DOI: https://doi.org/10.22141/2224-0721.14.8.2018.154858

Monitoring the status of the blood circulation in the lower extremities in patients with diabetes mellitus

N.V. Gulchiy, S.S. Nazarchuk, V.I. Dunaevskiy, V.I. Kotovskiy, V.I. Timofeev

Abstract


Background. Diabetes mellitus (DM) is a current medical and social problem. According to the data from International Diabetes Federation, 415 million people worldwide suffer from DM, and bу 2030, the number of patients is expected to be 552 millions. Diabetic foot syndrome is the most severe form of DM, manifestation of purulent­necrotic complications in the lower extremities, nearly 30–60 % of patients have it. After comparative analysis, the authors of this work noted that in people with diabetic foot syndrome, amputations of lower extremities are being performed 30 times more often than in persons without DM. There are two factors in the pathogenesis of diabetic neuropathy: metabolic and vascular, which may change with time; at early stages, metabolic forms prevail, then — vascular. The use of new examination methods will allow diagnose complications of diabetes mellitus in a timely manner, in particular, diabetic foot syndrome, which will significantly increase the effectiveness of treatment and quality of life. Raynaud’s syndrome manifests itself as a spasm of the large arteries of the distal limb, the tip of the nose. Among non­invasive diagnostic methods, the method of remote infrared thermography is quite informative. The use of thermography allows you to identify an early stage and to monitor the course of this disease. As can be seen from the set forth, Raynaud’s disease and the affection of the lower extremities in patients with DM have much in common. The aim of the study was to use remote infrared therapy for the differential diagnosis of major blood flow disorders in the arteries of the lower extremities of varying severity, which may be the result of Raynaud’s disease or the complication of DM or diabetic foot syndrome. Materials and methods. Patients’ examination was carried out according to the worked out methodology with the use of domestic thermographer with matrix photodetector. Results. A typical thermographic picture is a reduced temperature in the zone of the tip of the nose, hands and feet. Depending on the degree of disease development, the temperature gradient in cold zones may vary from 0.8 to –1.4… –12 °C. The highest temperature gradient is observed when patients are close to so­called thermoamputations of the hand or lower limb. Thermograms in Raynaud’s disease, as a rule, do not have signs of disturbed blood flow in the major vessels of the lower extremities. We observed another thermographic picture of the lower extremities when patients have DM. Patient S. with type 2 diabetes mellitus complained of pain and sensory impairment in the right lower limb. On the thermogram, the disturbance is visualized in the blood supply to the lower limb with the zones of the thermal asymmetry — hypo­ and hyperthermia. The temperature of the front surface of the right foot is 2.03 °C degrees lower than the temperature of the front surface of the left foot. There is a thermal asymmetry of the right and left legs, the temperature difference in the zones marked equals –0.94 °C. Despite the disturbed blood supply to the lower extremities, a sharp decrease in the temperature of the toe bones is not visualized thermograpically. Depending on in­patient and preventive treatment, which is associated with the constant intake of antihyperglycemic drugs, blood sugar levels ranged 19–14–7 mmol/l. Thermographic diagnosis allows non­invasive, easy for the patient dynamic monitoring of the treatment process. Conclusions. The conducted research showed the possibilities of remote infrared therapy in various forms of disturbed blood supply to the lower limbs in patients with DM. Triad of simultaneous thermographic signs, which are characteristic of Raynaud’s disease (violation of blood supply to the nose, hands, feet), is rarely observed when patients have diabetes mellitus, which makes it possible to carry out differential diagnosis of the above­mentioned pathologies. In order to detect the disorders of the micro­ and macrocirculation system in a timely manner, it is expedient to use remote infrared therapy as one of the modern non­invasive methods for determining comprehensive treatment and the prognosis of limb preservation with diabetic foot syndrome.


Keywords


Raynaud’s disease; diabetes mellitus; thermography; spasm; vessels

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