|
 |
|
|||||||
|
|||||||||
© 2001 by the American Diabetes Association, Inc.
Redistribution of Sudomotor Responses Is an Early Sign of Sympathetic Dysfunction in Type 1 Diabetes
From the Department of Medicine (R.D.H, K.D.B., G.G.H., R.W.P., L.F.B.) and the Departments of Community Medicine and Statistics (G.R.H.), West Virginia University, Morgantown, West Virginia.
Address correspondence and reprint requests to Robert D. Hoeldtke, MD, PhD, Department of Medicine, WVU Medical School, P.O. Box 9159, Morgantown, WV 26506-9159. E-mail: rhoeldtke{at}hsc.wvu.edu .
Patients with diabetic neuropathy typically have decreased sweating in the feet but excessive sweating in the upper body. Previous studies of sudomotor function in diabetes have included patients with long-standing disease. The present study was designed to test for the early presence of sudomotor dysfunction and to characterize its relation to glycemic control and other aspects of peripheral nerve function. A total of 37 patients (10 males, 27 females) enrolled in a longitudinal study, in which autonomic function was evaluated annually for 3 years. Patients enrolled 2-22 months after the diagnosis of type 1 diabetes. Forty-one age- and sex-matched healthy control subjects were also studied. Sweat production in response to acetylcholine stimulation was dramatically increased in the forearm at the time of the first evaluation (1.67 ± 0.24 µl/cm2 in the diabetic patients vs. 1.04 ± 0.14 µl/cm2 in the control subjects, P < 0.05). Likewise, the ratio of sweating in the forearm to sweating below the waist was higher in the diabetic patients (0.553 ± 0.07 µl/cm2) than in the control subjects (0.385 ± 0.04 µl/cm2, P < 0.05). Forearm sweat was negatively associated with the renin-to-prorenin ratio and vanillylmandelic acid (VMA) excretion (P < 0.025), tests of sympathetic nerve function. The ratio of sweating in the forearm to sweating in the foot was likewise increased in diabetic patients with poor glycemic control. We interpret this redistribution of sudomotor responses to be indicative of sympathetic nerve injury and conclude 1) that the sympathetic nervous system is especially vulnerable to the adverse effects of chronic hyperglycemia and 2) that sympathetic dysfunction can be detected very early in type 1 diabetes.
CiteULike 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
|
|
 |
|
  N. Papanas, K. Papatheodorou, D. Papazoglou, D. Christakidis, C. Monastiriotis, and E. Maltezos The New Indicator Test (Neuropad(R)): A Valuable Diagnostic Tool for Small-Fiber Impairment in Patients With Type 2 Diabetes The Diabetes Educator, March 1, 2007; 33(2): 257 - 266. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Maguire, M. E. Craig, A. Craighead, A. K.F. Chan, J. M. Cusumano, S. J. Hing, M. Silink, N. J. Howard, and K. C. Donaghue Autonomic Nerve Testing Predicts the Development of Complications: A 12-year follow-up study Diabetes Care, January 1, 2007; 30(1): 77 - 82. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Freccero, H. Svensson, S. Bornmyr, P. Wollmer, and G. Sundkvist Sympathetic and Parasympathetic Neuropathy Are Frequent in Both Type 1 and Type 2 Diabetic Patients Diabetes Care, December 1, 2004; 27(12): 2936 - 2941. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. D. Hoeldtke, K. D. Bryner, D. R. McNeill, S. S. Warehime, K. Van Dyke, and G. Hobbs Oxidative Stress and Insulin Requirements in Patients with Recent-Onset Type 1 Diabetes J. Clin. Endocrinol. Metab., April 1, 2003; 88(4): 1624 - 1628. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. D. Hoeldtke, K. D. Bryner, D. R. McNeill, G. R. Hobbs, J. E. Riggs, S. S. Warehime, I. Christie, G. Ganser, and K. Van Dyke Nitrosative Stress, Uric Acid, and Peripheral Nerve Function in Early Type 1 Diabetes Diabetes, September 1, 2002; 51(9): 2817 - 2825. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| Diabetes | Diabetes Care | Clinical Diabetes | Diabetes Spectrum |