The mechanism of accelerated peripheral vascular sclerosis in diabetes mellitus

Abstract

1. 1. An evaluation of the peripheral circulation was made in a group of forty-seven diabetic patients, employing the microplethysmographic method. All patients were below the age of forty-five years. 2. 2. Standard diagnostic technics failed to demonstrate any impairment of the peripheral circulation in each subject. 3. 3. Using the response to nitroglycerine as a test method, twenty-two of the forty-seven patients showed significant differences in blood flow and volume pulse amplitude in one great toe as compared with the contralateral toe. 4. 4. Following ganglionic blockade by tetraethylammonium, fifteen of these twenty-two patients continued to manifest significant reductions in flow and volume in one of the two halluxes. 5. 5. These findings are considered to imply the presence of occlusive peripheral vascular disease in these subjects. In view of the normal oscillometric index, the disease is localized to the digital bed. Similar vascular alterations have not been demonstrated in non-diabetic patients of similar age groups. 6. 6. It is suggested that the lesions in the digital bed are analogous to the vascular lesions of diabetic retinitis and intercapillary glomerulosclerosis, and constitute an integral manifestation and not a secondary complication of diabetes mellitus. 7. 7. The increased proximal resistance which will follow upon the development of a more distal occlusive angiopathy is considered to account, at least in part, for the increased incidence and accelerated development of clinical arteriosclerosis in diabetes. 8. 8. The alterations in the minute digital blood vessels appear to represent a vascular change distinct from the usual type of peripheral arteriosclerosis.