Diabetes

Photomed Laser Surg. 2016 Nov 17. [Epub ahead of print]

Role of Low-Level Laser Therapy as an Adjunct to Initial Periodontal Treatment in Type 2 Diabetic Patients: A Split-Mouth, Randomized, Controlled Clinical Trial.

Demirturk-Gocgun O1, Baser U1, Aykol-Sahin G2, Dinccag N3, Issever H4, Yalcin F1.

Author information

  • 11 Department of Periodontology, Faculty of Dentistry, Istanbul University , Istanbul, Turkey .
  • 22 Department of Periodontology, Faculty of Dentistry, Okan University , Istanbul, Turkey .
  • 33 Division of Diabetes, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University , Istanbul, Turkey .
  • 44 Department of Biostatistics, Istanbul Faculty of Medicine, Istanbul University , Istanbul, Turkey .

Abstract

OBJECTIVE:

In this split-mouth clinical trial, we evaluated the clinical benefits of low-level laser therapy (LLLT) as an adjunct to nonsurgical periodontal treatment in patients with type 2 diabetes mellitus (DM).

BACKGROUND DATA:

The impaired wound healing seen in diabetic patients may affect the results of periodontal treatment and may require an additional approach.

MATERIALS AND METHODS:

In total, 22 chronic periodontitis patients with type 2 DM were included. Applying a split-mouth design, two quadrants were treated with only scaling and root planing (SRP) as the control and those in the other two were treated with SRP + LLLT as the test sites in each patient. An 808?nm GaAlAs diode laser was performed in the test sites at the energy density of 4.46 J/cm2 on days 1, 2, and 7 after SRP. Plaque index (PI), probing depth (PD), bleeding on probing (BOP), and clinical attachment level were measured at baseline and again at 1 and 3 months after treatment. Deep periodontal pockets (PD 4mm) were evaluated separately.

RESULTS:

Test sites showed significant improvement in PI and BOP in deep pockets at the 1-month follow-up period (p<0.001 and <0.001, respectively), whereas no difference was found between the control and the test sites in other periodontal parameters.

CONCLUSIONS:

LLLT during periodontal treatment offered minimal short-term additional benefit in deep pocket healing in patients with type 2 DM.

Lasers Med Sci. 2016 Jul 12. [Epub ahead of print]

Modifying effect of intravenous laser therapy on the protein expression of arginase and epidermal growth factor receptor in type 2 diabetic patients.

Kazemikhoo N1, Sarafnejad AF2, Ansari F3, Mehdipour P4.

Author information

  • 1Skin and Stem Cell Research center, Tehran University of Medical Sciences, Tehran, Iran.
  • 2Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
  • 3Tehran University, Tehran, Iran.
  • 4Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, 14155-6447, Tehran, 14176-13151, Iran. mehdipor@tums.ac.ir.

Abstract

The epidermal growth factor receptor (EGFR) signaling pathway may be involved in cell activation and may influence the neuronal microenvironment, microglia activation, and production of proinflammatory cytokines. Arginase and nitric oxide synthase (NOS) both use L-arginine as a common substrate. Decreasing the arginase expression may increase L-arginine consumption by NOS and increase nitric oxide (NO) synthesis. Intravenous laser blood irradiation (ILBI) is an effective systemic treatment for different pathologies including diabetes mellitus. Previous studies have shown that low-level laser therapy can have an effect on the release of certain cytokines and growth factors. The aim of this study was to evaluate the effects of ILBI on the expression of arginase and epidermal growth factor receptor in type 2 diabetic patients. We used 630 nm red laser light, 1.5 mW, continuous mode, intravenously for 30 min in 13 type 2 diabetic patients and compared their blood samples using the flow cytometry technique, before and after ILBI. The difference between the percentage of cells before and after therapy was analyzed using repeated-measures ANOVA, and the relationship between EGFR and arginase expression in blood and tissue was evaluated by calculating the Pearson correlation coefficient. We found a significant decrease in the expression of both arginase- and EGFR-positive cells after laser therapy (P?<?0.01). In conclusion, laser therapy may have a beneficial effect for diabetic patients via decreasing arginase expression and activation of the NOS/NO pathway which increases NO production and vasodilation, and decreasing EGFR expression which may reduce neuroinflammation and its secondary damages.

