Early detection of microangiopathic complications of diabetes mellitus (DM) is necessary to analyze the patient's condition and prevent disease progression. The study was aimed to investigate the ...relationship between the presence of retinopathy and decreased reactivity of the microcirculatory bed in patients with diabetes.
The study involved 130 subjects: healthy volunteers (n = 48), DM patients without retinopathy (n = 53) and with retinopathy (n = 29). Skin microvascular reactivity was assessed on the forearm using laser Doppler flowmetry with a local heating test combined with occlusion.
The slope of local thermal hyperemia curve (Slope-120) and other parameters of microvascular reactivity showed difference in pairwise comparisons between the groups. Slope-120 had the highest sensitivity (0.759) and specificity (0.717) in detection of diabetic retinopathy. The decrease of Slope-120 was associated with retinopathy (odds ratio (OR) – 8.3 (2.9–24.1), p < 0.001), even after adjusting for other factors (OR – 11.0 (1.6–77.2), p = 0.016).
Thus, assessment of skin microvascular reactivity may be a useful test for detecting signs of microangiopathic complications and for screening patients in risk group. Decreased microvascular reactivity has been shown to be prospective as an independent indicator of retinopathy in type 1 DM.
•The diabetic microangiopathic changes occur in many organs and lead to complications.•The skin microcirculation can reflect signs of diabetes and diabetic complications.•In our study, decreased skin microvascular reactivity was associated with retinopathy.•It can be used as an independent risk factor for diabetic retinopathy presence.
Introduction
The development of new highly accurate, inexpensive and accessible methods for the detection of lower-extremity peripheral artery disease (LE-PAD) in diabetic patients is required. The ...aim of this study was to evaluate the accuracy of a new incoherent optical fluctuation flowmetry (IOFF) method in detecting legs with hemodynamically significant stenoses compared to ankle brachial index (ABI) and transcutaneous oximetry (TcPO2) in patients with diabetes mellitus (DM).
Materials and methods
Patients were recruited into 2 groups. Group 1 included patients with DM without LE-PAD and/or diabetic foot syndrome; Group 2 included patients with DM and LE-PAD. All patients underwent the following measurements: ultrasound (reference method), ABI, TcPO2, and the new IOFF method.
Results
The new IOFF method showed a sensitivity of 79.5% and a specificity of 89.8% in detecting limbs with hemodynamically significant stenosis (AUC 0.890, CI 0.822–0.957). TcpO2 allows the diagnosis of LE-PAD with 69.2% sensitivity and 86.2% specificity (AUC 0.817, CI 0.723–0.911). Using a standard ABI cut-off of less than 0.9, the sensitivity and specificity for this parameter were 34.5% and 89.7%, respectively. Increasing the diagnostic cut-off of the ABI on the study group to 0.99 improved sensitivity to 84.6% and specificity to 78% (AUC,0.824 CI 0.732–0.915).
Conclusions
The new IOFF technique has demonstrated high sensitivity and specificity in the detection of LE-PAD in patients with DM. The high accuracy, rapid measurement, and potential availability suggest that the new IOFF method has a high potential for clinical application in the detection of PAD.
The aim of the present study was to evaluate changes in cutaneous blood flow detected by incoherent optical fluctuation flowmetry (IOFF) in diabetic patients with diagnosed microangiopathies. The ...study includes 52 patients with type 2 diabetes mellitus (12 males, 40 females, median age 57 (51; 60) years). All patients were examined using the IOFF method using functional tests: occlusion test on the index finger, local heat test on the dorsum of the foot, and local heat test on the big toe. The patients were divided into 2 groups: 13 patients with both diabetic retinopathy and diabetic nephropathy (Group 2, severe microcirculatory disorders) and 39 patients with only 1 microangiopathic complication or without any (Group 1). Local thermal hyperaemia (LTH2_1) was higher in Group 1 than in Group 2 (p = 0.011). Post-occlusive reactive hyperaemia (PORH_2) was higher in Group 2 than in Group 1 (p = 0.009). No changes were detected on the big toe. When PORH_2 and LTH2_1 were used in combination, the area under the ROC curve (95% CI) was 0.733 (0.62 to 0.846). Thus, the IOFF method has the potential to accurately detect blood flow abnormalities associated with diabetic microangiopathies.
