Early changes in the skin microcirculation and muscle metabolism of the diabetic foot
Changes in the large vessels and microcirculation of the diabetic foot are important in the development of foot ulceration and subsequent failure to heal existing ulcers. We investigated whether oxygen delivery and muscle metabolism of the lower extremity were factors in diabetic foot disease. We st...
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| Veröffentlicht in: | The Lancet (British edition) 2005-11, Vol.366 (9498), p.1711-1717 |
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| creator | Greenman, Robert L Panasyuk, Svetlana Wang, Xiaoen Lyons, Thomas E Dinh, Thanh Longoria, Lydia Giurini, John M Freeman, Jenny Khaodhiar, Lalita Veves, Aristidis |
| description | Changes in the large vessels and microcirculation of the diabetic foot are important in the development of foot ulceration and subsequent failure to heal existing ulcers. We investigated whether oxygen delivery and muscle metabolism of the lower extremity were factors in diabetic foot disease.
We studied 108 patients (21 control individuals who did not have diabetes, 36 patients with diabetes who did not have neuropathy, and 51 patients with both diabetes and neuropathy). We used medical hyperspectral imaging (MHSI) to investigate the haemoglobin saturation (S
HSIO
2; % of oxyhaemoglobin in total haemoglobin [the sum of oxyhaemoglobin and deoxyhaemoglobin]) in the forearm and foot; we also used
31P-MRI scans to study the cellular metabolism of the foot muscles by measuring the concentrations of inorganic phosphate and phosphocreatine and calculating the ratio of inorganic phosphate to phosphocreatine (Pi/PCr).
The forearm S
HSIO
2 during resting was different in all three groups, with the highest value in controls (mean 42 [SD 17]), followed by the non-neuropathic (32 [8]) and neuropathic (28 [8]) groups (p |
| doi_str_mv | 10.1016/S0140-6736(05)67696-9 |
| format | Article |
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We studied 108 patients (21 control individuals who did not have diabetes, 36 patients with diabetes who did not have neuropathy, and 51 patients with both diabetes and neuropathy). We used medical hyperspectral imaging (MHSI) to investigate the haemoglobin saturation (S
HSIO
2; % of oxyhaemoglobin in total haemoglobin [the sum of oxyhaemoglobin and deoxyhaemoglobin]) in the forearm and foot; we also used
31P-MRI scans to study the cellular metabolism of the foot muscles by measuring the concentrations of inorganic phosphate and phosphocreatine and calculating the ratio of inorganic phosphate to phosphocreatine (Pi/PCr).
The forearm S
HSIO
2 during resting was different in all three groups, with the highest value in controls (mean 42 [SD 17]), followed by the non-neuropathic (32 [8]) and neuropathic (28 [8]) groups (p<0·0001). In the foot at resting, S
HSIO
2 was higher in the control (38 [22]) and non-neuropathic groups (37 [12]) than in the neuropathic group (30 [12]; p=0·027). The Pi/PCr ratio was higher in the non-neuropathic (0·41 [0·10]) and neuropathic groups (0·58 [0·26]) than in controls (0·20 [0·06]; p<0·0001).
