Diagnostic value of ankle peak systolic velocity in diabetic patients with critical limb ischemia

AIM: To evaluate the diagnostic value of ankle peak systolic velocity (APSV) in diabetic patients diagnosed with critical limb ischaemia (CLI) and its resolution after percutaneous transluminal angioplasty (PTA). MATERIALS AND METHODS: Forty-eight diabetic patients with CLI were included in this study. CLI was diagnosed according to the IWGDF 2015 criteria. Patients were examined before and 5–7 days after PTA with transcutaneous oxygen tension of the foot's soft tissues and APSV by duplex ultrasonography. RESULTS: The median transcutaneous oxygen tensions before and after PTA were 14 [3; 20.5] and 30 [18.5, 39.0] mmHg, respectively (p <0.001). The median APSV in diabetic patients with CLI was 10 [7.4; 15.5] cm/s before PTA and −46 [33.5, 59] cm/s after PTA (p <0.001). The APSV cutoff point for diabetic patients with CLI is ≤25.5 cm/s with a sensitivity of 79.4% [95% CI 62.1–91.3] and a specificity of 96.4% [95% CI 81.7–99.9]. CONCLUSIONS: APSV may be considered as an additional method for CLI assessment. Lower limb artery calcification, soft tissue oedema or infection and foot ulcer and gangrene influence the results of routine ischaemia diagnostic methods such as the ankle–brachial index, toe–brachial index, transcutaneous oximetry but not APSV

Indications for various options of foot deformities orthopedic correction in diabetic neuroosteoarthropathy

Diabetic osteoarthropathy is one of the most difficult complication of diabetes mellitus, requiring the cooperation of a many of specialitys, including traumatologists - orthopedists. However, there is no single approach to the choice of orthopedic treatment tactics for this group of patients. From 2015 to 2018 inclusive, there were 35 patients with diabetic osteoarthropathy that received conservative or surgical orthopedic treatment. 11 patients received conservative orthopedic treatment; 24 patients received surgical treatment. A total of 26 surgical interventions were performed. Two types of surgical interventions were performed: 1) resection of the protruding fragment of one or another bone of the tarsus - 12 operations 2) reconstructive surgery aimed at correcting gross deformation of the middle and / or hindfoot - 14 operations. Along with general clinical examination, all patients underwent orthopedic examination, determining the degree of blood supply disturbance. A differentiated approach to choosing the method of orthopedic treatment of the presented group of patients allowed to restore limb supportability, ensure stability in the ankle joint and joints of the middle foot, create conditions for healing and prevention of relapse of the ulcer. The experience gained allowed us to offer indications for a particular method of orthopedic treatment of foot deformities in diabetic osteoarthropathy, depending on the stage of the pathological process, its location, the severity of the deformation, and the clinical course of this pathology

Type 2 diabetes and prediabetes prevalence in patients with different risk factor combinations in the NATION study

