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23 June 2009

The influence of age and diabetes on the skin blood flow response to local pressure

Jerrold S. PetrofskyABCDEF, Gurinder S. BainsBCDEF, Michelle ProwseABCDEF, Katie Mc LellanABCDEF, Gomathi Ethiraju BCDEF, Scott LeeABCDEF, Shashi GundaBCDEF, Everett LohmanABCDE, Ernie SchwabABCDE

Med Sci Monit 2009; 15(7): CR325-331 :: ID: 869706

Abstract

Background
Previous data has shown that when pressure is applied to the skin of the ankle and on the foot, there is a reactive increase in circulation. In the present investigation, these studies were expanded to look at the response of the hand, back, and foot to applied pressure.
Material and Method
Ten young subjects whose average age was 26.5+/-3.3 yrs, 10 older subjects whose average age was 73.3+/-19.7 yrs and 10 people with diabetes whose average age was 60.1+/-5.7 yrs participated in the study. There was no statistical difference in the height or weight of the subjects. Hemoglobin A1c of the group with Diabetes averaged 6.98+/-1.15% with the mean duration of diabetes 13.6+/-9.5 yrs. An infrared laser Doppler flow meter was used to measure circulation on the hand, lower back, and on the bottom of the foot during applications of pressure at 15, 30, 45, and 60 kPa.
Results
For all three areas of the body, circulation was significantly less in the group with diabetes than the other two groups (p<0.05). When pressure was applied at 15 kPa, the blood flow to the skin initially decreased, but then increased in the younger subjects and in the older subjects but did not increase in subjects with diabetes for any area of the body. Further, after pressure was released, for any of the four pressures examined here, while the younger subjects showed a pronounced reactive hyperemia, subjects with diabetes showed a diminished hyperemia not proportional to the pressure that was applied.
Conclusions
It appears that the normal protective mechanism of a pressure induced hyperemia is absent or diminished in patients with diabetes with more effect on the periphery than on the core area of the body. More importantly, after pressure was applied and released, subjects with diabetes lacked a proportional hyperemia to recovery form the transient ischemia of the pressure.

Keywords: Pressure, Diabetes Mellitus - physiopathology, Demography, Aging - physiology, Aged, 80 and over, Adult, Regional Blood Flow - physiology, Skin - blood supply

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