Lasers Med Sci. 2015 Jan;30(1):363-6. doi: 10.1007/s10103-014-1672-7. Epub 2014 Oct 11.

Blue or red: which intravascular laser light has more effects in diabetic patients?

KazemiKhoo N1, Ansari F.
Author information
1Department of Medical Genetics, Tehran University of Medical Sciences, Tehran, Iran, nooshakazemi@gmail.com.
.
Abstract
The effects of intravascular laser irradiation of blood (ILIB), with 405 and 632.8 nm on serum blood sugar (BS) level, were comparatively studied. Twenty-four diabetic type 2 patients received 14 sessions of ILIB with blue and red lights. BS was measured before and after therapy. Serum BS decreased highly significant after ILIB with both red and blue lights (p<0.0001), but we did not find significant difference between red and blue lights. The ILIB effect would be of benefit in the clinical treatment of diabetic type 2 patients, irrespective of lasers (blue or red lights) that are used.
Diabetes Technol Ther.  2012 Sep;14(9):799-803.

Low-level lasers as an adjunct in periodontal therapy in patients with diabetes mellitus.

Obradovic R, Kesic L, Mihailovi? D, Jovanovic G, Antic S, Brkic Z.

Source

1 Department of Periodontology and Oral Medicine, University of Niš , Niš, Serbia .

Abstract

Abstract Background: Diabetes mellitus (DM) increases the risk of periodontitis, and severe periodontitis often coexists with severe DM. The proposed dual pathway of tissue destruction suggests that control of chronic periodontal infection and gingival inflammation is essential for achieving long-term control of DM. The purpose this study is to evaluate the effects of low-level laser therapy (LLLT) by exfoliative cytology in patients with DM and gingival inflammation.

Subjects and Methods: Three hundred patients were divided in three equal groups: Group 1 consisted of patients with periodontitis and type 1 DM, Group 2 of patients with periodontitis and type 2 DM, and Group 3 of patients with periodontitis (control group). After oral examination, smears were taken from gingival tissue, and afterward all of the patients received oral hygiene instructions, removal of dental plaque, and full-mouth scaling and root planing. A split-mouth design was applied; on the right side of jaws GaAlAs LLLT (670?nm, 5?mW, 14?min/day) (model Mils 94; Optica Laser, Sofia, Bulgaria) was applied for five consecutive days. After the therapy was completed, smears from both sides of jaws were taken. The morphometric analysis was done using the National Institutes of Health Image software program and a model NU2 microscope (Carl Zeiss, Jena, Germany).

Results: Investigated parameters were significantly lower after therapy compared with values before therapy. After therapy on the side subjected to LLLT, there was no significantly difference between patients with DM and the control group.

Conclusions: It can be concluded that LLLT as an adjunct in periodontal therapy reduces gingival inflammation in patients with DM and periodontitis.

Lasers Med Sci.  2012 Jun 15. [Epub ahead of print]

Effect of 635 nm irradiation on high glucose-boosted inflammatory responses in LPS-induced MC3T3-E1 cells.

Kwon H, Lim W, Kim J, Jeon S, Kim S, Karna S, Cha H, Kim O, Choi H.

Source

Department of Oral Pathology, School of Dentistry, Dental Science Research Institute, Chonnam National University, Bug-Gu, Gwangju, 500-757, South Korea.

Abstract

Hyperglycemia occurs in patients with poorly controlled diabetes mellitus and contributes to bone resorption and increased susceptibility to bacterial infections. Hyperglycemia can incite low-grade inflammation that can contribute to the resorption of bone, especially the periodontal bone. The increased susceptibility to periodontal infections can contribute to bone resorption through the activation of osteoclasts. In this study, the osteoblastic, clonal cell line, MC3T3-E1, was used in an in vitro model of hyperglycemia and lipopolysaccharide-induced reactive oxygen species generation to determine the potential anti-inflammatory effect of 635 nm light-emitting diode (LED) irradiation or whether 635 nm LED irradiation can be a potential anti-inflammatory treatment. LED irradiation of MC3T3-E1 cells stimulated with lipopolysaccharide in a high glucose-containing medium decreased the level of cyclooxygenase gene and protein expression and reduced the level of prostaglandin E2 expression by decreasing the amount of reactive oxygen species generation. LED irradiation also inhibited the osteoclastogenesis in MC3T3-E1 cells by regulating the receptor activator of nuclear factor kappa-B ligand and osteoprotegerin. These findings reveal the mechanisms which are important in the pathogenesis of diabetic periodontitis and highlight the beneficial effects of 635 nm LED irradiation in reducing the adverse effects of diabetic periodontitis.

