ANALYSIS OF THE EFFECT OF TRANSCRANIAL MAGNETIC STIMULATION ON PERIPHERAL BLOOD CIRCULATION AND REDOX PROCESSES IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND POLYNEUROPATHY
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Abstract
The methods of the effect of transcranial magnetic stimulation in type 2 diabetes mellitus patients with progressive damage to the microcirculatory bed and distal neuropathy were analyzed, new diagnostic and therapeutic methods were searched for to improve peripheral blood circulation and redox processes in these patients. The expediency of using the Laser Doppler fluometry (LDF) method in patients with type 2 diabetes mellitus (DM) with distal neuropathy during transcranial magnetic stimulation (TMS) therapy has been determined.
LDF is a relatively new non-invasive method for studying microcirculation, which allows to assess the overall level of peripheral perfusion and features of blood flow regulation in the microcirculatory bed in 20 patients with DM of both genders aged 44 to 75 years old suffering from DM for 5 to 14 years, with HbA1c levels of 7.6-11.8%. These patients underwent LDF and fluorescence diagnostics using LAKK-M device before and after short-term TMS sessions for 3 days. LDF was performed on the palm surface of the left ring finger according to generally accepted methods. Statistically significant changes in microcirculation (PM), vascular tone (CT), intravascular resistance (Rc) and cardiac spectra were obtained. According to the fluorescence diagnosis, the indicators of oxidative metabolism of porphyrins and NADH reacted most clearly to TCMS. It turned out that in 13 patients, CT and porphyrin levels were predominantly reduced, whereas in 7 subjects, a decrease in Rc and changes in NADH prevailed, and the most pronounced decrease in cardiac spectra was found. There were no correlations between the studied parameters and indicators of carbohydrate and lipid metabolism, duration of diabetes, gender and age.
Clinically, positive dynamics were revealed in the form of a decreased leg pain, improved sleep and performance, draws attention to the sudden appearance of drowsiness immediately after TMS and a decrease in blood sugar. Short-term TMS is accompanied by an increase in the volumetric characteristics of microhemodynamics and possibly a potential improvement in the transport function of blood and transcapillary metabolism and tissue trophism.
These TMS effects in patients with type 2 diabetes mellitus and polyneuropathy make it possible to determine the method of LDF and fluorescence, which reveals disorders of the microcirculatory bed and tissue metabolism and requires further study and implementation into clinical practice.
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Author Biographies
Надежда Ивановна Шумейко,
candidate of medical sciences, docent, head of the department of functional diagnosticsАнастасия Валерьевна Ямщикова,
candidate of medical sciences, senior researcher of the laboratory of physiology of slow wave processesСергей Николаевич Филимонов,
Filimonov Sergey Nikolaevich
Head of the Department of Human Ecology, Public Health and Healthcare.
Doctor of Medical Sciences, Professor, Excellence in Public Health of the Russian Federation. Education: higher medical, medical business. Medical experience since 1983 Born November 22, 1959 in the village. Izhmorka, Kemerovo region.
S.N. Filimonov is a highly qualified specialist in the field of therapy, cardiology, pulmonology, nephrology, occupational pathology, emergency medical care.
Actively engaged in scientific research. Range of professional and scientific interests: prevention, diagnostics, treatment and rehabilitation of patients with therapeutic pathology, the study of genetic and phenotypic markers, new aspects of the treatment of diseases of internal organs.
He has more than 450 published scientific papers, including 66 textbooks, 9 monographs, reference books, manuals, 16 invention patents and 1 computer program registration certificate, on various issues of therapy, cardiology, pulmonology, nephrology, occupational pathology, on clinical problems, course, rehabilitation and prediction of the results of the course of pathological processes (IHD, AH, COPD, etc.).
Internship: Ambulance station in Novokuznetsk (1983-1984).
Residency: Department of Cardiology Novokuznetsk GIDUV (1987-1989).
From 2004 to 2016 - Vice-Rector for Academic Affairs of NGIUV, since 2007 - Professor of the Department of Therapy of NGIUV, since 2017 - Director of the Research Institute of Complex Problems of Hygiene and Occupational Diseases.
