Diabetic Angiopathy Research Articles

Extracellular Hsp90α, which participates in vascular inflammation, is a novel serum predictor of atherosclerosis in type 2 diabetes

IntroductionAtherosclerosis is the main pathological change in diabetic angiopathy, and vascular inflammation plays an important role in early atherosclerosis. Extracellular heat shock protein 90 (eHsp90) is secreted into the serum...

POSA89 Annual Health Insurance Treatment Cost of Non-Insulin-Dependent Diabetes with Peripheral Circulatory Complications Based on Routinely Collected Financing Data

Circulatory complications (such as ulcer, angiopathy or gangrene) in diabetes could significantly raise individual and health insurance costs. Our aim was to determine the annual health insurance treatment cost of diabetes with peripheral circulatory complications in Hungary.

Treatment of diabetic angiopathy of the lower limb in the conditions of a specialized department.

The article presents our own experience in the treatment of diabetic angiopathy of the lower extremity in a specialized department.

La retina, una ventana de la enfermedad cerebrovascular en la diabetes

Cerebrovascular disease is one of the complications of long-term diabetes mellitus. While the structure and function of the great cerebral vessels may be more easily studied, the cerebral microcirculation is difficult to assess. However, a simple eye fundus examination with an ophthalmoscope enables to visualize the microvascular abnormalities that characterize diabetic retinopathy, which isth e most common microvascular complication of diabetes. The anatomical and functional similarity between retinal and cerebral microcirculation supports the hypothesis that alterations in retinal vascular reactivity could be considered as an early marker of cerebral microvascular dysfunction in diabetes. The initiating factor of diabetic angiopathies is endothelial dysfunction. Endothelial dysfunction results in a reduced bioavailability of nitric oxide (NO), as a consequence of decreased NO synthesis and/or increased production of free oxygen radicals that are NO scavengers. Diabetes also stimulates the production of endothelial-derived contractile factors such as superoxide anions and hydroxyl radicals, endothelin and certain cyclooxygenase (COX) derivatives. COX activation is related to a high level of oxidative stress. Oxidative stress participates in the inflammatory response involved in the diabetic vascular dysfunction. These pathogenic mechanisms have been shown in both cerebral and retinal arteries, mainly through in vitro vascular reactivity studies, suggesting that diabetes induces a profound change in microvascular regulatory mechanisms. The association between the degree of retinal perfusion, brain injuries and altered cognitive function indicates a certain parallelism in the degree of impairment of both retinal and brain circulations. In addition, prospective studies conclude that diabetic retinopathy predicts ischemic cerebrovascular disease independently of other risk factors, supporting the importance of cerebral microvascular disease in diabetics. Further research on the vascular abnormalities is needed to understand the pathogenic mechanisms underlying retinopathies and cerebrovascular disease in diabetes. In the near future, the use of fully automated methods to detect signs of retinopathy will not only facilitate the efficient evaluation of vascular changes in the retina but will also help to reduce cerebral vascular morbidity and mortality.

The pathogenetic significance of endothelial dysfunction in the development of diabetic nephropathy in patients with type 2 diabetes mellitus

