“ MONIKI ” named after M.F. Vladimirsky D. Kulikov , MD, PhD

“MONIKI” named after M.F. VladimirskyD. Kulikov, MD, PhD

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

Conclusions

Informative functional tests as well as an algorithm of the registration for the investigation of the blood skin microcirculation at diabetes were developed

A method for processing and evaluating the results was also obtained.

Diabetes Mellitus

It is time toSCREAM

*

*Data from Diabetes Atlas, 2013International Diabetes Federation (IDF)

10,8 % global healthcare

expenditure !

5.1 million people died and548 billion USD were spent

due to diabetes in 2013

at half-percent of cases patients already have different complications

at the time of diabetes diagnosis

Laser Doppler Flowmetry

to photo receiver

to photo receiver

from laser

Velocity

arterioles,0.7-3.9 mm/s

venules,0.3-1.2 mm/s

capillary,0.1-0.6 mm/s

LAKK diagnostic system

Distribution of the basal Mean perfusion normalized in groups

Sample size calculation, depending on standard deviation

nSS

YXZ

YX

22

5,2 3,2...2 ZtZaYSaXS YX ; Y;-XR

SupposingSupposing::

n=f(R,a)

Occlusive test results

Time (s)

ControlPatients

The

rel

ativ

e in

crea

se in

blo

od f

low

Occlusion(start)

Occlusion(stop)

Base flow registration

Recovery period

Combined occlusive+heating test results

Time (s)

ControlPatients

The

rel

ativ

e in

crea

se in

blo

od f

low

Base flow registration

Recovery period

Heating(41±C°)

Occlusion(start)

Occlusion(stop)

Combined heating+postural test on arms (methodology)

Combined heating+postural test on arms (results)

Time (s)

ControlPatients

The

rel

ativ

e in

crea

se in

blo

od f

low

Raising thelimb

Base flow registration

Recovery period

Lowering thelimb

Heating(41±C°)

Back to initial position

Combined heating+postural test on legs (methodology)

Combined heating+postural test on legs (results)

Time (s)

ControlPatients

The

rel

ativ

e in

crea

se in

blo

od f

low

Base flow registration Recovery period

Heating(41±C°)

Lowering thelimb

Back to initial position

Role of microcirculatory disorders in the pathogenesis of diabetes

Insulinresistance

Hyperglycemia

Microcirculatorydisorders

Jorneskog et al., 2005Clark, 2008Fredriksson et al., 2010Czernichow et al., 2010Jarnert et al., 2012

Possible application points

Early diagnostics of DM and it’s complications

Control of sugar-lowering treatment efficiency

III

Specific microvascular

disorders

High risk of diabetes

Prediabetes:IGT, IFG

(diagnosed by standard methods)

Severe microvascular complications

(can be clinically diagnosed)

Diagnosis of diabetes

Outcome of severe

complications: disability, death

Schematic diagram of the developed technique possible applications

Early microvascularcomplications

(clinical diagnosis is difficult /almost

impossible)

Appearance(onset) of diabetes

We`d like to detect here

We`d like to detect here

Time

Examples of information processing

Inclusion/Exclusion criteria

Age Body Mass Index Term of illness Micro/macrovascular complications in anamnesis Pernicious habits (alcohol, smoking) Arterial blood pressure level Status of carbohydrate metabolism

(compensation/decompensation) Received treatmentetc.

“MONIKI” named after M.F. Vladimirsky

200 000 patients with DM in register

“Mobile Diabetes Center”

3 000 patients with early disruptions in

carbohydrate metabolism

Conducting research in context of a clinical survey

Long-term case monitoring

Identifying signs for early diagnosis

Hyperglycemia Insulin resistance Microcirculationdisruptions

DM 1 type+ – +

DM 2 type+ + +

Prediabetes+/– +/– +/–

High-risk group– +/– +/–

+ symptomatic forms of DM (acromegaly, using of glucocorticoids, etc.)

Important

Metrological aspects of the research

Functional tests

Forming studying and control groups

Thank you for your attention!

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