Reduced Arteriovenous Shunting Capacity After Local Heating and Redistribution of Baseline Skin Blood Flow in Type 2 Diabetes Assessed With Velocity-Resolved Quantitative Laser Doppler Flowmetry

  1. Tomas Strömberg1
  1. 1Division of Biomedical Instrumentation, Department of Biomedical Engineering, Linköping University, Linköping, Sweden;
  2. 2Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden;
  3. 3Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
  1. Corresponding author: Ingemar Fredriksson, ingfr{at}imt.liu.se.

Abstract

OBJECTIVE To compare the microcirculatory velocity distribution in type 2 diabetic patients and nondiabetic control subjects at baseline and after local heating.

RESEARCH DESIGN AND METHODS The skin blood flow response to local heating (44°C for 20 min) was assessed in 28 diabetic patients and 29 control subjects using a new velocity-resolved quantitative laser Doppler flowmetry technique (qLDF). The qLDF estimates erythrocyte (RBC) perfusion (velocity × concentration), in a physiologically relevant unit (grams RBC per 100 g tissue × millimeters per second) in a fixed output volume, separated into three velocity regions: v <1 mm/s, v 1–10 mm/s, and v >10 mm/s.

RESULTS The increased blood flow occurs in vessels with a velocity >1 mm/s. A significantly lower response in qLDF total perfusion was found in diabetic patients than in control subjects after heat provocation because of less high-velocity blood flow (v >10 mm/s). The RBC concentration in diabetic patients increased sevenfold for v between 1 and 10 mm/s, and 15-fold for v >10 mm/s, whereas no significant increase was found for v <1 mm/s. The mean velocity increased from 0.94 to 7.3 mm/s in diabetic patients and from 0.83 to 9.7 mm/s in control subjects.

CONCLUSIONS The perfusion increase occurs in larger shunting vessels and not as an increase in capillary flow. Baseline diabetic patient data indicated a redistribution of flow to higher velocity regions, associated with longer duration of diabetes. A lower perfusion was associated with a higher BMI and a lower toe-to-brachial systolic blood pressure ratio.

Footnotes

  • Clinical trial reg. no. NCT01049737, clinicaltrials.gov.

  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

  • Received January 18, 2010.
  • Accepted April 1, 2010.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

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  1. Diabetes vol. 59 no. 7 1578-1584
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