Objective: to determine the level of circulating markers of endothelial dysfunction (endothelin‑1, von Willebrand factor (vfV), endothelial NO-synthase (e‑NOS)) in the blood serum of patients with type 2 diabetes mellitus (DM), as well as to assess the pathogenetic significance endothelial dysfunction in the development of diabetic nephropathy.Materials and methods: the study included 93 patients with type 2 DM, including 28 men (30.1%) and 65 women (69.9%), aged 30 to 79 years, the average age of patients was 59.7±8.4 of the year. The main group included patients with both newly diagnosed type 2 DM and a long-term diabetic history. The duration of the disease averaged 9.5±7.5 years. The majority of patients with DM type 2 (92.5%) at the time of inclusion in the study had various variants of microvascular complications of diabetes, only a small number of patientsin this group (7.5%) had no signs of diabetic angiopathy. Signs of various stages of diabetic nephropathy were observed in 60 patients (69.2%). The comparison group consisted of 30 patients with essential arterial hypertension, including 12 men (40%) and 18 women (60%), aged 34 to 70 years, on average 56.1 ± 8.1 years. The control group consisted of 32 apparently healthy individuals. In all patients, along with routine methods of clinical, laboratory and instrumental examination, the level of circulating markers of endothelial dysfunction (endothelin‑1, von Willebrand factor (vWF), endothelial NO-synthase (e‑NOS)) in blood serum was measured using enzyme-linked immunosorbent assay (ELISA).Results: in patients with DM type 2 and diabetic nephropathy, a statistically significant increase in the concentration of circulating markers of endothelial dysfunction was revealed in comparison with hypertensive patients and healthy individuals. An increase in the level of endothelin‑1 relative to the borderline reference value was found in 73 (78.5±4.1%), vfV in 63 (67.7±4.8%) and e‑NOS in 65 (69.9±4.7%) of patients with DM type 2. In the groups of participants with hypertension and healthy individuals, endothelial imbalance was noted by us significantly less often than in patients with DM type 2, the levels of endothelin‑1 and vfV in people with hypertension were increased in more cases than in healthy individuals. It was noted that the levels of circulating markers of endothelial dysfunction increase with an increase in the duration of DM type 2, and also significantly increase under conditions of carbohydrate decompensation.Conclusion: the results obtained confirm the pathogenetic role of endothelial dysfunction in the development of diabetic nephropathy in patients with type 2 diabetes, increasing endothelial imbalance in persons with a long diabetic history and lack of compensation for carbohydrate metabolism.

Determination of the total content of flavonoids in herbal mixtures with anti-diabetic activity

Diabetes mellitus is an important social and medical problem, as it causes the development of dangerous complications that lead to disability and mortality. This disease is characterized by a multi-vector pathogenesis that requires a comprehensive approach to treatment. Due to the use of mixtures of medicinal plants in the treatment of diabetes, it is possible to cover all aspects of the development of this disease and its complications, because the combination of different medicinal plants contain more biologically active substances that affect all parts of the pathogenetic mechanism of diabetes mellitus and its complications. Plant biocompounds have a wide range of pharmacological action and various mechanisms of influence on the development of diabetes and diabetic angiopathies (inactivation of the antioxidant defense system, activation of lipid peroxidation and the development of oxidative stress). In addition, the niche of the pharmaceutical market of Ukraine with phytomixtures is almost empty.
 The aim of the work was to study the total flavonoid content in some herbal mixtures, which have established hypoglycemic, hypolipidemic and antioxidant activity in previous studies in vivo
 The study of the total flavonoid content in herbal samples was carried out by UV-spectrophotometry with the recording of the absorption spectrum of complexation product of flavonoids with aluminum chloride (λmax 415 nm) in terms of rutin.
 According to the results of UV-spectrophotometric determination, it was found that the total flavonoid content in the herbal mixture No 3 was 1.47 ± 0.04%, in the herbal mixture No 4 – 1.78 ± 0.04%, in the herbal mixture No 7 – 1.29 ± 0.02%, in the herbal mixture No 13 – 1.16 ± 0.02% and in the herbal mixture No 19 – 3.62 ± 0.06% in terms of rutin.
 It was found that the best flavonoid content (3.62 ± 0.06%) was found in the plant mixture № 19, which contains nettle leaves, dandelion roots, blueberry leaves, rose hips and peppermint herb. Phytochemical studies may indicate a correlation between the content of flavonoids and pharmacological properties of the studied mixtures, because the functional hydroxyl groups of the latter cause strong antioxidant activity by neutralizing free radicals, chelation of heavy metal ions, increasing the activity of antioxidant protection products, which has been confirmed in previous in vivo and in vitro studies.

