Impairment of microvascular blood flow in patients with type 2 diabetes and cardiovascular autonomic neuropathy

BACKGROUND: Diabetic autonomic neuropathy is the reason for early morbidity and mortality on diabetic patients. The pathology not only cardiac innervation but microvascular is presented.AIMS: We estimated the parameters of skin microvascular blood flow in accordance with cardiovascular autonomic neu...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	T. A. Zelenina, V. V. Salukhov, A. B. Zemlianoi, S. G. Zheleznjak, O. A. Klitsenko
Formato:	article
Lenguaje:	EN RU
Publicado:	Endocrinology Research Centre 2021
Materias:	diabetic neuropathy diabetic foot autonomic neuropathy microcirculation doppler ultrasonography functional tests Nutritional diseases. Deficiency diseases RC620-627
Acceso en línea:	https://doaj.org/article/be3a1ced1c5d47088416f36701028861
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:be3a1ced1c5d47088416f36701028861
record_format	dspace
spelling	oai:doaj.org-article:be3a1ced1c5d47088416f367010288612021-11-14T09:00:23ZImpairment of microvascular blood flow in patients with type 2 diabetes and cardiovascular autonomic neuropathy2072-03512072-037810.14341/DM12372https://doaj.org/article/be3a1ced1c5d47088416f367010288612021-02-01T00:00:00Zhttps://www.dia-endojournals.ru/jour/article/view/12372https://doaj.org/toc/2072-0351https://doaj.org/toc/2072-0378BACKGROUND: Diabetic autonomic neuropathy is the reason for early morbidity and mortality on diabetic patients. The pathology not only cardiac innervation but microvascular is presented.AIMS: We estimated the parameters of skin microvascular blood flow in accordance with cardiovascular autonomic neuropathy (CAN) staging in diabetic patients. We also assessed other risk factors of CAN in patients with diabetes.MATERIALS AND METHODS: We included 76 patients with type 2 diabetes in the study (24 patients with resent-onset diabetes and/or diabetes without microvascular complications, 26 with diabetic sensorimotor neuropathy (SMN) and 26 with SMN and previous history of diabetic foot amputation). The SMN was diagnosed on the basis of patients complaints, anamnesis and data of clinical neurological examinations. CAN was detected using several cardiovascular autonomic reflex tests (CART) as a gold standard of diagnosis: the tilt-table test, a deepbreathing and Valsalva Maneuver, handgrip test, cold-stress vasoconstriction. According to the Toronto Diabetic Neuropathy Expert Group Recommendation all patients was separated on the groups: CAN 0 (all CARTs were normal), CAN 1 (possible/early CAN — one abnormal CART was presented), CAN 2 (definite/confirmed CAN –at least two abnormal CARTs were found), CAN 3 (severe/advanced CAN — in the cases of orthostatic hypotension in addition to CARTs abnormalities). Microvascular blood flow of skin at the nail roller of fingers skin was valuated at rest as well as in functional cold test by the method of High-frequency Ultrasonic Dopplerography using the “Minimax Doppler K” device (LLC JV “Minimax”, St. Petersburg, Russia).RESULTS: CAN 1 was found in 8% diabetic patients without microvascular complications, 42 and 21% patients with SMN and diabetic foot amputations respectively. CAN 2 was diagnosed in 27% patients with SMN and 58% patients history of diabetic foot amputations. CAN 3 in 8% and 19% cases in patients with SMN and history of diabetic foot amputations respectively. The parameters of microvascular blood flow at rest were significantly decreased in patients with confirmed/severe CAN in comparison with early staging of CAN and patients without CAN (Vm=2.5±0.66 sm/sec vs. 4.4±0.54 sm/sec and 5.1±1.01 sm/sec respectively; p=0.0033). The abnormal result of cold test was detected in 94% patients with confirmed/ severe CAN and 26% patients with CAN 1.CONCLUSIONS: This investigation has demonstrated in a cohort with type 2 diabetes patients with/without SMN and with/ without history of previously foot amputations that decrease the Vm (the variable of microvascular blood flow assessed by High-frequency Ultrasonic Dopplerography) lower than 2.4 sm/sec is associated with 6.4 times increased likelihood of confirmed/severe CAN as well as positive cold test result. That the patients with positive cold test results were 28.6 times more likely have confirmed/severe CAN.T. A. ZeleninaV. V. SalukhovA. B. ZemlianoiS. G. ZheleznjakO. A. KlitsenkoEndocrinology Research Centrearticlediabetic neuropathydiabetic footautonomic neuropathymicrocirculationdoppler ultrasonographyfunctional testsNutritional diseases. Deficiency diseasesRC620-627ENRUСахарный диабет, Vol 24, Iss 1, Pp 32-44 (2021)
institution	DOAJ
collection	DOAJ
language	EN RU
topic	diabetic neuropathy diabetic foot autonomic neuropathy microcirculation doppler ultrasonography functional tests Nutritional diseases. Deficiency diseases RC620-627
