scholarly journals Microcirculatory parameters in compensated and decompensated type 2 diabetes mellitus

2017 ◽  
Vol 89 (10) ◽  
pp. 28-35 ◽  
Author(s):  
O V Suchkova ◽  
Yu I Gurfinkel ◽  
M L Sasonko

Aim. To reveal the features of microcirculatory parameters in compensated and decompensated type 2 diabetes mellitus (T2DM). Subjects and methods. A total of 196 patients with T2DM were examined and divided into 2 groups: 1) 52 patients (40.4% of men) aged 52.8±8.7 years with compensated T2DM (glycated hemoglobin (HbA1с), 6.3±0.5%); 2) 68 patients (38.2% of men) aged 52.8±8.1 years with decompensated T2DM (HbA1с, 9.4±1.7%). Both patient groups had concomitant hypertension (its prevalence, degree, stage of hypertension were comparable). A control group consisted of 76 volunteers (40.8% of men) aged 52.2±8.7 years with normal carbohydrate metabolism and without signs of cardiovascular disease (HbA1с, 5.3±0.49%). Capillary blood flow in the finger nail-fold area was investigated in all the participants. A digital optical capillaroscope with image-processing software was used to obtain quantitative blood microcirculatory parameters. The diameters of arterial and venous capillary segments were measured, by calculating the remodeling rate. The degree of capillary tortuosity, network density, and polymorphism and the size of the perivascular zone (PZ) were estimated. Blood rheological properties and capillary blood flow velocity were also investigated. Results. The decompensated T2DM group compared to the compensated T2DM group was found to have a narrowing of the arterial capillary segment diameter (8.4±2.0 µm; p=0.009) and an increase in remodeling rates (1.47±0.22; p=0.000). The tendency of the PZ size to be larger in patients with decompensated T2DM compared to those with compensated T2DM (p=0.080) and the increase in this indicator compared to the control group (p=0.001) reflect the presence of edema syndrome in Group 2, as laboratory confirmed by a statistically significantly elevated sodium level (p=0.000; p=0.006). The enlarged venous capillary segment demonstrates involvement of the venous component in microcirculatory disorders in T2DM. The reduction in the density of the capillary network and the increase in capillary tortuosity and polymorphism, which were also observed in the patients of both groups versus the control group, are referred to as disorders that are characteristic of T2DM. Conclusion. In decompensated T2DM, capillary bed structural and functional changes are found as a narrowing of the arterial capillary segment, an increase in the rate of remodeling, and enlargement of the PZ. Digital capillaroscopy opens up new possibilities for assessing the magnitude of changes in the microcirculatory system in DM and can simultaneously evaluate the efficiency of treatment, by monitoring the status of the microvasculature.

2019 ◽  
Vol 6 (3) ◽  
pp. 132-136
Author(s):  
O. Bilovol ◽  
V. Nemtsova ◽  
I. Ilchenko ◽  
V. Zlatkina

