Post-occlusive reactive hyperaemia of skin microvasculature and foot complications in type 2 diabetes

Sean M Lanting; Alex L Barwick; Stephen M Twigg; Nathan A Johnson; Michael K Baker; Simon K Chiu; Ian D Caterson; Vivienne H Chuter

doi:10.1016/j.jdiacomp.2017.05.005

Post-occlusive reactive hyperaemia of skin microvasculature and foot complications in type 2 diabetes

J Diabetes Complications. 2017 Aug;31(8):1305-1310. doi: 10.1016/j.jdiacomp.2017.05.005. Epub 2017 May 14.

Authors

Sean M Lanting¹, Alex L Barwick², Stephen M Twigg³, Nathan A Johnson⁴, Michael K Baker⁵, Simon K Chiu⁶, Ian D Caterson⁷, Vivienne H Chuter⁸

Affiliations

¹ School of Health Sciences, University of Newcastle, Australia. Electronic address: Sean.Lanting@newcastle.edu.au.
² Charles Perkins Centre, University of Sydney, Australia.
³ Charles Perkins Centre, University of Sydney, Australia; Sydney Medical School, University of Sydney, Australia.
⁴ Charles Perkins Centre, University of Sydney, Australia; Discipline of Exercise and Sport Science, University of Sydney, Australia.
⁵ School of Exercise Science, Australian Catholic University, Australia.
⁶ School of Health Sciences, University of Newcastle, Australia.
⁷ Charles Perkins Centre, University of Sydney, Australia; Sydney Medical School, University of Sydney, Australia; School of Exercise Science, Australian Catholic University, Australia; Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Australia.
⁸ School of Health Sciences, University of Newcastle, Australia; Priority Research Centre for Physical activity and Nutrition, University of Newcastle.

PMID: 28545894
DOI: 10.1016/j.jdiacomp.2017.05.005

Abstract

Aims: Diabetes-related microvascular disease has been implicated in the development of foot ulceration and amputation. Assessment of microvascular function may be effective in identifying those at risk of diabetic foot complications. We investigated the relationship between active or previous foot complication and post-occlusive reactive hyperaemia (PORH) measured by laser-Doppler fluxmetry (LDF) in people with type 2 diabetes.

Methods: PORH measures were obtained from the hallux apex in 105 people with type 2 diabetes. Associations were investigated between active or previous foot complication and PORH measures: time to peak (TtPeak) and peak as a percentage of baseline (P%BL). Multinomial logistic regression was used to determine the association of PORH with the likelihood of active foot ulcer or previous foot complication.

Results: For each second increase in TtPeak, the likelihood of a participant having a history of foot complication is increased by 2% (OR=1.019, p=0.01). This association was not reflected in people with an active foot ulcer (OR=1.003, p=0.832). P%BL was not found to be significantly different between those with a current or previous foot complication and those without (p=0.404).

Conclusions: This investigation in a cohort with type 2 diabetes has demonstrated that longer TtPeak is associated with history of diabetic foot complications.

Keywords: Cutaneous reactivity; Diabetes; Foot complication; Microvascular disease; Post-occlusive reactive hyperaemia.

MeSH terms

Aged
Aged, 80 and over
Cohort Studies
Diabetes Mellitus, Type 2 / complications*
Diabetic Angiopathies / complications
Diabetic Angiopathies / diagnosis*
Diabetic Angiopathies / epidemiology
Diabetic Angiopathies / physiopathology
Diabetic Foot / complications
Diabetic Foot / diagnosis*
Diabetic Foot / epidemiology
Diabetic Foot / physiopathology
Diabetic Neuropathies / complications
Diabetic Neuropathies / diagnosis*
Diabetic Neuropathies / epidemiology
Diabetic Neuropathies / physiopathology
Female
Hallux
Humans
Hyperemia / etiology
Incidence
Laser-Doppler Flowmetry
Male
Microcirculation*
Microvessels / physiopathology*
Middle Aged
New South Wales / epidemiology
Recurrence
Risk Factors
Skin / blood supply*
Vascular Resistance