Abstract
Abstract
Purpose
To quantify sweat gland nerve fiber density in adolescents with diabetes. Additionally, to investigate associations between sudomotor innervation, sweat responses, and possible risk factors for sudomotor neuropathy.
Methods
Cross-sectional study where 60 adolescents with type 1 diabetes (duration > 5 years) and 23 control subjects were included. Clinical data, quantitative sudomotor axon reflex test, and skin biopsies were obtained. Skin tissue was immunostained and imaged by confocal microscopy. Quantification of the sweat gland volume and three-dimensional reconstruction of the nerve fibers was performed using a design-unbiased technique.
Results
Adolescents with diabetes had a significant reduction of maximum and mean values of nerve fiber length and nerve fiber density in sweat glands compared to controls (p values < 0.05). No association between nerve fiber density and sweat responses was found (p = 0.21). In cases with reduced sweat gland nerve fiber length, nerve fiber density, and volume, the sweat response was reduced or absent. Height, systolic blood pressure, time in hypoglycemia, and total daily and basal/total insulin dose were positively correlated to sweat response, while low-density lipoprotein, and HbA1c were negatively correlated with sweat response (p values < 0.05). Other microvascular complications and high cholesterol levels increased the relative risk for reduced sweat gland nerve fiber density.
Conclusion
Our findings of reduced sweat gland innervation in a selected group of adolescents add new knowledge about the structural changes that occur in autonomic nerves due to diabetes. Evaluating both the sweat gland innervation and sweat gland volume was important for understanding the association with sweat responses. Further research is needed to understand its clinical relevance.
Funder
Aarhus University
Steno Diabetes Center Aarhus
Novo Nordisk Foundation Challenge
Skibsreder Per Henriksen og Hustrus Fond
Tømrermester Jørgen Holm og Hustru Lisa F. Hansens Mindelegat
Vissing Fonden
Rissfort Fonden
Kirsten Dyrløv Madsens legat
Lipperts Fond
Reinholdt W. Jorck og Hustrus Fond
Helga og Peter Kornings Fond
Beckett Fonden
Dagmar Marschall Fond
Danske lægers Forsikring under Danica Pension
William Demant Fonden
Professor Iversens Rejsefond
Diabetesforeningen
NIH
FDA
Sturm Foundation
Mayo Funds
Royal Danish Library, Aarhus University Library
Publisher
Springer Science and Business Media LLC
Subject
Neurology (clinical),Endocrine and Autonomic Systems