Microcirculatory Vasomotor Changes in Type 2 Diabetes With Peripheral Neuropathy

NCT ID: NCT03847779

Last Updated: 2020-11-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

108 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-02-04

Study Completion Date

2020-06-30

Brief Summary

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Microcirculatory flow is subject to cyclic changes under the influence of heart rate, respiration, myogenic activity, neurogenic factors and endothelial factors. Microcirculatory oscillations (vasomotion) contribute significantly to tissue perfusion. Vasomotion analysis allowed to discriminate normoglycemic subjects, prediabetic subjects and diabetic subjects. Furthermore, changes in vasomotion can precede the emergence of global signs of microangiopathy complications in type 2 diabetes. In fact, few studies reported impaired vasomotion in type 2 diabetes with peripheral neuropathy. Vasomotion analysis after vasodilator (6-min walking test and hyperthermia) and after vasoconstrictor (foot lowering) stimulus could be an effective diagnostic tool to sharpen the diagnostic.

Objectives and Methodology: to study vasomotion at baseline and after exercise, hyperthermia and foot lowering within 3 groups of patients: diabetic without peripheral neuropathy, diabetic with subclinical peripheral neuropathy and diabetic with peripheral neuropathy and one group of sex- age- and body mass index-matched healthy control subjects.

All the subjects will benefit from a clinical, anthropometric, level of physical activity and biological evaluations. Type 2 diabetes participants will benefit from neuropathy evaluation. In addition, cutaneous microcirculation (perfusion and vasomotion) by means of Laser Doppler Flowmetry and Laser Speckle Imaging will be recorded at rest and after different stimuli (exercise, hyperthermia and foot lowering).

Detailed Description

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All the subjects will benefit from a:

* clinical: diabetes duration, treatments
* anthropometric: weight, height, BMI
* level of physical activity by means of the International Physical Activity Questionary, pedometers and the 6 minutes walking test
* biological evaluations: glycemia, HbA1C, lipids, high sensitive C-reactive protein, fibrinogen, 25(OH)D, creatinine, albumine Type 2 diabetes participants will benefit from neuropathy evaluation: sensory tests by means of Semmes-Weinstein monofilament and of Nerve Check, amplitude and velocity sural nerve and neuropathic symptom score (NSS) In addition, cutaneous microcirculation (perfusion and vasomotion) by means of Laser Doppler Flowmetry and Laser Speckle Imaging will be recorded at rest and after different stimuli (exercise, hyperthermia and foot lowering).

Conditions

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Diabetic Neuropathy Peripheral Small Vessel Disease of Diabetes Mellitus Vasodilation Vasoconstriction

Keywords

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vasomotion

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Non-neuropathy

Type 2 diabetic without neuropathy:

* Negative findings on Semmes-Weinstein monofilament
* Neuropathy symptom score (NSS) \<3
* Negative findings on Nerve Check and Diabetic Peripheral Neuropathy check.

Interventions by means of Laser Doppler Flowmetry and Laser Speckle Imaging:

* "rest" cutaneous microcirculation (perfusion and vasomotion)
* "Exercise" cutaneous microcirculation (perfusion and vasomotion)
* "Foot lowering" cutaneous microcirculation (perfusion and vasomotion)
* "Hyperthermia" cutaneous microcirculation (perfusion and vasomotion)
* blood sampling
* heart rate variability at rest
* pedometer during 4 days
* international Physical Activity Questionary
* Qualify of Life questionary (EQVOD)

Group Type EXPERIMENTAL

"Rest"

Intervention Type OTHER

Cutaneous perfusion and vasomotion assessment at rest in supoine position

"Exercise"

Intervention Type OTHER

Cutaneous perfusion and vasomotion assessment after the 6minute-wlaking test

"Foot lowering"

Intervention Type OTHER

Cutaneous perfusion and vasomotion assessment after foot lowering

"Hyperthermia"

Intervention Type OTHER

Cutaneous perfusion and vasomotion assessment during hyperthermia

Neuropathy

Type 2 diabetic with neuropathy

* Positive findings on Semmes-Weinstein monofilament
* Neuropathy symptom score (NSS) \>3
* Positive findings on Nerve Check and Diabetic Peripheral Neuropathy check.