Bratisl Lek Listy. 2010;111(4):205-11.

Complementary therapy in diabetic patients with chronic complications: a pilot study.

Palacka P, Kucharska J, Murin J, Dostalova K, Okkelova A, Cizova M, Waczulikova I, Moricova S, Gvozdjakova A.

Comenius University, Medical Faculty, Pharmacobiochemical Laboratory of 3rd Medical Clinic, Bratislava, Slovakia. pal_patrick@yahoo.com

Abstract

BACKGROUND: Oxidative stress and dysregulation of antioxidant function play a pivotal role in the diabetic complications.

METHODS: Fifty-nine patients with diabetes were randomly assigned into three groups. 1) PL group (n = 19): Polarized light (PL) was applied to neuropathic ulcers of diabetic foot twice daily for ten minutes in pulse regimen during three months. 2) QALA group (n = 20): Antioxidants (60 mg hydrosoluble CoQ10, 100 mg alpha-lipoic acid (ALA) and 200 mg vitamin E) were used in two daily doses for three months. 3) QALAPL group (n = 20): Patients used antioxidants along with PL applications. To test for differences in means, paired Student’s t-test (before and after three months) was used.

RESULTS: Three months application of PL significantly increased plasma concentrations of coenzyme Q10, alpha-tocopherol, tau-tocopherol and beta-carotene, and decreased lactate dehydrogenase (LDH) activity. Supplementation with antioxidants decreased plasma lipid peroxides, increased concentration of CoQ10 and improved echocardiographic parameters. Simultaneous application of PL and antioxidants significantly stimulated plasma CoQ10 and alpha-tocopherol concentrations, decreased LDH activity and contributed to improvement in heart left ventricular function in diabetics.

CONCLUSION: Thus the data show that supportive therapy with PL along with the antioxidants hydrosoluble CoQ10, alpha-lipoic acid and vitamin E is an effective way of controlling the complications of type 2 diabetes (Tab. 7, Fig. 2, Ref. 44).

J Photochem Photobiol B. 2010 May 3;99(2):105-10. Epub 2010 Mar 11.

Effects of low-level light therapy on streptozotocin-induced diabetic kidney.

Lim J, Sanders RA, Snyder AC, Eells JT, Henshel DS, Watkins JB 3rd.

School of Public and Environmental Affairs, Indiana University, 1315 East Tenth Street, Bloomington, IN 47405, United States.

Abstract

Hyperglycemia causes oxidative damage in tissues prone to complications in diabetes. Low-level light therapy (LLLT) in the red to near infrared range (630-1000nm) has been shown to accelerate diabetic wound healing. To test the hypothesis that LLLT would attenuate oxidative renal damage in Type I diabetic rats, male Wistar rats were made diabetic with streptozotocin (50mg/kg, ip), and then exposed to 670nm light at a dose of 9J/cm(2) once per day for 14weeks. The activity and expression of catalase and the activity of Na K-ATPase increased in kidneys of light-treated diabetic rats, whereas the activity and expression of glutathione peroxidase and the expression of Na K-ATPase were unchanged. LLLT lowered the values of serum BUN, serum creatinine, and BUN/creatinine ratio. In addition, LLLT augmented the activity and expression of cytochrome c oxidase, a primary photoacceptor molecule in the mitochondrial respiratory chain, and reduced the formation of the DNA adduct 8-hydroxy-2′-deoxyguanosine in kidney. LLLT improved renal function and antioxidant defense capabilities in the kidney of Type I diabetic rats. Thus, 670nm LLLT may be broadly applicable to the amelioration of renal complications induced by diabetes that disrupt antioxidant defense mechanisms.