Татьяна Петровна Маклакова,
doctor of medical sciences, head of the department of endocrinology and diabetologyЕвгения Петровна Каширина,
candidate of medical sciences, docent of the department of endocrinology and diabetologyArticle Details
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The authors declare that they have no apparent or potential conflicts of interest related to the publication of this article.
This work is licensed under a Creative Commons Attribution 4.0 License.
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References
Dedov II. Diabetes mellitus: development of technologies in diagnosis, treatment, and prevention. Diabetes Mellitus. 2010; 3: 6-13. Russian (Дедов И.И. Сахарный диабет: развитие технологий в диагностике, лечении и профилактике //Сахарный диабет. 2010; 3: 6-13.) doi: 10.14341/2072-0351-5480
Dedov II, Shestakova MV. Diabetes mellitus: acute and chronic complications. M., 2011. 48 p. Russian (Дедов И.И., Шестакова М.В. Сахарный диабет: острые и хронические осложнения. М., 2011. 48 с.)
Vasiliev PV, Shishkin AN, Erofeev NP, Bubnova NA, Pchelin IY. Non-invasive assessment of microcirculation in patients with late-stage complications of diabetes mellitus type 2. Regional blood circulation and microcirculation. 2015; 14(4): 28-33. Russian (Васильев П.В., Шишкин А.Н., Ерофеев Н.П., Бубнова Н.А., Пчелин И.Ю. Неинвазивная оценка микроциркуляции у пациентов с поздними осложнениями сахарного диабета 2-го типа //Регионарное кровообращение и микроциркуляция. 2015; 14(4): 28-33.) doi: 10.24884/1682-6655-2015-14-4-28-33
Bregovsky VB, Kapova IA, Alekseeva ES. Skin microcirculation disorders in the lower limbs in diabetes: a pathophysiological phenomenon or a treatment target? Diabetes Mellitus. 2011; 3: 49-53. Russian (Бреговский В.Б., Капова И.А., Алексеева Е.С. Нарушение кожной микроциркуляции в нижних конечностях при сахарном диабете: патофизиологический феномен или объект для лечения? //Сахарный диабет. 2011; 3: 49-53.) doi: 10.14341/2072-0351-6224
Nesterova MV, Galkina VV. Diabetic polyneuropathy: pathogenesis, classification, clinical presentation, and treatment. Neurology, Neuropsychiatry, Psychosomatics. 2013; 2: 97-105. Russian (Нестерова М.В., Галкина В.В. Патогенез, классификация, клиника и лечение диабетической полинейропатии //Неврология, нейропсихиатрия, психосоматика. 2013; 2: 97-105.) doi: 10.14412/2074-2711-2013-2422
Schramm JC, Dinh T, Veves A. Microvascular changes in the diabetic foot. Int J Low Extrem Wounds. 2006; 5(3): 149-159. doi: 10.1177/1534734606292281
Shishkin MV, Zvenigorodskaya LA, Mkrtumyan AM. Laser doppler flowmetry and fluorescence spectroscopy as methods for preclinical manifestations of diabetic foot syndrome assessment. Effective Pharmacotherapy. 2018; 18: 6-12. Russian (Шишкин М.В., Звенигородская Л.А., Мкртумян А.М. Лазерная допплеровская флоуметрия и флуоресцентная спектроскопия как методы оценки доклинических проявлений синдрома диабетической стопы //Эффективная фармакотерапия. 2018. № 18. С. 6-12)
Emanuel AL, Nieuwenhoff MD, Klaassen ES, Verma A, Kramer MHH, Strijers R, et al. Relationships Between Type 2 Diabetes, Neuropathy, and Microvascular Dysfunction: Evidence From Patients With Cryptogenic Axonal Polyneuropathy. Diabetes Care. 2017; 40(4): 583-590. doi: 10.2337/dc16-1690
Krupatkin AI, Sidorov VV, Merkulov MV, i dr. Funkcional`naya ocenka perivaskulyarnoj innervacii konechnostej s pomoshh`yu lazernoj dopplerovskoj floumetrii: posobie dlya vrachej. M., 2004. 26 s. Russian (Крупаткин А.И., Сидоров В.В., Меркулов М.В. и др. Функциональная оценка периваскулярной иннервации конечностей с помощью лазерной допплеровской флоуметрии: пособие для врачей. М., 2004. 26 с.)
