Peripheral blood flow disorders and its role in the development of diabetic peripheral polyneuropathy in children

Objective — to evaluate the state of blood supply to the lower extremities in children with type 1 diabetes mellitus by the results of the ankle­brachial index and to detect latent peripheral circulatory disorders in the development of diabetic peripheral polyneuropathy. Materials and methods. The study included 103 children (mean age (13.57 ± 0.24) years) with type 1 diabetes mellitus. Depending on the duration of the disease, two groups of patients were formed. Group 1 included 70 children with diabetes mellitus duration up to 5 years (mean duration (2.21 ± 0.16) years), group 2 consisted of 33 patients with diabetes mellitus duration over 5 years (mean duration (8.45 ± 0.41) years). The control group consisted of 33 children without carbo­hydrate metabolism disorders and neurological disorders. Diabetic peripheral polyneuropathy (DPP) was diagnosed in 47 (45.6 %) of 103 children with diabetes mellitus. The ankle­brachial index (ABI) was determined by measuring systolic blood pressure in the upper and lower extremities sequentially. To determine the latent disorders of peripheral circulation, the measurement and calculation of the ABI was performed before and after exercise. Paired linear regression analysis was used to assess the relationship between the indicators. ROC analysis was performed to determine the effectiveness of the use of the ABI as a screening group for the development of DPP. To assess the risk of developing DPP in children, the odds ratio and its 95 % confidence interval were calculated. Results and discussion. It has been established that in children with diabetes mellitus, the ABI values were signifi­cantly reduced compared with the values of the control group (p < 0.05). The degree of severity of neurological disorders in children with diabetes mellitus was dependent on the state of peripheral blood flow. Using the ROC curve analysis, the effectiveness of determining the ABI for detecting DPP was evaluated. It was found that the area under the ROC curve was higher when using the ABI after exercise compared to the same indicator at rest, indicating that after exercise the ABI can be used as a screening tool to identify a risk group for the development of DPP. Conclusions. Peripheral circulatory disorders are a risk factor and a marker for the development of diabetic peripheral polyneuropathy in children with type 1 diabetes mellitus. The resting ABI can be used as an initial screening test aimed at detecting peripheral blood flow disorders in children with diabetes mellitus and classifying them into risk groups for the development of diabetic peripheral polyneuropathy. Even when ABI values are normal in children with diabetes mellitus, in order to detect latent peripheral circulatory disorders, it is recommended to determine ABI after dosed exercise using a threshold value < 1.0.