Tijdschr Psychiatr. 2009;51(9):693-7.

Less need for insulin, a surprising effect of phototherapy in insulin-dependent diabetes mellitus.

[Article in Dutch]

Nieuwenhuis RF, Spooren PF, Tilanus JJ.

opleiding tot psychiater verbonden aan deGGZ Breburg Groep en was werkzaam in het St. Elisabeth Ziekenhuis te Tilburg.

Abstract

A 40-year-old woman with insulin-dependent diabetes mellitus was treated successfully with phototherapy for a seasonal affective disorder. Following sessions of phototherapy she developed hypoglycaemias and required less insulin. A review of the literature showed that melatonin has an inhibiting effect on insulin sensitivity. The melatonin secretion, which is suppressed by phototherapy, may cause an immediate decrease in the plasma glucose levels. This decrease may well be important for patients with insulin-resistant diabetes mellitus and seasonal affective disorder.

Photomed Laser Surg. 2008 Oct;26(5):433-42.

Role of nitric oxide in the visible light-induced rapid increase of human skin microcirculation at the local and systemic level: I. diabetic patients.

Samoilova KA, Zhevago NA, Menshutina MA, Grigorieva NB.

Institute of Cytology, Russian Academy of Sciences, St. Petersburg, Russia. samoilova3@yandex.ru

OBJECTIVE: This study aimed to reveal the effects of polychromatic visible (pVIS) or pVIS + near IR (nIR) light similar to some components of solar light on skin microcirculation and microvascular response to the vasodilatators acetylcholine (ACh) and nitroglycerine (NG), in the extremities of patients with diabetic microangiopathy.

BACKGROUND DATA: The mechanisms behind light-induced increases in microcirculation as well as extracellular effects of terrestrial pVIS and pVIS + nIR light remain unknown.

MATERIALS AND METHODS: In 24 subjects with type 2 diabetes mellitus local microcirculation was measured in the skin of the foot before and after exposure to both types of light. In another 26 patients systemic microcirculation was studied in the back of the hand before and after exposure of the lumbar-sacral area to light energy. Two different types of light therapy were performed by using two devises: Q-light, which delivers pVIP (385-750 nm) and pVIS nIR light (385-1700 nm) with a power density of 40 mW/cm2, which is similar to summer sunlight at noon in Central Europe.

RESULTS: At 2 min after irradiation (12 J/cm2) of the forefoot with pVIS or pVIS + nIR light, a rise in local blood flow volume (Qas) was observed, on average by 39% and 31%, respectively. The maximal effect (+41-47%) had developed in all patients at 30 min, and it then decreased and disappeared completely 24 h post-irradiation. We obtained similar results after irradiation of the sacral area in Qas of the skin of the hand. Both types of microcirculation also increased following a second exposure to the light sources. Enhancement of microcirculation was accompanied by a decrease in the microvascular response to ACh and NG solutions administered intracutaneously by iontophoresis.

CONCLUSION: Both types of irradiation stimulated microcirculation at the local and systemic levels through a mechanism of enhancement of endothelium-dependent and endothelium-independent vasodilation, in which nitric oxide plays a major role.

Srp Arh Celok Lek. 2007 May-Jun;135(5-6):257-63.

Influence of low-intensity laser therapy on spatial perception threshold and electroneurographic finding in patients with diabetic polyneuropathy.

[Article in Serbian]

Peri? Z.

INTRODUCTION: Low-intensity laser therapy (LILT) can be applied in cases when patients with diabetic polyneuropathy (DPN) suffer from chronic severe neuropathic pain.

OBJECTIVE: We wanted to analyse influence of LILT on spatial perception threshold (SPT) and electroneurographic (ENG) parameters in patients with painful DPN.