Downregulation of microRNA-185 expression in diabetic patients increases the expression of NOS2 and results in vascular injury.

The aim of the present study was to investigate the regulatory effect and mechanism of microRNA (miR)-185 in diabetic angiopathy. The expression of miR-185 and nitric oxide synthase 2 (NOS2) in the blood from diabetic patients was examined by reverse transcription-quantitative PCR and enzyme-linked immunosorbent assay. After establishment of diabetic rats, the expression of miR-185 and NOS2 in vascular tissues and blood was also measured. Then, miR-185 was overexpressed in HMEC-1 cells and the expression of NOS2 was determined. Dual-luciferase reporter assay was used to identify the direct interaction between miR-185 and NOS2 mRNA. The expression of NOS2 was upregulated and the expression of miR-185 was downregulated in the blood from patients with diabetes. Vascular tissues and blood of diabetic rats showed similar trends compared with that of human. HMEC-1 cells with overexpression of miR-185 had decreased expression of NOS2. Dual-luciferase reporter assay demonstrated the direct binding between miR-185 and NOS2. The present study demonstrates that upregulation of NOS2 in diabetic patients is associated with the downregulation of miR-185, which participates in the progression of diabetes possibly through regulating NOS2 expression.

Increasing prevalence of diabetic peripheral angiopathy and complications in hospitalized patients in the United States

Abstract Objectives We aim to assess prevalence of diabetes related peripheral arterial disease and associated outcomes in hospitalized patients in the United States. Methods Trends in hospitalizations in diabetic patients with PAD were determined using the 2003–2017 National Inpatient Sample database. Hospital outcomes including diabetic ulcer incidence, amputations, and revascularizations were analyzed. Results The analysis included 10,303,673 hospitalizations in diabetic patients with PAD (DMPAD) during the study period. Prevalence of PAD among patients with diabetes increased over time (p<0.001). The prevalence of foot ulcers in diabetics have also increased over time (p<0.001). The incidence of amputations in patients with diabetes showed a decreasing trend with increasing prevalence of revascularizations from 2003 to 2009. Since 2010 however, rising rates of amputations, both minor and major are seen, especially in younger populations (age 18–49). Hospital costs for amputations have increased ($6.6 billion in 2003 vs $ 14.8 billion in 2017) as well as the costs for revascularization (6.1 billion in 2003 vs $13 billion in 2017) during the study period (p<0.001). Conclusions In this analysis of patients with DMPAD, an alarming rate of disease prevalence and in-hospital limb outcomes, including costs, are realized in the current era. Funding Acknowledgement Type of funding sources: None.

Прогрессирование начальной диабетической ретинопатии: связь с состоянием углеводного обмена

Актуальность. Распознавание ранних стадий диабетической ретинопатии (ДР) у пациентов с сахарным диабетом 2-го типа (СД2) и прогнозирование их прогрессии имеет важное значение и является актуальной задачей современной офтальмологии. Цель исследования — изучить особенности возникновения и прогрессирования начальных стадий ДР и установить связь со степенью нарушения углеводного обмена у пациентов с СД2. Материалы и методы. Был обследован 91 пациент (182 глаза) с СД2. Согласно ETDRS по системе клинических признаков Airlie House определяли микроаневризмы (МА), микрогеморрагии (МГ), интраретинальные микрососудистые аномалии (ИРМА), ретинальные венозные аномалии, неперфузию сетчатки и связь их развития со степенью нарушения углеводного обмена у больных СД2. Результаты. У большинства пациентов (72,5 %) на начало исследования ДР не было (уровень ETDRS составил 0–10 на обоих глазах). У остальных (27,5 %) на одном глазу уровень ETDRS был 10, а на другом отмечены единичные изменения калибра сосудов, расширение и извитость вен, ИРМА или МГ, что соответствовало уровню ETDRS 14/15. У этих пациентов давность СД2 была больше (в среднем на 3 года), а нарушения углеводного обмена были более выраженными. В течение 1 года наблюдения глазные изменения прогрессировали по-разному: при отсутствии ДР в начале исследования прогрессия была отмечена в 50 % случаев, тогда как при их наличии — в 92 %. Пациенты с прогрессией имели больший стаж диабета и худшие показатели углеводного обмена. Выводы. Установлено, что диабетические изменения сетчатки начинаются с одиночных сосудистых изменений, при наличии которых в течение 1 года ДР развивается в большинстве случаев.

