Updates on Research Findings of Pedal Microcirculation and Diabetes

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How does the microcirculatory response differ between the feet of patients with and without diabetes? A poster recently presented at the Symposium for Advanced Wound Care provides an update on this knowledge.

In a study by Windy Cole, DPM, CWSP, FFPM, RCPS (Glasg), et al entitled "A Prospective Single-Site Case-Controlled Study Examining the Differences in Microcirculatory Stress Responses Between Diabetic and Non-Diabetic Feet Using an Advanced Near-Infrared Imaging System," the authors provide new data on the critical disparities in microcirculatory responses between feet of patients with and without diabetes. The researchers’ primary focus was to determine how diabetic neuropathy alters microvascular reactivity under stress and to evaluate the efficacy of near-infrared spectroscopy (NIRS) in detecting these variations.¹

Dr. Cole and colleagues point out that peripheral artery disease (PAD) screening is essential during diabetic foot assessments, but traditional, noninvasive vascular studies often yield misleading results in patients with diabetes due to neuropathy-related complications. This study sought to fill that knowledge gap by assessing how patients’ feet with diabetic neuropathy respond to controlled stressors compared to those without diabetes.

Conducted as a single-site, case-controlled study with 20 subjects, the researchers used NIRS to monitor microcirculatory changes in real-time. Participants underwent a standardized, five-minute exposure to several stress conditions, including heat, cold, elevation, and dependency, applied to the right foot, all within a carefully controlled clinic environment.¹

The results revealed a significant impairment in the microcirculatory stress response in diabetic neuropathic feet. The authors attribute this dysfunction to underlying endothelial damage and autonomic neuropathy, both of which can result in functional ischemia despite seemingly adequate blood flow. The researchers contend that these findings emphasize the critical need for more precise diagnostic tools in diabetic foot care.¹

According to this poster, NIRS emerged as a promising modality in noninvasively assessing tissue oxygenation and revealing subtle circulatory impairments not captured by traditional tests. Overall, NIRS can potentially play a vital role in early detection, monitoring, and targeted management of microcirculatory issues in patients with diabetes, which can possibly improve outcomes and reduce the risk of serious foot complications.¹
 
Reference
1.        Cole W, Kovolyan N. A prospective single-site case-controlled study examining the differences in microcirculatory stress responses between diabetic and non-diabetic feet using an advanced near-infrared imaging system. Poster presented at Symposium for Advanced Wound Care Spring. May 1-4, 2025. Grapevine, TX.