BACKGROUND: Neurogenic regulation is involved in the development of microcirculation response to local heating. We suggest that microvascular reactivity can be used to estimate the severity of ...diabetic polyneuropathy (DPN). OBJECTIVE: To evaluate the prospects for using the parameters of skin microvascular reactivity to determine the severity of DPN. METHODS: 26 patients with diabetes mellitus were included in the study (patients with retinopathy (n = 15), and without retinopathy (n = 11)). The severity of DPN was assessed using Michigan Neuropathy Screening Instrument (MNSI) and Norfolk QOL-DN (NQOLDN). Skin microcirculation was measured by laser Doppler flowmetry with local heating test. RESULTS: There were revealed moderate negative correlations between microvascular reactivity and the severity of DPN (for MNSI (Rs = –0.430), for NQOLDN (Rs = –0.396)). In patients with retinopathy, correlations were stronger than in the general group (for MNSI (Rs = –0.770) and NQOLDN (Rs = –0.636)). No such correlations were found in patients without retinopathy. CONCLUSION: Correlation of the microvascular reactivity and DPN was revealed in patients with registered structural disorders in microvessels (retinopathy). The lack of such correlation in patients without retinopathy may be explained by the intact compensatory mechanisms of microvessels without severe disorders.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
(1) Background: To date, there are no studies evaluating the ability of the incoherent optical fluctuation flowmetry (IOFF) method to assess foot tissue perfusion. The aim of this study was to ...evaluate the correlation between perfusion values measured by IOFF and TcPO2 in patients with diabetes-related lower-extremity complications. (2) Methods: This was an observational, cross-sectional, two-center study. Diabetic patients with peripheral artery disease and/or diabetic foot ulcers were studied (n = 27, examinations were carried out on 54 legs). Perfusion in the foot tissues was assessed using TcPO2 (reference standard for this study) and the IOFF method. (3) Results: High correlation coefficients of all perfusion parameters measured by IOFF with TcPO2 (Rs 0.7 to 0.76) were shown. The study demonstrated that the IOFF method allows, with a sensitivity of 85.7% and a specificity of 90.0%, the identification of patients with a critical decrease in TcPO2 < 20 mmHg. (4) Conclusions: The high correlation of IOFF parameters with TcPO2 and the moderately high sensitivity and specificity in detecting patients with severe ischemia of foot tissues shows the promise of the method for assessing a tissue perfusion in patients with diabetes-related lower-extremity complications.
BACKGROUND: Data of real clinical practice in diabetes mellitus (DM) register allow to evaluate features and trends in structure of glucose-lowering therapy (GLT).
AIM: Тo analyze of structure of GLT ...received by patients with type 2 diabetes mellitus (T2DM) in Moscow region for 2018 and to evaluate its dynamics over 15 years.
METHODS: Analysis of GLT structure was carried out on basis of data from register of patients with DM in Moscow region, which is part of National register of diabetes mellitus in Russian Federation. In March 2018 it contained data on 211,792 T2DM patients of Moscow region. Structure of GLT administration was evaluated according T2DM duration, patients age and presence of cardiovascular diseases (CVD). Dynamics of GLT is analyzed from 2004 to 2018 yrs.
RESULTS: In 2018 non-insulin glucose-lowering drugs (NIGD) prescription prevailed (78.3%), insulin therapy was prescribed in 18.5% of patients, 3.2% of patients did not receive drug therapy. Most commonly prescribed NIGD were metformin (69.3%) and sulfonylurea (51.3%). Older patients more often than younger did not use GLT at all and less frequently received insulin therapy and iDPP-4. Insulin therapy was prescribed twice as often in patients with CVD compared with patients without CVD (29.6% and 15.5%). NIGD monotherapy has been less commonly used in patients with CVD (67.3% and 81.2%). Glucagon-like peptide-1 receptor agonists (GLP-1 RA) were prescribed to patients with CVD GLP-1 RA in 0.1% of cases, without CVD in 0.3% of cases, and sodium-glucose cotransporter 2 (SGLT2) inhibitors in 1.1% and 0.6%. correspondently.