METHOD: We analysed 45 patients (25 males), average age 54.3 years (54.3 +/- 10.9), with clinical and ENG signs of painful DPN. The patients were divided into two groups: A and B. Group A consisted of 30 patients with DPN who had 30 LILT treatments over the period of 12 weeks and group B consisted of 15 patients with DPN who received only vitamin therapy per os within the same period. Prior to and after 12 weeks of treatment, the following ENG parameters were determined using surface electrodes: motor (MCV) and sensory conduction velocities (SCV) values (in m/s) of nervus (n.) peroneus (NP), n. tibialis (NT) and n. medianus (NM) and their motor distal latency (MDL) values (in ms). SPT value (score as number from 1 to 8) was determined with Tactile Circumferential Discriminator on dorsal part of foot’s big toe skin. For statistical analysis, we used Student’s t-test and Pearson correlation (sig. 2 tailed) study.

RESULTS; We registered statistically significant difference between SPT (p < 0.01) values prior to (5.25 +/- 1.11) and after (4.87 +/- 0.90) LILT, as well as NMMCV (p < 0.05) values prior to (47.18 +/- 5.08) and after (49.12 +/- 3.72) LILT. Besides, we registered, only after LILT, statistically significant correlation beetwen SPT and NMDML (p < 0.01) values and also beetwen SPT and NMSCV (p < 0.05) values. The differences and correlations beetwen other analysed parameters before and after treatments were not significant (p > 0.05).

CONCLUSION: In this study we registered significant decrease of SPT and increase of NMMCV after LILT and that indicated a favourable effect of this treatment in analysed patients with painful DPN. In our opinion these results need further investigation.

Photomed Laser Surg. 2007 Apr;25(2):78-84.

In vitro exposure of wounded diabetic fibroblast cells to a helium-neon laser at 5 and 16 J/cm2.

Houreld N, Abrahamse H.

Faculty of Health Sciences, Laser Research Unit, University of Johannesburg, Doornfontein, South Africa.

OBJECTIVE: The aim of the present investigation was to assess morphological, cellular, and molecular effects of exposing wounded diabetic fibroblast cells to He-Ne (632.8 nm) laser irradiation at two different doses. BACKGROUND DATA: An alternative treatment modality for diabetic wound healing includes low-level laser therapy (LLLT). Although it’s used in many countries and for many medical conditions, too many health care workers are unaware of this therapy, and there is still controversy surrounding its effectiveness. METHODS: Normal human skin fibroblast cells (WS1) were used to simulate a wounded diabetic model. The effect of LLLT (632.8 nm, 5 and 16 J/cm(2) once a day on two non-consecutive days) was determined by analysis of cell morphology, cytotoxicity, apoptosis, and DNA damage. RESULTS: Cells exposed to 5 J/cm(2) showed a higher rate of migration than cells exposed to 16 J/cm(2), and there was complete wound closure by day 4. Exposure of WS1 cells to 5 J/cm(2) on two non-consecutive days did not induce additional cytotoxicity or genetic damage, whereas exposure to 16 J/cm(2) did. There was a significant increase in apoptosis in exposed cells as compared to unexposed cells. CONCLUSION: Based on cellular morphology, exposure to 5 J/cm(2) was stimulatory to cellular migration, whereas exposure to 16 J/cm(2) was inhibitory. Exposure to 16 J/cm(2) induced genetic damage on WS1 cells when exposed to a He-Ne laser in vitro, whereas exposure to 5 J/cm(2) did not induce any additional damage.

Photomed Laser Surg. 2005 Apr;23(2):167-71.

Green light emitting diode irradiation enhances fibroblast growth impaired by high glucose level.

Vinck EM, Cagnie BJ, Cornelissen MJ, Declercq HA, Cambier DC.

Department of Rehabilitation Sciences and Physiotherapy, Ghent University, 9000 Ghent, Belgium. elke.vinck@UGent.be

BACKGROUND AND OBJECTIVE: The chronic metabolic disorder diabetes mellitus is an important cause of morbidity and mortality due to a series of common secondary metabolic complications, such as the development of severe, often slow healing skin lesions. In view of promoting the wound-healing process in diabetic patients, this preliminary in vitro study investigated the efficacy of green light emitting diode (LED) irradiation on fibroblast proliferation and viability under hyperglycemic circumstances.

MATERIALS AND METHODS: To achieve hyperglycemic circumstances, embryonic chicken fibroblasts were cultured in Hanks’ culture medium supplemented with 30 g/L glucose. LED irradiation was performed on 3 consecutive days with a probe emitting green light (570 nm) and a power output of 10 mW. Each treatment lasted 3 min, resulting in a radiation exposure of 0.1 J/cm2.

