BACKGROUND: Sudomotor dysfunction is one of the earliest manifestations of diabetic peripheral neuropathy.(1)Electrochemical Skin conductance test is a sensitive and specific test for the diagnosis of sudomotor dysfunction.(2) , however the risk factors and determinants of the sudomotor dysfunction are poorly understood. AIMS OF THE STUDY : The aim of this study was to investigate factors associated with abnormal Esc test as a marker of early DPN in patients with type 2 diabetes. MATERIALS AND METHODS: This study involved 523 Type 2 Diabetic patients who were > 18 years of age and not on any drugs affecting the sweat function. Electrochemical Skin conductance(ESC) measurements were recorded in all the patients using the stainless steel hand and feet electrodes connected to a computer and a value of ESC < 60 µS was used to define sudomotor dysfunction. Participants were also evaluated for clinical examination, biochemical investigations and vibration perception threshold. Logistic regression analysis was performed to determine the predictors of sudomotor dysfunction. RESULTS : The mean age and diabetes duration were 49.4 ± 11.7 and 4.4 ± 3.6 years respectively. Twenty-nine percent of participants were found to have abnormal Esc test. A significant inverse correlation was observed between Vibration perception threshold and electrochemical skin conductance measures (r=0.45; p < 0.01). Abnormal Esc measures were found to be associated with insulin therapy, age, presence of macrovasular complications, duration of diabetes and HbA1c in univariate analysis. On multivariate regression analysis after adjusting for confounding factors age, insulin therapy and duration of diabetes were found to be significant predictors of sudomotor dysfunction. The odds ratio of having DPN based on sweat gland dysfunction were 1.02 (95% C.I.: 1.00, 1.05), 3.97 (95% C.I.: 1.78, 8.78), 1.49 (95% C.I.: 1.36, 1.64) for age , insulin therapy and duration of diabetes respectively. CONCLUSION: There is a high prevalence of sudomotor dysfunction in type 2 diabetes.(3) Necessity of insulin therapy and duration of diabetes were the diabetes related factors associated with a lower Esc values, indicating an association of chronic hyperglycaemia on sudomotor function.Traditional risk factors identified with diabetic peripheral neuropathy also stand relevant for sudomotor dysfunction.(4)
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