Temperature proximal-to-distal dorsal hand gradient as a thermography signs of altered glucose metabolism. Variations and perspective to use

Aim. To evaluate the temperature proximal-to-distal dorsalhand gradient (PDG) in patients with altered glucose metabolism.

Methods. Analyzed 120 patients with altered glucose metabolism, divided to three groups: group 1 — abnormal glucose tolerance test (R73) and type 2 diabetes mellitus without complications (E11.9) — 50 pts, 30 m/20 f, mean age 61,5 ± 11,1), group 2 — Type 1 diabetes mellitus [Е10] — 25 pts, 7 m/18 f, mean age 44,4 ± 13,1); group 3 — type 2 diabetes mellitus with multiple complications [Е11.7] and type 2 diabetes mellitus with unspecified complications [Е11.8] — 45 pts, 14 m /31 f., mean age 62,2 ± 10,8). Thermal images were shoot by Russian made thermography camera TVS–300med, 388 x 360 pix, sensitivity 0,03℃. PDG calculated as a difference between mean temp of proximal and distal phalanges of 2–5 fingers and estimated for right or left hand separately.

Results. Two thermography signs were observed: «inverted» PDG, when temperature of distal phalanges is higher than proximal and founded more often in group 1 and «false normal», when temperature of proximal phalanges is higher than distal, and name in this manner, because founded more often in «complicated» groups 2 and 3. Analysis confirmed that group 1 and group 3 pts significantly differed in mean PDG value (p<0,05).

Conclusion. Our results show that thermography examination pointed out variety of dorsal hand signs for altered glucose metabolism and significant difference in mean PDG value for group 1 and 3. Therefore infrared thermography could be suggested as an objective tool for screening and monitoring of disease.

1. Белова А.Н., Кудыкин М.Н., Шейко Г.Е. Диабетическая периферическая нейропатия: эпидемиология, патогенез, клиника, диагностика, лечение // Российский медико-биологический вестник им. акад. И.П. Павлова. 2016;24(4):139–151. doi:10.23888/pavlovj20164139–151.

2. Воловик М.Г., Долгов И.М. Современные возможности и перспективы развития медицинского тепловидения // Медицинский алфавит. 2018;3(25):45–51.

3. Дедов И.И., Токмакова А.Ю., Егорова Д.Н., Галстян Г.Р. Клинические рекомендации по диагностике и лечению синдрома диабетической стопы. М., 2015. 17 с.

4. Павлов Ю.И. Характеристика параметров кровотока при различных формах синдрома диабетической стопы // Ангиология и сосудистая хирургия 2005;11(3):21–25.

5. Шестакова М.В., Викулова О.К., Железнякова А.В. и др. Эпидемиология сахарного диабета в Российской Федерации: что изменилось за последнее десятилетие? // Терапевтический архив. 2019;91(10):4–13. doi: 10.26442/00403660.2019.10.000364.

6. Ahmad J. The diabetic foot // Diabetes Metab Syndr Clin Res Rev. 2016;10:48–60. doi: 10.1016/j.dsx.2015.04.002

7. Albers J.M., Hermann W.H., Pop-Bususi R. et al. Subclinical neuropathy at trial completion possible predictors of incident neuropathy? // Diabetes Care. 2007;30(10):2613–18, http://dx.doi.org/10.2337/dc07–0850.

8. Astasio-Picado Á., Escamilla Martínez E., Gómez-Martín B. Comparison of thermal foot maps between diabetic patients with neuropathic vascular neurovascular and no complications // Current Diabetes Reviews 2019; 15 (6): 503–509. doi: 10.2174/1573399815666190206160711.

9. Bagavathiappan S., Philip J., Jayakumar T. et al. Correlation between Plantar Foot Temperature and Diabetic Neuropathy: a case study by using an infrared thermal imaging technique // J Diabetes Sci Technol. 2010 Nov;4(6):1386–1392. doi: 10.1177/193229681000400613.

10. Bharara M., Cobb J.E., Claremont D.J. Thermography and thermometry in the assessment of diabetic neuropathic foot: a ase for furthering the role of thermal techniques // Int J Low Extrem Wounds. 2006:5:250–260. doi: 10.1177/1534734606293481.

11. Bharara M., Schoess J., Armstrong D.G. Coming events cast their shadows before: detecting inflammation in the acute diabetic foot and the foot in remission // Diabetes Metab Res Rev. 2012;28(1):15–20. doi: 10.1002/dmrr.2231.

