1. “MONIKI” named after M.F. Vladimirsky D. 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

2. 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.

3. Diabetes Mellitus It is time to SCREAM * *Data from Diabetes Atlas, 2013 International Diabetes Federation (IDF) 10,8 % global healthcare expenditure ! 5.1 million people died and 548 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

4. Laser Doppler Flowmetry 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

5. Distribution of the basal Mean perfusion normalized in groups

6. Sample size calculation, depending on standard deviation Supposing:  n=f(R,a)

7. Occlusive test results Time (s) Control Patients The relative increase in blood flow Occlusion (start) Occlusion (stop) Base flow registration Recovery period

8. Combined occlusive+heating test results Time (s) Control Patients The relative increase in blood flow Base flow registration Recovery period Heating (41±C°) Occlusion (start) Occlusion (stop)

9. Combined heating+postural test on arms (methodology)

10. Combined heating+postural test on arms (results) Time (s) Control Patients The relative increase in blood flow Raising the limb Base flow registration Recovery period Lowering the limb Heating (41±C°) Back to initial position

11. Combined heating+postural test on legs (methodology)

12. Combined heating+postural test on legs (results) Time (s) Control Patients The relative increase in blood flow Base flow registration Recovery period Heating (41±C°) Lowering the limb Back to initial position

13. Role of microcirculatory disorders in the pathogenesis of diabetes Insulin resistance Hyperglycemia Microcirculatory disorders Jorneskog et al., 2005 Clark, 2008 Fredriksson et al., 2010 Czernichow et al., 2010 Jarnert et al., 2012

14. Possible application points Early diagnostics of DM and it’s complications Control of sugar-lowering treatment efficiency

17. Examples of information processing

18. 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 treatment etc.

19. “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

20. Identifying signs for early diagnosis HyperglycemiaInsulin resistanceMicrocirculation disruptions DM 1 type +–+ DM 2 type +++ Prediabetes +/– High-risk group –+/– + symptomatic forms of DM (acromegaly, using of glucocorticoids, etc.)

21. Important Metrological aspects of the research Functional tests Forming studying and control groups

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