Association of sudomotor dysfunction with risk of subclinical carotid atherosclerosis in patients with type 2 diabetes

Aims: To assess the correlation between sudomotor dysfunction and subclinical carotid atherosclerosis (SCAS) in people with type 2 diabetes (T2D).

Methods: This was a cross-sectional study conducted in Shanghai between 2020 and 2023 amongst adult people with T2D, enrolling 1788 subjects according to inclusion and exclusion criteria. The median age was 60 (51-66) years, the median HbA1c was 8.3 (7.1-9.9) %, with a disease duration of 11 (5-17) years, and the 61.2 % of subjects were male. The presence of SCAS was assessed with a doppler ultrasound examination to evaluate intima-media thickness (IMT) and atherosclerotic plaque. The sudomotor function was assessed with the SUDOSCAN (Impeto Medical Inc., Paris, France), sudomotor dysfunction was defined as feet electrochemical skin conductance (FESC) <60 μs.

Results: Subjects with SCAS were older, had a longer diabetes duration, had higher systolic blood pressure and were more likely to be male. Further, these subjects showed a lower median FESC level (76.8 μs vs. 74.4 μs, p = 0.003) and a higher proportion of abnormal sudomotor function (26.9% vs. 19.5%, p < 0.001) compared to subjects without SCAS.

After correction for a large number of covariates (e.g. age, gender, BMI, HbA1c, diabetes treatment and lipid profile) people with sudomotor dysfunction showed a 1.48‐fold (OR = 1.48, 95% CI: 1.13–1.95) increased risk of SCAS as compared to those with normal sudomotor function.

Conclusions: This cross-sectional study showed that sudomotor dysfunction is significantly associated with the risk of SCAS in a large population of Asian people with T2D.

Comments: This study confirms the need and the usefulness of a non-invasive device, easy to use, that could provide objective and stable measurements with high repeatability and reproducibility for the assessment of diabetic neuropathy (DN) in large-scale assessment of DN.

Further, these results also confirm, in an Asian population, that microvascular complications are strictly related to macrovascular ones preceding their onset. Among the microvascular complications, it is paramount to consider also DN and autonomic neuropathy as risk factors for cardiovascular disease. In particular, in this study, sudomotor dysfunction was associated with SCAS, an early marker of cardiovascular disease.

However, longitudinal studies are needed to establish also a causal link between sudomotor disfunction and the development of SCAS and cardiovascular disease.

Luca D'Onofrio

Reference: Wang M, Lu J, Zhu W, Ni J, Wang Y, Yu J, Zhao W, Du R, Zhou J. Association of Sudomotor Dysfunction With Risk of Subclinical Carotid Atherosclerosis in Patients With Type 2 Diabetes. Diabetes Metab Res Rev. 2025 Jan;41(1):e70030. doi: 10.1002/dmrr.70030. PMID: 39748556.

🔗 https://onlinelibrary.wiley.com/doi/10.1002/dmrr.70030