12. Brånemark P.I., Fagerberg S.E., Langer L., Save-Söderbergh J. Infrared thermography in diabetes mellitus. A preliminary study // Diabetologia. 1967 Dec 1; 3 (6): 529–532. https://doi.org/10.1007/BF01213572.

13. Frykberg R.G., Gordon I.L., Reyzelman A.M. et al. Feasibility and efficacy of a smart mat technology to predict development of diabetic plantar ulcers // Diabetes Care. 2017;40:973–980. doi: 10.2337/dc16–2294.

14. Gatt A., Formosa C., Cassar K. et al. Thermographic patterns of the upper and lower limbs: baseline data // Int. J. Vasc. Med., 2015;15:831369. doi: 10.1155/2015/831369.

15. Guimarães C.M.D.de Sá, Balbinot L.F., Brioschi M.L. Imagens infravermelhas na avaliação do pé diabetico // Surg Cosmet Dermatol. Rio de Janeiro, abr-jun. 2018;10(2):116–120. doi: http://www.dx.doi.org/10.5935/scd1984–8773.20181021154 [in Portugal].

16. Harding J.R., Wertheim D.F., Williams R.J. et al. Infrared Imaging in Diabetic Foot Ulceration // European Journal of Thermology. October 1988;8:145–149. doi: 10.1109/IEMBS.1998.745591.

17. Hauer J.L., Boland O.M., Ewing D.J., Clarke B.F. Hand skin blood flow in diabetic patients with autonomic neuropathy and microangiopathy // Diabetes Care. 1991;14(10);897–902. doi: 10.2337/diacare.14.10.897

18. IDF diabetes atlas (IDF–2019), 9th ed. International Diabetes Federation, 2019. 176 pp.

19. Jung P., Trautinger F. Capillaroscopy of toes // Dtsch Dermatol Ges. 2013;11(9):855–866. doi: 10.1111/ddg.12117.

20. Lahiri B., Bagavathiappan, Raj B., Philip J. Infrared Thermography for Detection of Diabetic Neuropathy and Vascular Disorder. In: Application of Infrared to Biomedical Sciences, Series in BioEngineering. E.Y.K.Ng and M.Etehadtavakol (eds.). Springer, Verlag, 2017. pp. 217–247. doi 10.1007/978–981–10–3147–2_13.

21. Lavery L.A., Petersen B.J., Linders D.R. et al. Unilateral remote temperature monitoring to predict future ulceration for the diabetic foot in remission // BMJ Open Diabetes Res Care. 2019;7(1):e000696. doi: 10.1136/bmjdrc–2019–000696.

22. Macdonald A., Petrova N., Ainarkar S. et al. Thermal symmetry of healthy feet: a precursor to a thermal study of diabetic feet prior to skin breakdown // Physiol. Meas. 2017;38(1):33–44. doi:10.1088/1361–6579/38/1/33.

23. Renero-C F.-J. The abrupt temperature changes in the plantar skin thermogram of the diabetic patient: looking in to prevent the insidious ulcers // Diabetic Foot & Ankle. 2018;9:1,1430950. doi: 10.1080/2000625x.2018.1430950.

24. Shahani B.T., Halperin J.J., Boulu P., Cohen J. Sympathetic skin response — A method of assessing unmyelinated axon dysfunction in peripheral neuropathies // J Neurol Neurosurg Psychiatry. 1984;47:536–542. doi: 10.1136/jnnp.47.5.536.

25. Uccioli L., Mancini L., Giordano A. et al. Lower limb arterio–venus shunts, autonomic neuropathy and diabetic foot // Diabetes Res Clin Pract. 1992;16:123–130. doi: 10.1016/0168–8227(92)90083–4.

26. Uematsu S., Edwin D.H., Jankel W.R. et al. Quantification of thermal asymmetry. Part 1: Normal values and reproducibility // J Neurosurg. 1988;69:552–555. doi: 10.3171/jns.1988.69.4.0552.

27. Vardasca R., Ring E.F.J., Plassmann P., Jones C.D. Thermal symmetry of the upper and lower extremities in healthy subjects // Thermology International 2012;22(2):53–60.

28. Watkins P.J. The diabetic foot // Br Med J. 2003;326:977–979. doi: 10.1136/bmj.326.7396.977.

29. Yang Z., Zhang Y., Chen R. et al. Simple tests to screen for diabetic peripheral neuropathy // Cochrane Database of Systematic Reviews 2018, Issue 7. Art. No.: CD010975. doi: 10.1002/14651858.cd010975.pub2