CONCLUSION: Metformin was most commonly prescribed drug in GLT structure for T2DM patients in the Moscow region in 2018 yr. Percentage of new drugs in the structure of GLT increased mainly due to iDPP-4, and secondly due to SGLT2 inhibitors. New classes of GLT were more often prescribed to patients of younger age, with diabetes duration up to 10 years, overweight or obese. Administration of NIGD with proven cardiovascular protection in presence of CVD is almost two times less than for those without CVD.
This review includes results of scientific and clinical use of laser Doppler flowmetry (LDF) in patients with diabetes mellitus. LDF is a non-invasive method for the quantitative evaluation of ...microcirculation, which can assess microcirculatory rhythms and conduct functional tests with various impacts, allowing the exploration of regulatory mechanisms of microcirculation.
LDF reveals specific diabetes changes in the regulatory function of microcirculation. Microcirculation disturbances, which are traditionally associated with the pathogenesis of complications, also occur in patients with early disorders of carbohydrate metabolism and may precede the manifestation of diabetes. However, this method is still not applied in clinical practice. In this review, we analysed factors limiting the implementation of LDF in practical medicine and suggest ways to improve its clinical significance.
The aim of this study was to assess the quantitative composition of muscle and adipose tissue in type 2 diabetes mellitus (T2DM) patients on the basis of dual-energy X-ray absorptiometry for the ...diagnosis of obesity and sarcopenia.
Dual-energy X-ray absorptiometry was administered to 50 patients with T2DM. Evaluation of the composition of muscle and adipose tissue was performed.
The median of Appendicular Lean Mass Index (ALMI) in the general group was 8.04 7.32; 8.97. In general, there was a decrease in the appendicular muscle mass with increasing age. According to the results of T-score ALMI and Z-score ALMI, we did not identify patients with sarcopenia. However, the calculation of the T- and Z-criteria, adjusted for fat mass, led to a significant decrease of these parameters and in 98.0% it was possible to identify patients who meet the criteria of sarcopenia.
We did not detect patients with sarcopenia on the basis of ALMI, T-ALMI. After revision of these criteria for fat mass, almost all patients started to meet the criteria of sarcopenia (98.0%).
The hemorheologic disorders, which are potentially deleterious in a wide range of pathologies, were studied in patients with type-1 and type-2 diabetes mellitus. The significant determinants of blood ...viscosity, red blood cells (RBC) deformability and RBC reversible aggregation were assessed by ektacytometry and by laser backscattering technique, respectively. For both types of the disease, we observed acceleration of the first phase of RBC aggregation that contrasted with its deceleration at the second phase. The hydrodynamic stability of the aggregates, especially the smallest ones, exceeded the normal values in both cases. The influence of GP IIb/IIIa receptor inhibitor, monafram on RBC aggregation and disaggregation was the same in the cases of patients and normal subjects. The maximal shear induced RBC stretching exceeded the normal one in patients of both groups. The data reveal not only pathological but also compensatory character of hemorheological alterations in patients with type-1 and type-2 diabetes mellitus.
Economic development of unconventional reservoirs requires a combination of different techniques such as horizontal drilling and hydraulic fracturing. To obtain valuable information about the ...effectiveness of a hydraulic fracturing operation, it is a common practice to use borehole microseismic monitoring by deploying arrays of geophones in wells nearby. Microseismic monitoring provides important data about fracture parameters including: half-length, geometry, orientation and complexity of the fracture network. Based on this information, stimulation programs can be improved to increase production volumes. However, inaccurate microseismic acquisition design can result in poor quality raw microseismic data that undermines the success of this important operation.
In this study, we developed a comprehensive workflow using Multiple Criteria Decision Analysis (MCDA) to optimize microseismic acquisition design in order to improve borehole microseismic data quality. The influence of multiple parameters, such as average distance to microseismic events, receiver and event aperture, and wave-field complexity, is considered. A computer code is developed to resolve the conflicting parameters to achieve the best possible data quality. The program output is used recommend an optimum depth and location for deploying the borehole geophone array(s). The algorithm is then applied to a case study that utilizes synthetic microseismic data and real well trajectories from several vertical and horizontal wells in Williston Basin, North Dakota.
•Optimizing distance alone is not enough for best borehole microseismic design.•Optimization parameters often conflict with each other.•Unique wellbore geometries and relative locations require an automated solution.•Our code solves for the best geophone array location based on 4 criteria.
PDF
