DOI: 10.25881/20728255_2021_16_3_18

Authors

Glazkova P.A.1, Babenko A.Yu.2, Kononova Yu.A.2, Glazkov A.A.1, Zagarov S.S.1, Kovaleva Yu.A.1, Lar’kov R.N.1, Britvin T.A.1, Mazur N.N.1, Kulikov D.A.1, 3, Rogatkin D.A.1

1 Moscow Regional Research and Clinical Institute («MONIKI»), Moscow

2 Almazov National Medical Research Centre, St. Petersburg

3 Moscow Region State University, Mytishchi

Abstract

Background: To date, the development of new scales that, based on routine laboratory and instrumental examinations, would allow an integral assessment of the severity of cardiovascular system damage in patients with diabetes mellitus is relevant. The development of such scales can help to objectively rank patients according to the severity of damage to the cardiovascular system in clinical and scientific research aimed at creating new instrumental methods for assessing hemodynamic disorders.

Aim: development of a scale for scoring the severity of damage to the cardiovascular system in patients with diabetes.

Materials and methods. To apply the developed scale, 18 diabetic patients were included in the study, divided into two contrast groups: group 1 — patients without vascular complications of diabetes mellitus (n = 9), group 2 — patients with diabetic foot syndrome of DM (n = 9). All subjects underwent laboratory and instrumental examinations to diagnose diabetes complications.

Results. The scale for scoring the severity of functional impairment of the cardiovascular system in patients with diabetes mellitus was developed. The scale is including 5 categories: lower extremity arterial disease; cardiac and cerebrovascular disease; diabetic nephropathy; diabetic retinopathy; and diabetic neuropathy. Approbation of the scale showed that median scores in group 1 were significantly higher than in group 2 (2.5 [2; 3] points vs. 10.5 [8; 12] points, p<0.001). This result is consistent with the clinical picture. Using this approach also allows patients to be ranked according to the severity of their cardiovascular involvement within groups. Patients in group 2 with a high score have a more severe vascular lesion than patients in the same group with a lower score.

Conclusion: a scale for the objective integral scoring of cardiovascular severity in diabetic patients has been developed. The scale can be used for scientific and clinical studies involving diabetic patients.

Keywords: diabetes mellitus, cardiovascular system, diabetes complications.

References

1. Dedov II, Shestakova MV, Mayorov AYu, editors. Standards of specialized diabetes care. Clinical Recommendations. 9th Edition (revised). Moscow, 2019. 214 p. (In Russ).

2. Strain WD, Paldánius PM. Diabetes, cardiovascular disease and the microcirculation. Cardiovasc Diabetol. 2018; 17(1): 1-10. doi: 10.1186/s12933-018-0703-2.

3. American Diabetes Association. Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020; 43(1): 1-212. doi: 10.2337/dc20-S015.

4. Young BA, Lin E, Von Korff M, et al. Diabetes complications severity index and risk of mortality, hospitalization, and healthcare utilization. Am J Manag Care. 2008; 14: 15-23.

5. Glasheen WP, Renda A, Dong Y. Diabetes complications severity index (DCSI)—update and ICD-10 translation. Journal of Diabetes and its Complications. 2017; 31(6): 1007-1013. doi: 10.1016/j.jdiacomp.2017.02.018.

6. Tehrani S, Bergen K, Azizi L, et al. Skin microvascular reactivity correlates to clinical microangiopathy in type 1 diabetes: A pilot study. Diabetes and Vascular Disease Research. 2020; 17(3): 1-9. doi: 10.1177%2F1479164120928303.

7. Ushakova LYu. Ultrasound examination of blood vessels. International reviews: clinical practice and health. 2013; 4(4): 5-15 (In Russ).

8. Mills JLSr, Conte MS, Armstrong DG, et. al. Society for Vascular Surgery Lower Extremity Guidelines Committee. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg. 2014; 59(1): 220-34. e1-2. doi: 10.1016/j.jvs.2013.08.003.

9. Bokeriya LA, Pokrovskiy AV, Akchurin RS, et. al. National recommendations for the diagnosis and treatment of arterial diseases of the lower extremities. Moscow. 2019. 89 p. (In Russ).

10. Huang W, Li L. The Chronic Kidney Disease and Abnormal Retinal Blood Vessels. Integrative Ophthalmology. Springer, Singapore. 2020: 159-172. doi: 10.1007/978-981-13-7896-6_26.

11. Hijazi MM, Buchmann SJ, Sedghi A, Illigens BM, Reichmann H, Schackert G, et al. Assessment of cutaneous axon-reflex responses to evaluate functional integrity of autonomic small nerve fibers. Neurol Sci. 2020; 41(7): 1685-96. doi: 10.1007/s10072-020-04293-w.

12. Feldman EL, Stevens MJ, Thomas PK, et al. A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes Care. 1994; 17(11): 1281-9. doi: 10.2337/diacare.17.11.1281.

13. Hershey DS, FNP-BC. Diabetic Peripheral Neuropathy: Evaluation and Management. J Nurse Pract. 2017; 13(3): 199-204. doi: 10.1016/j.nurpra. 2016.08.034.

14. Herman WH, Pop-Busui R, Braffett BH, et al. Use of the Michigan Neuropathy Screening Instrument as a measure of distal symmetrical peripheral neuropathy in Type 1 diabetes: results from the Diabetes Control and Complications Trial / Epidemiology of Diabetes Interventions and Complications. Diabet Med. 2012; 29(7): 937-44. doi: 10.1111/j.1464-5491.2012.03644.x.

15. Hershey DS. Diabetic Peripheral Neuropathy: Evaluation and Management. J Nurse Pract. 2017; 13(3): 199-204. e1. doi: 10.1016/j.nurpra.2016.08.034.

For citation

Glazkova P.A., Babenko A.Yu., Kononova Yu.A., Glazkov A.A., Zagarov S.S., Kovaleva Yu.A., Lar’kov R.N., Britvin T.A., Mazur N.N., Kulikov D.A., Rogatkin D.A. Scale for scoring the severity of functional impairment of the cardiovascular system in patients with diabetes mellitus. Bulletin of Pirogov National Medical & Surgical Center. 2021;16(3):18-24. (In Russ.) https://doi.org/10.25881/20728255_2021_16_3_18