Abstract
Several authors have reported higher skin temperature in the feet of diabetic subjects with autonomic neuropathy. We reexamined this association in a cross-sectional study of 712 veterans with diabetes mellitus. Potential subjects included all diabetic patients enrolled in a general internal medicine clinic at a veterans affairs healthcare system. Sensory neuropathy was defined as any pedal insensitivity to the 5.07 monofilament. Autonomic neuropathy was determined using standard cardiovascular reflex tests. An infrared surface scanner was used to measure foot skin temperature at multiple sites. Subjects with sensory neuropathy had lower mean plantar foot skin temperature than those without (28.4°C vs. 28.9°C, P=.0101). Autonomic neuropathy as a dichotomous variable was unrelated to foot skin temperature. Foot skin temperature, though, negatively correlated with greater drop in systolic blood pressure with standing, which is an indicator of autonomic neuropathy ( r=−.08, P=.0385). Adjustment for potential confounding factors using multiple linear regression analysis resulted in diminution of the associations between foot skin temperature and sensory neuropathy or orthostatic blood pressure drop, but the latter association remained statistically significant in the right foot. Diabetic veterans with sensory or autonomic neuropathy do not have higher foot skin temperature. Our results suggest that skin temperature may be slightly lower with higher orthostatic blood pressure fall. Other causes exist for the frequently observed differences in skin temperature in the feet of diabetic subjects.
Highlights
In the same way, left foot temperature its higher too in patients with diabetic neuropathy, although this result its less significant (0,86oC)(p =0,589) Conclusions: these results suggest that at home patient self-monitoring foot temperatures may be an effective tool to prevent foot complications in individuals with high risk diabetic foot
Skin temperature monitoring reduces the risk for diabetic foot ulceration in high-risk patients
Summary
La Diabetes Mellitus (DM) es una enfermedad crónica multisistémica caracterizada por: hiperglucemia, alteraciones en el metabolismo lipídico y proteico y complicaciones crónicas macro y microvasculares, debidas, fundamentalmente, a un déficit absoluto o relativo de insulina, a la alteración de su utilización, o a ambas. Los principales factores relacionados con el desarrollo de dichas ulceras son la perdida de sensibilidad en el pie: Neuropatía Diabética Periférica (NDP), y la disminución del suministro sanguíneo: Enfermedad Arterial Periférica (EAP), además de las deformidades y los traumatismos menores en el pie[1]. El diagnóstico precoz es de vital importancia por numerosas razones, entre ellas, que más del 50% de las NDP son asintomáticas por lo que los pacientes tienen un alto riesgo de padecer úlceras en sus pies[6,7]. Y si, por lo tanto, la monitorización de la temperatura podría tener utilidad a la hora de realizar un diagnóstico precoz, siendo así un método sencillo, barato y rápido con el que poder evitar posibles complicaciones tales como la úlcera diabética en el pie, tan común en pacientes que sufren esta patología
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