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Development of the method for evaluating the

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Development of the method for evaluating
the status of blood microcirculation system
and the risk of microvascular complications
development at diabetes mellitus based on
optical spectroscopy
“MONIKI” named after M.F. Vladimirsky
D. Kulikov, MD, PhD
Conclusions
п‚— Informative functional tests as well as an algorithm
of the registration for the investigation of the blood
skin microcirculation at diabetes were developed
п‚— A method for processing and evaluating the results
was also obtained.
Diabetes Mellitus
*Data from Diabetes Atlas, 2013
International Diabetes Federation (IDF)
5.1 million people died and
548 billion USD were spent
*
due to diabetes in 2013
10,8 % global healthcare
expenditure !
Reactive
medicine
It is time to
SCREAM
Proactive
medicine
at half-percent of cases patients
already have different complications
at the time of diabetes diagnosis
Laser Doppler Flowmetry
to photo
receiver
from
laser
to photo
receiver
arterioles,
0.7-3.9 mm/s
LAKK diagnostic system
capillary,
0.1-0.6 mm/s
Velocity
venules,
0.3-1.2 mm/s
Distribution of the basal Mean perfusion
normalized in groups
1
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
0
2.5
5
7.5
10
12.5
15
17.5
20
22.5
25
27.5
30
Basal Mean perfusion (pf. un.)
Rogatkin et al. (2012), normal finger
Morozov (2008), normal finger
Gorenkov et al. (2003), normal forearm
Gorenkov et al. (2003), forearm for VD patients
Sample size calculation, depending on standard
deviation
Z пЂЅ
X пЂ­Y
S X пЂ« SY
2
пѓ—
n
Supposing:
2
Z пЂѕ t п‚» 2 ... 2 ,3 п‚®
R пЂЅ X - Y;
Z пЂЅ 2 ,5
S X пЂЅ aX ; S Y пЂЅ aY
пѓћ
n=f(R,a)
The relative increase in blood flow
Occlusive test results
Occlusion
(start)
Occlusion
(stop)
Recovery period
Base flow
registration
Time (s)
Control
Patients
Combined occlusive+heating test results
The relative increase in blood flow
Occlusion
(start)
Occlusion
(stop)
Heating
(41В±CВ°)
Control
Patients
Recovery period
Base flow
registration
Time (s)
Combined heating+postural test
on arms (methodology)
Combined heating+postural test
on arms (results)
Lowering the
limb
Back to initial
position
The relative increase in blood flow
Raising the
limb
Control
Patients
Heating
(41В±CВ°)
Recovery period
Base flow
registration
Time (s)
Combined heating+postural test
on legs (methodology)
The relative increase in blood flow
Combined heating+postural test
on legs (results)
Back to initial
position
Lowering the
limb
Control
Patients
Heating
(41В±CВ°)
Base flow
registration
Recovery period
Time (s)
Role of microcirculatory disorders in the pathogenesis of
diabetes
Microcirculatory
disorders
Insulin
resistance
Hyperglycemia
Jorneskog et al., 2005
Clark, 2008
Fredriksson et al., 2010
Czernichow et al., 2010
Jarnert et al., 2012
Possible application points
 Early diagnostics of DM and it’s complications
п‚— Control of sugar-lowering treatment efficiency
Schematic diagram of the developed
technique possible applications
Specific
microvascular
disorders
Prediabetes:
IGT, IFG
(diagnosed by
standard methods)
Severe microvascular
complications
(can be clinically
diagnosed)
Diagnosis of
diabetes
We`d like to
detect here
Time
High risk of diabetes
We`d like to
detect here
I
Early microvascular
complications
(clinical diagnosis is
difficult /almost
impossible)
Appearance
(onset) of diabetes
II
Outcome of
severe
complications:
disability, death
Examples of information processing
Inclusion/Exclusion criteria
п‚— Age
п‚— Body Mass Index
п‚— Term of illness
п‚— Micro/macrovascular complications in anamnesis
п‚— Pernicious habits (alcohol, smoking)
п‚— Arterial blood pressure level
п‚— Status of carbohydrate metabolism (compensation/decompensation)
п‚— Received treatment
etc.
“MONIKI” named after M.F. Vladimirsky
п‚— 200 000 patients with DM in register
 “Mobile Diabetes Center”
п‚— 3 000 patients with early disruptions in carbohydrate
metabolism
п‚— Conducting research in context of a clinical survey
п‚— Long-term case monitoring
Identifying signs for early diagnosis
DM 1 type
DM 2 type
Prediabetes
High-risk group
Hyperglycemia
Insulin resistance
Microcirculation
disruptions
+
–
+
+
+
+
+/–
+/–
+/–
–
+/–
+/–
+ symptomatic forms of DM (acromegaly, using of glucocorticoids, etc.)
Important
п‚— Metrological aspects of the research
п‚— Functional tests
п‚— Forming studying and control groups
Thank you for your attention!
www.medphyslab.com
zdolsk2@gmail.com
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