Prospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2023; 11(22): 5244-5251
Published online Aug 6, 2023. doi: 10.12998/wjcc.v11.i22.5244
Diabetic neuropathy results in vasomotor dysfunction of medium sized peripheral arteries
Fahrettin Ege, Ömer Kazci, Sonay Aydin
Fahrettin Ege, Department of Neurology, VM Medicalpark Hospital, Ankara 063200, Turkey
Ömer Kazci, Department of Radiology, Ankara Training and Research Hospital, Ankara 063200, Turkey
Sonay Aydin, Department of Radiology, Erzincan Binali Yıldırım University Faculty of Medicine, Erzincan 063200, Turkey
Author contributions: Fahrettin EGE and Omer Kazci contributed equally to this work; Sonay Aydin designed the research study; Omer Kazci analyzed the data and wrote the manuscript; All authors have read and approved the final manuscript.
Institutional review board statement: This study adhered to the most recent version of the Declaration of Helsinki, and the No. 2 Clinical Research Ethics Committee of Ankara City Hospital allowed the procedures. The ethics committee at Ankara City Hospital is the most approved ethics body within the Turkish Ministry of Health. Due to the nature and significance of our research, we deemed it necessary to obtain ethical approval from Ankara City Hospital (Approval number: E3-22-1307).
Informed consent statement: Each participant and/or guardian gave informed consent(s).
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sonay Aydin, MD, PhD, Academic Editor, Academic Research, Associate Professor, Department of Radiology, Erzincan Binali Yıldırım University Faculty of Medicine, Mengücek, Erzincan 063200, Turkey. sonay.aydin@erzincan.edu.tr
Received: March 29, 2023
Peer-review started: March 29, 2023
First decision: June 1, 2023
Revised: June 6, 2023
Accepted: July 3, 2023
Article in press: July 3, 2023
Published online: August 6, 2023
Processing time: 126 Days and 15.5 Hours
Abstract
BACKGROUND

The effect of the sympathetic nervous system on peripheral arteries causes vasoconstriction when smooth muscle cells in the walls of blood vessels contract, which leads to narrowing of arteries and reduction of the blood flow.

AIM

To compare sympathetic vasomotor activation of the brachial arteries in healthy subjects and patients with painful diabetic neuropathy; and therefore, to assess whether there is significant vasomotor dysfunction of medium sized arteries in diabetic neuropathy.

METHODS

The study included 41 diabetic neuropathy patients and 41 healthy controls. Baseline diameter and flow rate of the brachial arteries were measured. Then, using a bipolar stimulus electrode, a 10 mA, 1 Hz electrical stimulus was administered to the median nerve at the wrist level for 5 s. The brachial artery diameter and blood flow rate were re-measured after stimulation.

RESULTS

In the control group, the median flow rate was 70.0 mL/min prior to stimulation and 35.0 mL/min after stimulation, with a statistically significant decrease (P < 0.001), which is consistent with sympathetic nervous system functioning (vasoconstriction). In the diabetic neuropathy group, median flow rate before the stimulation was 35.0 mL/min. After stimulation, the median flow rate was 77.0 mL/min; thus, no significant decrease in the flow rate was detected. In the control group, the median brachial artery diameter, which was 3.6 mm prior to stimulation, decreased to 3.4 mm after stimulation, and this decrease was also statistically significant (P = 0.046). In the diabetic neuropathy group, the median brachial artery diameter increased from 3.4 mm to 3.6 mm following nerve stimulation. Once again, no narrowing was observed.

CONCLUSION

Our research suggests that diabetic neuropathy results in significant vasomotor dysfunction of medium sized peripheral arteries. Physiological vasoconstriction in response to sympathetic activation is impaired in diabetic neuropathy.

Keywords: Diabetic neuropathy; Vasomotor; Dysfunction; Peripheral arteries; Doppler ultrasound

Core Tip: Our research is consistent with the observations that diabetic neuropathy results in sympathetic vasomotor dysfunction. Furthermore, the new non-invasive, inexpensive, and user-friendly technique that we offer is sensitive to this phenomenon in medium sized arteries. It also has the potential to be used as a tool for early detection of sympathetic dysfunction due to other causes. Our research suggests that diabetic neuropathy results in significant vasomotor dysfunction of medium sized peripheral arteries. Moreover, this is the first study to investigate diabetic autonomic neuropathy in medium sized arteries. Physiological vasoconstriction in response to sympathetic activation is impaired in painful diabetic neuropathy.