Interventions by means of Laser Doppler Flowmetry and Laser Speckle Imaging:

* "rest" cutaneous microcirculation (perfusion and vasomotion)
* "Exercise" cutaneous microcirculation (perfusion and vasomotion)
* "Foot lowering" cutaneous microcirculation (perfusion and vasomotion)
* "Hyperthermia" cutaneous microcirculation (perfusion and vasomotion)
* blood sampling
* heart rate variability at rest
* pedometer during 4 days
* international Physical Activity Questionary
* Qualify of Life questionary (EQVOD)

Group Type EXPERIMENTAL

"Rest"

Intervention Type OTHER

Cutaneous perfusion and vasomotion assessment at rest in supoine position

"Exercise"

Intervention Type OTHER

Cutaneous perfusion and vasomotion assessment after the 6minute-wlaking test

"Foot lowering"

Intervention Type OTHER

Cutaneous perfusion and vasomotion assessment after foot lowering

"Hyperthermia"

Intervention Type OTHER

Cutaneous perfusion and vasomotion assessment during hyperthermia

Controls

matched for age, sexe and BMI with diabetic patients.

Interventions by means of Laser Doppler Flowmetry and Laser Speckle Imaging:

* "rest" cutaneous microcirculation (perfusion and vasomotion)
* "Exercise" cutaneous microcirculation (perfusion and vasomotion)
* "Foot lowering" cutaneous microcirculation (perfusion and vasomotion)
* "Hyperthermia" cutaneous microcirculation (perfusion and vasomotion)
* blood sampling
* heart rate variability at rest
* international Physical Activity Questionary
* Qualify of Life questionary (EQVOD)

Group Type EXPERIMENTAL

"Rest"

Intervention Type OTHER

Cutaneous perfusion and vasomotion assessment at rest in supoine position

"Exercise"

Intervention Type OTHER

Cutaneous perfusion and vasomotion assessment after the 6minute-wlaking test

"Foot lowering"

Intervention Type OTHER

Cutaneous perfusion and vasomotion assessment after foot lowering

"Hyperthermia"

Intervention Type OTHER

Cutaneous perfusion and vasomotion assessment during hyperthermia

Interventions

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"Rest"

Cutaneous perfusion and vasomotion assessment at rest in supoine position

Intervention Type OTHER

"Exercise"

Cutaneous perfusion and vasomotion assessment after the 6minute-wlaking test

Intervention Type OTHER

"Foot lowering"

Cutaneous perfusion and vasomotion assessment after foot lowering

Intervention Type OTHER

"Hyperthermia"

Cutaneous perfusion and vasomotion assessment during hyperthermia

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* For diabetic patients, HbA1C \>6.5 and diabetes duration \>5years
* For healthy control no diabetes mellitus, no cardiovascular or renal pathology

Exclusion Criteria

* nondiabetic neuropathy
* on medication known to affect microcirculation
* presence of active foot ulcer or wound healing history \<3months
* inability to walk 6 minutes
* alcohol consumption of more than 3 units per day
Minimum Eligible Age

40 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University of Avignon

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Eric Benamo, MD

Role: PRINCIPAL_INVESTIGATOR

Centre Hospitalier Avignon

Locations

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Centre Hospitalier Henri Duffaut

Avignon, , France

Site Status

Countries

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France

References

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Reynes C, Beaume JB, Latil-Plat F, Ennaifer H, Rocher L, Antoine-Jonville S, Benamo E, Knapp Y, Vinet A. Concomitant Peripheral Neuropathy and Type 2 Diabetes Impairs Postexercise Cutaneous Perfusion and Flowmotion. J Clin Endocrinol Metab. 2021 Sep 27;106(10):e3979-e3989. doi: 10.1210/clinem/dgab414.

Reference Type DERIVED
PMID: 34111245 (View on PubMed)

Other Identifiers

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UAPV-012019-AVJ

Identifier Type: -

Identifier Source: org_study_id