spellingShingle	diabetic neuropathy diabetic foot autonomic neuropathy microcirculation doppler ultrasonography functional tests Nutritional diseases. Deficiency diseases RC620-627 T. A. Zelenina V. V. Salukhov A. B. Zemlianoi S. G. Zheleznjak O. A. Klitsenko Impairment of microvascular blood flow in patients with type 2 diabetes and cardiovascular autonomic neuropathy
description	BACKGROUND: Diabetic autonomic neuropathy is the reason for early morbidity and mortality on diabetic patients. The pathology not only cardiac innervation but microvascular is presented.AIMS: We estimated the parameters of skin microvascular blood flow in accordance with cardiovascular autonomic neuropathy (CAN) staging in diabetic patients. We also assessed other risk factors of CAN in patients with diabetes.MATERIALS AND METHODS: We included 76 patients with type 2 diabetes in the study (24 patients with resent-onset diabetes and/or diabetes without microvascular complications, 26 with diabetic sensorimotor neuropathy (SMN) and 26 with SMN and previous history of diabetic foot amputation). The SMN was diagnosed on the basis of patients complaints, anamnesis and data of clinical neurological examinations. CAN was detected using several cardiovascular autonomic reflex tests (CART) as a gold standard of diagnosis: the tilt-table test, a deepbreathing and Valsalva Maneuver, handgrip test, cold-stress vasoconstriction. According to the Toronto Diabetic Neuropathy Expert Group Recommendation all patients was separated on the groups: CAN 0 (all CARTs were normal), CAN 1 (possible/early CAN — one abnormal CART was presented), CAN 2 (definite/confirmed CAN –at least two abnormal CARTs were found), CAN 3 (severe/advanced CAN — in the cases of orthostatic hypotension in addition to CARTs abnormalities). Microvascular blood flow of skin at the nail roller of fingers skin was valuated at rest as well as in functional cold test by the method of High-frequency Ultrasonic Dopplerography using the “Minimax Doppler K” device (LLC JV “Minimax”, St. Petersburg, Russia).RESULTS: CAN 1 was found in 8% diabetic patients without microvascular complications, 42 and 21% patients with SMN and diabetic foot amputations respectively. CAN 2 was diagnosed in 27% patients with SMN and 58% patients history of diabetic foot amputations. CAN 3 in 8% and 19% cases in patients with SMN and history of diabetic foot amputations respectively. The parameters of microvascular blood flow at rest were significantly decreased in patients with confirmed/severe CAN in comparison with early staging of CAN and patients without CAN (Vm=2.5±0.66 sm/sec vs. 4.4±0.54 sm/sec and 5.1±1.01 sm/sec respectively; p=0.0033). The abnormal result of cold test was detected in 94% patients with confirmed/ severe CAN and 26% patients with CAN 1.CONCLUSIONS: This investigation has demonstrated in a cohort with type 2 diabetes patients with/without SMN and with/ without history of previously foot amputations that decrease the Vm (the variable of microvascular blood flow assessed by High-frequency Ultrasonic Dopplerography) lower than 2.4 sm/sec is associated with 6.4 times increased likelihood of confirmed/severe CAN as well as positive cold test result. That the patients with positive cold test results were 28.6 times more likely have confirmed/severe CAN.
format	article
author	T. A. Zelenina V. V. Salukhov A. B. Zemlianoi S. G. Zheleznjak O. A. Klitsenko
author_facet	T. A. Zelenina V. V. Salukhov A. B. Zemlianoi S. G. Zheleznjak O. A. Klitsenko
author_sort	T. A. Zelenina
title	Impairment of microvascular blood flow in patients with type 2 diabetes and cardiovascular autonomic neuropathy
title_short	Impairment of microvascular blood flow in patients with type 2 diabetes and cardiovascular autonomic neuropathy
title_full	Impairment of microvascular blood flow in patients with type 2 diabetes and cardiovascular autonomic neuropathy
title_fullStr	Impairment of microvascular blood flow in patients with type 2 diabetes and cardiovascular autonomic neuropathy
title_full_unstemmed	Impairment of microvascular blood flow in patients with type 2 diabetes and cardiovascular autonomic neuropathy
title_sort	impairment of microvascular blood flow in patients with type 2 diabetes and cardiovascular autonomic neuropathy
publisher	Endocrinology Research Centre
publishDate	2021
url	https://doaj.org/article/be3a1ced1c5d47088416f36701028861
work_keys_str_mv	AT tazelenina impairmentofmicrovascularbloodflowinpatientswithtype2diabetesandcardiovascularautonomicneuropathy AT vvsalukhov impairmentofmicrovascularbloodflowinpatientswithtype2diabetesandcardiovascularautonomicneuropathy AT abzemlianoi impairmentofmicrovascularbloodflowinpatientswithtype2diabetesandcardiovascularautonomicneuropathy AT sgzheleznjak impairmentofmicrovascularbloodflowinpatientswithtype2diabetesandcardiovascularautonomicneuropathy AT oaklitsenko impairmentofmicrovascularbloodflowinpatientswithtype2diabetesandcardiovascularautonomicneuropathy
_version_	1718429486256488448

Impairment of microvascular blood flow in patients with type 2 diabetes and cardiovascular autonomic neuropathy

Ejemplares similares