Effect of glycemic control on sudomotor denervation in type 2 diabetes
Journal
Diabetes Care
Journal Volume
35
Journal Issue
3
Pages
612-616
Date Issued
2012
Author(s)
Abstract
OBJECTIVE - Sudomotor symptoms are a common component of diabetic autonomic neuropathy, but the pathology of sudomotor innervation and its relationship with glycemic control have remained obscured. RESEARCH DESIGN AND METHODS - We enrolled 42 patients (26 males and 16 females aged 56.64 ± 12.67 years) with diabetic neuropathy defined by symmetric distally predominant sensory symptoms, abnormal nerve conduction studies, and reduced intraepidermal nerve fiber density in the leg. Skin biopsies of the distal leg were immunostained with antiprotein gene product 9.5 for nerve fibers and counterstained with Congo red for sweat glands. Sweat gland innervation index (SGII) was quantified with a new computerized area-based morphometric system. RESULTS - Protein gene product 9.5(+) nerve terminals surrounded secretory coils of the sweat glands in the skin of control subjects. Sudomotor denervation was present in diabetic patients, manifesting as depletion of periglandular nerve fibers with lower SGII compared with 42 age- and sex-matched control subjects (2.54 ± 1.87 vs. 4.68 ± 1.51%, P < 0.001). The SGII was correlated with HbA 1c (P = 0.011) and was lower in patients with anhidrosis of the feet compared with those with normal sweating of the feet (0.82 ± 0.69 vs. 3.00 ± 1.81%, P = 0.001). Sudomotor denervation was concordant with cardiac autonomic dysfunction as assessed with reduced heart rate variability (P = 0.003). CONCLUSIONS - Sudomotor denervation is a significant presentation of diabetic neuropathy, and the SGII was associated with HbA 1c. A skin biopsy offers a structural assessment of sudomotor innervation. ? 2012 by the American Diabetes Association.
SDGs
Other Subjects
congo red; glucose; hemoglobin A1c; adult; anhidrosis; area under the curve; article; autonomic dysfunction; autonomic innervation; autonomic neuropathy; cardiovascular disease; clinical article; controlled study; denervation; diabetic neuropathy; disease duration; dysautonomia; female; gastrointestinal disease; glucose blood level; glycemic control; heart rate variability; human; human tissue; immunohistochemistry; leg; male; nerve conduction disorder; nerve ending; nerve fiber; non insulin dependent diabetes mellitus; receiver operating characteristic; sensitivity and specificity; sensory dysfunction; skin biopsy; sweat gland; sweating; sympathetic tone; Adult; Aged; Blood Glucose; Diabetes Mellitus, Type 2; Female; Humans; Male; Middle Aged; Nerve Fibers; Prospective Studies; Skin; Sweat Glands
Type
journal article