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Nabavi Nouri M, Ahmed A, Bril V, et al. Diabetic neuropathy and axon reflex-mediated neurogenic vasodilatation in type 1 diabetes. PLoS One. 2012;7(4):e34807doi: 10.1371/journal.pone.0034807.
Nabavi Nouri, M., Ahmed, A., Bril, V., Orszag, A., Ng, E., Nwe, P., & Perkins, B. A. (2012). Diabetic neuropathy and axon reflex-mediated neurogenic vasodilatation in type 1 diabetes. PloS one, 7(4), e34807. https://doi.org/10.1371/journal.pone.0034807
Nabavi Nouri, Maryam, et al. "Diabetic neuropathy and axon reflex-mediated neurogenic vasodilatation in type 1 diabetes." PloS one vol. 7,4 (2012): e34807. doi: https://doi.org/10.1371/journal.pone.0034807
Nabavi Nouri M, Ahmed A, Bril V, Orszag A, Ng E, Nwe P, Perkins BA. Diabetic neuropathy and axon reflex-mediated neurogenic vasodilatation in type 1 diabetes. PLoS One. 2012;7(4):e34807. doi: 10.1371/journal.pone.0034807. Epub 2012 Apr 17. PMID: 22529938; PMCID: PMC3328500.
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PLoS One. 2012;7(4):e34807. doi: 10.1371/journal.pone.0034807. Epub 2012 Apr 17.

Diabetic neuropathy and axon reflex-mediated neurogenic vasodilatation in type 1 diabetes.

PloS one

Maryam Nabavi Nouri, Ausma Ahmed, Vera Bril, Andrej Orszag, Eduardo Ng, Patti Nwe, Bruce A Perkins

Affiliations

  1. Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

PMID: 22529938 PMCID: PMC3328500 DOI: 10.1371/journal.pone.0034807

Abstract

OBJECTIVE: Axon reflex-mediated neurogenic vasodilatation in response to cutaneous heating may reflect early, pre-clinical small fibre dysfunction. We aimed to evaluate the distribution of the vascular flare area measured by laser doppler imaging ("LDI(FLARE) area") in type 1 diabetes and in healthy volunteers.

RESEARCH AND METHODS: Concurrent with clinical and electrophysiological examination to classify diabetic sensorimotor polyneuropathy (DSP), LDI(FLARE) area (cm(2)) was determined in 89 type 1 diabetes subjects matched to 64 healthy volunteers. We examined the association and diagnostic performance of LDI with clinical and subclinical measures of DSP and its severity.

RESULTS: Compared to the 64 healthy volunteers, the 56 diabetes controls without DSP had significantly lower LDI(FLARE) area (p = 0.006). The 33 diabetes cases with DSP had substantially lower LDI(FLARE) area as compared to controls without DSP (p = 0.002). There was considerable overlap in LDI(FLARE) area between all groups such that the ROC curve had an AUC of 0.72 and optimal sensitivity of 70% for the detection of clinical DSP. Use of a subclinical definition for DSP, according to subclinical sural nerve impairment, was associated with improved AUC of 0.75 and sensitivity of 79%. In multivariate analysis higher HbA1c and body mass index had independent associations with smaller LDI(FLARE) area.

CONCLUSIONS: Axon reflex-mediated neurogenic vasodilatation in response to cutaneous heating is a biomarker of early nerve dysfunction in DSP. Its independent association with glycemic exposure in diabetes subjects and both glycemic exposure and BMI in healthy volunteers highlights the existence of small-fibre dysfunction in the natural history of DSP.

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