PECULIARITIES OF THE CHANGE IN THE RESPIRATORY MUSCLES STRENGTH IN PATIENTS WITH 2 TYPE OF DIABETES MELLITUS COMPLICATED BY THE DIABETIC FOOT SYNDROME

The relationship between cardiorespiratory disorders and diabetic foot syndrome has not been adequately studied. In particular, there is no information on the strength of the respiratory muscles in this category of patients. The purpose of the study: to determine the presence of respiratory muscles weakness in patients with type 2 diabetes mellitus complicated by diabetic foot syndrome. Materials and methods. 72 patients were examined, 16 of them with type 2 diabetes mellitus complicated by the neuroischemic type of diabetic foot syndrome I-IV st. Wagner made up the first (main) group. The second group (comparisons) included 29 patients with type 2 diabetes mellitus not complicated by diabetic foot syndrome. The third group (comparisons) were 27 patients without diabetes. The groups were randomized by sex and exclusion criteria. Determination of the strength of the respiratory muscles was carried out by measuring the maximum static pressure levels at the mouth level that the patient created during maximum inspiration and maximum expiration in closed airways. Results. The forces of the respiratory muscles with inspiratory effort in patients with type 2 diabetes mellitus complicated by diabetic foot syndrome was reduced by 18.5 cm of water column (p <0.01) compared with diabetic patients without diabetic foot syndrome and by 17.3 cm water column (p <0.01) compared with patients without diabetes. The expiratory effort showed a decrease in the forces of the respiratory muscles in the patients of the first group by 49.4 cm of water column (p <0.01) compared to patients of the second group and by 27.4 cm of water column (p <0.05) compared to patients third group. In women with diabetic foot syndrome, the inspiratory muscular forces was reduced in comparison with patients without diabetic foot and without diabetes syndrome by 27.1 (p <0.01) and by 23.3 (p< 0.05) cm of water column, respectively. In men with diabetic foot syndrome, the same index was lowered by 13.9 (p> 0.05) and 17.7 (p <0.05) cm of water column, respectively, compared to the second and third groups, respectively. The expiratory effort revealed a decrease in the forces of the respiratory muscles in men in all groups in approximately the same range, without a significant difference between the groups. In women with diabetic foot syndrome, there is a marked decrease in the strength of the expiratory muscles: by 48.4 cm of water column (p <0.01), compared to women of the second group and by 20.6 cm of water column (p <0.05) patients of the third group. Conclusions. Patients with diabetes mellitus complicated by diabetic foot syndrome showed a decrease in the strength of inspiratory and expiratory muscle. In women with diabetic foot syndrome, there is a more pronounced decrease in the strength of the respiratory muscles during exhalation compared to men with this pathology.

1. Dedov I.I., Shestakova M.V., Vikulova O.K. Epidemiology of diabetes mellitus in Russian Federation: clinical and statistical report according to the federal diabetes registry. Diabetes Mellitus. 2017; 20 (1): 13-41 [In Russian].

2. Risman B.V., Chmyrev I.V., Gamolin S.V. Quality of life and function of feet patients with purulent-necrotic complications of diabetic foot. Vestnik VMA. 2011; 2(34): 87-96 [In Russian].

3. Sivozhelezova O.K., Ivanov K.M. The quality of the life of the patients with the chronic heart insufficiency and the destructive forms of the syndrome of the diabetic foot. Vestnik OSU. 2014; 6 (167): 229-232 [In Russian]

4. Hsia C.C.W. Lung function changes related to Diabetes Mellitus. C.C.W. Hsia, Ph. Raskin. Diabetes Technology & Therapeutics. 2007; 2(1): 73-82.

5. Zhautikova S.B., Sejsembekov T.Z., Kenzhina Z.Z. The state of respiratory organs in extrapulmonary diseases. J. Clin. Med. Kaz. 2013; 2 (28): 79-80 [In Russian].

6. Svetlakova N.V. State of ventilatory function of lungs and hemodynamics of lesser circulation in patients with type I diabetes mellitus during intensive insulin therapy. Perm Medical Journal. 2008; 4(25): 47-53 [In Russian].

7. Sokolov E.I. Demidov Yu.I., Dudayev V.A. The condition of external respiratory mechanics in patients with type I diabetes. Clinical Medicine. 2007; 9: 54-58 [In Russian].

8. Sokolov E.I. Demidov Yu.I. Gas exchange function of the lungs in patients with type I diabetes mellitus. Therapeutic archive. 2008; 3: 63-66 [In Russian]

9. Ospanova T.S., Zaozerskaya N.V. Clinical and pathogenetic features of respiratory disorders in patients with diabetic nephropathy and obesity. Belgorod State University Scientific Bulletin. 2014;

10. 11 (182): 62-67 [In Russian]

11. Boulbou M. Diabetes mellitus and lung function. M. Boulbou, K. Gourgoulianis, V. Klisiaris [et al.] Med. Princ. Pract. 2003; 12(2): 87-91.

12. Avdeev S.N. Assessment of the strength of the respiratory muscles in clinical practice. Аtmosphere. Pulmonology and Allergology. 2008; 4: 12-17 [In Russian]