Influence of Diabetes Mellitus on the Biomechanical Properties of the Human Skin as Measured Using the Cutometer: A Case-Control Study

ABSTRACT

OBJECTIVE: Longstanding diabetes mellitus has been suggested to cause several skin problems associated with biomechanical skin properties. However, the association between impaired skin properties and diabetic peripheral neuropathy (DPN) has not been clarified. This study aimed to investigate the biomechanical properties of the diabetic human skin and their relationship with DPNs. METHODS: This case-control study included 39 chronic diabetic patients and 41 matched healthy controls. The diabetic group was divided into subgroups according to the presence of diabetic sensorimotor polyneuropathy (DSPN) and peripheral autonomic neuropathy (PAN) as determined by the results of nerve conduction study and sympathetic skin response test, respectively. Different skin regions were measured using the non-invasive Cutometer instrument (Courage and Khazaka Electronic GmbH, Cologne, Germany). The following skin parameters were compared between the groups distensibility (Uf), elasticity (Ua/Uf and Ur/Uf), and viscoelasticity (Uv/Ue). The impact of DPNs, participant age, and diabetes duration on the investigated skin properties was analyzed. RESULTS: The diabetic group showed higher Uf values, and lower Ua/Uf, Ur/Uf, and Uv/Ue values, compared to the control group. However, no significant differences in biomechanical skin properties were noted between diabetic patients with PAN and without PAN. There were also no differences in the investigated skin properties between diabetic patients with DSPN and without DSPN. Diabetes duration and participant age of both groups had a significant impact on the skin properties. CONCLUSION: A long-term hyperglycemic state could induce inferior biomechanical skin properties in the peripheral limbs; however, this phenomenon seems unrelated to DPNs.