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  • 1
    Electronic Resource
    Electronic Resource
    Evaluation of thermal and vibration sensation in diabetic neuropathy (1985)
    Springer
    Diabetologia 28 (1985), S. 131-137 
    Details
    ISSN: 1432-0428
    Keywords: Diabetes mellitus ; neuropathy ; thermal sensation ; vibration perception threshold
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Sensory evaluation of diabetic neuropathy was undertaken by a new technique for assessment of thermal sensitivity. The method is simple and reproducible, and the mean normal value of the lateral border of the foot was 6.0 °C (3.6–9.8 °C, 95% confidence limits). Four groups of patients with diabetic neuropathy were examined: 22 with neuropathic ulcers and/or Charcot joints (groups 1 and 2); all showed severe abnormalities (range 10.8-〉30 °C), frequently more than three times the upper limit of normal. In contrast thermal sensitivity in 15 patients with painful neuropathy (group 4) varied from normal to grossly abnormal (range 3.9-〉30 °C) confirming this form of neuropathy as a distinct entity. The majority of those 10 patients with autonomic neuropathy alone (group 3) had abnormal thermal sensitivity (range 6.4-〉30 °C). Comparison of thermal sensitivity (a small fibre modality) with vibration perception threshold (a large fibre modality) showed that thermal sensitivity is sometimes selectively affected, especially in those with painful neuropathy, suggesting that the small fibres are more vulnerable in diabetes. Frequent involvement of the hands confirms the “stocking and glove” distribution of diabetic neuropathy. We conclude that impairment of thermal sensivity is the rule in symptomatic diabetic neuropathy and its assessment provides a simple quantitive measurement suitable for long-term studies of its natural history.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00273859
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  • 2
    Electronic Resource
    Electronic Resource
    Diabetic autonomic neuropathy (1980)
    Springer
    Diabetologia 18 (1980), S. 471-478 
    Details
    ISSN: 1432-0428
    Keywords: Diabetes ; autonomic neuropathy ; peripheral neuropathy ; heart rate
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The use of heart rate monitoring in the diagnosis of diabetic autonomic neuropathy, and its value in observing the natural history of this disorder, has been assessed. Two tests were used: measurement of heart rate variation during deep breathing and of heart rate change on standing up. Two hundred and eighty seven diabetics aged between 20 and 49 years were studied, and 21 of them were observed repeatedly over 3 to 5 years. Heart rate variation (HRV) on deep breathing proved to be the more sensitive diagnostic index of autonomic neuropathy and was abnormal or borderline in 62 of 64 patients with established autonomic symptoms. Autonomic abnormalities were also detected in some diabetics without autonomic symptoms especially in those with peripheral neuropathy, 30% of whom had abnormal HRV on deep breathing. Abnormal tests appeared to represent permanent autonomic damage and may be present for years without the development of autonomic symptoms, occasionally (7%) preceding any other manifestation of diabetic neuropathy. Serial observations of HRV on deep breathing over 3 to 5 years showed little change, although overall there was a small deterioration of autonomic function, with a decrease of HRV score of 1.0 per year. The tests used are simple, and provide quantitative bedside measurements of autonomic function. When heart rate variation is normal, autonomic neuropathy is virtually excluded.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00261703
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  • 3
    Electronic Resource
    Electronic Resource
    Cardiovascular effects of insulin: Plasma volume changes in diabetics (1978)
    Springer
    Diabetologia 15 (1978), S. 453-457 
    Details
    ISSN: 1432-0428
    Keywords: Diabetes ; insulin ; plasma volume ; heart rate ; blood pressure ; autonomic neuropathy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The mechanism by which insulin can alter the heart-rate and blood pressure of diabetics has been studied. Insulin decreased the plasma volume of 16 diabetics without complications by an average of 190 ml, a 6% change. Nine diabetics with severe autonomic neuropathy had no significant change in plasma volume after insulin. The basal plasma volume of autonomic neuropathy patients was smaller than that of the uncomplicated diabetics, perhaps accounting for the disparity observed between these two groups of diabetics. The decrease of plasma volume could thus account for the heart rate increase of uncomplicated diabetics, but not for the induction of hypotension in those with autonomie neuropathy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02342869
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  • 4
    Electronic Resource
    Electronic Resource
    Blood flow in the diabetic neuropathic foot (1982)
    Springer
    Diabetologia 22 (1982), S. 9-15 
    Details
    ISSN: 1432-0428
    Keywords: Blood flow ; diabetic neuropathy ; neuropathic ulcer ; Charcot joint ; transit time ; Doppler technique
