Comparison of vascular and neurological parameters between diabetic subjects without diabetic foot ulceration or amputation and those with either foot ulceration or a lower extremity amputation a pilot study /

by Duim-Beytell, Martha Catharina.

Comparison of vascular and neurological parameters between diabetic subjects without diabetic foot ulceration or amputation and those with either foot ulceration or a lower extremity amputation: a pilot study. Student: Martha Catharina Duim-Beytell Promotor: Prof. P. Rheeder Department: Division of Clinical Epidemiology Faculty of Health Sciences University of Pretoria Degree: MSc (Clinical Epidemiology) Background: It is likely that lower limb ulceration, lower limb amputation, or their absence in diabetic subjects, indicate varying degrees of long-term diabetes and its complications, and that measures of atherosclerosis and neuropathy would reflect these differences. Objectives: To determine feasibility and, based on our results, make sample size estimates for future study: By comparing peripheral and central vasculature between diabetic subjects with lower extremity ulcers, diabetic subjects with lower extremity amputation and a group of diabetics without these complications — through evaluating toe blood pressure (TBP), toebrachial index (TBI) and pulse wave velocity (PWV); also, by comparing peripheral and autonomic nervous system integrity between these groups — through sensory, nerve conduction, needle-examination and autonomic function assessment. Study design: A cross-sectional, descriptive and comparative pilot study. Setting: Pretoria Academic Hospital. Participants: Three groups of ten patients consecutively selected from diabetes and diabetic foot clinics — ten with chronic lower extremity ulcers, ten with healed lower extremity amputations and ten diabetic controls. Methods: Assessment of peripheral and autonomic neuropathy included evaluation of 5.07/10g monofilament sensation, vibration perception (using a 128Hz tuning fork), nerve conduction and electromyography, cutaneous autonomic response and heart rate variability (expressed as