The Mechanoreceptor's Role in Plantar Skin Changes in Individuals with Diabetes Mellitus.

Claudio Zippenfennig,Thomas L Milani,Isabel C N Sacco,Renan L Monteiro,Tina J Drechsel

doi:10.3390/jcm10122537

Claudio Zippenfennig, Thomas L Milani + Show 3 more

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https://doi.org/10.3390/jcm10122537

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Abstract

Mechanical skin properties (MSPs) and vibration perception thresholds (VPTs) show no relationship in healthy subjects. Similar results were expected when comparing MSP and VPT in individuals with diabetes mellitus (DM) and with diabetic (peripheral-)neuropathy (DPN). A healthy control group (33 CG), 20 DM and 13 DPN participated in this cross-sectional study. DM and DPN were classified by using a fuzzy decision support system. VPTs (in µm) were measured with a modified vibration exciter at two different frequencies (30 and 200 Hz) and locations (heel, first metatarsal head). Skin hardness (durometer readings) and thickness (ultrasound) were measured at the same locations. DPN showed the highest VPTs compared to DM and CG at both frequencies and locations. Skin was harder in DPN compared to CG (heel). No differences were observed in skin thickness. VPTs at 30 and 200 Hz correlated negatively with skin hardness for DPN and with skin thickness for DM, respectively. This means, the harder or thicker the skin, the better the perception of 30 or 200 Hz vibrations. Changes in MSP may compensate the loss of sensitivity up to a certain progression of the disease. However, the influence seems rather small when considering other parameters, such as age.

Highlights

Diabetes is a metabolic disease characterized by raised blood glucose levels
In a recently published paper, we showed from an evolutionary perspective that there is no relationship between mechanical skin properties and vibration perception thresholds (VPTs) [18]
From an evolutionary point of view, calluses protect the sole of the foot without causing a loss of vibration sensitivity [18] (p. 262). Does this change from a pathological perspective? The aim of this study is to investigate the relationship between VPTs of rapidly adapting Meissner (RAI) and Pacinian corpuscles (RAII) with the mechanical skin properties of the plantar foot in individuals with diabetes mellitus (DM) and with diabeticneuropathy (DPN)

Summary

Introduction

Diabetes is a metabolic disease characterized by raised blood glucose levels. Hyperglycemia can lead to various secondary diseases. One of these secondary diseases is diabetic neuropathy [1]. The determination of vibration perception thresholds (VPTs) can represent an important factor in the early diagnosis of diabetic neuropathy [4]. The development of diabetes leads to changes in the biomechanical properties of the skin. These can be further altered by degradation processes in the context of diabetic neuropathy [5]. The quantification of mechanical skin properties is an important step for ulcer risk classification in people with diabetic neuropathy [5]

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