Identification of the Protein Glycation Sites in Human Myoglobin as Rapidly Induced by d-Ribose

Protein glycation is an important protein post-translational modification and is one of the main pathogenesis of diabetic angiopathy. Other than glycated hemoglobin, the protein glycation of other globins such as myoglobin (Mb) is less studied. The protein glycation of human Mb with ribose has not been reported, and the glycation sites in the Mb remain unknown. This article reports that d-ribose undergoes rapid protein glycation of human myoglobin (HMb) at lysine residues (K34, K87, K56, and K147) on the protein surface, as identified by ultra-high performance liquid chromatography-mass spectrometry (UHPLC-MS) and electrospray ionization tandem mass spectrometry (ESI-MS/MS). Moreover, glycation by d-ribose at these sites slightly decreased the rate of the met heme (FeIII) in reaction with H2O2 to form a ferryl heme (FeIV=O). This study provides valuable insight into the protein glycation by d-ribose and provides a foundation for studying the structure and function of glycated heme proteins.

Ближайшие и отдаленные результаты хирургического лечения синдрома диабетической стопы и оценка качества жизни больных (обзор литературы)

В настоящее время при многих хронических заболеваниях все большее значение придается исследованию качества жизни (КЖ). Сахарный диабет (СД) в силу сложного режима контроля и лечения, а также многочисленных соматических проявлений (острых и хронических осложнений) оказывает выраженное воздействие на КЖ. КЖ, в свою очередь, оказывает значительное влияние на прогноз заболевания. В данном обзоре рассмотрены ближайшие и отдаленные результаты хирургического лечения синдрома диабетической стопы, определения КЖ и сходных понятий, освещены основные подходы к исследованию КЖ при СД, приведен перечень наиболее часто использующихся инструментов для оценки КЖ. Анализ публикаций показал, что до сих пор недостаточно проводилась системная проработка данной проблемы, не реализованы возможности современного уровня развития техники и информационных технологий для ее решения. Таким образом, несмотря на дальнейшее развитие сосудистой хирургии, многие вопросы, связанные с диагностикой и методами лечения больных с язвенно-некротическими поражениями нижних конечностей, остаются нерешенными. Качество диагностических и лечебных мероприятий по-прежнему зависит от профиля лечебного учреждения, наличия в нем отделения хирургии сосудов, субъективного отношения врачей к тем или иным методам лечения, их знаний и опыта в этой области. Наиболее эффективно решить данные проблемы и повысить качество диагностики, лечения и последующей жизни пациентов позволяет создание алгоритма, определяющего последовательность действий врачей при поступлении в стационар такого больного. Анализ литературы показал, что для более точной оценки ближайших и отдаленных результатов реконструктивных сосудистых операций у больных с диабетической ангиопатией необходимо использовать определение показателя КЖ и его параметров, что в дальнейшем позволяет выбрать наилучший способ оперативного лечения в каждом конкретном случае, а также выявить влияние хирургической операции или других видов лечения на психику пациента. По мнению некоторых авторов, имеющиеся классификации синдрома диабетической стопы неполно отражают клиническую картину осложнений, а следовательно, в большинстве случаев не определяют тактику лечения больных. Существуют различные мнения в отношении оперативно-хирургических приемов. Недостаточно полно и не всегда обоснованно описаны способы снижения послеоперационных осложнений, частота которых во многих клиниках превышает 30 %.

