Фізичне та психічне функціонування осіб з діабетичною полінейропатією на фоні мультиморбідності

Abstract

The article analyzes the physical and psychological components of the people´s quality of life (QOL) with diabetic polyneuropathy (DP) on the basis of type I and II diabetes mellitus with comorbid pathology. Has been demonstrated the prevalence of more frequent multimorbid pathology in this nosology and its effect on patients' QOL. QOL is recognized as an integral part of a comprehensive analysis of new methods of diagnosis, treatment, prevention, quality of treatment and medical assistance [2]. With the highest frequency in diabetes detect sensory or sensorimotor forms of distal symmetrical DP. However, there are movement disorders in diabetes, including cranial neuropathy and Bruns-Garland syndrome (diabetic amyotrophy) [3], which interfere with the satisfactory functioning of patients. The aim of the work is to assess the extent of physical and mental functioning of people with DP on the background of multimorbidity. Materials and methods. Were examined 92 patients with DP on the basis of type I and II diabetes mellitus, aged from 19 to 69 years. Were carried out clinical and neurological examination of patients, laboratory and instrumental methods of examination (ultrasound examination of the abdominal cavity, thyroid gland), electroneuromyography (ENMG). Static calculation was done in MS Excel 2003. Results and discussion. In groups A and B with the highest frequency among cardiovascular diseases was arterial hypertension - 91%, 97% and coronary heart disease - 27%, 41%. In group C - chronic hepatitis (40%), chronic cholecystitis (40%), chronic pancreatitis (40%), chronic gastroduodenitis (40%). In people of group D , gallstone disease was diagnosed more often than in other pathologies (43%). The leading place in group E is occupied by autoimmune thyroiditis (29%), idiopathic hypothyroidism (29%), thyrotoxicosis (29%), in group F - nodular goiter (57%). The longest duration of diabetes mellitus (Fig. 3) is observed in group A - 24.54 ± 2.46 years, the smallest in group D - 7.14 ± 1.01 years. Diabetic foot syndrome was diagnosed in patients of groups A and B in 14%, group C - in 2%. According to the HDRS scale, signs of anxiety and depression weren"t detected in groups I and II (4.74 ± 0.47; 4.76 ± 0.53 and 5.54 ± 0.61; 5.76 ± 0.65). In persons of group I, the indicators of QOL are higher than in group II. The highest indicators are of groups I and II in the domains social (SF) and physical functioning (PF) - 66.75 ± 2.41; 65.5 ± 3.23 and 63.39 ± 3.54; 61.42 ± 3.88. In group A, the level of QOL is slightly- higher than in group B, in particular in the domains of mental health (MH) - 53.09 ± 3.12, bodily pain (BP) - 50.90 ± 4.05, role emotional (RE) - 37,83±9,11. Also the manifestations of DP in such group of individuals (group A) are manifested by the absence or mild pain, which causes in people of this group higher rates of QOL. QOL in patients of group C is higher than in group D, in particular, the indicators of physical functioning (PF) - 68.75 ± 5.88, social functioning (SF) - 65.62 ± 5.35, role emotional (RE) - 58.33 ± 18.75, mental health (MH) - 54 ± 5.36. In group D, the data are hight in the domains of social functioning (SF) 60.71 ± 16.0 and physical functioning (PF) 57.14 ± 8.37. In the examined patients of group F the level of QOL is higher than in group E, it was, in the domains of physical functioning (PF) - 76.42 ± 7.99, bodily pain (BP) - 61.28 ± 11.18, general health (GH) - 60.85 ± 7.33. Among all groups of patients, the highest indicators of physical functioning (PF) were observed in group F (76.42 ± 7.99) and C (68.75 ± 5.88), the lowest in group D (57.14 ± 8.37 ). Physical health (PH) is low in all groups, but slightly higher in group F (47.90 ± 3.45). The mental health (MH) is low in all groups of patients, slightly higher in group C (47.89 ± 3.59). When comparing QOL in groups A and C, they are higher than in comparison groups (B and D), because they are people who receive insulin therapy and, accordingly, less vulnerable to complications of diabetes and have a better course of nosology. Conclusions. The level of QOL in persons with DP on the basis of type I and II diabetes mellitus with multimorbidity is generally not high. Patients in group D showed the lowest levels of QOL, they also have a level of glycated hemoglobin much higher than in other groups. In group F, the data of QOL are higher, because people with DP on the basis of type I diabetes (group E) have a higher frequency of concomitant thyroid damage, the manifestations of which significantly complicate the course of the underlying disease and reduce levels of functioning. Often manifestations of diabetic foot occur in the onset of DP, when the fibers responsible for sensitivity are damaged, which causes the appearance of the neuropathic component of pain, so in persons of group B the lowest among all groups is the level of QOL in the domain of pain intensity. In addition, it is convenient to monitor the results of treatment by conducting a QOL survey several times a year. Careful analysis of QOL in all areas of functioning in patients with DP allows to detect early mental disorders and timely start treatment, including psychotherapy sessions.