Abstract. INFLUENCE OF HORMONAL DISORDERS ON ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH ARTERIAL HYPERTENSION AND COMORBIDE ENDOCRINOPATHIES Bilovol O.M., Nemtsova V.D., Ilchenko I.A., Zlatkina V.V. Purpose: to investigate the effect of hormonal changes on endothelial dysfunction (ED) in patients with a comorbid course of hypertension (H), type 2 diabetes mellitus (T2DM) and subclinical hypothyroidism (SHT). Methods: 183 patients with  H stage II were divided into 3 groups: Group 1 (n=50) - with isolated H (comparison group); Group 2 (n=63) - with a combined course of H and T2DM; Group 3 (n=70) - with comorbidity of H, T2DM and SHT. Blood pressure levels, carbohydrate, lipid and thyroid metabolism, plasma insulin concentration, insulin resistance (IR) the HOMA-IR index, vascular endothelial growth factor (VEGF-A) plasma levels were investigated. Results: Dyslipidemia was more pronounced in group 2 than in group 1. The addition of SHT was accompanied by a tendency to increase all the atherogenic lipids. IR was observed in all patients groups and was significantly higher than in control group (p<0.05). Significant increase of VEGF-A levels in all patients groups in comparison with the control (p<0.05) was found. In group 2 VEGF-A was lower than in group 1, which is probably due to the protective effect of metformin. Analysis  of the influence of thyroid dysfunction degree on ED revealed significant increase of VEGF-A levels in TSH>6.0 μMU/ml subgroup (352.55±17.64 pg/ml vs 461.74±20.13 pg/ml (p<0.05)). Conclusion: Hormonal disorders contribute to aggravation of endothelial dysfunction in patients with hypertension and comorbid endocrinopathies - type 2 diabetes mellitus and subclinical hypothyroidism. Even minor decrease in thyroid function lead to the progression of endothelial dysfunction. Key words: hypertension, type 2 diabetes mellitus, subclinical hypothyroidism, endothelial dysfunction   Резюме. ВПЛИВ ГОРМОНАЛЬНИХ ПОРУШЕНЬ НА ЕНДОТЕЛІАЛЬНУ ДИСФУНКЦІЮ УПАЦІЄНТІВ З АРТЕРІАЛЬНОЮ ГІПЕРТЕНЗІЄЮ ТА КОМОРБІДНИМИ ЕНДОКРИНОПАТІЯМИ Біловол О.М., Немцова В.Д., Ільченко І.А., Златкіна В.В. Мета: дослідити вплив гормональних змін на ендотеліальну дисфункцію (ЕД) у пацієнтів з коморбідним перебігом артеріальної гіпертензії (АГ), цукрового діабету 2 типу (ЦД2Т) тасубклінічного гіпотиреозу (СГТ). Матеріали та методи: 183 пацієнта з АГ II стадії були розділені на 3 групи: 1-а група (n=50) - з ізольованою АГ (група порівняння); Група 2 (n=63) - з поєднаним перебігом АГ та ЦД2Т; Група 3 (n 70) – з комбінованим перебігом АГ, ЦД2Т і СГТ. Вивчали рівні артеріального тиску, показники вуглеводного, ліпідного і тиреоїдного обміну, концентрацію інсуліну в плазмі, індекс інсулінорезистентності (ІР) - HOMA-IR, рівні васкулоендотеліального фактора росту (VEGF-A) в плазмі. Результати. Ступінь дисліпідемії у 2-й групі була більш вираженою, ніж в 1-й. Приєднання СГТ супроводжувалося тенденцією до збільшення всіх атерогенних фракцій ліпідів. ІР спостерігалася у всіх групах пацієнтів і була достовірно більше, ніж у контрольній групі (р<0,05). Виявлено достовірне підвищення рівнів VEGF-A у всіх групах пацієнтів в порівнянні з контролем (р<0,05). В 2-й групі рівні VEGF-A були нижче, ніж в 1-й групі, що, ймовірно, пов'язано з протективним ефектом метформіну. Аналіз впливу ступеня гіпофункції щитовидної залози на ЕД виявив значне збільшення рівнів VEGF-A в підгрупі TSH> 6,0 мкМ / мл (352,55 ± 17,64 пг / мл і 461,74 ± 20,13 пг / мл відповідно, р <0,05). Висновки. Гормональні порушення сприяють погіршенню ендотеліальної дисфункції у пацієнтів з артеріальною гіпертензією та супутніми ендокринопатіями - цукровим діабетом 2 типу та субклінічним гіпотиреозом. Навіть незначне зниження функції щитовидної залози призводить до прогресування ендотеліальної дисфункції. Ключові слова:  гіпертензія, цукровий діабет 2 тип, субклінічний гіпотиреоз, ендотеліальна дисфункція    Резюме. ВЛИЯНИЕ ГОРМОНАЛЬНЫХ НАРУШЕНИЙ НА ЭНДОТЕЛИАЛЬНУЮ ДИСФУНКЦИЮ У ПАЦИЕНТОВ С АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИЕЙ И КОМОРБИДНЫМИ ЭНДОКРИНОПАТИЯМИ Беловол О.М., Немцова В.Д., Ильченко И.А., Златкина В.В. Цель: исследовать влияние гормональных изменений на эндотелиальную дисфункцию (ЭД) у пациентов с коморбидным течением артериальной гипертензии (АГ), сахарного диабета 2 типа (СД2Т) и субклинического гипотиреоза (СГТ). Материалы и методы: 183 пациента с АГ IIстадии были разделены на 3 группы: 1-я группа (n = 50) - с изолированной АГ (группа сравнения); Группа 2 (n = 63) - с сочетанным течением АГ и СД2Т; Группа 3 (n = 70) - комбинированное течение АГ, СД2Т и СГТ. Изучали уровни артериального давления,  показатели  углеводного, липидного и тиреоидного обмена, концентрацию инсулина в плазме, индекс инсулинорезистентности (ИР)- HOMA-IR, уровни васкулоэндотелиального фактора роста(VEGF-A) в плазме. Результаты. Степень дислипидемии во 2-й группе была более выраженной, чем в 1-й.  Присоединение СГТ сопровождалось тенденцией к увеличению всех атерогенных фракций липидов. ИР наблюдалась во всех группах пациентов и была достоверно больше, чем в контрольной группе (р<0,05). Выявлено достоверное повышение уровней VEGF-A во всех группах пациентов по сравнению с контролем (р <0,05). Во 2-й группе уровни VEGF-A были ниже, чем в 1-й группе, что, вероятно, связано с протективным эффектом метформина. Анализ влияния степени дисфункции щитовидной железы на ЭД выявил значительное увеличение уровней VEGF-A в подгруппе TSH> 6,0 мкМ/мл (352,55 ± 17,64 пг / мл и 461,74 ± 20,13 пг / мл соответственно, р<0,05). Заключение. Гормональные нарушения способствуют ухудшению эндотелиальной дисфункции у пациентов с артериальной гипертензией и сопутствующими эндокринопатиями - сахарным диабетом 2 типа и субклиническим гипотиреозом. Даже незначительное снижение функции щитовидной железы приводит к прогрессированию эндотелиальной дисфункции. Ключевые слова: гипертензия, сахарный диабет 2 тип, субклинический гипотиреоз, эндотелиальная дисфункция     