BACKGROUND: Type 2 diabetes (T2D) is multifactorial disease. NATION epidemiological study may provide the information about the prevalence of T2D and prediabetic state in patients with different risk factor combinations in Russian population. AIMS: To evaluate the prevalence of T2D and prediabetic state in NATION cohort depending on the amount of diabetes risk factors. MATERIALS AND METHODS: NATION is an epidemiological, cross-sectional study, designed to assess the prevalence of T2D in Russian adult population, where HbA1c was used to establish T2D (HbAc≥6,5%) and prediabetes (5,7%≤HbA1c<6,5%). Patients with T2D were either previously diagnosed or newly diagnosed. Current study presents an additional analysis of NATION cohort focused on the prevalence of T2D and prediabetic state among patients with different risk factor combinations. RESULTS: T2D and prediabetic state prevalence gradually increased among patients with following risk factors (prevalence of T2D and prediabetes respectively): low physical activity (4,3%, 18,3%), rare fruit and vegetable consumption (4,8%, 18,7%), T2D family history (7,7%, 20,3%), age ≥45 years (9,5%, 31,3%), obesity grade 1 (9,6%, 30,3%), obesity grade 2 (14,6%, 37,8%), obesity grade 3 (20,1%, 39,7%), hypertension (14,7%, 38,2%), history of diabetes during pregnancy (14,1%, 24,7%). Prevalence of T2D with single and multiple risk factors was compared to the prevalence of T2D in young patients (<45 years) without additional diabetes risk factors. Age ≥45 years was associated with 7-fold increase in T2D prevalence; obesity – 8,8-fold; family history – 5,7-fold; hypertension – 10,8-fold (p<0,001 for comparisons of every group with patients <45 years of age without other risk factors). When one patient had several risk factors combined, the prevalence of T2D increased progressively: combination of age ≥45 years and family history led to 10,7-fold rise; combination of age ≥45 years and BMI≥30kg/m2 – 11,2-fold; combination of age ≥45 years, family history and BMI≥30kg/m2 – 15,3-fold; combination of age ≥45 years, family history, BMI≥30kg/m2 and hypertension – 19,1-fold (p<0,001 for comparisons of every group with patients <45 years of age without other risk factors). CONCLUSIONS: Presence of multiple risk factors, such as age ≥45 years, obesity and hypertension led to progressive increase in the prevalence of T2D and prediabetic state. These data are important to identify patients at the highest risk of T2D among Russian population

Glycaemic benefit of iGlarLixi in insulin-naive type 2 diabetes patients with high HbA1c or those with inadequate glycaemic control on two oral antihyperglycaemic drugs in the LixiLan-O randomized trial

In this post hoc analysis of the randomized controlled LixiLan‐O trial in insulin‐naive type 2 diabetes mellitus (T2DM) patients not controlled on metformin with or without a second oral antihyperglycaemic drug (OAD), the efficacy and safety of the fixed‐ratio combination, iGlarLixi (insulin glargine 100 U [iGlar] and lixisenatide [Lixi]), compared to its individual components was assessed in two patient subgroups: (1) a baseline HbA1c ≥9% (n = 134); (2) inadequate control (HbA1c ≥7.0% and ≤9.0%) despite administration of two OADs at screening (n = 725). Treatment with iGlarLixi resulted in a significantly greater reduction in least squares mean HbA1c compared with iGlar or Lixi alone in both subgroups (HbA1c ≥9% group: 2.9%, 2.5%, 1.7%; two OADs group: 1.5%, 1.2%, 0.7%, respectively). Target HbA1c 70% of patients on iGlarLixi in both subgroups, while mitigating the weight gain observed with iGlar alone. Rates of hypoglycaemic events were low overall. These results suggest that iGlarLixi achieves superior glycaemic control compared with iGlar or Lixi alone in T2DM patients with HbA1c ≥9% or those inadequately controlled on two OADs

Near-infrared fluorescence imaging with indocyanine green in diabetic patient with critical limb ischemia: a case report

A case report of type 2 diabetic patient with critical limb ischemia (CLI) after successful endovascular revascularization is reported. The diagnosis of CLI was established according to clinical data and results of lower limb ischemia assessment by non-invasive methods. The unique feature of this case is presentation of results of the new method of lower limb ischemia assessment fluorescent angiography in near infrared range using indocyanine green (ICG). Following parameters of fluorescent angiography in near infrared range are analyzed in different regions of interest: Tstart(sec) the time of fluorescence occurrence (Istart, unit) in the analyzed area after intravenous administration of ICG; Tmax (sec) time to achieve maximum fluorescence (Imax, unit) after intravenous injection of ICG; Tmax Tstart (sec) the time difference between Imax and Istart. In this clinical case, the time of achievement Istart, Imax, Tmax Tstart in different regions of interest decreased after successful endovascular revascularization of lower limb arteries

A prospective randomized controlled trial of bone metabolism in patients with charcot foot

