Abstract
Objective: to determine the effect of etiological and social factors on the development and course of diabetic foot syndrome (DFS). Cardiovascular diseases are the most common pathology in the world, leading to disability of early death. Their development is closely associated with type 2 diabetes (T2DM), the prevalence of which currently has signs of a pandemic. Early diagnosis of vascular lesions of various organs and systems in men with T2DM makes it possible, under the condition of timely and adequate treatment, to prevent or slow down the development of cardiovascular events: heart attacks, strokes. The goal is to study the state of testicular, renal
and cerebral blood flow in men with diabetes mellitus using the radionuclide method.
Material and methods. The study involved 2264 patients with T2DM (1186 men, 1078 women) who were hospitalized at the Ukrainian Scientific and Practical Center for Endocrine Surgery, transplantation of endocrine organs and tissues of the Ministry of Health of Ukraine for the last 5 years old. The patients were divided into 2 groups: І — patients with T2DM with DFS (n=705, 448 men, 257 women), ІІ (control) — patients with T2DM without DFS (n=1559, 738 men, 821 women). The age, social status, duration of the disease, the presence of obesity, complications of diabetes
and concomitant cardiovascular pathology, the structure of surgical interventions, medical tactics, the level of glycated hemoglobin, as well as the relationship between them were studied. Used methods of statistical processing and retrospective analysis. Results. The average age of patients with diabetes І group was higher than in patients of group II, and the average age of women in both groups was higher than among men. Most patients in both groups were 50-69 years old. The proportion of patients with diabetes among the socially unprotected segments of the population in
group I was 81.4% against 70.0% in group II, and the proportion of women from this category of patients in both groups was higher. The average duration of diabetes was higher in the first group and in women. The majority of patients in the І group had the duration of diabetes 6-10 (29.9%) and 11-15 years (23.8%), in the II group — 1-5 (28.4%) and 6-10 years (28.8%). The mean body mass index (BMI) in both groups corresponded to grade 1 obesity. The proportion of patients with obesity in Group I was 45.8%, in Group II it was 54.2%, with morbid obesity it was 5.1% and 8.3%, respectively. The incidence rates of diabetic angiopathy of the lower limbs, diabetic retinopathy,
myocardial infarction and stroke in the І and ІІ groups were 39.6%, 65.1%, 18.4%, 12.2% and 24.0%, 56.3%, 8.8%, 7.2%, respectively. The frequency of DFS in men (37.8%) was 1.6 times higher in women (23.8%), and diabetic polyneuropathy, on the contrary, in men. In the І group, the frequency of atherosclerosis of the lower extremities was 47.1% against 20.2% in ІІ, venous thrombosis of the lower extremities — 4.6% against 2.1%, and hypertension — 81.7% against 77.4%. The shares of patients on insulin monotherapy (18.7%), combination therapy with insulin and oral hypoglycemic drugs (OHD) (34.6%) and insulin therapy in general (53.3%) were higher in group I (group II — 11 0%, 26.7% and 37.7%, respectively) due to a decrease in the proportion
of patients on monotherapy and, in general, on therapy for OHD (in group I — 45.2% and 79.9%, in group II — 59.9% and 86.7%, respectively). The average level of glycated hemoglobin (HbA1c)
practically did not differ (in group I — 8.90Ѓ}1.96%, in group II — 9.09Ѓ}2.10%). In women of both groups, the average HbA1c level (in the І group — 9.23Ѓ}2.02%, in the ІІ — 9.30Ѓ}2.05%) and the proportion of diabetes patients in the decompensation stage (in the І group — 69.8%, in ІІ — 69.4%) were higher than in men (8.7% and 8.9%, 60.6% and 59.9%, respectively). The presence of cardiovascular complications of diabetes and comorbidities affected the structure of surgical interventions on the heart and blood vessels. The proportion of patients who underwent surgery on the heart and blood vessels in the group I was 5.7 times higher than in group II (23.3% vs. 4.1%). More than 40% (in the І group — 44.1%, in the ІІ — 40.6%) were diagnostic intervention interventions. Conclusions. Age, social status of the patient, the duration of diabetes, the presence of diabetic angiopathy and atherosclerosis of the lower extremities, and the course of the disease — the progression of lower extremity diabetic angiopathy, atherosclerosis of the lower extremities, and the presence of venous thrombosis of the lower extremities, hypertension, myocardial infarction and stroke affect the development of DFS. The development and course of DFS do not significantly affect the presence of obesity and dyslipidemia in the patient with diabetes. The frequency of DFS in men (37.5%) is 1.6 times higher than in women (24.0%). The social status of patients, the presence of cardiovascular complications of diabetes and concomitant pathology adversely affect the availability, adequacy and effectiveness of treatment of diabetes and comorbidities, and also affects the therapeutic management of patients (increasing the proportion of patients on insulin therapy from 37.7% to 53.3% due to a decrease in the proportion of patients on the treatment of OHD from 86.7% to 79.9%), the frequency of surgical interventions on the heart and blood vessels (an increase in the proportion of patients who underwent surgery from 4.1% to 23.3%.