PRELIMINARY STUDY Distal Sensorimotor Polyneuropathy Affects Skeletal Muscle Perfusion and Metabolism by Tc-99m Sestamibi Leg Scintigraphy in Patients With Type 2 Diabetes Betul Ugur-Altun, MD,* Gulay Durmus-Altun, MD,† Funda Ustun, MD,† Nilda Turgut, MD,‡ Armagan Altun, MD, FESC,§ and Armagan Tugrul, MD* Abstract: We evaluated the effects of distal symmetric sensorimo- tor polyneuropathy (DSP) on skeletal muscle perfusion and metab- olism in patients with type 2 diabetes. Twenty-three patients with type 2 diabetes underwent electrophysiological and Tc-99m sesta- mibi leg scintigraphic studies. The study patients were divided into 2 groups: group I (n = 14) with DSP and group II (n = 9) without DSP. We found decreased Tc-99m sestamibi uptake ratios (UR) of both legs in patients with DSP (right UR 7.98  6.85, left UR 7.78  7.01 vs. right UR 8.91  7.98, left UR 8.67  8.23, respectively) than without DSP, although it did not reach statistical significance. The regression equation of right UR was (Tc-99m sestamibi UR =1.927  velocity of tibial nerve-0.942  amplitude of sural nerve- 81.94). In conclusion, electrophysio- logical variables of tibial motor and sural sensory nerves predict Tc-99m sestamibi UR at leg scintigraphy in patients with type 2 diabetes. Additionally, decreased Tc-99m sestamibi UR in patients with type 2 diabetes with DSP was found. Key Words: type 2 diabetes mellitus, neuropathy, leg scintigraphy, Tc-99m sestamibi, uptake ratio (The Endocrinologist 2005;15: 146 –149) D iabetes mellitus is a common cause of polyneuropathy, which has been reported in more than 66% of patients with diabetes, and a major cause of morbidity owing to foot ulceration and amputation. 1 Diabetic neuropathy may de- velop as a consequence of both metabolic and vascular abnormalities. A strong association exists among neuropathy, nephropathy, and retinopathy. This association suggests that vascular dysfunction may be a common mechanism that underlies all the long-term complications of diabetes. Distal symmetric sensorimotor polyneuropathy (DSP), more commonly referred to as peripheral diabetic neuropathy (PDN), is the most common type of diabetic neuropathy. 1,2 DSP starts in the long nerve fibers of the toes and fingertips. Neuropathy may develop as a consequence of both metabolic and vascular abnormalities. It is proposed that an abnormal vasa nervosum will cause local ischemia and poor nerve function. Early detection of DSP is important in patients with diabetes because preventive interventions can be applied to decrease morbidity. Diabetes is a major cause of morbidity owing to foot ulceration and amputation. Arteriovenous shunting causes dysfunction of the microcirculation with reduced distribution of blood to areas of need. Thus, tissue ischemia can occur in a foot with palpable pedal pulses. DSP affects the peripheral nerve function, which controls the distribution of blood through arteriolar vessels. 3 Technetium 99m-metoxyisobutylisonitrile (Tc-99m sestamibi) is a lipophilic cation used primarily as a myocar- dial perfusion imaging agent in the assessment of coronary artery disease. It has also been used for assessment of skeletal muscle perfusion and metabolism in patients with peripheral artery disease and other metabolic diseases. 4–8 We evaluated possible effects of DSP on skeletal muscle perfusion and metabolism in patients with type 2 diabetes. MATERIALS AND METHODS Twenty-three patients (11 men, 12 women; mean age 52  9 years, range 37– 64 years) with type 2 diabetes mellitus (according to World Health Organization criteria) were recruited from the Diabetic Clinic of Endocrinology and Metabolism Department. The duration of diabetes in study patients was 4.7  5.2 years (range 1–20 years). The protocol was approved by the ethics committee, and oral informed consent was obtained from all study patients. Exclusion criteria were: 1) other possible causes of neuropathy or neuromuscular diseases (for example, alcoholism, liver and From the Departments of *Endocrinology and Metabolism, †Nuclear Med- icine, ‡Neurology, and §Cardiology, Medical School, Trakya University, Edirne, Turkey. Reprints: Betul Ugur-Altun, MD, Kocasinan Mah. Celik 6 Yesil Kosk Apt D:5, 22030 Edirne, Turkey. E-mail: altun@medscape.com. Copyright © 2005 by Lippincott Williams & Wilkins ISSN: 1051-2144/05/1503-0146 DOI: 10.1097/01.ten.0000164211.52984.90 The Endocrinologist • Volume 15, Number 3, May/June 2005 146