DIABETIC CUTANEOUS MICROANGIOPATHY

PURPOSE: To determine a potential relationship between skin blood flow changes and the duration of diabetes and the presence of other microvascular complications. PATIENTS AND METHODS: Skin blood flow was measured by laser Doppler techniques at the finger and toe pulps, areas of predominant arteriovenous anastomotic (AVA) flow, and on the finger and toe dorsums, which have a greater nutritive microvascular contribution, in 83 diabetic patients and 39 nondiabetic control subjects. The average duration of diabetes was 14 1 years. Thirty-four patients had retinopathy. Eighteen patients had proteinuria. Forty patients had definite signs and symptoms of neuropathy, whereas 11 had no detectable neuropathy. RESULTS: There was little difference between diabetic and nondiabetic skin blood flow at normal body temperatures. However, at an elevated slr,in temperature of 44-degrees-C, significant reductions in skin blood flow versus control were demonstrated in the diabetic group. Skin blood flow at finger and toe dorsums showed a decrease as a function of the duration of diabetes. In contrast, there was little, if any, relationship between the duration of diabetes and skin blood flow at the finger and toe pulps. Diabetic patients with retinopathy had significantly lower blood flow at both finger and toe dorsums than those without retinopathy. Even excluding patients with recent onset of diabetes from the analysis, flows at finger (18.6 +/- 2.0 mL/min/100 g) and toe dorsums (11.2 +/- 1.4 mL/min/100 g) in the patients with retinopathy were significantly lower than in diabetic patients without retinopathy [finger: 28.6 +/- 2.7 mL/min/100 g (p < 0.01) and toe: 15.1 1.5 mL/min/100 g (p < 0.05)]. The presence of proteinuria was also associated with lower blood flow at the toe dorsum. There were no differences between patients with or without clinical diabetic neuropathy. At finger and toe pulps, there were no significant differences between diabetic patients with or without retinopathy, proteinuria, or neuropathy. CONCLUSIONS: There appears to be a diabetic cutaneous microangiopathy that coexists with diabetic retinal and renal microvascular disease. This process is expressed at sites of nutritive microvasculature. The ability to use the skin as a model for diabetic microangiopathy would have great practical importance, both experimentally and in clinical practice.