Сахарный диабет (Jul 2016)
Clinical and pathogenetic features of lesions of the lower extremities in patients with type 2 diabetes mellitus and chronic venous insufficiency
Abstract
Comorbid chronic venous insufficiency (CVI) and type 2 diabetes mellitus (T2DM) are common, particularly in older people. The severity of DM and its complications can worsen the course of CVI and affect its management.Aim. To assess the impact of T2DM on lesions of the lower extremities in patients with CVI.Materials and methods. Eighty patients with CVI of the lower limbs were examined. Forty patients had T2DM (main group) and 40 patients did not have T2DM (control group). Physical examination, clinical and biochemical tests, ultrasound scanning of veins and arteries of the lower extremities and electroneuromyography (ENMG) of the lower extremities were performed for all patients. The state of the microvasculature was studied by laser Doppler flowmetry (LDF) for 15 patients in the main group and 15 patients in the control group.Results. T2DM exacerbated the course of CVI, which was clinically characterized by a greater severity of trophic (p = 0.0001) and oedema (p = 0.03) syndromes. Morphological changes in the venous blood flow in patients with T2DM with CVI were characterized by bilateral lesions (p = 0.03), more frequent failure of sapheno-femoral anastomosis (p = 0.02) and perforating veins of the lower leg (p = 0.0004). The pathogenesis of such complications was associated with diabetic factors, including hyperglycaemia, НbА1с > 10%, duration of DM > 10 years and the presence diabetic microangiopathy of the lower limbs. Diabetic macroangiopathy and polyneuropathy were associated with disruption of the morphological and functional characteristics of the venous system and the disruption of the microcirculation in the lower extremities, contributing to increased oedema and trophic changes. At the same time, the presence of diabetic neuropathy masked the symptoms of CVI due to reductions in pain (p = 0.0004).Conclusion. Diabetes exacerbates the course of CVI due to poor glycaemic control (HbA1c > 10%), long duration of diabetes (>10 years) and the presence of macroangiopathy in the lower extremities. Diabetic neuropathy of the lower limbs and diabetic microangiopathy aggravates the venous disease through disruption of microcirculation and increases the expression of trophic changes in the lower extremities.
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