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2 . 2022

Integrated approach to forecasting development of diabetic foot syndrome

Abstract

Background. Diabetes mellitus is one of the most significant diseases worldwide. In 6–11% of patients, diabetic foot syndrome develops, about which 40–70% of patients are operated on. With the development of a purulent-necrotic process, amputations are performed in 50% of patients with diabetic foot resulting in 28–40% mortality.

Aim. Development of a model for predicting the risk of developing diabetic foot syndrome based on a comprehensive assessment of gene polymorphisms of vascular tone regulation factors, platelet receptors, vascular wall remodeling, and changes in the state of the microvasculature.

Material and methods. Polymorphisms of the genes NOS3 с.-786Т>С, EDN1 c.594G>T (p.Lys198Asn), ITGB3 c.1565T>C, MMP9 c.-8202A>G, VEGFA c.-634C>G  by polymerase chain reaction were studied in 198 patients with uncomplicated diabetes mellitus and 199 patients with diabetic foot. Patients from each group, comparable in frequency of the polymorphisms of the studied genes, were examined on the state of the microvasculature using the laser Doppler flowmetry method. The study was prospective in nature. The analysis of the results included compliance with Hardy–Weinberg law, chi-square, odds ratio and its confidence interval, Mann–Whitney test using the Bonferroni correction, V-Cramer indicator, non-linear regression analysis.

Results. An association of the ITGB3 c. 1565T>C  polymorphism in a heterozygous state with the risk of developing a diabetic foot was established. The relationship between the index of total microcirculation, the average fluctuation of perfusion, the maximum amplitude of oscillations  of the neurogenic, myogenic, respiratory, and vascular ranges at a point on the forearm, the index of total microcirculation, and the coefficient of variation at a point on the back of the foot and first toe were revealed with the development of diabetic foot syndrome. Using the method of nonlinear regression analysis, based on the obtained data, a prognostic model is created to determine the relative risk of developing diabetic foot in a particular patient.

Conclusion. The area under the ROC curve for the developed model was 80.1%, which indicates good information content of the developed model and makes it possible to use it in clinical practice to assess the individual risk of developing diabetic foot syndrome.

Keywords:diabetes mellitus; diabetic foot; gene polymorphism; microvasculature; laser Doppler flowmetry

Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Troitskaya N.I., Shapovalov K.G., Mudrov V.A. Integrated approach to forecasting development of diabetic foot syndrome. Clinical and Experimental Surgery. Petrovsky Journal. 2022; 10 (2): 46–53. DOI: https://doi.org/10.33029/2308-1198-2022-10-2-46-53  (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)
Вскрытие
Medicine today

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