BACKGROUND: Diabetic neuroosteoarthropathy (DNOAP, Charcot’s foot) - is a progressive destructive inflammatory disease of the osteoarticular apparatus of the foot, untimely and inadequate treatment of which can lead to the formation of gross deformities. More often, DNOAP is unilateral, bilateral lesion is relatively rare. It is not always possible to trace the relationship between the debut of DNOAP with trauma and chronic hyperglycemia. There is data demonstrating the role of individual pro-inflammatory factors in the pathogenesis of DNOAP, however, studies combining the evaluation of various metabolic markers of Charcot’s foot formation are currently extremely poor. AIM: To evaluate the hormonal and metabolic markers of bone formation and resorption in patients with DNOAP and without this diabetic complication. METHODS: A prospective, controlled trial included 70 patients with type 2 diabetes mellitus (37 men and 43 women) who formed 2 groups: group 1 included patients with DNOAP, group 2 was formed by patients with diabetes without foot skeleton damage. All patients underwent a study of 1,25-OH-vitamin D, sclerostin, pro-MMP-1, C-terminal propeptide type 1 collagen (PICP), type 1 collagen, osteocalcin, PTH, 25-OH-vitamin D, beta-cross-slaps. RESULTS: The results of the studies confirmed the presence of vitamin D deficiency in all patients with diabetes mellitus included in the study, revealed the absence of statistically significant differences between the groups in the values of sclerostin, pro-MMP-1; 25-OH-vitamin D, type I collagen, and osteocalcin (p > 0.05). However, significant differences were found in the 1.25-OH vitamin D levels: patients with DNOAP presented the lower rates of 1,25-OH-vitamin D in comparison to control group (p <0.05). Beta-cross and PICP levels were significantly higher in DNOAP patients as well (p <0.05). Those findings show the more severe collagen degradation in patients with DNOAP and can be the genetically predisposed cause of DNOAP development. Though further studies are needed. CONCLUSION: In patients with DNOAP a decrease in 1,25-OH-vitamin D levels was found, as well as the alteration of the synthesis and destruction of collagen (beta-cross-slaps and PICP) compared to patients with diabetes mellitus without osteoarticular disorders

The initial level of heart rate variability determines the dynamics of the neuropathy of the autonomic nervous system and temperature sensitivity in rats with streptozotocin diabetes

BACKGROUND: The development of diabetes mellitus (DM) is accompanied by hyperglycemia, which leads to the development of neuropathy. We assume that the individual characteristics of the organization of the autonomic nervous system (ANS) in humans affect not only the ability to withstand stress, but can determine the course of diseases, including diabetes. AIMS: The study of the dynamics of heart rate variability and temperature sensitivity in rats against the background of hyperglycemia depending on the organization of the initial regulation of the heart under ANS. MATERIALS AND METHODS: 70 male rats were randomized by weight and level of total heart rate variability (HRV) on animals with initially low and high levels of total HRV. Diabetes was modeled by a single i.p. injection of streptozotocin (STZ). The control group received a single i.p. injection of citrate buffer (CB). Before the induction of diabetes, as well as on 21, 42 and 70 days after the injection of STZ, a comprehensive examination of rats’ condition was carried out: 1) assessment of HRV; 2) analysis of temperature-pain sensitivity; 3) assessment of glucose and ketone bodies in the blood. Similarly, animals in the CB group were examined. RESULTS: The change in HRV and temperature-pain sensitivity in rats depends on the initial level of HRV. In rats with low variability, the reaction time in the pain test increased by 8–32% from the 28th day of the experiment, from 21 days the bradycardia increased and the decrease in individual HRV indices at rest, but not the response of these parameters to cold stress. CONCLUSION: The development of ANS’s lesion depends on the initial level of HRV. Low variability animals are more resistant to hyperglycemia: the normal ranges of CP reactions from the side of HR, the parameters of total HRV and the CVHS contribution to it are longer, but there is a loss of temperature sensitivity. Initially, highly variable rats with the development of diabetes do not lose temperature sensitivity, but demonstrate an imbalance in the regulatory circuits of heart rate and HRV

Hypoglycemia and the risk of cognitive impairment and dementia in elderly and senile patients with type 2 diabetes