Belcheva A, Shindova M, Hanna R. Efficacy of Laser Doppler Flowmetry, as a Diagnostic Tool in Assessing Pulp Vitality of Traumatised Teeth: A Split Mouth Clinical Study. J Pers Med. 2021; 11(8): 801. doi: 10.3390/jpm11080801
Ginzburg ML. Lazernaya dopplerovskaya floumetriya i spektrofotometriya v diagnostike i ocenke e`ffektivnosti lecheniya mikrocirkulyatorny`x narushenij u bol`ny`x vibracionnoj bolezn`yu: abstr. dis. … cand. med. sci. M., 2005. 24 p. Russian (Гинзбург М.Л. Лазерная допплеровская флоуметрия и спектрофотометрия в диагностике и оценке эффективности лечения микроциркуляторных нарушений у больных вибрационной болезнью: автореф. дис. ... канд. мед. наук. М., 2005. 24 с.)
Lazernaya dopplerovskaya floumetriya mikrocirkulyacii krovi: rukovodstvo dlya vrachej /pod red. AI Krupatkina, VV Sidorova. M., 2005. 256 s. Russian (Лазерная допплеровская флоуметрия микроциркуляции крови: руководство для врачей /под ред. А.И. Крупаткина, В.В. Сидорова. М., 2005. 256 с.)
Dunaev AV, Sidorov VV, Stewart NA, Sokolovski SG, Rafailov EU. Laser reflectance oximetry and Doppler flowmetry in assessment of complex physiological parameters of cutaneous blood microcirculation. March 2013. Proceedings of SPIE – The International Society for Optical Engineering 8572. doi: 10.1117/12.200179
Kozlov VI, Azizov GA, Gurova OA, Litvin FB. Lazernaya dopplerovskaya floumetriya v ocenke sostoyaniya i rasstrojstv mikrocirkulyacii krovi: metod. posobie dlya vrachej. M., 2012. 32 s. Russian (Козлов В.И., Азизов Г.А., Гурова О.А., Литвин Ф.Б. Лазерная допплеровская флоуметрия в оценке состояния и расстройств микроциркуляции крови: метод. пособие для врачей. М., 2012. 32 с.)
Rogatkin DA, Bychenkov OA, Polyakov PYu. Noninvasive spectrophotometry in the modern radiology: problems of accuracy and informativeness of diagnostic results. Almanac of Clinical Medicine. 2008; XVII(Part 1): 83-87. Russian (Рогаткин Д.А., Быченков О.А., Поляков П.Ю. Неинвазивная спектрофотометрия в современной радиологии: вопросы точности и информативности результатов измерений //Альманах клинической медицины. 2008. Т. XVII, Часть 1. С. 83-87)
Kamenskaya OV, Klinkova AS, Loginova IYu, Levicheva EN, Cherniavsky AM. The functional state of the microcirculatory blood flow of peripheral tissues in patients with systemic atherosclerosis in combination with diabetes mellitus. Regional Circulation and Microcirculation. 2012; 11(2): 16-21. Russian (Каменская О.В., Клинкова А.С., Логинова И.Ю., Левичева Е.Н., Чернявский А.М. Функциональное состояние микроциркуляторного кровотока периферических тканей у пациентов с системным атеросклерозом в сочетании с сахарным диабетом 2 типа //Регионарное кровообращение и микроциркуляция. 2012. Т. 11, № 2. С. 16-21.) doi: 10.24884/1682-6655-2012-11-2-16-21
Gubareva NA, Podtaev SY, Parshakov AA. Diagnostics of vasodilation disorders of skin microvessels in patients with diabetic foot syndrome during local thermal testing. Regional Circulation and Microcirculation. 2015; 14(3): 27-33. Russian (Губарева Н.А., Подтаев С.Ю., Паршаков А.А. Диагностика нарушений вазодилатации микрососудов кожи у больных с синдромом диабетической стопы при проведении локальной тепловой пробы //Регионарное кровообращение и микроциркуляция. 2015. Т. 14, № 3. С. 27-33.) doi: 10.24884/1682-6655-2015-14-3-27-33