Relationship of skin temperature to sympathetic dysfunction in diabetic at-risk feet.

The relationship of plantar skin temperature to diabetic neuropathy was studied using clinical, nerve conduction and autonomic evaluations. The sympathetic skin response (SSR) was found present in both feet of 25 control subjects and 29 (out of 69) diabetic patients (SSR+ group). For those diabetic patients absent with the SSR in both feet, 18 patients (at-risk group) had preulcerative skin lesions (dry and fissured skin) and 22 did not (SSR- group). The at-risk group showed significantly higher mean foot temperature (30.2+/-1.3 degrees Celsius) than the SSR- (27.9+/-1.7 degrees Celsius), the SSR+ (27.1+/-2.0 degrees Celsius) and the control group (26.8+/-1.8 degrees Celsius). The SSR- group had smaller temperature differences (7.2+/-1.7 degrees Celsius versus 8.6+/-1.6 degrees Celsius, p<0.05) and smaller normalized temperature (referencing to the forehead temperature) (0.19 versus 0.24, p<0.01) than the SSR+ group. Although the three diabetic groups had no significant differences in clinical and cardiovascular abnormalities, the at-risk group showed more nerve conduction abnormalities than the SSR- and SSR+ groups (55% versus 23% and 14%, p<0.02). This study indicated that the thermoregulatory sweating abnormality signified early sympathetic damage in diabetic feet. Assessing skin conditions and sudomotor activities should help identify small fiber neuropathy in diabetic patients with at-risk feet conditions.

[1]  L. Lavery,et al.  Effectiveness of the diabetic foot risk classification system of the International Working Group on the Diabetic Foot. , 2001, Diabetes care.

[2]  P. Watkins,et al.  The diabetic foot , 2003, BMJ : British Medical Journal.

[3]  Cheng-Kung Cheng,et al.  Assessing Foot Temperature Using Infrared Thermography , 2005, Foot & ankle international.

[4]  D. Goldstein,et al.  Local sympathetic denervation in painful diabetic neuropathy. , 2002, Diabetes.

[5]  P K Thomas,et al.  Diabetes mellitus and the nervous system , 1998, Journal of neurology, neurosurgery, and psychiatry.

[6]  E. Boyko,et al.  Skin temperature in the neuropathic diabetic foot. , 2001, Journal of diabetes and its complications.

[7]  F. Vinicor,et al.  Independent Physiological Predictors of Foot Lesions in Patients With NIDDM , 1997, Diabetes Care.

[8]  J. Halperin,et al.  Sympathetic skin response--a method of assessing unmyelinated axon dysfunction in peripheral neuropathies. , 1984, Journal of neurology, neurosurgery, and psychiatry.

[9]  C. Ionescu-Tirgoviste,et al.  Peripheral sympathetic neuropathy evaluated by recording the evoked electrodermal response using an impedance reactometer. , 1990, Diabetes research and clinical practice.

[10]  L. Ho,et al.  Abnormal cardiovascular reflex tests are predictors of mortality in Type 2 diabetes mellitus , 2001, Diabetic medicine : a journal of the British Diabetic Association.

[11]  M B Brown,et al.  A Practical Two-Step Quantitative Clinical and Electrophysiological Assessment for the Diagnosis and Staging of Diabetic Neuropathy , 1994, Diabetes Care.

[12]  J. Spire,et al.  Sympathetic skin response in diabetic neuropathy , 1987, Muscle & nerve.

[13]  J. Hayes,et al.  Autonomic Function in Neuropathic Diabetic Patients With Foot Ulceration , 1993, Diabetes Care.

[14]  J. Tooke,et al.  Diabetic Neuropathy and the Microcirculation , 1995, Diabetic medicine : a journal of the British Diabetic Association.

[15]  M. McGill,et al.  Response of Charcot's arthropathy to contact casting: assessment by quantitative techniques , 2000, Diabetologia.

[16]  Jun Kimura,et al.  Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice , 1983 .

[17]  A V Greco,et al.  Lower limb arterio-venous shunts, autonomic neuropathy and diabetic foot. , 1992, Diabetes research and clinical practice.

[18]  B. Sumpio.  Primary care: Foot ulcers , 2000 .

[19]  G. Hobbs,et al.  Redistribution of sudomotor responses is an early sign of sympathetic dysfunction in type 1 diabetes. , 2001, Diabetes.