SKIN CAPILLARY CIRCULATION SEVERELY IMPAIRED IN TOES OF PATIENTS WITHIDDM, WITH AND WITHOUT LATE DIABETIC COMPLICATIONS

We have recently shown that the skin microcirculation of toes is signi ficantly impaired in patients with diabetes and peripheral vascular di sease, and this may be one major reason why these patients are highly susceptible to developing skin ulcers. The aim of the present study wa s to investigate whether the skin microcirculation is impaired also in diabetic patients free from macroangiopathy. One foot in each of 20 p atients with insulin-dependent diabetes was investigated: 10 patients with and 10 patients without late complications. All patients had norm al arterial circulation of their lower extremities. Two groups of age- and sex-matched healthy subjects served as controls. The capillary bl ood cell velocity in the nailfold of the great toe was investigated by computerised videophotometric capillaroscopy, and the total microcirc ulation within the same area evaluated by laser Doppler fluxmetry. The capillary blood cell velocity and the total skin microcirculation wer e studied during rest, and during postocclusive reactive hyperaemia. T he total microcirculation was similar in patients and control subjects , whereas the capillary circulation was markedly reduced (p < 0.01) in the patients. The ratio between the capillary and total microcirculat ion was significantly decreased (p < 0.05-0.01) in the patients as com pared to the control subjects, indicating a local maldistribution of b lood in the skin microcirculation of the diabetic patients. The result s of the present study show that in spite of a normal total. skin micr ocirculation in the toes of insulin-dependent diabetic patients, both with and without late complications, the nutritional capillary circula tion is severely impaired. These findings indicate that a chronic isch aemia is present in the skin capillaries of diabetic feet, and is rela ted to the diabetic disease per se and not to late diabetic complicati ons, and may be a cause for these complications.