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In diabetic Charcot neuroarthropathy impaired microvascular function is related to long lasting metabolic control and low grade inflammatory process.
Microvasc Res. 2015 Sep; 101:143-7.MR

Abstract

AIMS

The aim of this study was to assess microvascular function associated with the occurrence of Charcot neuroarthropathy (CN) in patients with diabetes.

METHODS

We evaluated 70 diabetic patients (54 men) with Charcot neuroarthropathy (CN-DM), median age 59 (IQR: 51-62), mean disease duration 16±8years. The control group were 70 subjects with diabetes and without Charcot neuroarthropathy (DM), 54 men, median age 60 (54-62), mean diabetes duration 15±7years. We assessed metabolic control of diabetes, serum C-reactive protein concentration (CRP) and cardiovascular autonomic neuropathy (CAN). We used AGE-Reader to measure skin autofluorescence (AF) associated with accumulation of advanced glycation end products that reflects long lasting metabolic control. Microvascular function was examined by laser Doppler flowmetry (PERIFLUX 5000) with thermal hyperemia (TH) and postocclusive reactive hyperemia (PORH).

RESULTS

CN-DM patients as compared to DM subjects had lower HbA1c level [7.6 (6.6-8.4) vs 8.4 (7.3-9.7)%, p<0.001], lower eGFR [75.9±24.1 vs 86.6±17.8ml/min/1.73m(2), p=0.003], higher CRP serum concentration [3.8 (2.3-10.1) vs 1.9 (0.8-4.4)mg/l, p<0.001] and higher skin autofluorescence [2.8 (2.5-3.1) vs 2.6 (2.3-2.9)AU, p=0.03]. The cardiovascular autonomic neuropathy (CAN) was more frequently diagnosed in CN-DM subjects [59 vs 27%, p<0.001]. The peak flow during thermal hyperemia (THmax) was lower in CN-DM subjects as compared to DM group [156 (93-240) vs 235 (155-300)PU, p=0.001]. We found negative correlation between THmax and CRP concentration (Rs=-0.34, p=0.003), TG concentration (Rs=-0.37, p=0.002) and skin AF (Rs=-0.32, p=0.04) and positive correlation between THmax and HDL cholesterol level (Rs=0.42, p<0.001) in CN-DM patients. There was also a positive correlation between PORHpeak and HDL cholesterol level (Rs=-0.23, p=0.04).

CONCLUSION

Deterioration of microvascular function and autonomic system dysfunction are present in Charcot neuroarthropathy. Impaired microvascular reactivity is associated with worse long lasting metabolic control of diabetes and low grade inflammatory process.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Poznan University of Medical Sciences, Department of Internal Medicine and Diabetology, Poland. Electronic address: olaaraszkiewicz@interia.pl.

Poznan University of Medical Sciences, Department of Internal Medicine and Diabetology, Poland.

Poznan University of Medical Sciences, Department of Internal Medicine and Diabetology, Poland.

Poznan University of Medical Sciences, Department of Internal Medicine and Diabetology, Poland.

Poznan University of Medical Sciences, Department of Internal Medicine and Diabetology, Poland.

Wierusz-Wysocka B

Poznan University of Medical Sciences, Department of Internal Medicine and Diabetology, Poland.

Zozulinska-Ziolkiewicz D

Poznan University of Medical Sciences, Department of Internal Medicine and Diabetology, Poland.

MeSH

C-Reactive ProteinCardiovascular DiseasesCase-Control StudiesDiabetes ComplicationsDiabetes Mellitus, Type 1Diabetes Mellitus, Type 2Diabetic NeuropathiesFemaleGlomerular Filtration RateGlycation End Products, AdvancedHumansHyperemiaInflammationLaser-Doppler FlowmetryMaleMicrocirculationMiddle AgedSkin

Pub Type(s)

Journal Article

Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26239695

Citation

Araszkiewicz, Aleksandra, et al. "In Diabetic Charcot Neuroarthropathy Impaired Microvascular Function Is Related to Long Lasting Metabolic Control and Low Grade Inflammatory Process." Microvascular Research, vol. 101, 2015, pp. 143-7.

Araszkiewicz A, Soska J, Borucka K, et al. In diabetic Charcot neuroarthropathy impaired microvascular function is related to long lasting metabolic control and low grade inflammatory process. Microvasc Res. 2015;101:143-7.

