Document Detail

Mild peripheral neuropathy prevents both leg muscular ischaemia and activation of exercise-induced coagulation in Type 2 diabetic patients with peripheral artery disease.
MedLine Citation:
PMID:  17888132     Owner:  NLM     Status:  MEDLINE    
AIM: To study the influence of peripheral neuropathy on intermittent claudication in patients with Type 2 diabetes (T2DM). METHODS: Twenty-five patients with T2DM were grouped according to the ankle/brachial index (ABI): 10 with ABI > 0.9 without peripheral artery disease (PAD; group T2DM) and 15 with ABI < 0.9 with PAD (group T2DM + PAD). Twelve individuals without T2DM with PAD (group PAD without T2DM) were also enrolled. Tests for peripheral neuropathy were performed in all patients. ABI, rate pressure product, prothrombin fragments 1 + 2 (F1+2), thrombin-anti-thrombin complex (TAT), and d-dimer were measured before and after a treadmill test. During exercise both initial and absolute claudication distance and electrocardiogram readings were recorded. RESULTS: We found mild peripheral neuropathy in 20% of group T2DM and 46.7% of group T2DM + PAD (P < 0.01). After exercise, the rate pressure product increased in each group; ABI fell in T2DM + PAD (P < 0.0001) and in PAD without T2DM (P = 0.0005); the fall was greater in the latter group. Initial and absolute claudication distances were similar in PAD patients. In group T2DM + PAD, absolute claudication distance was longer in the subgroup without peripheral neuropathy (P < 0.05), whereas ABI and rate pressure products were similar. F1+2 values at rest were higher in group T2DM + PAD. After exercise, F1+2 values and TAT increased only in group PAD without T2DM. CONCLUSION: Only group PAD without T2DM experienced muscular ischaemia, whereas group T2DM + PAD did not. Mild peripheral neuropathy may have prevented them from reaching the point of muscular ischaemia during the treadmill test, because they stopped exercising with the early onset of pain. Reaching a false absolute claudication distance may induce ischaemic preconditioning. These findings suggest a possible protective role of mild peripheral neuropathy in T2DM patients with intermittent claudication, by preventing further activation of coagulation during treadmill testing.
F Piarulli; M Sambataro; N Minicuci; L Scarano; B Laverda; M R Baiocchi; G Baldo-Enzi; S Galasso; G Bax; D Fedele
Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  Diabetic medicine : a journal of the British Diabetic Association     Volume:  24     ISSN:  0742-3071     ISO Abbreviation:  Diabet. Med.     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-09-24     Completed Date:  2007-12-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8500858     Medline TA:  Diabet Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  1099-104     Citation Subset:  IM    
Department of Medical and Surgical Science, University of Padova, Padova, Italy.
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MeSH Terms
Blood Coagulation / physiology
Diabetes Mellitus, Type 2 / complications*,  physiopathology,  therapy
Diabetic Angiopathies / complications*,  physiopathology
Diabetic Neuropathies / complications*,  physiopathology
Intermittent Claudication / etiology
Ischemia / physiopathology*
Middle Aged
Muscle, Skeletal / blood supply*
Outcome Assessment (Health Care)
Peripheral Nervous System Diseases / etiology,  physiopathology
Risk Factors

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