Relationship between post-occlusive forearm skin reactive hyperaemia and vascular disease in patients with Type 2 diabetes-a novel index for detecting micro- and macrovascular dysfunction using laser Doppler flowmetry

To investigate the relationship between the novel post-occlusive forearm skin reactive hyperaemia (PORH) index and macro- and microangiopathy by comparing it with traditional indices and a morphological analysis of skin blood flow after ischaemia. We studied 20 control subjects and 104 patients with Type 2 diabetes. Cutaneous blood flow (flux) in response to 5-min arterial occlusion in the forearm was measured using laser Doppler flowmetry. We defined the PORH index as the ratio of the area under the curve (AUC) 1 min after the release of the cuff relative to the AUC of a 1-min period before cuff inflation. The flux in response to arterial occlusion was divided morphologically into three patterns. Brachial-ankle pulse wave velocity (baPWV) was measured. The PORH index was markedly lower in patients with diabetes than in control subjects. The PORH index correlated negatively with urinary albumin, peroneal motor nerve conduction velocity, and baPWV in the patients with diabetes. The PORH index, but not the morphological analysis, was an independent determinant of cardiovascular disease in patients with diabetes. The PORH index may be the most sensitive indicator of micro- and macrovascular disease of the various measures of PORH in patients with Type 2 diabetes. Diabet. Med. 26, 83-88 (2009).