RESULTS: A Mann-Whitney U test revealed a higher proliferation rate (p = 0.001) in all irradiated cultures in comparison with the controls.

CONCLUSION: According to these results, the effectiveness of green LED irradiation on fibroblasts in hyperglycemic circumstances is established. Future in vivo investigation would be worthwhile to investigate whether there are equivalent positive results in diabetic patients.

Vopr Kurortol Fizioter Lech Fiz Kult. 2002 Jul-Aug;(4):9-11.

[Use of infrared laser therapy in patients with ischemic heart disease associated with diabetes mellitus type 2 in health resort]

[Article in Russian]

Zin’kovskaia TM, Zavrazhnykh LA, Golubev AD.

Infrared laser therapy (300 Hz) combined with balneotherapy and patients’ education is more effective than standard sanatorium rehabilitation in patients with ischemic heart disease associated with diabetes mellitus type 2. 81.8% patients showed good response manifesting in less frequent anginal attacks, episodes of pain and painless ischemia and lower doses of antianginal drugs. Systolic and diastolic arterial pressure lowered by 18 and 10 mm Hg on the average, respectively. Multimodality rehabilitation of IHD patients with type 2 diabetes mellitus improves hemostasis, carbohydrate and lipid metabolism. Coronary circulation response lasted for 24 weeks

Clinical-pathogenetical aspects of combined laser therapy efficiency use in patients with diabetes mellitus, as compared with pharmacologic therapy.

T.V. Kovalyova et al

Izhevsk State Medical Academy, 2nd Municipal Out-Patient Department, Izhevsk, Russia

The use of combined laser therapy (CLT) in the treatment of patients with diabetes mellitus (DM) is a method of choice, allowing to reduce the pharmacologic dependence or to even avoid the intake of numerous drugs.

According to our long-term observations, the use of CLT allows to decrease the doses of sugarcorrecting medications in patients with insulin-dependent and non-insulin-dependent diabetes mellitus 1,5-2 times in the result of the first course of treatment. The application of CLT in patients with diabetic angiopathy of the lower limbs vessels corrects the disorders of macro- and microdynamics, hemorheology and immunity. The course treatment of such patients allows to preserve the stable compensation of diabetes mellitus and to stop the progression of diabetic angiopathy.

Thus, the wide application of CLT in medical practice gives the real possibility to reduce the death rates of diabetic patients of cardio-vascular diseases, coronary heart disease, severe renal pathologies, gangrene and other diabetic complications. It also improves the quality of life and capacity for work.

Dynamics of hyperlipidemia and peripheral blood flow in patients with diabetes mellitys after the cournse of combined laser therapy in ambulatory-polyclinic conditions.

Oprysko T V et al.

218 patients with DM were treated with laser blood irradiation. 93 patients had DM I type and 125 DM II type. A HeNe laser of 2 mW was used intravenously. In addition an infrared 890 nm laser (5-20 mW) was used for irradiation over the projections of the liver, spleen and pancreas. Treatment was given daily for a period of 8 days. Repeated sessions were given at 3 and 6 months. Sugarcorrecting medications were decreased 200%. From the first day the patients´extremities grew warmer, pain decreased and symptoms of encephalopathy decreased. Levels of total blood cholesterol, LDL cholesterol and triglycerides decreased to normal values with a simultaneous increase of alhpa-LP. Sugar concentration in blood also decreased.

Used by the kind permission of the Czech Society for the Use of Laser in Medicine, www.laserpartner.org

Ambulatory Application of Combined Laser Therapy in Patients with Diabetes Mellitus and Dyslipidemia

Laser Partner, 17.5.2002

T.V. Kovalyova, Out-Patient Department of the 2-nd Municipal Clinical Hospital, Izhevsk, Russia

e-mail: laser@udm.ru

Abstract

This study sought to evaluate the dynamics of lipid metabolism in blood plasma and clinical efficiency of combined laser therapy (CLT) in patients with diabetes mellitus.

