Impaired Distal Thermoregulation in Diabetes and Diabetic Polyneuropathy
Open accessAbstract
OBJECTIVE: To determine how thermoregulation of the feet is affected by diabetes and diabetic polyneuropathy in both wakefulness and sleep. RESEARCH DESIGN AND METHODS: Normal subjects, diabetic subjects without neuropathy, diabetic subjects with small-fiber diabetic polyneuropathy, and those with advanced diabetic polyneuropathy were categorized based on neurological examination, nerve conduction studies, and quantitative sensory testing. Subjects underwent foot temperature monitoring using an iButton device attached to the foot and a second iButton for recording of ambient temperature. Socks and footwear were standardized, and subjects maintained an activity diary. Data were collected over a 32-h period and analyzed. RESULTS: A total of 39 normal subjects, 28 patients with diabetes but without diabetic polyneuropathy, 14 patients with isolated small-fiber diabetic polyneuropathy, and 27 patients with more advanced diabetic polyneuropathy participated. No consistent differences in foot temperature regulation between the four groups were identified during wakefulness. During sleep, however, multiple metrics revealed significant abnormalities in the diabetic patients. These included reduced mean foot temperature (P < 0.001), reduced maximal temperature (P < 0.001), increased rate of cooling (P < 0.001), as well as increased frequency of variation (P = 0.005), supporting that patients with diabetic polyneuropathy and even those with only diabetes but no diabetic polyneuropathy have impaired nocturnal thermoregulation. CONCLUSIONS: Nocturnal foot thermoregulation is impaired in patients with diabetes and diabetic polyneuropathy. Because neurons are highly temperature sensitive and because foot warming is part of the normal biology of sleep onset and maintenance, these findings suggest new potentially treatable mechanisms of diabetes-associated nocturnal pain and sleep disturbance.
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The resulting reduction in the distal temperature amplitude has been observed in diabetic patients before polyneuropathy manifested, suggesting that altered peripheral temperature rhythms identify patients early at risk of disease progression.
“The resulting reduction in the distal temperature amplitude has been observed in diabetic patients before polyneuropathy manifested32, suggesting that altered peripheral temperature rhythms identify patients early at risk of disease progression.”
From Diurnal rhythms of wrist temperature are associated with future disease risk in the UK Biobank (2023) · cites this paper as [32]
The ensuing peripheral vascular disease and neuropathy impair thermoregulation specifically at night.
“The ensuing peripheral vascular disease and neuropathy impair thermoregulation specifically at night32,33.”
From Diurnal rhythms of wrist temperature are associated with future disease risk in the UK Biobank (2023) · cites this paper as [32]
Skin temperature measurements did not correlate with ambient temperature readings from a second device placed nearby on participants' external clothing.
“Further support comes from a study where the skin temperature measurements did not correlate with ambient temperature readings from a second device placed nearby on the participants’ external clothing, suggesting that a device worn on the wrist sufficiently captures the biological signal and is little contaminated by ambient temperature32.”
From Diurnal rhythms of wrist temperature are associated with future disease risk in the UK Biobank (2023) · cites this paper as [32]
A device worn on the wrist sufficiently captures the biological signal and is little contaminated by ambient temperature.
“suggesting that a device worn on the wrist sufficiently captures the biological signal and is little contaminated by ambient temperature32”
From Diurnal rhythms of wrist temperature are associated with future disease risk in the UK Biobank (2023) · cites this paper as [32]
Temperature traces in the UK Biobank study capture biological signal compellingly and agree with field studies.
“Our results indicate that the temperature traces in the UKBB study capture biological signal compellingly and agree with field studies13,23,32.”
From Diurnal rhythms of wrist temperature are associated with future disease risk in the UK Biobank (2023) · cites this paper as [32]
An explanation for some of the strong associations observed in this study might be that small amplitude temperature rhythms diminish thermosensitive gene regulation, which in combination with disease-specific perturbations, like those observed for diabetic neuropathy, lead to the emergence of specific disease phenotypes.
“An explanation for some of the strong associations observed in this study might be that small amplitude temperature rhythms diminish thermosensitive gene regulation, which in combination with disease-specific perturbations, like those observed for diabetic neuropathy,32,33 lead to the emergence of specific disease phenotypes.”
From Diurnal rhythms of wrist temperature are associated with future disease risk in the UK Biobank (2023) · cites this paper as [32]
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- Authors
- Rutkove, S. B., Veves, A., Mitsa, T., Nie, R., Fogerson, P. M., Garmirian, L. P., & Nardin, R. A.
- Affiliations
- Beth Israel Deaconess Medical Center (US)
- University of Massachusetts Dartmouth (US)
- Corresponding author
- Rutkove, Seward B.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2009-02-05
- Volume
- 32
- Issue
- 4
- Pages
- 671-676
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC2660475
- OpenAlex
- W2171764205
- Cited by
- 48
- References
- 24
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 2 · 2023: 3 · 2022: 2 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 3 · 2017: 4 · 2016: 3 · 2015: 2 · 2014: 3 · 2013: 9 · 2012: 1
- FWCI
- 1.55
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Funders
- National Institutes of Health
- National Institute of Diabetes and Digestive and Kidney Diseases (R21DK071178)
- Topics
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
- Health Sciences › Medicine › Physiology › Thermoregulation and physiological responses
- Keywords
- diabetic polyneuropathy, diabetes mellitus, foot temperature, small fiber neuropathy, sleep, nocturnal pain, sleep disorders, thermosensitive neurons, quantitative sensory testing
- MeSH terms
- Adult, Body Temperature Regulation, Circadian Rhythm, Clothing, Diabetes Mellitus, Diabetic Neuropathies, Equipment Design, Female, Foot, Homeostasis, Humans, Male, Middle Aged, Motor Activity, Movement, Nerve Fibers, Neural Conduction, Shoes, Sleep, Wakefulness, Monitoring, Ambulatory
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