Background. Type 2 diabetes mellitus (DM 2) is one of the significant medical, social and economic problems in the Republic of Belarus due to the high prevalence and development of severe complications. The need to predict and prevent diabetic foot ulcer (DFU) is becoming one of the most urgent clinical tasks, which requires the introduction into practice of indicators available for routine determination that can predict the course of DFU. Objective. To study the prognostic significance of the hematological ratio in assessing the risk of occurrence and clinical course of DFU. Material and methods. A non-randomized study was performed, in which 74 patients participated. The entire sample was retrospectively divided into 2 groups: patients with DM 2 (control group, n=43) and patients with DM 2 who have DFU (experimental group, n=31). Venous blood was taken on an empty stomach to determine the level of neutrophils, lymphocytes, platelets, glycated hemoglobin (HbA1), neutrophil-lymphocytic ratio (NLR) and plateletlymphocytic ratio (PLR) were calculated. Results. It was revealed that the patients of the control and experimental groups did not differ in gender, age, body mass index (BMI), absolute number of lymphocytes and HbA1 level. It was found that in patients of the control group, the level of neutrophils, platelets, as well as NLR and PLR in the blood was statistically higher (p<0.05). Spearman's correlation analysis showed that in the control and experimental groups, all the studied indicators do not correlate with the NLR. In the experimental group, the BMI indicator negatively correlates with PLR (r=0.52; p<0.05), and Hba1c positively correlates with aphids (r=0.555; p<0.05). The NLR was equal in patients of category 1-3 according to the classification of DFU of the University of Texas (N=15) – 2.06 (1.55; 2.21) nmol/l, in patients of category 4-6 (N=16) – 4.33 (3.28; 5.73) (p<0.05). The PLR in patients with the smallest category was 95.88 (86.04; 108.63) nmol/l, in patients with the largest category – 174.98 (150.23; 210.64) (p<0.05). The area under the ROC curve for the indicators of NLR and PLR was the largest – 0.761 and 0.708, respectively. Conclusions. 1. The content of neutrophils and platelets in the blood, NLR and PLR was significantly higher in patients with DFU compared with patients who have DM 2 without DFU. 2. In patients with DM2 complicated by DFU, the indicator PLR negatively correlates with BMI and positively correlates with HbA1. 3. The NLR and PLR in patients with DFU increase with an increase in the risk of possible amputation of the lower limb during the year. 4. In patients with DFU the NLR and PLR have the great diagnostic value as a laboratory criterion of DFU.

Objective. To study blood cortisol level in patients with diabetic foot syndrome (DFS), to analyze the possibility of using cortisol level as a biochemical criterion of diagnosis and severity of DFS.Materials and methods. A non-randomized study was performed on 59 patients, who were divided into two groups: patients with the 3rd degree deforming arthritis of the knee joint without a history of diabetes mellitus (DM) and patients with DFS. Venous blood was collected on an empty stomach to determine the levels of cortisol, C-reactive protein, glycated hemoglobin, total protein, and hemoglobin.Results. Our data demonstrated that the blood cortisol level was statistically significantly higher (p < 0.05) and higher than normal in the experimental group of patients with DFS (701.69 (626.44; 904.63) nmol/L) when compared with the control group of patients with 3rd degree deforming knee joint arthrosis without a history of DM (423.7 (326.5; 516.20) nmol/L). Blood cortisol levels in patients with DFS decreased statistically significantly in 5 days after the treatment and was 382.26 nmol/L. Body mass index (BMI) (r = 0.946; p < 0.01) correlated with blood cortisol levels in patients with type 2 diabetes and with a complication of DFS. In patients with DFS, determination of blood cortisol content has the greatest diagnostic value as a biochemical criterion of DFS compared with other studied parameters (AUC, 0.915; p = 0.037). Cortisol content in patients with DFS gradually increases with the increase in the classification category of the University of Texas.Conclusion. Determining the level of cortisol in blood can be useful in the diagnosis of DFS, as well as to determine the degree of soft tissue damage of the lower extremities.

Background. One of the most dangerous complications of diabetes mellitus (DM) is damage to the lower extremities, leading to the development of diabetic foot syndrome (DFS) due to the progression of tissue metabolism disorders. For effective care of patients with DFS, it is important to identify patients at risk of malnutrition, apply various methods of diagnosing and assessing nutritional deficiencies. Evaluation of the nutritional status (NS), the degree and type of its violations is important for determining the approach to its correction. Objective. To establish the most significant prognostic criteria of the severity of DFS in patients with DM; to study changes in some indicators of NS. Material and methods. A prospective non-randomized observational study of patients with stage 3 deforming arthrosis of the knee joint, who do not have a history of DM, and those with DM complicated by DFS was conducted. To assess the NS of the patients, biochemical parameters in the blood were determined: the level of hemoglobin, total protein, albumin, total cholesterol, 25-hydroxycalciferol (25(OH)D). Results and conclusions. The NS of the patients without DM and those with DM complicated by DFS had significant differences in terms of patient weight, body mass index, blood levels of total protein, albumin, total cholesterol and 25(OH)D (p<0.01). In patients with DFS, the blood levels of total protein, albumin, total cholesterol and 25(OH) D (p<0.01) were statistically lower. As the severity of the foot soft tissue lesion increased, there was a significant high negative correlation of patients’ weight (r =-0.763), body mass index (r =-0.721), blood levels of total protein (r =-0.779), albumin (r =-0.711), total cholesterol (r =-1.089). The level of 25(OH)D content showed an insignificant average negative correlation (r =-0.386; p>0.05). The patients’ weight, body mass index, blood albumin and 25(OH) D levels had the highest AUC (0,828) and the greatest statistical diagnostic significance for assessing nutrition of patients with DFS.

Background. Diabetes mellitus is a global threat to public health. DFU is a marker of increased mortality in diabetic patients. It is important to understand the factors that would indicate the appearance of complications of diabetes mellitus. Objective. To investigate the factors influencing the occurrence of complications in patients with diabetes mellitus, to identify independent predictors of complications. Material and methods. A prospective non-randomized observational study was carried out from June 1, 2021 to September 1, 2021. The study involved 42 patients. The patients were divided into 2 groups: group 1 included subjects with a history of type 2 diabetes, group 2 – those with type 2 diabetes, complicated by DFU. Results. During the study, the level of platelets in the blood of all patients was 222.0 (177.5; 318.5)×109/l. The platelet count in group 1 was equal to 186 (154.5; 251.5)×109/l, and in group 2 it was 326.0 (239.25; 357.25)×109/l, statistical differences were significant (p <0.001). We divided the patients with DFS according to the Wagner classification, where platelet counts were determined for each of the classification grades. The level of platelets in patients with grade 1 was 267.0 (222.0; 322.5)×109/l, in those with grade 2 – 358.0 (234.75; 280.25)×109/l, in subjects with grade 3 – 340 (309.5; 360.5)×109/l, in those with grade 4 – 328 (305,75; 330,0)×109/l, and in those with grade 5 – 404 (293.5; 407.75)×109/l. The obtained data showed that the platelet count in the blood of patients with diabetes mellitus, complicated by diabetic foot syndrome was higher, than in patients with diabetes mellitus without complications. The platelet count in patients with diabetic foot syndrome gradually increased with an increase in the degree on the Wagner scale. The blood platelet count can be useful in assessing the severity of diabetic foot syndrome. Conclusions. The platelet count in patients with type 2 diabetes can be considered as a laboratory criterion and an independent risk factor for complications.