IMPAIRED VASOCONSTRICTION OF PERIPHERAL CUTANEOUS BLOOD-FLOW IN TYPE-1 DIABETIC-PATIENTS FOLLOWING FOOD INGESTION

Abnormalities in cutaneous blood flow (CBF) in otherwise healthy subje cts with Type 1 diabetes mellitus (DM) have been demonstrated in respo nse to local insults to the skin. To investigate whether defects also occurred in response to a regular daily activity, CBF was measured wit h laser Doppler flowmetry (LDF), before and 20 min after starting a mi xed meal in 13 male Type 1 DM subjects with no clinical evidence of ne uropathy, nephropathy or macroangiopathy and compared to 7 non-diabeti c controls. Diabetic subjects and controls were of similar age and bod y mass index (mean +/- SD, 33.7 +/- 7.4 vs 37.1 +/- 9.2 years and 25.2 +/- 2.9 vs 24.5 +/- 2.9 kg m(-2), respectively). In subjects with DM, HbA(1c) was 8.3 +/- 0.6% (normal range 4-5.5%) and duration of diabet es was 18 (8-38) years, median (range). Following a mixed meal the CBF fell in the controls by 36% (24 to 56), median (range), compared to 3 % (-5 to 18) in Type 1 DM subjects, P < 0.0005. These results show the re is a normal physiological fall in CBF following food ingestion whic h is attenuated in Type 1 DM. These abnormalities of vasoconstriction in the peripheral microcirculation are present after 8 years of diabet es and precede the development of clinically apparent neuropathy or va scular disease. (C) 1998 John Wiley & Sons, Ltd.