Araszkiewicz, A., Soska, J., Borucka, K., Olszewska, M., Niedzwiecki, P., Wierusz-Wysocka, B., & Zozulinska-Ziolkiewicz, D. (2015). In diabetic Charcot neuroarthropathy impaired microvascular function is related to long lasting metabolic control and low grade inflammatory process. Microvascular Research, 101, 143-7. https://doi.org/10.1016/j.mvr.2015.07.008

Araszkiewicz A, et al. In Diabetic Charcot Neuroarthropathy Impaired Microvascular Function Is Related to Long Lasting Metabolic Control and Low Grade Inflammatory Process. Microvasc Res. 2015;101:143-7. PubMed PMID: 26239695.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - In diabetic Charcot neuroarthropathy impaired microvascular function is related to long lasting metabolic control and low grade inflammatory process. AU - Araszkiewicz,Aleksandra, AU - Soska,Jacek, AU - Borucka,Katarzyna, AU - Olszewska,Marta, AU - Niedzwiecki,Pawel, AU - Wierusz-Wysocka,Bogna, AU - Zozulinska-Ziolkiewicz,Dorota, Y1 - 2015/08/01/ PY - 2015/05/09/received PY - 2015/07/30/revised PY - 2015/07/30/accepted PY - 2015/8/5/entrez PY - 2015/8/5/pubmed PY - 2016/6/22/medline KW - Advanced glycation end products KW - Charcot neuroarthropathy KW - Inflammatory process KW - Laser Doppler flowmetry SP - 143 EP - 7 JF - Microvascular research JO - Microvasc Res VL - 101 N2 - AIMS: The aim of this study was to assess microvascular function associated with the occurrence of Charcot neuroarthropathy (CN) in patients with diabetes. METHODS: We evaluated 70 diabetic patients (54 men) with Charcot neuroarthropathy (CN-DM), median age 59 (IQR: 51-62), mean disease duration 16±8years. The control group were 70 subjects with diabetes and without Charcot neuroarthropathy (DM), 54 men, median age 60 (54-62), mean diabetes duration 15±7years. We assessed metabolic control of diabetes, serum C-reactive protein concentration (CRP) and cardiovascular autonomic neuropathy (CAN). We used AGE-Reader to measure skin autofluorescence (AF) associated with accumulation of advanced glycation end products that reflects long lasting metabolic control. Microvascular function was examined by laser Doppler flowmetry (PERIFLUX 5000) with thermal hyperemia (TH) and postocclusive reactive hyperemia (PORH). RESULTS: CN-DM patients as compared to DM subjects had lower HbA1c level [7.6 (6.6-8.4) vs 8.4 (7.3-9.7)%, p<0.001], lower eGFR [75.9±24.1 vs 86.6±17.8ml/min/1.73m(2), p=0.003], higher CRP serum concentration [3.8 (2.3-10.1) vs 1.9 (0.8-4.4)mg/l, p<0.001] and higher skin autofluorescence [2.8 (2.5-3.1) vs 2.6 (2.3-2.9)AU, p=0.03]. The cardiovascular autonomic neuropathy (CAN) was more frequently diagnosed in CN-DM subjects [59 vs 27%, p<0.001]. The peak flow during thermal hyperemia (THmax) was lower in CN-DM subjects as compared to DM group [156 (93-240) vs 235 (155-300)PU, p=0.001]. We found negative correlation between THmax and CRP concentration (Rs=-0.34, p=0.003), TG concentration (Rs=-0.37, p=0.002) and skin AF (Rs=-0.32, p=0.04) and positive correlation between THmax and HDL cholesterol level (Rs=0.42, p<0.001) in CN-DM patients. There was also a positive correlation between PORHpeak and HDL cholesterol level (Rs=-0.23, p=0.04). CONCLUSION: Deterioration of microvascular function and autonomic system dysfunction are present in Charcot neuroarthropathy. Impaired microvascular reactivity is associated with worse long lasting metabolic control of diabetes and low grade inflammatory process. SN - 1095-9319 UR - https://www.unboundmedicine.com/medline/citation/26239695/In_diabetic_Charcot_neuroarthropathy_impaired_microvascular_function_is_related_to_long_lasting_metabolic_control_and_low_grade_inflammatory_process_ DB - PRIME DP - Unbound Medicine ER -