Claudicação intermitente em indivíduos com diabetes mellitus tipo 2: avaliação e sua relação com composição corporal, sexo e risco de pé diabético

Abstract

Diabetes Mellitus (DM) is characterized by being a non-transmissible chronic disease and represents an important cause of morbidity and mortality in the world. Atherosclerosis is one of the most commonly encountered peripheral obstruction processes in individuals with DM, causes gradual decrease of blood flow to the extremities and systemically, results in vascular peripheral obstructive arterial disease (PAD). One of the main symptoms that can be found in these individuals is intermittent claudication (IC). Individuals with Type 2 Diabetes Mellitus (T2DM) have a high risk of developing Diabetic Foot, due to loss of sensitivity and vascular alterations. Thus, the development of the present study sought to study IC in diabetic individuals and to present easily accessible methods to identify individuals who are limping. The objectives were to assess IC in individuals with T2DM and its relation to body composition, gender and the risk of developing Diabetic Foot. For the evaluation, a questionnaire was used to characterize the subject with socioeconomic data, physical activity level (IPAQ), blood pressure (BP) and body composition (bioimpedance balance); assessment of the risk of developing Diabetic Foot (“Cuidando do Pé” application) and specific tests to identify ankle brachial index (ABI), 'Edinburgh Claudication Questionnaire' (ECQ), and six-minute walk test (6MWT). The main findings indicate a majority of the female sex, low level of education, oral antidiabetic use, hypertension, mean age of 61.6 ± 10.2 years and diagnosis time 11.3 ± 8.2 years. Had a high risk of developing Diabetic Foot; in relation to the classification of ABI around 26% presented some alteration; in the ECQ, 27.3% classified as claudicants, most with suggestion of grade 1 and typical. According to the 6MWT, the studied sample walked close to the predicted value; 30.6% reported symptoms of IC, being 'burning' the most prevalent. In the comparison of the data, it was observed that men presented higher values of ABI and 6MWT when compared to women (p <0.05); BMI and IGC were the inverse (p <0.05). When comparing the symptoms of the 6MWT, those who presented symptoms walked less (407.4m vs 436.7m, p = 0.005) and had a BMI (32.6 vs 30.6, p = 0.023) and IGC (39.2 vs 33, 7; p = 0.003). In the comparison of the ABI scores with the 6MWT, it was observed that people with 'normal' scores ranged farther when compared to the 'PAD' score (p <0.05). There was a negative correlation between ECQ and 6WMT, and the smaller the footage in the test, the higher the ECQ scores, showing that people with T2DM and claudicant pacient walked less. The methods used to assess IC in the sample studied were similar in identifying some symptom of claudication or alteration, but the associated use of the tools to better understand the vascular alterations in the T2DM population is suggested.