Цукровий діабет й екзокринна недостатність підшлункової залози (огляд літератури)

На сьогодні все більше значення надається дослідженню проблеми екзокринної панкреатичної недостатності, що спостерігається в значної кількості хворих на цукровий діабет (ЦД) 1-го і 2-го типу і може потенційно впливати на компенсацію ЦД. Механізм зниження зовнішньої секреції підшлункової залози при ЦД пов’язаний із дисбалансом інгібуючих і стимулю­ючих панкреатичну секрецію гормонів, із фіброзом залози в результаті діабетичної ангіопатії. При ЦД 2-го типу в патогенезі зовнішньосекреторної панкреатичної недостатності беруть участь механізми, що є наслідком метаболічного синдрому. Замісну ферментну терапію слід розглядати як один із перспективних методів лікування хворих на ЦД.

Можливості фотоплетизмографії у ранній діагностиці діабетичної ангіопатії нижніх кінцівок

Актуальність. У більшості випадків цукрового діабету (ЦД) ускладнення у вигляді діабетичної ангіопатії нижніх кінцівок діагностується досить пізно, при появі клінічних проявів судинної патології. Оздоровчі заходи на цьому етапі носять паліативний характер, не зупиняючи прогресування самої патології. У зв’язку з цим стає актуальною діагностика початкових проявів діабетичної ангіопатії на доклінічному етапі. Мета дослідження: виявити відмінність в стані мікроциркуляції у верхніх і нижніх кінцівках у хворих на ЦД для можливості діагностики початкових стадій діабетичної ангіопатії нижніх кінцівок за допомогою методу фотоплетизмографії. Матеріали та методи. У дослідженні брали участь три групи людей: здорові особи, хворі на ЦД до 5 років і хворі на ЦД понад 10 років, яким проводилася фотоплетизмографія нігтьового ложа пальців кисті і пальців стопи. Результати. Виявлено відсутність різниці в стані мікроциркуляції в руках і ногах здорових людей. Виявлена вірогідна різниця в стані мікроциркуляції верхніх і нижніх кінцівок при ЦД, що збільшується при зростанні тривалості ЦД і декомпенсації вуглеводного обміну. Це дозволяє використовувати фотоплетизмографію нігтьового ложа пальців кистей і стоп для діагностики ранніх етапів формування діабетичної ангіопатії нижніх кінцівок. Висновки. Однією з ранніх ознак початку діабетичної ангіопатії є поява асиметрії в мікроциркуляції між кистями і стопами, що виявляється фотоплетизмографією. Виявлення діабетичної ангіопатії на доклінічному етапі відкриває можливості для активної та ефективної профілактики судинних ускладнень при ЦД, попереджаючи розвиток синдрому діабетичної стопи.

Revealing the Angiopathy of Lacrimal Gland Lesion in Type 2 Diabetes

For a better understanding of diabetic angiopathy (DA), the potential biomarkers in lacrimal DA and its potential mechanism, we evaluated the morphological and hemodynamic alterations of lacrimal glands (LGs) in patients with type 2 diabetes and healthy counterparts by color Doppler flow imaging (CDFI). We further established a type 2 diabetic mice model and performed hematoxylin-eosin (HE) staining, immunofluorescence staining of CD31, RNA-sequencing analysis, and connectivity map (CMap) analysis. We found atrophy and ischemia in patients with type 2 diabetes and mice models. Furthermore, we identified 846 differentially expressed genes (DEGs) between type 2 diabetes mellitus (T2DM) and vehicle mice by RNA-seq. The gene ontology (GO) analysis indicated significant enrichment of immune system process, regulation of blood circulation, apoptotic, regulation of secretion, regulation of blood vessel diameter, and so on. The molecular complex detection (MCODE) showed 17 genes were involved in the most significant module, and 6/17 genes were involved in vascular disorders. CytoHubba revealed the top 10 hub genes of DEGs, and four hub genes (App, F5, Fgg, and Gas6) related to vascular regulation were identified repeatedly by MCODE and cytoHubba. GeneMANIA analysis demonstrated functions of the four hub genes above and their associated molecules were primarily related to the regulation of circulation and coagulation. CMap analysis found several small molecular compounds to reverse the altered DEGs, including disulfiram, bumetanide, genistein, and so on. Our outputs could empower the novel potential targets to treat lacrimal angiopathy, diabetes dry eye, and other diabetes-related diseases.

