Endocrine Abstracts

Purpose: To assess the influence of diabetic polyneuropathy (DPN) on the course of chronic venous insufficiency (CVI) of the lower limbs in patients with combined pathology.

Methods: 40 patients with CVI of the lower limbs in combination with diabetes mellitus (DM) type 2 were examined. DPN was diagnosed in 34 patients - group 1, 6 patients had no DPN - group 2. The diagnosis of CVI was established according to the international classification of CEAP. The intensity of subjective symptoms of CVI was assessed using Venous Clinical Severity Score (VCSS). Neurological examination included the use of the Neuropathy Disability score (NDS) and electroneuromyography (EMG).

Results: The patients in group 2 varicose changes had more often: 50% versus 11.7% in group 1 (P=0.02), in group 2 trophic changes prevailed: 53% versus 0% (P=0.01). A significant difference in VCSS was revealed: in group 1−9.6 3.2, in group 2−6.3 1.7 points (P=0.01). In patients with DPN a positive correlation between the NDS and severity of CVI (r=0.43; P=0.01) and between the NDS and VCSS (r=0.5; P=0.002) was determined. Analyzing individual subjective manifestations of CVI using VCSS, in group 1 there was a positive correlation between the NDS and hyperpigmentation (r=0.45; P=0.007), NDS and induration (r=0.44; P=0.008). According to the results of EMG in patients with DPN and trophic changes of the lower limbs M-response amplitude on n. Tibialis 3.4 [ 2.2;6.1 ] mV and n. Peroneus 1.4 [1.0;3.5] mV , as well as speed of propagation of excitation (SPE) on n. Peroneus 42 [39; 44] m/s and n. Suralis 27 [21;39 ] m/s were significantly lower compared with patients without trophic changes, which M-response amplitude on n. Tibialis 6.4 [5.2;7.1] mV (P=0.01) and n. Peroneus 3.7 [2.5; 4.6] mV (P=0.002) for the speed of propagation of excitation n. Peroneus 45 [42;48 ] m/s (P=0.02) and n. Suralis 39 [36;42 ] m/s (p=0.009)

Conclusion: DPN aggravates the CVI in patients with DM type 2. The defeat of the sensory and motor fibers according to EMG is associated with more serious trophic disorders caused by chronic venous insufficiency.