The state of capillary microcirculation in patients with diabetes mellitus

Abstract

Objective — to study endothelial alterations at the level of the microcirculatory section of the blood circulation system in patients with diabetes mellitus by using capillaroscopy in the comprehensive examination.
 Materials and methods. The clinical examination was performed with the involvement of 37 patients with type 1 and type 2 diabetes mellitus, aged 21 to 65 years, with various manifestations and severity of the disease. The patients have been assigned into two groups. The first group (control) consisted of 12 patients without diabetes, the second group (study group) included 37 patients with type 1 and type 2 diabetes mellitus. The state of the microcirculatory bed of the lower extremities was estimated using capillaroscopy by the Dino‑Lite MEDL4N5 Pro capillaroscope (Netherlands).
 Results. The analysis of indicators of skin microcirculation showed that both quantitative and qualitative changes in skin microcirculation were observed in patients with diabetes mellitus compared to the control group. The color of the background changed from pale pink to deep red, and with a severe form it even had a grayish tint. Various changes in the size and shape of capillaries and capillary loops have been registered, indicating the processes of capillary destruction and neoangiogenesis. The structural changes of the capillaries were especially prominent with clinically pronounced symptoms. The most frequent changes detected were the spiral‑twisted capillaries. The pattern of the venous network was more pronounced; the spastic altered and shortened arterial genua were conjoined with dilated and tortuous venous ones; aneurysmal dilatations and arterio‑venous anastomoses were common. In addition, the capillaroscopic examination makes it possible to observe a decrease in the number of capillaries, which is expressed in varying degrees, up to the formation of so‑called avascular areas. Blood flow is granular, intermittent, its velocity is slowed down.
 Conclusions. The severity of diabetic microangiopathy is directly proportional to the duration of the disease. The use of indicators of skin microcirculation makes it possible to predict the probability of the development of diabetic microangiopathy and the degree of its expressiveness in different periods of the disease.