This review includes results of scientific and clinical use of laser Doppler flowmetry (LDF) in patients with diabetes mellitus. LDF is a non-invasive method for the quantitative evaluation of microcirculation, which can assess microcirculatory rhythms and conduct functional tests with various impacts, allowing the exploration of regulatory mechanisms of microcirculation. LDF reveals specific diabetes changes in the regulatory function of microcirculation. Microcirculation disturbances, which are traditionally associated with the pathogenesis of complications, also occur in patients with early disorders of carbohydrate metabolism and may precede the manifestation of diabetes. However, this method is still not applied in clinical practice. In this review, we analysed factors limiting the implementation of LDF in practical medicine and suggest ways to improve its clinical significance.

Background: The aim of this study was to investigate the relationship between postprandial glycemic levels based on flashmonitoring and the production of intestinal hydrogen (H₂) and methane (CH₄) gases based on the measurement of the amount of these gases in exhaled air. Materials and Methods: We studied 14 subjects with type 2 diabetes mellitus (T2DM) and 14 individuals without diabetes (control) with two food load tests, including two types of dietary fiber (inulin and guar gum), with the simultaneous determination of gases in exhaled air and the assessment of glucose levels. Results: All subjects in the control group had a significant increase in exhaled H₂. OR for increased hydrogen production in patients with T2DM was 0.17 (95% CI 0.031–0.93, p = 0.043). The level of H₂ in exhaled breath after food load in patients with T2DM was lower than in normoglycemic subjects. There was an inverse correlation between maximum glucose rise and maximum H₂ in exhaled air after food load in normoglycemic subjects (r = −0.569, p = 0.034). Patients with T2DM had direct correlations between the level of CH₄ in exhaled air and the parameters of postprandial glycemia in the lactulose test (p < 0.05). Conclusions: The confirmation of a causal relationship between decreased H₂ production, increased intestinal CH₄ production, and more severe postprandial glycemia may identify new therapeutic targets in the correction of postprandial glycemia in patients with T2DM.

BACKGROUND: Data of real clinical practice in diabetes mellitus (DM) register allow to evaluate features and trends in structure of glucose-lowering therapy (GLT). AIM: Тo analyze of structure of GLT received by patients with type 2 diabetes mellitus (T2DM) in Moscow region for 2018 and to evaluate its dynamics over 15 years. METHODS: Analysis of GLT structure was carried out on basis of data from register of patients with DM in Moscow region, which is part of National register of diabetes mellitus in Russian Federation. In March 2018 it contained data on 211,792 T2DM patients of Moscow region. Structure of GLT administration was evaluated according T2DM duration, patients age and presence of cardiovascular diseases (CVD). Dynamics of GLT is analyzed from 2004 to 2018 yrs. RESULTS: In 2018 non-insulin glucose-lowering drugs (NIGD) prescription prevailed (78.3%), insulin therapy was prescribed in 18.5% of patients, 3.2% of patients did not receive drug therapy. Most commonly prescribed NIGD were metformin (69.3%) and sulfonylurea (51.3%). Older patients more often than younger did not use GLT at all and less frequently received insulin therapy and iDPP-4. Insulin therapy was prescribed twice as often in patients with CVD compared with patients without CVD (29.6% and 15.5%). NIGD monotherapy has been less commonly used in patients with CVD (67.3% and 81.2%). Glucagon-like peptide-1 receptor agonists (GLP-1 RA) were prescribed to patients with CVD GLP-1 RA in 0.1% of cases, without CVD in 0.3% of cases, and sodium-glucose cotransporter 2 (SGLT2) inhibitors in 1.1% and 0.6%. correspondently. CONCLUSION: Metformin was most commonly prescribed drug in GLT structure for T2DM patients in the Moscow region in 2018 yr. Percentage of new drugs in the structure of GLT increased mainly due to iDPP-4, and secondly due to SGLT2 inhibitors. New classes of GLT were more often prescribed to patients of younger age, with diabetes duration up to 10 years, overweight or obese. Administration of NIGD with proven cardiovascular protection in presence of CVD is almost two times less than for those without CVD.

(1) Background: To date, there are no studies evaluating the ability of the incoherent optical fluctuation flowmetry (IOFF) method to assess foot tissue perfusion. The aim of this study was to evaluate the correlation between perfusion values measured by IOFF and TcPO₂ in patients with diabetes-related lower-extremity complications. (2) Methods: This was an observational, cross-sectional, two-center study. Diabetic patients with peripheral artery disease and/or diabetic foot ulcers were studied (n = 27, examinations were carried out on 54 legs). Perfusion in the foot tissues was assessed using TcPO₂ (reference standard for this study) and the IOFF method. (3) Results: High correlation coefficients of all perfusion parameters measured by IOFF with TcPO₂ (Rs 0.7 to 0.76) were shown. The study demonstrated that the IOFF method allows, with a sensitivity of 85.7% and a specificity of 90.0%, the identification of patients with a critical decrease in TcPO₂ < 20 mmHg. (4) Conclusions: The high correlation of IOFF parameters with TcPO₂ and the moderately high sensitivity and specificity in detecting patients with severe ischemia of foot tissues shows the promise of the method for assessing a tissue perfusion in patients with diabetes-related lower-extremity complications.

Место гликлазида МВ в структуре сахароснижающей терапии на примере регистра сахарного диабета Московской области

Цель – измерение и сравнение сил агрегации и дезагрегации отдельных эритроцитов при образовании или развале парного агрегата in vitro в крови больных сахарным диабетом 1 типа (СД1) и сахарным диабетом 2 типа (СД2), используя метод оптического захвата. Материалы и методы. Всего в исследование были включены 50 человек. Из них 10 человек с СД1 (в возрасте 28±15,8 года), 26 человек с СД2 (в возрасте 66±13 лет). Группу контроля составили 14 практически здоровых добровольцев (46±21 год). Измерения сил парного взаимодействия эритроцитов в разбавленной суспензии проводились in vitro методом двухканального оптического захвата. Измерялась сила агрегации эритроцитов FA (пН), сила дезагрегации FD (пН) и вычислялось отношение сил FD/FA. Результаты. Значение сил агрегации эритроцитов значимо не отличалось в группе СД1 от группы контроля. Однако силы дезагрегации в группе СД1 оказались достоверно ниже по сравнению с группой контроля (р<0,05). Отношение сил дезагрегации к силам агрегации было меньше в группе СД1 по сравнению с группой контроля (р<0,005). При СД2 силы агрегации эритроцитов были выше по сравнению с группой контроля (р<0,005). При этом отношения сил дезагрегации к силам агрегации при СД1 и СД2 не отличались. Заключение. Как для СД1, так и СД2 характерна гиперагрегация эритроцитов. Однако, учитывая полученные данные, можно предположить, что механизмы такой гиперагрегации различны.