Features of macro- and microvascular complications in patients with type 2 diabetes mellitus (observational case-control study)

Background. Diabetic macro- and microvascular complications are the most important chronic complications of type 2 diabetes mellitus (DM2), many features of which require further study. Continued research in this area can help improve the quality of diagnostics of these complications, including at the early stages of their development.

Objective. Evaluation of the features of macro- and microvascular complications in DM2 patients.

Methods. A total of 122 DM2 patients at an average age of 62.3±9.5 years were examined. The control group consisted of 40 practically healthy individuals. All patients underwent standard examinations, including determination of glycated hemoglobin, blood lipids, creatinine, uric acid, insulin, cystatin C levels, daily proteinuria, and urine albumin-creatinine ratio. Neurological status with assessment of pain, tactile, and vibration sensitivity was examined. Echocardiography, ultrasound examination of the brachiocephalic arteries, reactive hyperemia test, and ultrasound of the peroneal nerves (PN) were performed.

Results. The patients included in the study had a fairly long duration of diabetes, were characterized by poor glycemic control, and the presence of multiple vascular risk factors; therefore, most of them developed a wide range of microvascular complications, which were often presented in various combinations. Among these patients, there was a high proportion of individuals with various macrovascular DM2 complications, as well as with associated comorbid conditions. Clinical and laboratory data of diabetic patients were characterized by numerous differences from healthy individuals, including higher levels of blood pressure, glycemia, insulin resistance, lipidemia, uricemia, azotemia, albuminuria; a number of clinical and laboratory features were noted in patients with various microvascular complications of diabetes. DM2 patients demonstrated distinct manifestations of cardiovascular remodeling. Clinical features of diabetic polyneuropathy (DPN) and sonographic characteristics of PN demonstrated a close relationship, which allows to consider PN ultrasound as one of the possible accessible and informative methods for diagnosing (including at early, asymptomatic or low-symptom stages) and predicting the course of DPN in DM2.

Conclusion. The diagnostic approaches used allow to evaluate the features of diabetes-associated microvascular and macrovascular complications at the modern stage, to study their relationships with each other and with the nature of the course of DM2. The close relationships between the sonographic characteristics of PN and the clinical features of DPN established in this work allow to consider PN ultrasound as one of the possible accessible and informative methods for diagnosing DPN in DM2.