Study: People with Diabetic Foot Ulcers Don’t Vasodilate after Pressure Challenge. A New Marker for Risk (and Treatment Target)?

Important new work from our Lyonnaise and German colleagues published in the journal Diabetes.

Neurovascular response to pressure in patients with diabetic foot ulcer

Julien Vouillarmet MD1, Audrey Josset-Lamaugarny2,3, Paul Michon MD1, Jean Louis Saumet MD, PhD2,3, Audrey Koitka-Weber PhD4,5, Samir Henni MD4, Berengere Fromy PhD2,3, Dominique Sigaudo-Roussel PhD2,3

Diabetic foot ulcer (DFU) is a problem worldwide and prevention is crucial. We hypothesized that the inability of the skin to respond to pressure is involved in DFU pathogenesis and could be an important predictive factor to take into account.

Skin blood flow response to locally applied pressure. Data are median ± interquartile range, min-max (p < 0.05, one-way Anova; post-test p < 0.01 all diabetic groups vs healthy control group). VD: percentage of vasodilation compare to baseline (%), DFU is diabetic foot ulcer. *p < 0.05; *a: a significant difference (p < 0.05) was found between healthy subjects and each of the other groups.

We included 29 patients with DFU and 30 patients with type 2 diabetes without DFU. Neuropathy and skin blood flow at rest were assessed in response to acetylcholine, sodium nitroprusside, local heating (42°C), and to non-noxious locally applied pressure. Results were compared to those obtained from 10 healthy age-matched control subjects.

Vasodilatation in response to pressure was significantly impaired in both diabetic groups compared to healthy subjects. The vasodilator capacity to pressure was significantly lower in patients with DFU compared to those without DFU, despite the absence of significant difference in cutaneous pressure perception threshold and vascular reactivity to acetylcholine, sodium nitroprusside, and heat.

This pronounced alteration of neurovascular response to pressure in patients with DFU is a good marker of skin vulnerability and could be used to better predict individuals at risk.

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