Non-invasive assessment of microcirculation in patients with late-stage complications of diabetes mellitus type 2

The aim of our study was to assess of microcirculation using laser Doppler flowmetry (LDF) in patients with diabetic foot syndrome (DFS) caused by diabetes mellitus type 2. Materials and methods. The main group consisted of 16 patients with DFS. In the control group, 19 patients without diabetes mellitus were included. An LDF investigation was performed using Biopac LDF 100C system. Estimated glomerular filtration rate (eGFR) was determined using CKD-EPI formula. Results and discussion. According to LDF, patients with DFS had the severe form of microcirculatory failure, with abrupt worsening of venous drainage, caused by venous lesion during the diabetic microangiopathy. The marker LDF phenomena were decreasing of flaxmotion index, low- and high-frequency flaxmotions contribution and increasing of high-frequency flaxmotion contribution. During the eGFR decreasing in the main group a simultaneous decreasing of low-frequency flaxmotion contribution and flaxmotion index, also with increasing of high-frequency flaxmotions contribution and intravascular resistance shows to stazic form of microcirculatory disorder. Exposed correlations of LDF-indexes with eGFR can show that LDF has potential possibilities for diagnostics and progression assessment of microangiopathic changes. Summary. In patients with diabetes mellitus type 2, a progressive microcirculation failure takes place. With the development of the microangiopathy, a negative influence of venous stasis prevails over the ischemic events. The development of chronic kidney disease is an independent risk-factor of microangiopathic complications of diabetes mellitus type 2. Preclinical diagnostics of renal lesion is important for timely beginning of the protective therapy of severe microvascular complications.

лазерная допплеровская флоуметрия, неинвазивная диагностика, микроциркуляция, сахарный диабет 2-го типа, синдром диабетической стопы, хроническая болезнь почек, laser Doppler flowmetry, non-invasive diagnostics, microcirculation, diabetes mellitus type 2, diabetic foot syndrome, chronic kidney disease

1. Божанская В. В., Старикова Л. Г. Осложнения при инсулиннезависимом сахарном диабете. Современные представления // Вестник новых мед. технол. 1999. № 2. С. 68-71.

2. Герасимчук П. А., Кисиль П. В., Власенко В. Г., Павлышин А. В. Показатели эндотелиальной дисфункции у больных с синдромом диабетической стопы // Вестник РАМН. 2014. № 5-6. С. 107-110.

3. Кудрякова С. В., Сунцов Ю. И. Макрососудистые осложнения при сахарном диабете 2 типа // Сахарный диабет. 2007. № 3. С. 15.

4. Петров С. В., Козлов В. И., Азизов Г. А. Лазерная допплеровская флоуметрия в комплексном обследовании больных хронической венозной недостаточностью // Лазерная мед. 2008. Т. 12. № 2. С. 36-41.

5. Салтыков Б. Б., Пауков В. С. Диабетическая микроангиопатия. М.: Медицина, 2002. 240 с.

6. Сахарный диабет: острые и хронические осложнения / под ред. И. И. Дедова, М. В. Шестаковой. М.: Мед. информ. аг-во, 2011. 480 с.

7. Fredriksson I., Larsson М., Nystrom F. Н. et al. Reduced arteriovenous shunting capacity after local heating and redistribution of baseline skin bloodflow in type 2 diabetes assessed with velocity-resolved quantitative laser Doppler flowmetry // Diabetes. 2010. Vol. 59. P. 1578-1584. doi: 10.2337/db10-0080.

8. Garg J. P, Bakris G. L. Microalbuminuria: marker of vascular dysfunction, risk factor for cardiovascular disease // Vase. Med. 2002. № 7 (1). P. 35-43. doi: 10.1191/1358863x02vm412ra

9. International Diabetes Federation. IDF Diabetes: Atlas update poster. 6th ed. Brussels, Belgium: International Diabetes Federation, 2014.

10. Klausen К. P., Parving H. H., Scharling H., Jensen J. S. The association betweenmetabolic syndrome, microalbuminuria and impaired renal function in the general population: impact on cardiovascular disease and mortality // J. Intern. Med. 2007. № 262 (4). P. 470-478. doi: 10.1111/j.1365-2796.2007.01839.x.

11. Standi E., Balletshofer B., Dahl B. et al. Predictors of 10-year macrovascular and overall mortality in patients with N1DDV: the Munich general practitioner project // Ibid. 1996. Vol. 39. № 12. P. 1540-1545.