SUDOSCAN and diabetes

SUDOSCAN and diabetes

Diabetes complications

Controlling disease progression

Type 2 diabetes often progresses in silence, without developing clinically relevant symptoms. It frequently remains undiagnosed until complications appear. As much as one third of all cases may not be detected at all [1].

At the same time, there is epidemiologic evidence that complications are triggered in a much earlier stage of the disease than previously thought [2, 3]. For a substantial number of patients, irreversible tissue damage (peripheral vascular disease, nephropathy, retinopathy, neuropathy) have already set in at the time of diagnosis [4].

60-70% of patients with diabetes have neuropathies [5].

 

Reducing risk of diabetic foot and cardiovascular complications

Diabetic Autonomic Neuropathy (DAN) is a serious and common complication of diabetes that can involve the entire autonomic nervous system. It frequently precedes other complications and manifests as dysfunctions in one or more organ systems, for example cardiovascular, gastrointestinal, genitourinary, ocular or sudomotor.

Diabetic foot

Loss of autonomous innervation affects peripheral microvascular perfusion. It ultimately results in dry skin, loss of sweating and the development of fissures and cracks leading to infectious ulcers and gangrene [6]. In the long run, amputation and foot ulceration are the most common consequences of peripheral diabetic neuropathy and major causes of morbidity and disability. Every 30 seconds a lower limb is lost to diabetes somewhere in the world and up to 70 % of all leg amputations are due to the same cause. Currently available methods used to detect distal peripheral neuropathy rely on assessment of irreversible damage to the large nerve fibres. The commonly used tests (pinprick, sensation, vibration sensation, pressure sensation) are subjective and offer poor reproducibility.

Cardiovascular complications

Cardiovascular Autonomic Neuropathy (CAN) is the clinically most critical form of diabetic autonomic neuropathy. It is caused by a loss of autonomous cardiac innervation and results in diminished Heart Rate Variability
(HRV) and vascular dynamics. Detecting Cardiovascular Autonomic Neuropathy early can help prevent sudden cardiac death and myocardial infarction [6-7]. Heart Rate Variability has proven to be a predictor for all-cause mortality but is time consuming and requires specific diagnostic equipment [7].

SUDOSCAN is an innovative device to detect and follow-up diabetic foot and cardiac autonomic neuropathy.


[1]   American Diabetes Association. Standards of Medical Care in Diabetes. Diabetes Care. 2007; 30(suppl):S4-S41
[2]   Deedwania PC, Fonseca VA. Diabetes, prediabetes and cardiovascular risk: shifting the paradigm. Am J Med. 005; 11:939-947
[3]   DECODE Study Group EDEG. Is the current definition for diabetes relevant to mortality risk from all causes and cardiovascular and noncardiovascular diseases? Diabetes Care. 2003; 26(3):688-696
[4]   Weissmann PN. Reappraisal of the pharmacologic approach to treatment of type 2 diabetes mellitus. Am J Cardiol. 2002; 90(suppl):42G-50G
[5]   National Diabetes Statistics fact sheet, NIIDDK, 2007
[6]     Vinik AI, Maser RE, Mitchell BD, Freeman R. Diabetic Autonomic Neuropathy. Diabetes Care 2003; 26:1553-1579
[7]     Vinik AI, Ziegler D. Diabetic Cardiovascular Autonomic Neuropathy. Circulation 2007; 115:387-397

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