2020 ◽  
Vol 16 (4) ◽  
pp. 27-32
Author(s):  
S.O. Rykov ◽  
K.V. Korobov ◽  
S.Yu. Mogilevskyy ◽  
D.S. Ziablitsev

Relevance. The numerous pro-inflammatory and antiangiogenic properties of endothelial monocyte-activating polypeptide-II (EMAP-II) suggest its possible role in the onset and progression of diabetic non-proliferative retinopathy (DNPR) in type 2 diabetes mellitus (T2DM). Objective – is to determine the blood EMAP-II in the DM2 patients and to establish its connection with the progression of DNPR. Material and methods. We examined 91 patients with DM2 (182 eyes), who were divided into groups: 1st – there was no DNPR in both eyes and 2nd – there was no retinopathy in one eye, and isolated vascular anomalies were noted in the other (ETDRS level 14, 15). The control group included 25 patients of the corresponding age and gender. The patients were re-examined after 1 year. The level of EMAP-II was determined by the enzyme immunoassay in blood plasma once at the beginning of the study. Statistical packages MedStat and MedCalc v.15.1 (MedCalc Software bvba) were used for statistical research. Results. The analysis of clinical and laboratory parameters showed that the initial manifestations of diabetic retinal lesions were manifested in 27.5% of patients after 7.16±1.11 years and were accompanied by greater glycemia. The level of EMAP-II in DM2 was many times higher than in the control, which depended on the presence of diabetic vascular changes in the retina: in patients without changes in the retina (group 1) – by 3.7 times, and in patients with initial vascular anomalies (group 2) – 5.2 times (p<0.001). The level of EMAP-II at the beginning of the study was associated with the progression of diabetic changes in the retina after 1 year – with their presence, it was 1.5 times higher than without them (p<0.001). Stratification by stage of DNPR after 1 year also showed the dependence of the severity of diabetic changes in the retina on the initial level of EMAP-II: in the presence of single vascular anomalies and initial DNPR, it was increased by 3-4 times, while with moderate DNPR – 5.9 times (p<0.001 for all comparisons). Conclusion. Thus, a significant increase in the level of EMAP-II in T2DM was established, and the dependence of the initial diabetic changes in the retina and the degree of their progression in 1 year after the increasing of the blood EMAP-II level.


2021 ◽  
Vol 17 (6) ◽  
pp. 486-490
Author(s):  
A.Yu. Kholikov ◽  
Yu.M. Urmanova

Background. The main risk factors for cardiovascular diseases (CVD) are diabetes mellitus, anemia, microalbuminuria, proteinuria, azotemia, hyperlipidemia, obesity, smoking, lack of physical activity, and non-traditional factors are metabolic and hemodynamic disorders. The combined effect of diabetes mellitus and renal insufficiency increases the risk of CVD and confirms the worse survival prognosis of these patients compared to the general population. The study was aimed to study changes in the parameters of cerebral hemodynamics in patients with type 2 diabetes mellitus receiving programmed hemodialysis. Materials and me­thods. During the period from January 1, 2019 to June 1, 2021, 117 patients suffering from type 2 diabetes mellitus with chronic renal failure stage V on programmed hemodialysis were examined and observed. Of these, there were 58 women and 59 men. The average age of men was 67.0 ± 4.2 years, women — 64.0 ± 5.6 years. Twenty patients of the matched age formed the control group. The number of hemodialysis sessions in patients ranged from 2 to 162. All patients underwent examinations that included general clinical, biochemical, hormonal blood tests, Dopplerography of the main arteries of the head. Results. With the increasing degree of cerebral ischemia, the linear velocity of blood flow (LBFV) decreased in all the main arteries of the head: the common caro­tid artery, the internal carotid artery, the vertebral artery on both sides (p < 0.05). At the same time, the differences in the LBFV from healthy individuals were significant. The stenosis of the lumen of the main vessels of the head occurred mostly in patients of the third group with stage V diabetic nephropathy and grade III chronic cerebral ischemia, while they most often had multiple vascular stenosis. Conclusions. Dopplerography of the main arteries of the head is an informative method for determining the prognosis of cerebral ischemia in patients with type 2 diabetes mellitus and chronic kidney disease. Linear blood flow velocity was reduced in all groups of patients with type 2 diabetes mellitus and chronic kidney disease.