Our results indicate that tissue S
HSIO
2 is reduced in the skin of patients with diabetes, and that this impairment is accentuated in the presence of neuropathy in the diabetic foot. Additionally, energy reserves of the foot muscles are reduced in the presence of diabetes, suggesting that microcirculation could be a major reason for this difference.</description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(05)67696-9</identifier><identifier>PMID: 16291064</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>London: Elsevier Ltd</publisher><subject>Associated diseases and complications ; Biological and medical sciences ; Blood vessels ; Case-Control Studies ; Diabetes ; Diabetes Mellitus - metabolism ; Diabetes. Impaired glucose tolerance ; Diabetic Foot - metabolism ; Diabetic Neuropathies - metabolism ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Energy reserves ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Feet ; Female ; Forearm ; General aspects ; Humans ; Male ; Medical imaging ; Medical sciences ; Metabolism ; Microcirculation ; Middle Aged ; Muscle, Skeletal - metabolism ; Muscles ; Muscular system ; Oxygen - metabolism ; Skin - blood supply</subject><ispartof>The Lancet (British edition), 2005-11, Vol.366 (9498), p.1711-1717</ispartof><rights>2005 Elsevier Ltd</rights><rights>2006 INIST-CNRS</rights><rights>Copyright Lancet Ltd. Nov 12-Nov 18, 2005</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c472t-d22e6d41d5bc4ee8841fdcf1fdc43be07ae7b8f3d340cf2ee523a5b3d238a6143</citedby><cites>FETCH-LOGICAL-c472t-d22e6d41d5bc4ee8841fdcf1fdc43be07ae7b8f3d340cf2ee523a5b3d238a6143</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0140673605676969$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17260094$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16291064$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Greenman, Robert L</creatorcontrib><creatorcontrib>Panasyuk, Svetlana</creatorcontrib><creatorcontrib>Wang, Xiaoen</creatorcontrib><creatorcontrib>Lyons, Thomas E</creatorcontrib><creatorcontrib>Dinh, Thanh</creatorcontrib><creatorcontrib>Longoria, Lydia</creatorcontrib><creatorcontrib>Giurini, John M</creatorcontrib><creatorcontrib>Freeman, Jenny</creatorcontrib><creatorcontrib>Khaodhiar, Lalita</creatorcontrib><creatorcontrib>Veves, Aristidis</creatorcontrib><title>Early changes in the skin microcirculation and muscle metabolism of the diabetic foot</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><description>Changes in the large vessels and microcirculation of the diabetic foot are important in the development of foot ulceration and subsequent failure to heal existing ulcers. We investigated whether oxygen delivery and muscle metabolism of the lower extremity were factors in diabetic foot disease.
We studied 108 patients (21 control individuals who did not have diabetes, 36 patients with diabetes who did not have neuropathy, and 51 patients with both diabetes and neuropathy). We used medical hyperspectral imaging (MHSI) to investigate the haemoglobin saturation (S
HSIO
2; % of oxyhaemoglobin in total haemoglobin [the sum of oxyhaemoglobin and deoxyhaemoglobin]) in the forearm and foot; we also used
31P-MRI scans to study the cellular metabolism of the foot muscles by measuring the concentrations of inorganic phosphate and phosphocreatine and calculating the ratio of inorganic phosphate to phosphocreatine (Pi/PCr).
The forearm S
HSIO
2 during resting was different in all three groups, with the highest value in controls (mean 42 [SD 17]), followed by the non-neuropathic (32 [8]) and neuropathic (28 [8]) groups (p<0·0001). In the foot at resting, S
HSIO
2 was higher in the control (38 [22]) and non-neuropathic groups (37 [12]) than in the neuropathic group (30 [12]; p=0·027). The Pi/PCr ratio was higher in the non-neuropathic (0·41 [0·10]) and neuropathic groups (0·58 [0·26]) than in controls (0·20 [0·06]; p<0·0001).
