Ann Atheroscler Res | Volume 1, Issue 2 | Research Article | Open Access
Ágnes Diószegi1, Melinda Vass1, Anna Flaskó1, Kristóf Gál1, Ferenc Mechler2, Miklós Káplár3, László Csiba2* and Pál Soltész1
1Department of Internal Medicine, University of Debrecen, Hungary
2Department of Neurology, University of Debrecen, Hungary
3Department of Internal Medicine, University of Debrecen, Hungary
*Correspondance to: László CsibaFulltext PDF
Diabetic leg developing with vascular and neuropathic path mechanism is a late onset complication of diabetes mellitus. Connection and therapeutic manageability of the two mechanisms is in close correlation, but it is still an unsolved issue. In our study we performed complex examination of patients presenting with symptoms referring to polyneuropathy. With ENG analysis we determined the conduction velocity, amplitude and distal latencies. Examination of motor fibres was performed by stimulating the peroneal nerve, while sensory fibres were assessed through stimuli of the sural nerve and the peroneal nerve. Presence of macro vascular involvement was confirmed by ankle-brachial index test and by Duplex ultrasound. Microcirculation was assessed by laser-Doppler test, triggering the Venous-Arteriolar (VA) reflex. During the measurement we detected the metabolic status by monitoring cholesterol, triglyceride, LDL, HDL, A1C levels and parameters of renal function, which were then compared to the above specified factors. We performed our examinations in the age- and gender-specific control group. We examined 50 (34 males, 16 females) patients presenting with polyneuropathic complaints with average ages of 64, 62 years. Average duration of the disease being present was 15.38 years. Regarding the tests assessing microcirculation, when analysing the Venous-Arteriolar (VA) reflex within the control group, we detected significantly higher (78% vs. 31.8%; p=0.001) decrease in conduction velocity, compared to the diabetic patient group. We discovered significant correlation between the level of A1C characterizing the glycaemic control, and the decreased VA reflex response referring to microcirculatory disorder resulting from a neurogenic damage (R=0.322; p=0.024). We also found a similar association between increased triglyceride level and these pathological reflex response (R=0.35; p=0.015). ENG confirmed the presence of peripheral polyneuropathy (in 40% very severe, mixed type sensory-motoric neuropathy with axonal dominance, in 48% moderately severe, mixed type sensory-motoric neuropathy, in 6% severe sensory-motoric neuropathy with demyelinising dominance, and in 6% of them sensory-motoric neuropathy) in all cases. On the other hand we have not found a significant correlation between neuropathy confirmed by the ENG examination and the severity of the microcirculation disorder. Our results suggest that among macroangiopathic involvement of a diabetic leg, type and severity of the presenting neuropathy, the metabolic status of the patient and the observed microcirculation disorder, the latter one, the VA reflex measured by laser-Doppler is suitable for complex characterization of neuropathic, microcirculatory and metabolic status.
Diabetes mellitus; Neuropathy; Microcirculatory damage
Diószegi Á, Vass M, Flaskó A, Gál K, Mechler F, Káplár M, et al. Analysis of the Correlation between Microvascular Involvement and Neuropathy in Association with Metabolic Disorders in Case of Diabetic Leg Syndrome. Ann Atheroscler Res. 2018;1(2):1008.