2021 ◽  
Vol 24 (2) ◽  
pp. 111-121
Author(s):  
A. V. Simanenkova ◽  
S. M. Minasian ◽  
T. L. Karonova ◽  
T. D. Vlasov ◽  
N. V. Timkina ◽  
...  

Background: Myocardial infarction (MI) is one of the leading causes of mortality in patients with type 2 diabetes mellitus (DM), therefore it is essential to give preference to a glucose-lowering drug having optimal cardioprotective properties. A comparative study of the various sodium-glucose co-transporter inhibitors representatives’ protective effects in experimental MI was not carried out within the framework of one study.Aim: To evaluate the influence of empagliflozin (EMPA) and canagliflozin (CANA), in comparison with sitagliptin (SITA), on hemodynamic parameters and myocardial damage area in rats with diabetes type 2 model in experimental MI.Materials and methods: Type 2 DM was modelled in Wistar rats by means of 4-week high-fat diet followed by nicotinamide 230 mg/kg and streptozotocin 60 mg/kg administration. 4 weeks after DM induction the following groups were made: «DM+SITA» — treatment with SITA 50 mg/kg, «DM+EMPA» — treatment with EMPA 2 mg/kg, «DM+CANA» — treatment with CANA 25 mg/kg per os once daily for 8 weeks. Animals in «DM» group remained untreated for the following 8 weeks. Rats in control group were fed with standard chow. 16 weeks after the experiment beginning transient global myocardial ischemia was modelled in all rats. Hemodynamic parameters and myocardium necrosis area were evaluated.Results: The necrosis area was larger in «DM» group, than in control one (p=0.018). Infarction size in «DM+SITA» did not differ from that in «DM» group (62.92(41.29;75.84) and 57.26(45.51;70.08)%, р=0.554). Necrosis area in «DM+EMPA» and «DM+CANA» groups was smaller than in «DM» group (37.90(20.76;54.66)%, 46.15(29.77;50.55) vs 57.26(45.51;70.08)%, р=0.008 and р=0.009, respectively). Necrosis size did not differ between «DM+EMPA» and «DM+CANA» groups (p=0.630). Ischemic contracture in «DM+CANA» group was less prominent than under the use of all other glucose-lowering drugs. We observed increase of coronary blood flow in «DM+EMPA» group, in comparison with «DM», «DM+CANA» and «DM+SITA» groups.Conclusions: SITA does not have cardioprotective effect in ischemia-reperfusion injury in diabetic rats. EMPA and CANA have similarly prominent infarct-limiting properties. EMPA is able to increase coronary blood flow, whereas cardioprotective action of CANA is associated with ischemic contracture diminishing.


Author(s):  
Shah Namrata Vinubhai ◽  
Pardeep Agarwal ◽  
Bushra Fiza ◽  
Ramkishan Jat

Background: Serum ferritin is known as an index for body iron stores also as an inflammatory marker and it is influenced by several disease. We were looking for a correlation between HbA1c and S. Ferritin in type 2 DM. Methodology: The present study a total of 150 participants were enrolled of which 100 were confirmed cases of Type 2 Diabetes Mellitus and rest 50 age and sex matched healthy subjects constituted the control group. All were screened for HbA1c, Fasting blood sugar, Post prandial blood sugar and S.Ferritin. Results: A highly significant variation and positive correlation was observed with respect to S.Ferritin and HbA1c levels. Mean S.Ferritin was high in the subgroup with poor glycemic control. Conclusion: The fasting, post prandial sugar levels, HbA1c and S.Ferritin were significantly higher in the diabetic subjects. This study shows a positive correlation between HbA1c and S. Ferritin levels. So we can conclude that in diabetic patients S. Ferritin may serve as an independent marker of poor glycemic and metabolic control. Keywords: Serum ferritin, Type 2 Diabetes Mellitus, HbA1c.