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The mechanisms which underlie the development of Charcot joints and foot ulceration are poorly understood. The present study using non-invasive Doppler techniques demonstrates that in the neuropathic leg, the arteries are rigid, peripheral blood flow is increased and associated with arteriovenous shunting. We studied 10 diabetics with severe neuropathy (including five with Charcot changes), 16 diabetics without neuropathy and 10 control subjects. Markedly abnormal blood velocity profiles (sonograms) were demonstrated only in those patients with severe neuropathy. They showed increased diastolic flow (indicated by a reduced Pulsatility Index of 2.88 ±0.8 (mean ±SD) compared with 9.53±4.0 (p〈0.001) in the diabetics without neuropathy and 10.8±3.7 (p〈0.001) in the control subjects) suggesting arteriovenous shunting. Increased rigidity was indicated by decreased transit times -57±6.3 ms (mean±SD) in the diabetics with neuropathy compared with 66 ±7.6ms (p〈0.01) in the diabetics without neuropathy and 67±9.1 ms (p〈0.05) in the control subjects. This was accompanied by raised ankle systolic pressures -199±22 mmHg (mean +SD) in the diabetics with neuropathy compared with 151±15 mmHg, (p〈0.001) in the diabetics without neuropathy and 146±18 mmHg (p〈0.001) in the control subjects. Medial wall calcification occurred almost exclusively in the neuropathic subjects. These alterations in blood flow which include arteriovenous shunting may be important in the pathogenesis of complications of the neuropathic leg.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00253862
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  • 5
    Electronic Resource
    Electronic Resource
    Direct measurement of capillary blood flow in the diabetic neuropathic foot (1988)
    Springer
    Diabetologia 31 (1988), S. 652-656 
    Details
    ISSN: 1432-0428
    Keywords: Blood flow ; capillaries ; diabetic neuropathy ; foot ; television microscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The two major components of the microcirculation in the diabetic neuropathic foot have been examined in detail. Nutritive capillary blood flow was measured directly using the non-invasive technique of television microscopy, applied to the toe nailfold. Arteriovenous shunt flow was assessed using the technique of laser Doppler flowmetry, applied to the toe pulp. Fourteen diabetic patients with peripheral and autonomic neuropathy, 11 with no clinical evidence of neuropathy and 14 normal subjects were studied. Laser Doppler flowmetry (predominantly arteriovenous shunt flow) was increased more than three-fold (p〈0.01) in the diabetic patients with neuropathy compared to control subjects, (median 3.57, interquartile range 2.00–5.32 volts vs median 0.93, interquartile range 0.47–2.36 volts respectively). There was no evidence of skin capillary closure. The calculated capillary blood flow (erythrocyte flux) was significantly increased in the diabetic neuropathic patients compared to control subjects (median 76.4, interquartile range 34.4–109.8 picolitres/s vs median 23.2, range 8.0–44.8 picolitres/s, p〈0.01). This study demonstrates that foot skin capillary blood flow is increased in diabetic patients with neuropathy. There is, therefore, no evidence to support the supposition that capillary ischaemia, either secondary to a “capillary steal phenomenon” or “advanced microangiopathy”, is a feature of diabetic neuropathy under resting conditions.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00278747
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  • 6
    Electronic Resource
    Electronic Resource
    Capillary blood flow in the diabetic neuropathic foot (1989)
    Springer
    Diabetologia 32 (1989), S. 330-330 
    Details
    ISSN: 1432-0428
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00265554
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  • 7
    Electronic Resource
    Electronic Resource
    Morphometry of endoneurial capillaries in diabetic sensory and autonomic neuropathy (1990)
    Springer
    Diabetologia 33 (1990), S. 611-618 
    Details
    ISSN: 1432-0428
    Keywords: Diabetic neuropathy ; hereditary motor and sensory neuropathy ; sural nerve ; endoneurial capillaries ; basal lamina
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Nerve biopsies were obtained from 27 patients with diabetic neuropathy. All had a symmetric distal sensory and autonomic neuropathy or a purely sensory neuropathy. Mean age was 39.8 years (range 23–57 years). Two patients had Type 2 (non-insulin-dependent) diabetes mellitus and the remainder Type 1 (insulin-dependent) diabetes. Morphometric observations on endoneurial capillaries were compared with results from organ donor control cases and from patients with type 1 hereditary motor and sensory neuropathy. The area of the lumen of the capillaries did not differ between the three groups. The area occupied by the capillary endothelial cells in transverse section and the number of endothelial cell nuclei were increased both in the patients with diabetic neuropathy and hereditary motor and sensory neuropathy, as was the thickness of the surrounding basal laminal zone. ‘Closure’ of endoneurial capillaries in diabetic neuropathy, reported in another study, was not confirmed. Capillary density and nearest-neighbour distances were similar in the diabetic and organ donor control cases. Capillary density was reduced in the patients with hereditary motor and sensory neuropathy, this being related to increased fascicular area consequent upon the presence of hypertrophic changes. The presence of thickening of the pericapillary basal laminal zone and endothelial cell hyperplasia both in diabetic and hereditary motor and sensory neuropathy, the latter being a neuropathy in which a vascular basis can be discounted, makes it difficult to use such changes as an argument favouring a vascular cause for diabetic neuropathy. There were differences in the basal laminal zone between the diabetic and hereditary motor and sensory neuropathy cases suggesting that the reduplicated basal lamina was more persistent in the diabetic patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00400205
