Microcirculation of the Diabetic Foot
There is now general acceptance that the abnormalities of the microcirculation are one of the early changes that occur in diabetes (1–7). Such abnormalities, which manifest during the course of diabetes as the triopathy of retinopathy, nephropathy, and neuropathy, have been found to be related to the duration and severity of diabetes (8–10). The pattern of these abnormalities, however, may be different between the two main types of diabetes, as is evident in the higher prevalence of proliferative retinopathy in type 1 diabetic patients and of maculopathy in type 2 diabetic patients (11). Intensive glycemic control, as shown in the Diabetes Control and Complications Trial (DCCT), was found to delay significantly the development and progression of these microvascular complications in type 1 diabetic patients (10). Similar results were also reported in type 2 diabetic patients (12,13). In this context, the capillary microcirculation to foot skin is not an exception and has shown signs of significant impairment in diabetic patients, especially when metabolic control is poor (14). This chapter focuses on the changes that occur in the microcirculation of the diabetic foot and the different methods used for their evaluation.
KeywordsDiabetic Patient Sodium Nitroprusside Small Vessel Disease Hyperemic Response Baseline Flow
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