Ann Clin Neurophysiol.  2023;25(1):32-37. 10.14253/acn.2023.25.1.32.

Vascular dysfunction in patients with type 2 diabetes mellitus

• Khandelwal E
• Jain M
• Tripathi S

• KMID: 2541820
• DOI: http://doi.org/10.14253/acn.2023.25.1.32

Abstract

Background
Type 2 diabetic mellitus (T2DM) is an emerging global pandemic which is associated with lots of co-morbidities and reported vascular dysfunctions. T2DM associated vascular dysfunctions leads to vasculopathy in the form of altered peripheral vascular dynamics. Cold stress test (CST) is a reliable sympathetic reactivity test used for assessing vascular dysfunctions. In this study we are trying to quantify vascular dysfunctions in T2DM patients non invasively by various parameters of photoplethysmography (PPG) of cold stress test.
Methods
Case control study had done in referral health center AIIMS, Raipur. Parameters are recorded by finger-PPG before, during and after CST (1 min) in 2 groups, control (n = 20 healthy volunteers) and case (n = 20 diagnosed T2DM patients).
Results
Due to cold stress, PPG parameter peak amplitude was significantly decreased in both healthy and T2DM groups (p <0.001 and p <0.001, respectively). However, recovery trend of amplitude was significantly slow in T2DM compared to healthy subjects. Another PPG parameter peak to peak interval was significantly higher in healthy group compared to T2DM patients.
Conclusions
This study showed that T2DM patients has significant deranged pulse volume parameters like amplitude and peak to peak interval can be used to objectively quantify the vasculopathy in T2DM patients by using sympathetic reactivity to cold stress.

Keyword

Vasculopathy; Diabetes mellitus; Cold stress; Autonomic dysfunction

Figure

• 

  Fig. 1. Schematic representation of various PPG measures derived from a digital physiograph after simultaneously recording ECG and PPG signals. PPI, peak to peak interval; PTT, pulse transit time; PPG, photoplethysmography; ECG, electrocardiography.

Reference

1. Khandelwal E, Jaryal AK, Deepak KK. Pattern and prevalence of cardiovascular autonomic neuropathy in diabetics visiting a tertiary care referral center in India. Indian J Physiol Pharmacol. 2011; 55:119–127.

2. Ding H, Triggle CR. Endothelial cell dysfunction and the vascular complications associated with type 2 diabetes: assessing the health of the endothelium. Vasc Health Risk Manag. 2005; 1:55–71.

3. Cooper ME, Bonnet F, Oldfield M, Jandeleit-Dahm K. Mechanisms of diabetic vasculopathy: an overview. Am J Hypertens. 2001; 14:475–486.

4. Stehouwer CD, Henry RM, Ferreira I. Arterial stiffness in diabetes and the metabolic syndrome: a pathway to cardiovascular disease. Diabetologia. 2008; 51:527–539.

5. Ewing DJ, Clarke BF. Diagnosis and management of diabetic autonomic neuropathy. Br Med J (Clin Res Ed). 1982; 285:916–918.

6. Yamamoto K, Iwase S, Mano T. Responses of muscle sympathetic nerve activity and cardiac output to the cold pressor test. Jpn J Physiol. 1992; 42:239–252.

7. Allen J. Photoplethysmography and its application in clinical physiological measurement. Physiol Meas. 2007; 28:R1–R39.

8. Naschitz JE, Bezobchuk S, Mussafia-Priselac R, Sundick S, Dreyfuss D, Khorshidi I, et al. Pulse transit time by R-wave-gated infrared photoplethysmography: review of the literature and personal experience. J Clin Monit Comput. 2004; 18:333–342.

9. Foo JY, Lim CS. Pulse transit time as an indirect marker for variations in cardiovascular related reactivity. Technol Health Care. 2006; 14:97–108.

10. Geleris P, Stavrati A, Boudoulas H. Effect of cold, isometric exercise, and combination of both on aortic pulse in healthy subjects. Am J Cardiol. 2004; 93:265–257.

11. Pistorius MA, Briant C, Planchon B. Determination of reference temperatures for a cold test in digital plethysmography. J Mal Vasc. 1994; 19:195–198.

12. IBM C. IBM SPSS statistics for Windows [Internet]. Armonk (NY), USA: IBM Corp;c2012. [accessed 2022 Jul 18]. Available from: https://www.ibm.com/products/spss-statistics.

13. Moriyama K, Ifuku H. Assessment of cardiac contractility during a cold pressor test by using (dP/dt)/P of carotid artery pulses. Eur J Appl Physiol. 2007; 100:185–191.

14. Awad AA, Ghobashy MA, Ouda W, Stout RG, Silverman DG, Shelley KH. Different responses of ear and finger pulse oximeter wave form to cold pressor test. Anesth Analg. 2001; 92:1483–1486.

15. Woolam GL, Schnur PL, Vallbona C, Hoff HE. The pulse wave velocity as an early indicator of atherosclerosis in diabetic subjects. Circulation. 1962; 25:533–539.