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“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!
www.medphyslab.com
zdolsk2@gmail.com
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