Background:
@EN Diabetic autonomic neuropathy encompasses multiple disturbances of motor, sensory, and reflex function affecting the cardiovascular, gastrointestinal, and urogenital systems. In addition, there is impairment of sudornotor and vasomotor
thermoregulatory mechanisms, and pupillary reflex function in diabetic autonomic neuropathic patients The relative importance of peripheral autonomic dysfunction to the genesis of the diabetic neuropathic foot remains uncertam
To evaluate distal sudomotor deficits and to correlate such deficits with tests of cardiovascular autonomic nerve function, pupil size and peripheral somatic nerve function, I attempted to measure the acetylcholine sweatspot test score in foot
dorsum of
diabetic patients. Also the aims of this study were to examine the relationship between sudomotor autonomic neuropathy and diabetic neuropathic foot ulceration.
@ES Methods:
@EN Swatspot test for autonomic denervation based on the local sweat response to 0.1 ml 1% acetylcholine administered inareatradermally, which depends on an intact local sympathetic supply, was performed. An area on the dorsum of the foot to be
tested
was painted was painted with 2% iodine in absolute alcohol, which was allowed to dry. The area was marked on the skin and painted with a thin layer of fine starch in arachis oil. The normal response is a uniform distribution of dark spots of
iodine
discoloration. In diabetic autonomic neuropathy this pattern is lost to varying degrees. To measure patchy loss of sweating, a×10 magnification photographic image of the response was used. Sweat spots were counted in sixty 2.5 cm squares of a
20×20
cm grid centered on the injection site, the central four squares being ignored.
@ES Results:
@EN 1) In diabetic patients, diminished or absent sweating of the feet was observed compared than that of normal control groups significantly(33.8±2406 vs 0.3±0.7, p<0.001).
2) There was a significant positive correlation between the sweatspot test and ages(r=0.48, p=0.018), numbers of neurologic symptom(r=0.75, p=0.001) in diabetic patients. There was a significant negative correlation among the heart rate
variation
during deep breathing(r=-0.49, p=0.018), the blood pressure response to standing(r=-0.36, p=0.042), the pupil test(r=-0.43, p=0.072), and the sweatsot test in diabetic patients. There was no significant correlation(p>0.05) among the glycated
hemoglobin(r=0.06), the duration of diabetes(r=0.28), the heart rate response to Valsalva maneuve (r=-0.04), and the sweatspot test in diabetic patients.
3) Panormalities of sweating tend to correlate with sural nerve conduction velocities(r=-0.45, p=0.027) in diabetic patients.
4) Diabetic patients with neuropathic foot ulceration showed significantly high sweatspot score (complete absence of sweat responses) compared with patients with no foot ulceration(60±0.0 vs 28.5±23.6, p=0.002). The sweatspot test was the most
useful, predictable test(p=0.001) for development of diabetic neuropathic foot ulceration compared with other autonomic tests (pupil test, the heart rate variation during deep breathing, and the sural nerve conduction velocities.
The sweating test can easily be performed at the bed side and severely abnormal value in a diabetic patient should be regarded as a risk factor for neuropathic ulceration.
@ES Conclusion:
@EN Acetylcholine stimulated sweating abnormalities are common in diabetic patients. The sweastspot test in the feet should prove useful for assessing the role of autonomic neuropathy in diabetic foot ulceration and, possibly, as a more sensitive
test
for diabetic autonomic neuropathy in genera. The acetylcholine sweatspot test was a simple and useful method to evaluate autonomic neuropathy in diabetic patients.
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