2018 ◽  
Vol 4 (2) ◽  
pp. 58-62
Author(s):  
Roksana Yeasmin ◽  
MA Muttalib ◽  
Kazi Nazneen Sultana ◽  
Nizamul Hoque Bhuiyan ◽  
Md Jamil Hasan Karami ◽  
...  

Background: Type 2 diabetes mellitus is a chronic disease characterized by relative or absolute deficiency of insulin, resulting in glucose intolerance.Objectives: The present study was planned to see the associations of serum uric acid with positive Rheumatoid factor in type 2 male diabetes mellitus patients. Methodology: This case control study was carried out at the department of Biochemistry at Ibrahim Medical College, Dhaka, Bangladesh. The duration of the study was from June 2015 to June 2016 for a period of one year. In this present study, male patients with type 2 diabetes mellitus were taken as case group and age and sex matched healthy male were taken as control group. Rheumatoid factor was measured from the blood of all case and control group respondents. Others blood para meters were also measured for the correlation with the diabetes mellitus patients.Results: In this present study, 110 male patients presented with type 2 diabetes mellitus were recruited as case and age and sex matched healthy male were recruited as control. More rheumatoid factor positive in type 2 DM male patients with the uric acid range between 6.5 to 9.5 mg/dL. The number of patients was 5 out of total 9 rheumatoid factor positive cases. In this study serum uric acid was significantly correlated with rheumatoid factor in type 2 male diabetic patients. Rheumatoid factor positive cases were taking insulin among 9 and it was statistically significantly associated (p<0.001). Conclusion: In this study serum uric acid is significantly associated with positive rheumatoid factor in type 2 male diabetic patients.Journal of Current and Advance Medical Research 2017;4(2):58-62


2021 ◽  
Vol 40 (1) ◽  
Author(s):  
Freda Lalrohlui ◽  
Souvik Ghatak ◽  
John Zohmingthanga ◽  
Vanlal Hruaii ◽  
Nachimuthu Senthil Kumar

AbstractOver the last few decades, Mizoram has shown an increase in cases of type 2 diabetes mellitus; however, no in-depth scientific records are available to understand the occurrence of the disease. In this study, 500 patients and 500 healthy controls were recruited to understand the possible influence of their dietary and lifestyle habits in relation with type 2 diabetes mellitus. A multivariate analysis using Cox regression was carried out to find the influence of dietary and lifestyle factors, and an unpaired t test was performed to find the difference in the levels of biochemical tests. Out of 500 diabetic patients, 261 (52.3%) were males and 239 (47.7%) were females, and among the control group, 238 (47.7%) were males and 262 (52.3%) were females. Fermented pork fat, Sa-um (odds ratio (OR) 18.98), was observed to be a potential risk factor along with tuibur (OR 0.1243) for both males and females. Creatinine level was found to be differentially regulated between the male and female diabetic patients. This is the first report of fermented pork fat and tobacco (in a water form) to be the risk factors for diabetes. The unique traditional foods like Sa-um and local lifestyle habits like tuibur of the Mizo population may trigger the risk for the prevalence of the disease, and this may serve as a model to study other populations with similar traditional practices.


Author(s):  
Hadi Bazyar ◽  
Seyed Ahmad Hosseini ◽  
Sirous Saradar ◽  
Delsa Mombaini ◽  
Mohammad Allivand ◽  
...  

Abstract Background In patients with type 2 diabetes mellitus (T2DM) the inflammatory and metabolic responses to epigallocatechin-3-gallate (EGCG) are unknown. Objectives Evaluate the impacts of EGCG on metabolic factors and some biomarkers of stress oxidative in patients with T2DM. Methods In this randomized, double-blind, placebo-controlled trial, 50 patients with T2DM consumed either 2 tablets (300 mg) EGCG (n=25) or wheat flour as placebo (n=25) for 2 months. The total antioxidant capacity (TAC), interleukin-6 (IL-6), lipid profile, mean arterial pressure (MAP), atherogenic index of plasma (AIP) were evaluated before and after the intervention. Results The finding of present study exhibited a significant increase in the serum levels of TAC after the EGCG supplementation (p=0.001). Also, in compare with control group, the mean changes of TAC were significantly higher in supplement group (p=0.01). In intervention group, a significant decrease was observed in the mean levels of triglyceride, total cholesterol, diastolic blood pressure (DBP), AIP, and MAP (p<0.05). Taking EGCG resulted in the mean changes of total cholesterol, MAP and DBP were significantly lower in compare with control group (p<0.05). Conclusions This study recommended that EGCG supplementation may be improved blood pressure, lipid profile, AIP, and oxidative status in patients with T2DM.


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