Acetylcholine iontophoresis in diabetic patients with and without peripheral neuropathy: a potential therapeutic tool

Background Iontophoresis had been widely used as a therapeutic option in the field of dermatology and physiotherapy. In vascular medicine, vasodilating response to acetylcholine (ACh) iontophoresis had been also previously studied in the evaluation of endothelial dysfunction in diabetes mellitus and its microvascular complications but less was published about its therapeutic implementations. The current study aimed at investigating the therapeutic role of ACh iontophoresis in the improvement of endothelial dysfunction seen in diabetic patients with and without peripheral neuropathy (PN). Patients and methods Forty patients with type 2 diabetes mellitus, 20 with and 20 without PN, were subjected to a therapeutic program of ACh iontophoresis three times a week for 2 successive weeks ‘long-term iontophoresis’. Percentage change in perfusion was measured in the two groups using laser Doppler flowmetry. Readings were taken pretreatment and post-treatment on three occasions: at baseline temperature, after local warming to 35°C, and at maximal flow after exposure to ACh iontophoresis ‘short-term iontophoresis’. Results Perfusion significantly improved after 2 weeks of therapy in the two groups with percentage change improvement of 180.65 vs. 131.50% in the baseline, 219.45 vs. 149.40% after local warming to 35°C and 269.60 vs. 236.95% after short-term ACh iontophoresis in patients without and those with PN, respectively, with P values of 0.0004, 0.0005, and 0.049, respectively. Conclusion ACh iontophoresis may be an optional treatment procedure for improving cutaneous perfusion in diabetics for further randomized control studies.