovolaemic circulatory stress in type 1 diabetes mellitus

Lindenberger

Olsen

Länne

2011

Diabetes and Vascular Disease Research

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Diabetes mellitus is associated with decreased haemodynamic stability and reduced tolerance to hypovolaemia. Compensatory haemodynamic responses during experimental hypovolaemia in type 1 diabetes patients with (DMR+) and without (DMR-) retinopathy as well as healthy controls (C) were studied. Lower body negative pressure created hypovolaemic circulatory stress. Volumetric techniques were used to assess the compensatory capacitance response (redistribution of peripheral venous blood to the central circulation) and to assess capillary fluid absorption from tissue to blood. The compensatory capacitance response was 1/3 lower in DMR+ compared with C (p = 0.002) and DMR-(p = 0.01). Net capillary fluid absorption was reduced by one-third in DMR-and DMR+ compared with C (each p < 0.05). Type 1 diabetes patients with retinopathy demonstrate reduced mobilisation of peripheral venous blood to the central circulation. Furthermore, type 1 diabetes patients present with impaired capillary fluid absorption, which in combination with potentially decreased sympathetic vasoconstriction impedes cardiovascular homeostasis during acute hypovolaemic stress.

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“…This increase in diameter of the capillaries is probably the result of long-standing increased capillary blood flow, cq capillary pressure. Recently Sandeman et al found nail-fold capillary hypertension early in the course of diabetes [26], Long-standing raised capillary pressure is supposed to induce late structural changes, which ultimately lead to loss of microvascular function and relative under-perfusion, which can result in reduced healing potential of skin following minor injury [27,28], If the increase in capillary flow due to sympa thetic denervation as found in our study, exist in diabetic neuropathic feet, it may in parallel accelerate and compound intrinsic microvascular functional abnormalities.…”

Section: Discussionmentioning

confidence: 99%

The influence of ulnar nerve blockade on skin microvascular blood flow*

Netten

Wollersheim

Gielen

et al. 1995

Eur J Clin Investigation

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Abstract. Microvascular research is seriously ham pered by the great temporal and spatial variability of the measured skin blood flow and variation in sympa thetic vasomotor reflexes within and between persons. Therefore skin vasomotor reflexes were studied before and after ulnar nerve blockade within the same person, resulting in a temporal complete denervation of the fifth finger and partial denervation of the fourth finger. Skin temperature and laser Doppler flux (LDF) were registrated to measure predominantly arteriove nous shuntflow. Measurements were performed on the palmar tip of the second and fifth finger in nine healthy volunteers, at baseline, and during a sympa thetic reflex test (i.e. inspiratory gasp) and postural response test. Beat-to-beat digital blood pressure was recorded from the third and fourth finger by a Finapres device. Baseline capillary blood cell velocity (CBV) was measured at the nailfold of the second and the fifth finger. After ulnar blockade baseline skin temperature, LD F and CBV increased significantly, with respectively (mean ± SE) 3*2±0*9°C, 20*9 ±5*9 relative perfusion units and 0*79 ±0*40 m m " 1 s. The percentage LDF decrease of the fifth finger during inspiratory gasp was 48*2 ±5*3% before and 3*1 ±0-9% after blockade. The postural response test showed a decrease in LDF of the fifth finger with no significant difference before and after block ade, respectively 12*3 ±14*7% and 8*0±2*7%, while no difference was found in the increase in digital blood pressure in the denervated fourth finger compared to both the same finger before blockade and to the third non-blocked finger. It is concluded that ulnar nerve blockade enables the study of sympathetic skin vasomotor reflexes by comparison of a denervated and a non-denervated vascular bed within the same person. After ulnar blockade arteriovenous shunt flow as well as nutritional capillary blood flow increased significantly. Postural vasoconstrictor response is not abolished by ulnar blockade, suggesting that local regulatory mechanisms are more important.

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Relation of Skin Capillary Pressure in Patients with Insulin-Dependent Diabetes Mellitus to Complications and Metabolic Control

Abstract: Nail-fold capillary hypertension may develop early in the course of diabetes, before the emergence of microvascular disease, and may be influenced by changes in metabolic control.

Cited by 177 publications

References 30 publications

Macro-microangiopathy and endothelial dysfunction in NIDDM patients with and without diabetic nephropathy

Macro-microangiopathy and endothelial dysfunction in NIDDM patients with and without diabetic nephropathy

Impaired compensatory response to hypovolaemic circulatory stress in type 1 diabetes mellitus

The influence of ulnar nerve blockade on skin microvascular blood flow*

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