Our results indicate that tissue S
HSIO
2 is reduced in the skin of patients with diabetes, and that this impairment is accentuated in the presence of neuropathy in the diabetic foot. Additionally, energy reserves of the foot muscles are reduced in the presence of diabetes, suggesting that microcirculation could be a major reason for this difference.</description><subject>Associated diseases and complications</subject><subject>Biological and medical sciences</subject><subject>Blood vessels</subject><subject>Case-Control Studies</subject><subject>Diabetes</subject><subject>Diabetes Mellitus - metabolism</subject><subject>Diabetes. Impaired glucose tolerance</subject><subject>Diabetic Foot - metabolism</subject><subject>Diabetic Neuropathies - metabolism</subject><subject>Endocrine pancreas. Apud cells (diseases)</subject><subject>Endocrinopathies</subject><subject>Energy reserves</subject><subject>Etiopathogenesis. Screening. Investigations. Target tissue resistance</subject><subject>Feet</subject><subject>Female</subject><subject>Forearm</subject><subject>General aspects</subject><subject>Humans</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medical sciences</subject><subject>Metabolism</subject><subject>Microcirculation</subject><subject>Middle Aged</subject><subject>Muscle, Skeletal - metabolism</subject><subject>Muscles</subject><subject>Muscular system</subject><subject>Oxygen - metabolism</subject><subject>Skin - blood supply</subject><issn>0140-6736</issn><issn>1474-547X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BEC</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkEuLFTEQRoMoznX0JyhBUHTRWnl00lmJDOMDBlzogLuQTipOxu7OmHQL8-_tvvfigBs3VbU4X1F1CHnK4A0Dpt5-BSahUVqoV9C-VloZ1Zh7ZMeklk0r9ff7ZPcXOSGPar0GAKmgfUhOmOKGgZI7cnnuynBL_ZWbfmClaaLzFdL6cx3G5Ev2qfhlcHPKE3VToONS_YB0xNn1eUh1pDnuIyG5Hufkacx5fkweRDdUfHLsp-Tyw_m3s0_NxZePn8_eXzReaj43gXNUQbLQ9l4idp1kMfi4FSl6BO1Q910UQUjwkSO2XLi2F4GLzikmxSl5edh7U_KvBetsx1Q9DoObMC_Vqk4bozu-gs__Aa_zUqb1NsuMAcmE3qD2AK1_11ow2puSRlduLQO7Sbd76XYzaqG1e-nWrLlnx-VLP2K4Sx0tr8CLI-Cqd0MsbvKp3nGaKwCzce8OHK7OficstvqEk8eQCvrZhpz-c8ofhJWezg</recordid><startdate>20051112</startdate><enddate>20051112</enddate><creator>Greenman, Robert L</creator><creator>Panasyuk, Svetlana</creator><creator>Wang, Xiaoen</creator><creator>Lyons, Thomas E</creator><creator>Dinh, Thanh</creator><creator>Longoria, Lydia</creator><creator>Giurini, John M</creator><creator>Freeman, Jenny</creator><creator>Khaodhiar, Lalita</creator><creator>Veves, Aristidis</creator><general>Elsevier Ltd</general><general>Lancet</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0TT</scope><scope>0TZ</scope><scope>0U~</scope><scope>3V.</scope><scope>7QL</scope><scope>7QP</scope><scope>7RV</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88A</scope><scope>88C</scope><scope>88E</scope><scope>88G</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8C1</scope><scope>8C2</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>KB~</scope><scope>LK8</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2P</scope><scope>M7N</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>20051112</creationdate><title>Early changes in the skin microcirculation and muscle metabolism of the diabetic foot</title><author>Greenman, Robert L ; Panasyuk, Svetlana ; Wang, Xiaoen ; Lyons, Thomas E ; Dinh, Thanh ; Longoria, Lydia ; Giurini, John M ; Freeman, Jenny ; Khaodhiar, Lalita ; Veves, Aristidis</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c472t-d22e6d41d5bc4ee8841fdcf1fdc43be07ae7b8f3d340cf2ee523a5b3d238a6143</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Associated diseases and complications</topic><topic>Biological and medical sciences</topic><topic>Blood vessels</topic><topic>Case-Control Studies</topic><topic>Diabetes</topic><topic>Diabetes Mellitus - metabolism</topic><topic>Diabetes. Impaired glucose tolerance</topic><topic>Diabetic Foot - metabolism</topic><topic>Diabetic Neuropathies - metabolism</topic><topic>Endocrine pancreas. Apud cells (diseases)</topic><topic>Endocrinopathies</topic><topic>Energy reserves</topic><topic>Etiopathogenesis. Screening. Investigations. Target