Research results show that poor glycemic control and recurrent episodes of severe hypoglycaemia are associated with a decrease in cognitive function in elderly people with type 2 diabetes mellitus (T2DM). On the other hand, patients with diabetes mellitus associated with cognitive impairment/dementia are most at risk of developing hypoglycaemic conditions. It is obvious that the relationship between hypoglycaemia and dementia is very complex and has a mutually aggravating nature. Studies also show that individuals of older age groups with diabetes and cognitive impairment have a high risk of developing hypoglycaemic conditions, such as unwanted side effects from glucose-lowering therapy. In this case, of particular interest is the question that is being actively studied at the present time, which is concerning the effect of different groups of glucose-lowering antidiabetic drugs on the cognitive status and the rate of cognitive decline in diabetic patients with cognitive impairment. In this review, we attempted to summarise, systematise, and present data available in the literature concerning the effect of hypoglycaemia on the risk of cognitive impairment and dementia in elderly and senile patients with type-2 diabetes, as well as the degree of participation in this process of of various groups of sugar-lowering antidiabetic drugs

An economic value of the glycated hemoglobin test in diabetes mellitus type 2 diagnosis

BACKGROUND: Diagnostic of diabetes mellitus type 2 (DM2T) in time is very actual for treatment and prevention of potential complications of illness. Fasting blood glucose test (FBG) is a widely used method of primary DM2T diagnose. Glycated hemoglobin (HbA1c) test is an alternative and used more rarely due to expensive. AIM: Modelling of comparative expenditures for DM2T control in cases of primary diagnostic by HbA1c test or FBG test usage in 20-years horizon. METHODS: Retrospective analysis of aggregated epidemiological Russian NATION study data in 810 patients with prediabetes and DM2T with both analysis performed, with sensitivity and specificity of each is detected. The simulation model of DM2T outcomes has been used for Health Technology assessment (direct and indirect costs of Diabetes control during 20 years). Three algorithms of the DM2T treatment were investigated for understanding of expenditures in case on diagnostic on-time and case of late verification with metformin, gliflozines, gliptins, Glucagon-like peptide-1 receptor agonists, basal insulin analogs and their combinations. RESULTS: FBG test has more negative results for DM2T diagnostics in compare with HbA1c analysis (77,4% and 36,5% accordingly). Amount of false negative results in FBG test in 3 times more often occurred in comparison with HbA1c. HbA1c test in 3 times more precisely than FBG test for carbon metabolism abnormalities detection. Diagnostic in time with HbA1c test in compare with late process of illness detection by FBG can cut common expenditures on 26,3-27,7% depending on treatment option due to macrovasular complications decreasing. Disability rate is expected decrease on 21% to 20-th year in case of diagnostic with HbA1c performing instead FBG test. CONCLUSION: HbA1c test has diagnostic advantages in compare with FBG test for primary investigation (dispanserization). Direct and indirect expenditures in average for one patient with DM2T on 20-years horizon including cost of drugs, analysis, complications, disabilities are less in case of diagnostic in time with HbA1c test in comparison with late diagnostics in case of FBG test execution

Keratinocytes differentiation and wound healing in rats with streptozotocin – induced diabetes and severe hyperglycemia

BACKGROUND: Diabetes mellitus leads to disruption of the skin repair processes, but the leading mechanisms of this pathology have not yet been identified. In this regard, in our work, we decided to check how hyperglycaemia affects the process of keratinocyte phenotype changes during wound healing. AIMS: To study the effect of hyperglycaemia on wound healing and differentiation of keratinocytes in a rat streptozotocin-induced diabetes model. MATERIALS AND METHODS: Diabetes mellitus was induced in rats by using streptozotocin, 65 mg / kg, intraperitoneally, once. The wound was applied in the supra-scapular region on the 42nd day, after which (after 8, 16, and 24 days) the repair process was evaluated using histological methods. Immunohistochemistry was used to evaluate the expression of cytokeratin-10 and cytokeratin-17. RESULTS: In rats with diabetes mellitus, wound healing slowed down in the later stages, compared with the control group. In general, wound healing was accompanied by an increase in the expression of cytokeratin-10 in its region compared with intact skin, and contractile keratinocytes activation was disrupted in diabetic rat wounds. CONCLUSIONS: Hyperglycaemia slightly slows wound healing in rats and impairs contractile keratinocytes activation