Introduction

Atherosclerosis in patients with diabetes mellitus (DM) is characterized by early development and spreading, that enables to speak about DM as a natural model of atherosclerosis [5]. DM and atherosclerosis are diseases with similar lipid disorders accompanied by hypercholesterolemia, hypertriglyceridemia and hypo-alpha-cholesterolemia [5]. It is established that under insulin-dependent DM (IDDM) hyperlipoproteinemia is secondary. It results from absolute insulin insufficiency and reduction of lipoprotein lipase activity. Hyperlipoproteinemia may be reversible provided that it is effectively treated. Besides, any dyslipoproteinemia under DM is not only a strong risk factor for the development of atherosclerosis, but also is one of the leading factors in a specific microangiopathy pathogenesis [1,2]. “Usual” for DM patients hypoxia is considerably intensified under dys- and hyperlipoproteinemia, simultaneously increasing insulin defficiency and decreasing receptor sensitivity of cells. It hampers the treatment of patients and promotes the progression of diabetic microangiopathies.

Patients with NIDDM are not protected from CHD caused by qualitative and quantitative changes of blood lipoproteins (LP) [3]. Out of quantitative LP changes characteristic of NIDDM are hypertriglyceridemia and high-density lipoprotein cholesterol reduction [6,15,16,20,25,27] on early stages of the disease [9], which are registered in 20% patients [17,22,26]. According to some investigations [4,7,14] the most common lipid disorder under NIDDM is combined hyperlipidemia, revealed in the high levels of triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c) and the reduced level of high-density lipoprotein cholesterol (HDL-c). The most usual lipid disorder under NIDDM is hypertriglyceridemia, in most cases type IV, generally stipulated by the intensified very low-density lipoproteins cholesterol (VLDL-c) synthesis [5]. The HDL-c reduction is revealed both under newly established NIDDM and in patients with a prolonged diabetic record corrected by hypoglycemic preparations and insulin. Some investigations established a connection between insulin resistance and the low level of HDL-c [18]. The HDL-c concentration increases under insulin therapy [21] and weight reduction [3,13]. According to M. Laakso et al. (1988), the HDL-c reduction is of great importance for CHD morbidity and mortality prognosis in patients with NIDDM. The HDL-c reduction down to 0,9 mmol/l and less was accompanied by the fourfold risk of CHD death.

A number of investigations [10,17,22] showed that hypercholesterolemia, stipulated by the increased level of LDL-c, is revealed in 54-77% of patients. Correction of glycemia is accompanied by the reduction of TC and LDL-c level [27]. Multiple Risk Factor Intervention Trial (MRFIT) [24] established the interconnection between TC and heart mortality of patients with DM. The obtained results showed that the higher cholesterol level in diabetic patients caused the higher risk of heart death. However, the same cholesterol level caused the higher (3-4 times) CHD mortality in patients with DM as compared to patients without it.

The analysis of not numerous literature showed that there are still no any optimum approaches to lipid disorders treatment under DM. Moreover, dyslipidemia in diabetic patients are not practically corrected at present, that is mainly stipulated by high prices for known drugs.

Objective: This study sought to evaluate the dynamics of lipid metabolism in blood plasma and clinical efficiency of combined laser therapy (CLT) in patients with IDDM and NIDDM.

Materials and Methods

Within the last 2 years in conditions of out-patient department we observed 205 patients with NIDDM and 54 – with IDDM.

The lipidnormalizing effect of CLT in combination with antioxidant therapy (aevit 600 mg a day) we have studied in 60 individuals with NIDDM (8 men and 52 women), mean age – 57,3± 3,2 years, with the level of fasting glycemia no more than 9,0 mmol/l, HbA1c – 7,3± 0,19 and 7,27± 0,23%. The other 29 patients (with NIDDM) constituted the control group and have been treated only by sugar-reducing medications.

In all patients we conducted lipid profile investigation. We also controlled glycemia, enzymatic blood activity (ALT, AST), clinical manifestations of angiopathy and performed the conjunctival biomicroscopy. All examinations have been done prior to treatment, in 2 weeks (i.e. immediately after the treatment), in 8 days, 1, 4 and 9 months after the treatment.

