Usefulness of Enhanced Power Doppler Imaging in Monitoring Acral Microcirculation in Type 2 Diabetes Mellitus and its Complications

This study compared hemodynamic changes of acral arterioles (pulps and nail beds of fingers and toes) and the microcirculatory status of acra between patients with uncomplicated ( n = 45) or complicated ( n = 36) type 2 diabetic mellitus (type 2 DM) and healthy subjects ( n = 40). Enhanced power Doppler imaging (e-Flow) was used to display the nail bed arterioles and distal branches of pulp arterioles (digitales palmares propriea and digitales plantares propriea) in the end knuckle of the right middle finger and right big toe. Arteriolar density (AD) was assessed by vascular pixel percentage. Compared to healthy subjects, in patients with DM the end diastolic velocity (EDV) of the nail bed arterioles of both finger and toe was diminished, while the vascular resistance index (RI) was increased. These changes became more prominent with a longer duration of the disease. Furthermore, both the peak systolic velocity (PSV) and AD were decreased in patients with DM. These hemodynamic changes were also evident in the pulp arterioles of fingers and toes, although they appeared at more advanced stages of the disease. Overall, the abnormal changes were more pronounced in patients with complications. In conclusion, hemodynamic changes (e.g. decrease in the number of acral arterioles) progress with a longer duration of the disease. The acral arteriolar damage is more pronounced in patients with a complicated type 2 DM.