Dmitry A. Kulikov, Russian Federation
M. F. Vladimirsky Moscow Regional Research and Clinical Institute Endocrinology departmentPresenter of 2 Presentations
NEW COMPLEX TECHNIQUE AND DEVICE FOR NONINVASIVE ASSESSMENT OF BLOOD MICROCIRCULATION IN PATIENTS WITH DIABETES MELLITUS
Abstract
Background and Aims
Previous attempts to use photoplethysmography (PPG), tissue reflectance oximetry (TRO), Laser Doppler Flowmetry (LDF), etc. for dynamic evaluation of microvascular complications of diabetes mellitus (DM) have not led to success. We propose new method – incoherent optical fluctuation flowmetry (IOFF), which additionally allows to implement PPG and TRO within IOFF probe. Current study was aimed on the first validation of combined diagnostic IOFF-TRO-PPG technique for microcirculation assessment in patients with DM.
Methods
Oscillometric tonometry, IOFF, PPG and TRO techniques were combined in single device and used to assess a set of 7 parameters of central and peripheral hemodynamics. Pilot measurements were conducted on 18 DM patients (8 with diabetic retinopathy and 10 without it) and 18 healthy volunteers. To consider influence of peripheral and central hemodynamic factors (heart rate, blood pressure, arterial stiffness, blood flow, etc.) in assessment of skin microvasculature functional state (including endothelial and neurogenic regulation), we calculated complex diagnostic criterion (DC) as the weighted function of all measured quantities.
Results
DC in the control group was -0.5±1.9, in DM patients without retinopathy – -3.1±1.1, in DM patients with retinopathy – -4.9±1.5. ANOVA with LSD post-hoc analysis showed all groups were pairwise different. DC parameter allowed us to classify patients into these three groups with 72.2% accuracy.
Conclusions
The device, created on the basis of IOFF, allows to perform comprehensive assessment of peripheral hemodynamics and to reveal microcirculation disorders of various genesis. In long term, the proposed technology can be used to assess DM complications risk and as additional endpoint in DM management.
THE ODDS OF RETINOPATHY ARE INCREASED IN DIABETES PATIENTS WITH REDUCED MICROVASCULAR REACTIVITY ON LOCAL HEATING
- Dmitry A. Kulikov, Russian Federation
- Alexey A. Glazkov, Russian Federation
- Polina A. Glazkova, Russian Federation
- Ksenia A. Kozlova, Russian Federation
- Ilya A. Barsukov, Russian Federation
- Yulia A. Kovaleva, Russian Federation
- Alexander V. Dreval, Russian Federation
- Dmitry A. Rogatkin, Russian Federation
Abstract
Background and Aims
Non-invasive microcirculation assessment is a promising additional method to estimate the risks of complications development and to monitor the treatment efficacy. Aim of this study was to show that a non-invasive microcirculation assessment, using a laser Doppler flowmetry (LDF), can be used to evaluate odds of complications in patients with diabetes.
Methods
The study included 107 volunteers without diabetes (Group 1) and 250 diabetes patients which were divided into two groups: patients without retinopathy (Group 2) and those with retinopathy (Group 3). Perfusion was assessed using Laser Doppler Flowmetry during local heating test on the dorsal surface of the forearm.
Results
The highest difference between groups was revealed in the “slope of the microcirculatory curve in the first two minutes of heating” parameter: the Kruskal-Wallis test with post hoc Dunn tests showed that all three groups were pairwise different with p<0,01. A logistic regression analysis was performed for patients with diabetes mellitus: odds ratio for retinopathy (95% CL) with HbA1c (1% increase) was 1.09 (0.94 - 1.26), with diabetes duration (1 year increase) - 1.16 (1.11 - 1.22), with “slope” parameter - 0.26 (0.21 - 0.57).
Conclusions
Use of the LDF method enabled to determine skin microcirculation disorders both in patients with retinopathy and in those without it. It was shown that these microcirculatory disorders - unlike the singly measured HbA1c - indicate increased odds of retinopathy in a diabetes patient. We suppose that this parameter can be used in prospect for the additional control of the risks of the retinopathy development.