Significance of determination of hemodynamic phenotypes in early diagnosis of cardiovascular disorders in children with diabetes mellitus

Aim. To stratify hemodynamic phenotypes in children with diabetes mellitus and their frequency, depending on the duration of the disease. Materials and methods. The study involved 72 children suffering from diabetes, aged 10 to 16 years who were divided into 3 groups. The first group – 22 children with diabetes mellitus up to 1 year. The second group – 24 patients with a disease duration of 1 to 5 years. The third group – 26 children with the disease over 5 years. Control group – 20 children, representative by age and sex. All children underwent daily blood pressure monitoring (ABPM) with the ABPM-04 device (Meditech Ltd, Hungary). Diagnosis of latent hemodynamic disorders was performed by the method of quantitative analysis of the relationships of blood pressure parameters, which involved a linear regression of systolic blood pressure by pulse blood pressure. According to the results of regression, 6 hemodynamic phenotypes were determined, which characterized the individual features of the circulatory system: harmonic, myocardial-insufficient subtype of harmonic, borderline diastolic harmonic, borderline systolic harmonic, dysfunctional diastolic and dysfunctional systolic. According to ABPM results, the ambulatory arterial stiffness index (AASI) was calculated using a linear regression equation. The results were statistically processed using statistics software package Statistica 13.0 (StatSoft Inc., No. JPZ8041382130ARCN10-J). Results. It was found that in the dynamics of diabetes the registration of the harmonic hemodynamic phenotype during the day decreased due to an increase in the proportion of patients with dysfunctional diastolic hemodynamic phenotype. At the same time, in children with diabetes, there was a significant increase in AASI from the first year of the disease with a progressive increase with its dynamics. The highest values of AASI were observed in dysfunctional hemodynamic phenotype. Conclusions. In children with diabetes mellitus observed the formation of disharmonious hemodynamic phenotypes in the dynamics of the disease. In combination with increased vascular stiffness these changes realized in systemic circulatory disorders and the development of a diabetic angiopathy. Detected disorders, apparently, became the risk factors of hypertension. Determination of hemodynamic phenotype in children with diabetes mellitus can be used as screening method for preclinical diagnosis of latent disorders of the cardiovascular system, early treatment and prevention.

Cardiovascular Pathology – a Factor of the Adverse Course of Diabetic Polyneuropathy

