Impaired distal thermoregulation in diabetes and diabetic polyneuropathy.
Impaired distal thermoregulation in diabetes and diabetic polyneuropathy.
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DOI：
10.2337/dc08-1844
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发表时间：
2009-04
期刊：
影响因子：
16.2
通讯作者：
Nardin RA
中科院分区：
文献类型：
--
作者：
Rutkove SB;Veves A;Mitsa T;Nie R;Fogerson PM;Garmirian LP;Nardin RA
确定糖尿病和糖尿病性多发性神经病在清醒和睡眠时如何影响足部温度调节。根据神经系统检查、神经传导研究和定量感觉测试对正常受试者、无神经病变的糖尿病受试者、伴小纤维糖尿病多发性神经病变的糖尿病受试者和伴晚期糖尿病多发性神经病变的受试者进行分类。受试者使用连接到足部的iButton设备进行足部温度监测，并使用第二个iButton记录环境温度。袜子和鞋子是标准化的，受试者保持活动日记。在32小时内收集数据并进行分析。共有39名正常受试者，28名糖尿病患者，但没有糖尿病多发性神经病，14例孤立性小纤维糖尿病多发性神经病，和27例更先进的糖尿病多发性神经病患者参加。在清醒状态下，四组之间的足部温度调节没有一致的差异。然而，在睡眠期间，多个指标显示糖尿病患者存在显著异常。这些包括平均足部温度降低（P < 0.001），最高温度降低（P < 0.001），冷却速率增加（P < 0.001），以及变化频率增加（P = 0.005），支持糖尿病多发性神经病患者，甚至仅患有糖尿病但没有糖尿病多发性神经病的患者夜间体温调节受损。糖尿病和糖尿病性多发性神经病患者夜间足部温度调节受损。由于神经元对温度高度敏感，并且因为足部变暖是睡眠开始和维持的正常生物学的一部分，这些发现表明糖尿病相关夜间疼痛和睡眠障碍的新的潜在可治疗机制。
To determine how thermoregulation of the feet is affected by diabetes and diabetic polyneuropathy in both wakefulness and sleep. Normal subjects, diabetic subjects without neuropathy, diabetic subjects with small-fiber diabetic polyneuropathy, and those with advanced diabetic polyneuropathy were categorized based on neurological examination, nerve conduction studies, and quantitative sensory testing. Subjects underwent foot temperature monitoring using an iButton device attached to the foot and a second iButton for recording of ambient temperature. Socks and footwear were standardized, and subjects maintained an activity diary. Data were collected over a 32-h period and analyzed. A total of 39 normal subjects, 28 patients with diabetes but without diabetic polyneuropathy, 14 patients with isolated small-fiber diabetic polyneuropathy, and 27 patients with more advanced diabetic polyneuropathy participated. No consistent differences in foot temperature regulation between the four groups were identified during wakefulness. During sleep, however, multiple metrics revealed significant abnormalities in the diabetic patients. These included reduced mean foot temperature (P < 0.001), reduced maximal temperature (P < 0.001), increased rate of cooling (P < 0.001), as well as increased frequency of variation (P = 0.005), supporting that patients with diabetic polyneuropathy and even those with only diabetes but no diabetic polyneuropathy have impaired nocturnal thermoregulation. Nocturnal foot thermoregulation is impaired in patients with diabetes and diabetic polyneuropathy. Because neurons are highly temperature sensitive and because foot warming is part of the normal biology of sleep onset and maintenance, these findings suggest new potentially treatable mechanisms of diabetes-associated nocturnal pain and sleep disturbance.
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影响因子：
11
作者：
Fronczek, R.;Raymann, R. J. E. M.;Van Someren, E. J. W.
通讯作者：
Van Someren, E. J. W.
影响因子：
14.5
作者：
WALL, PD
通讯作者：
WALL, PD
影响因子：
0.4
作者：
Davison, M;Shiner, JS
通讯作者：
Shiner, JS
影响因子：
9.5
作者：
Pavlov, Alexey N.;Makarov, Valeri A.;Sosnovtseva, Olga V.
通讯作者：
Sosnovtseva, Olga V.
影响因子：
16.2
作者：
Arora, S;Smakowski, P;Veves, A
通讯作者：
Veves, A