tissue resistance</topic><topic>Feet</topic><topic>Female</topic><topic>Forearm</topic><topic>General aspects</topic><topic>Humans</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medical sciences</topic><topic>Metabolism</topic><topic>Microcirculation</topic><topic>Middle Aged</topic><topic>Muscle, Skeletal - metabolism</topic><topic>Muscles</topic><topic>Muscular system</topic><topic>Oxygen - metabolism</topic><topic>Skin - blood supply</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Greenman, Robert L</creatorcontrib><creatorcontrib>Panasyuk, Svetlana</creatorcontrib><creatorcontrib>Wang, Xiaoen</creatorcontrib><creatorcontrib>Lyons, Thomas E</creatorcontrib><creatorcontrib>Dinh, Thanh</creatorcontrib><creatorcontrib>Longoria, Lydia</creatorcontrib><creatorcontrib>Giurini, John M</creatorcontrib><creatorcontrib>Freeman, Jenny</creatorcontrib><creatorcontrib>Khaodhiar, Lalita</creatorcontrib><creatorcontrib>Veves, 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edition)</jtitle><addtitle>Lancet</addtitle><date>2005-11-12</date><risdate>2005</risdate><volume>366</volume><issue>9498</issue><spage>1711</spage><epage>1717</epage><pages>1711-1717</pages><issn>0140-6736</issn><eissn>1474-547X</eissn><coden>LANCAO</coden><abstract>Changes in the large vessels and microcirculation of the diabetic foot are important in the development of foot ulceration and subsequent failure to heal existing ulcers. We investigated whether oxygen delivery and muscle metabolism of the lower extremity were factors in diabetic foot disease.
We studied 108 patients (21 control individuals who did not have diabetes, 36 patients with diabetes who did not have neuropathy, and 51 patients with both diabetes and neuropathy). We used medical hyperspectral imaging (MHSI) to investigate the haemoglobin saturation (S
HSIO
2; % of oxyhaemoglobin in total haemoglobin [the sum of oxyhaemoglobin and deoxyhaemoglobin]) in the forearm and foot; we also used
31P-MRI scans to study the cellular metabolism of the foot muscles by measuring the concentrations of inorganic phosphate and phosphocreatine and calculating the ratio of inorganic phosphate to phosphocreatine (Pi/PCr).
The forearm S
HSIO
2 during resting was different in all three groups, with the highest value in controls (mean 42 [SD 17]), followed by the non-neuropathic (32 [8]) and neuropathic (28 [8]) groups (p<0·0001). In the foot at resting, S
HSIO
2 was higher in the control (38 [22]) and non-neuropathic groups (37 [12]) than in the neuropathic group (30 [12]; p=0·027). The Pi/PCr ratio was higher in the non-neuropathic (0·41 [0·10]) and neuropathic groups (0·58 [0·26]) than in controls (0·20 [0·06]; p<0·0001).
Our results indicate that tissue S
HSIO
2 is reduced in the skin of patients with diabetes, and that this impairment is accentuated in the presence of neuropathy in the diabetic foot. Additionally, energy reserves of the foot muscles are reduced in the presence of diabetes, suggesting that microcirculation could be a major reason for this difference.</abstract><cop>London</cop><pub>Elsevier Ltd</pub><pmid>16291064</pmid><doi>10.1016/S0140-6736(05)67696-9</doi><tpages>7</tpages></addata></record> |
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| ispartof | The Lancet (British edition), 2005-11, Vol.366 (9498), p.1711-1717 |
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| subjects | Associated diseases and complications Biological and medical sciences Blood vessels Case-Control Studies Diabetes Diabetes Mellitus - metabolism Diabetes. Impaired glucose tolerance Diabetic Foot - metabolism Diabetic Neuropathies - metabolism Endocrine pancreas. Apud cells (diseases) Endocrinopathies Energy reserves Etiopathogenesis. Screening. Investigations. Target tissue resistance Feet Female Forearm General aspects Humans Male Medical imaging Medical sciences Metabolism Microcirculation Middle Aged Muscle, Skeletal - metabolism Muscles Muscular system Oxygen - metabolism Skin - blood supply |
| title | Early changes in the skin microcirculation and muscle metabolism of the diabetic foot |
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