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Diabetic neuropathy and microcirculation

Abstract

The microcirculation in diabetic and neuropathic feet is subject to the same changes found in other end organs of diabetic patients, such as the retina or the kidney. Complications such as foot ulceration lead to further morbidity and hospitalizations. Research into the causes of microcirculatory dysfunction has revealed an interplay of numerous factors. The most prominent findings are impaired endothelium-dependent and -independent vasodilation and reduced or absent nerve-axon reflex-related vasodilation. This renders the diabetic foot unable to mount a vasodilatory response under conditions of stress, such as injury, and makes it functionally ischemic even in the presence of satisfactory blood flow under normal conditions.

Introduction

Diabetic foot problems are major contributors to health care costs and hospitalizations. Fifteen percent of diabetic patients will suffer foot ulceration, a clear risk factor for limb loss, during their lifetimes. The main causes of ulceration are diabetic neuropathy and vascular disease of both the macro- and microcirculation. A complete understanding of how the disease process works is essential in learning how to best prevent and treat these complications. Abnormalities of the microcirculation occur early in the course of diabetes [1–4]. Eventual manifestations of altered microcirculation, such as retinopathy, nephropathy, and neuropathy, are related to the duration and severity of diabetes [5,6]. In the DCCT (Diabetes Control and Complications Trial), intensive glycemic control was found to significantly delay the development and progression of these microvascular complications in type 1 diabetic patients, with similar results reported in type 2 diabetic patients [6–9]. The capillary microcirculation to foot skin undergoes changes that are similar to that of the retina, nerves, and kidneys, and has shown signs of significant impairment in diabetic patients, especially when metabolic control is poor [10].

‘Small-vessel Disease’: An Outdated Term For the purpose of clarity in discussing microcirculation, the concept of “small-vessel disease” must be eliminated. Early retrospective pathologic studies in diabetic patients who underwent amputation led to the misconception that abnormalities in the microcirculation are occlusive in nature, socalled “small-vessel disease.” It was postulated that such occlusions occur even in the absence of any macrovascular occlusive problem and cause ischemic lesions and impairment of wound healing. This idea originated from the histologic existence of periodic acid-Schiff-positive material occluding the medium-sized or small arteries in amputated limb specimens [11]. However, subsequent physiologic studies [12] and other prospective staining and arterial casting studies [13,14] have demonstrated the absence of such occlusive lesions. Furthermore, the term “small-vessel disease” initially referred to medium or small size arteries, not to the microcirculation. Therefore, as it stands, the phrase creates confusion and should no longer be used.

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HOW D’OXYVA CAN HELP?

D’OXYVA is the only fully noninvasive, completely painless transdermal (over-the-skin) microcirculatory solution that has been clinically tested to significantly improve microcirculation.

The improvement of microcirculation, i.e., blood flow to the smallest blood vessels, benefits one’s health, immune system and overall sense of well-being in a variety of ways.

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