Diabetic polyneuropathy (DP) and angiopathy are interdependent processes, as disturbances in the microcirculatory system of peripheral nerves lead to increased axonal damage and is a kind of predictor of polyneuropathy progressing [6]. 80% of deaths from diabetes mellitus (DM) are associated with cardiovascular catastrophes, including coronary heart disease (CHD), stroke and peripheral artery disease [3]. The objective: to analyze the most common cardiovascular pathology (CVP) and show its impact on the course of DP in type I and II DM. Materials and methods. Was clinically examined 101 patient with DP. The examined patients were divided into groups: with DP on the background of type 1 DM (group I) (n=54) and with DP on the background of type II DM (group II) (n=47), and also were divided into subgroups: DP on the background of type I and II DM and existing CVP (including diabetic angiopathy) 82 (82%) (subgroup А) and with the DP on the background of DM type I and II without CVP – 19 (19%) (subgroup В). Patients were examined to determine the neurological status, were performed laboratory and instrumental methods of examination. Static calculation was performed in MS Excel 2003 and in the programme STATISTICA 10. Results. Regarding to the patients of subgroup А and В we noted the natural predominance of trophic disorders, changes in the reflex sphere and sensitivity in subgroup А. Patients of group II more often than in group I had pathology of the cardiovascular system. Hypertension (HT) and CHD in both cases were registered with a high frequency. In subgroup А there was a combination of several nosologies: from the respiratory, urinary, gastroenterological system (1%), urinary and gastroenterological (3%), gastroenterological and endocrine (2%), urinary and endocrine (1%). In subgroup В diseases of urinary and gastroenterological pathology were found in (5%), gastroenterological (5%), endocrine (11%). The examined patients from group I and with the concomitant CVP have lower linear velocity of blood flow (LVBF) on both tibial arteries, patients in group II – have marginally higher LVBF. Analysis of the results of duplex scanning of lower extremity arteries showed a high incidence of stenosis, in particular the anterior tibial arteries (ATA) up to 30–40%, posterior tibial arteries (PTA) up to 40–50% and occlusion (PTA and femoral, popliteal, tibial segment) in individuals of group I. Conclusions. In patients with DP on the background of type I and II DM and available CVP (subgroup А), the clinical manifestations of polyneuropathy were quite pronounced, especially in the field of trophic disorders, because CVP enhances the ischemia of the microsaceous channel of the peripheral nerves. In addition, persons with concomitant CVP have a wide range of another comorbid pathology, which accelerates the onset of DM complications.

Temporal Trends in Hospitalization for Lower Extremity Peripheral Artery Disease in Ontario: The Importance of Diabetes

We sought to assess temporal trends in peripheral artery disease (PAD)-related hospitalization rates in Ontario. Trends in quarterly rates of PAD hospitalization per 100,000 Ontarians between 2006 and 2019 were assessed using autocorrelated linear regression. Stratified analyses according to age, sex, and most responsible diagnosis code type (with vs without diabetes-specific PAD codes) were performed. From 2006 to 2019, overall PAD hospitalizations did not decrease significantly when diabetes-specific codes were included. A significant decrease was observed among women and those older than 65 years old. Future studies of PAD epidemiology and outcomes using administrative data should include diabetic angiopathy.

Machine Learning Approaches to Predict Risks of Diabetic Complications and Poor Glycemic Control in Nonadherent Type 2 Diabetes.

Purpose: The objective of this study was to evaluate the efficacy of machine learning algorithms in predicting risks of complications and poor glycemic control in nonadherent type 2 diabetes (T2D). Materials and Methods: This study was a real-world study of the complications and blood glucose prognosis of nonadherent T2D patients. Data of inpatients in Sichuan Provincial People’s Hospital from January 2010 to December 2015 were collected. The T2D patients who had neither been monitored for glycosylated hemoglobin A nor had changed their hyperglycemia treatment regimens within the last 12 months were the object of this study. Seven types of machine learning algorithms were used to develop 18 prediction models. The predictive performance was mainly assessed using the area under the curve of the testing set. Results: Of 800 T2D patients, 165 (20.6%) met the inclusion criteria, of which 129 (78.2%) had poor glycemic control (defined as glycosylated hemoglobin A ≥7%). The highest area under the curves of the testing set for diabetic nephropathy, diabetic peripheral neuropathy, diabetic angiopathy, diabetic eye disease, and glycosylated hemoglobin A were 0.902 ± 0.040, 0.859 ± 0.050, 0.889 ± 0.059, 0.832 ± 0.086, and 0.825 ± 0.092, respectively. Conclusion: Both univariate analysis and machine learning methods reached the same conclusion. The duration of T2D and the duration of unadjusted hypoglycemic treatment were the key risk factors of diabetic complications, and the number of hypoglycemic drugs was the key risk factor of glycemic control of nonadherent T2D. This was the first study to use machine learning algorithms to explore the potential adverse outcomes of nonadherent T2D. The performances of the final prediction models we developed were acceptable; our prediction performances outperformed most other previous studies in most evaluation measures. Those models have potential clinical applicability in improving T2D care.