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  • 8
    Electronic Resource
    Electronic Resource
    Book review (1994)
    Springer
    Diabetologia 37 (1994), S. 1170-1170 
    Details
    ISSN: 1432-0428
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00418386
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  • 9
    Electronic Resource
    Electronic Resource
    Elevated serum levels of macrophage-derived cytokines precede and accompany the onset of IDDM (1996)
    Springer
    Diabetologia 39 (1996), S. 60-69 
    Details
    ISSN: 1432-0428
    Keywords: Cytokines ; T helper subsets ; interleukin-2 ; interferon-γ ; interleukin-1 ; tumour necrosis factor ; prediabetes ; identical twins
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary To determine whether cytokines could have a role in the development of insulin-dependent diabetes mellitus (IDDM), we measured serum levels of cytokines derived from T helper 1 (interleukin-2 and interferon-γ), T helper 2 (interleukin-4 and inter-leukin-10) lymphocytes and macrophages (tumour necrosis factor-α, interleukin-1 α and interleukin-1 Β) in patients before and after the onset of IDDM. Recently diagnosed IDDM patients had significantly higher levels of interleukin-2, interferon-γ, tumour necrosis factor-α and interleukin-1 α than patients with either long-standing IDDM, non-insulin-dependent diabetes (NIDDM), Graves' disease, or control subjects (p〈0.05 for all). Compared with control subjects, patients with long-standing IDDM and those with NIDDM had higher interleukin-2 and tumour necrosis factor-α levels (p〈0.01 for all). Interleukin-4 and interleukin-10 were detectable in sera of patients with Graves' disease only, while interleukin-1 Β was not detectable in the serum of any control or test subject. To investigate whether high cytokine levels precede the onset of IDDM, we studied 28 non-diabetic identical co-twins of patients with IDDM, followed-up prospectively for up to 6 years after the diagnosis of the index. Levels of tumour necrosis factor-α and interleukin-1 α were elevated above the normal range more frequently in the eight twins who developed diabetes than in those 20 who did not (p〈0.005). Analysis of T helper 1 and T helper 2 profiles of the twin groups did not reveal a clear difference between prediabetic twins and twins remaining non-diabetic. These results support the notion that T helper 1 lymphocytes may play a role in the development of IDDM. This is associated with release of macrophage-derived cytokines, which is also a feature of the prediabetic period. The lack of evidence of a dominant T helper 1 profile of cytokine release before diabetes onset suggests that additional events, activating this arm of the cellular immune response, are required in the immediate prediabetic period.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00400414
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  • 10
    Electronic Resource
    Electronic Resource
    Selective neuropathy and preserved vascular responses in the diabetic Charcot foot (1992)
    Springer
    Diabetologia 35 (1992), S. 148-154 
    Details
    ISSN: 1432-0428
    Keywords: Charcot arthropathy ; selective neuropathy ; blood flow
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Charcot arthropathy is a disabling complication of diabetic neuropathy. It is however, unclear why it occurs in only a small number of neuropathic patients. We have studied 12 diabetic patients (10 insulin-dependent) with an acute Charcot arthropathy, and compared their neuropathy and vascular responsiveness with 12 diabetic patients (10 insulin-dependent) with recurrent neuropathic foot ulceration, 12 diabetic control subjects (9 insulin-dependent) and 10 normal non-diabetic subjects. The Charcot arthropathy patients demonstrated a preservation of warm perception, 6 (5.5) °C, but complete loss of peripheral cold perception, 10 (0) °C, p〈0.001 (median (interquartile range)). This contrasted with the ulcerated neuropathy patients, who had equally severe impairment of both warm and cold sensory thresholds, 10 (0.5) °C vs 10 (1) °C, respectively, the diabetic control subjects who were able to detect a 2 (1.3) °C warm stimulus and 3 (3.5) °C cold stimulus and the normal subjects, whose warm threshold was 2 (1) °C and cold was 2 (1) °C. Light touch perception at the foot was preserved in the Charcot patients 4 (4) g vs 100 (50) g, p〈0.0002, in the ulcerated neuropathy patients. Vibration perception at the great toe and cardiovascular autonomic function tests (heart rate variability, Valsalva ratio and postural systolic blood pressure fall) were abnormal in both the Charcot patients and ulcerated neuropathy group, with no differences seen between the two groups. Peak skin blood flow at the great toe in response to local heating was preserved in the Charcot arthropathy patients, 63.36 (28.72) flow units when compared to the diabetic and normal subjects, 62.72 (47) flow units and 76.3 (33.92) flow units, respectively and much greater than in the ulcerated neuropathy patients 28.94 (37.39) flow units, p〈0.0002. The diabetic patients developing Charcot arthropathy thus have a neuropathy and vascular responsiveness which distinguishes them from diabetic subjects developing neuropathic ulceration. This may be important in the pathogenesis of the Charcot foot.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00402547
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