E.V. Ivanov1, M.R. Akhmetshina2, A.R. Gizatulina3, A.A. Glazkov4, Yu.A. Kovaleva5, S.A. Gavrilova6

1–3,6 Lomonosov Moscow State University (Moscow, Russia)

4,5 Moscow Regional Research and Clinical Institute ("MONIKI") (Moscow, Russia)

1 ivanovev102@yandex.ru, 2 Marina2842@gmail.com, 3 albina.giz@yandex.ru, 4 staaglz@gmail.com, 5 yulia.kovaleva@mail.ru, 6 sgavrilova@mail.ru

Microcirculatory disorders are the most common complication of type 2 diabetes mellitus (DM2). Severe obesity is usually associated with more severe microangiopathy. However, the characteristics of microcirculatory complications in patients with different combinations of obesity and diabetes are not fully known. Type 2 diabetes mellitus not accompanied by obesity may be associated with other factors in the development and aggravation of disease severity. Aim of the study: to perform an analysis of factors associated with tissue blood flow abnormalities in patients with DM2 with and without obesity.

Twenty patients with DM2, including 10 with obesity and 10 without obesity, were selected for the study. A wide range of peripheral blood flow parameters were simultaneously determined by the method of incoherent optical fluctuation flowmetry: median perfusion, postocclusive reactive hyperemia index, response to heat test at different stages, pulse waveform. Along with routine biochemical parameters (concentration of glucose, triglycerides, total cholesterol, glycated hemoglobin, number of erythrocytes and hemoglobin, AST and ALT) we determined insulin concentration and insulin resistance index HOMA-IR.

The presence of obesity did not significantly affect the perfusion parameters in patients; no differences were found in any of the measured parameters when dividing into groups on the basis of BMI 35 kg/m2. At the same time high glucose concentration and high level of glycated hemoglobin statistically significantly correlated with decreased vascular reactivity to heating. When clearly divided into two groups by BMI value, patients differed in their metabolic state. It can be noted that dyslipidemia was significantly higher among obese patients. This is directly related to the volume of adipose tissue, dietary patterns. High cholesterol concentration correlated with increased perfusion: indices of postocclusive reactive hyperemia, baseline perfusion at two points, response to heat test and high BMI. High insulin concentration and increased HOMA-IR index were significantly correlated with pulse waveform abnormalities regardless of BMI.

Among the parameters affecting the degree of tissue blood flow disturbance in patients with type 2 diabetes mellitus, the parameters related to the level of glycemia are the most important. At the same time, the main parameters characterizing the degree of obesity not only do not affect but can also be associated with better characteristics of microcirculation. The presence of insulin resistance, manifested by high insulin concentration and increased HOMA-IR index, correlates with impaired pulse waveform index. The results obtained show the necessity to clarify the form of obesity among all patients with diabetes mellitus regardless of BMI and the expediency of tissue blood flow monitoring in patients with severe hyperglycemia.

Ivanov E.V., Akhmetshina M.R., Gizatulina A.R., Glazkov A.A., Kovaleva Yu.A., Gavrilova S.A. Associations between peripheral blood flow and metabolic state in patients with type 2 diabetes mellitus. Technologies of Living Systems. 2024. V. 21. № 1. Р. 20-28. DOI: https://doi.org/10.18127/j20700997-202401-02 (In Russian)

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