Changes in Morphometric Indicators of Blood Vessels of Masticatory Muscles in Simulation of Diabetic Angiopathy in Rats

Summary. Relevance. Diabetic joint damage is common in the clinic. The blood vessels of the masticatory muscles that affect the morphogenesis of diabetic arthropathy of the temporomandibular joint remain poorly studied in this pathology.
 Objective: to study the features of remodeling of blood vessels of the masticatory muscles of the temporomandibular joint in experimental hyperglycemia by quantitative morphological methods.
 Materials and Methods. The study material was 45 laboratory mature white male rats, which were divided into 3 groups. The 1st group consisted of 15 intact apparently healthy animals, the 2nd included 15 rats with one-month diabetic angiopathy, and the 3rd had 15 rats with two-month specified pathology. Diabetes mellitus was simulated by a single intraperitoneal injection of streptozotocin from Sigma at a dose of 50 mg/kg. Euthanasia of animals was performed by bloodletting under thiopental anesthesia one and two months after the start of the experiment. The blood glucose concentration was determined. Histological micropreparations were made from the temporomandibular joint and the temporal and external pterygoid muscles. Morphometric measurements of small caliber arteries (outer diameter 26-50 μm), veins and microvessels of the hemomicrocirculatory tract were performed on muscle micropreparations; relative volumes of damaged synoviocytes and chondrocytes were determined on micropreparations of joints. Quantitative indicators were processed statistically.
 Results and Conclusions. It was revealed that the gleam of arteries considerably decreases, their wall thickens, and endotheliocytes are damaged in the studied muscles with the modeled pathology. Venous vessels are dilated, full-blooded with a reduced wall thickness. The most pronounced changes in these experimental conditions are the structure of microvessels, which is characterized by narrowing of arterioles, precapillary arterioles and hemocapillaries, pronounced expansion of postcapillary venules and venules. Plethora, stasis, thrombosis, irregularity of the lumen, sacculation, and varicose expansions were noted in venous microvessels. Venous fullness led to hypoxia, disorders of trophism and metabolism, dystrophy, necrobiosis of muscle fibers and stromal structures, foci of infiltration and sclerosis. It was revealed that morphological changes in the vascular bed of the masticatory muscles affect the morphogenesis of diabetic arthropathy of the temporomandibular joint.

The Role of Physical Therapy in the Combined Treatment of Patients with Lower Extremities Diabetic Angiopathies

One of the most disabling complications of diabetes mellitus is angiopathy of the lower extremities. Diabetic polyneuropathy and diabetic foot syndrome are closely associated with vascular complications of diabetes mellitus, which significantly aggravate the course of the disease and contribute to high mortality. Diabetic polyneuropathy and diabetic foot syndrome are closely associated with the diabetes mellitus vascular complications that significantly aggravate the course of the disease and contribute to high mortality. Despite the improvement in the results of pharmacotherapy of diabetes mellitus, the problem of treating its vascular complications is far from being solved. Traditionally, therapeutic physical training is used among the methods of non-drug treatment of diabetes mellitus and its complications. As a method of pathogenetic focus on many risk factors for the development of diabetes and its complications, physical therapy exercises contribute to the correction of the syndrome of hypodynamia, obesity, and muscle atrophy. At the same time, there is insufficient data on how exercise therapy affects the quality of life of patients, functional characteristics of walking and objective indicators of blood flow in the lower extremities. This review identifies the main approaches to the application, advantages and disadvantages of individual methods of therapeutic physical training in the correction of functional disorders in patients with lower extremities diabetic angiopathies. We can currently talk about the proven safety of the physical therapy use in patients with diabetic angiopathies. Meanwhile, the scientific data on the high efficiency of this method is still insufficient.