Hypolipidemic action of CLT has been evaluated by the dynamics of TC, TG, LDL-C, HDL-C and atherogenity rate (AR). Lipid profile has been investigated in venous blood serum taken in the morning hours after 12-14 hours fasting. For trials we used biochemical analyser.  TC – by Enzyme methods (CHOD-PAP), TG – UV enzyme method, HDL-c – after VLDL-c and LDL-c sedimentation by heparin in magnesium ions presence. VLDL-c and LDL-c we determined by W. Friedwald: VLDL-c = TG/5, LDL-c = TC – (HDL-c – VLDL-c). AR has been calculated by A.N. Klimov: AR = TC – HDL-c/HDL-c.

The conjunctival biomicroscopy has been conducted with the help of photoobservation slot lamp. Different parameters of microcirculation (vascular convolution, blood flow speed, arteriovenular interrelations, red blood cell aggregation, etc.) have been assessed.

We performed a staged course treatment within 9 months. Repeated courses were given in 3 and 6 months. Each course consisted of 8-10 sessions of intravenous laser blood irradiation (ILBI) by red spectrum laser, l =0,63 mm, capacity at the light-guide end – 2 mW, exposure – 15-30 min. Simultaneously we conducted a percutaneous procedure by low intensive laser irradiation (LILI) in the near infrared spectrum, l =0,89 mm, capacity at the light-guide end – 5 – 20 mW in combination with magnetic nozzles on gastrocnemius muscle, liver, pancreas, spleen projections – frequency 150 Hz, exposure 4 min. on each zone.

Results

29 patients of the control group showed no obvious deviations of blood plasma lipids after 10-days intake of aevit (table 1). This conformity has been also registered under the subsequent courses of antioxidant therapy by aevit in 3 and 6 months.

In the main group of patients (table 2) TC level prior to treatment averaged to 8,2± 0,31 mmol/l, TG – 2,14± 0,08 mmol/l, LDL-c – 7,87± 0,30 mmol/l, HDL-c – 0,99± 0,04 mmol/l. AR made up 7,28± 0,28, LDL/HDL-c ratio – 7,94± 0,30 (with current standard being < 5,0).

Immediately after the conducted therapy no significant deviations of lipid profile have been seen. The level of TC slightly decreased to 7,98± 0,31 (p<0,01). The level of TG even slightly increased until 2,51± 0,09 (p<0,01). In a part of patients the normalization of the examined parameters was accompanied by a temporary elevation of LDL-c from 7,87± 0,30 tî 7,9± 0,30 (p<0,05), that was probably connected with the intensified biosynthesis of lipids, resulting from the improved metabolism in liver. At the same time HDL-c concentration increased from 0,99± 0,04 tî 1,14± 0,04 (p<0,05). AR decreased from 7,28± 0,28 tî 6,00± 0,23 (p<0,05), respectively. LDL/HDL-c ratio made up 6,92± 0,27 (p<0,05).

Hypolipidemic action of CLT has been distinctively revealed in 1 month after the performed treatment with the efficient reduction of TC level from 7,98± 0,31 tî 5,31± 0,20 (?< 0,01). The tendency to the reduction of TG from 2,51± 0,09 tî 1,69± 0,06 (p<0,01) and elevation of HDL-c from 1,14± 0,04 tî 1,42± 0,05 (p<0,01) has been registered. The level of LDL-c decreased from 7,90± 0,30 tî 6,63± 0,25 (?<0,05). AR lowered from 6,00± 0,23 tî 2,73± 0,10 (?<0,01). The LDL/HDL-c ratio decreased from 6,92± 0,27 tî 4,66± 0,18 (p<0,01).

In 9 months the level of TC made up 6,01± 0,23 (p<0,01), TG – 1,62± 0,06 (p<0,01), LDL-c – 5,82± 0,22 (p<0,01), HDL-c – 1,39± 0,05 (p<0,01), AR – 3,30± 0,13 (p<0,001), LDL/HDL-c – 4,18± 0,16 (p<0,01).

Within the whole staged treatment blood plasma lipids in patients of the control group remained practically unchanged.

We also established positive deviations in clinical picture. It manifested in dynamics of general clinical diabetic symptoms, diabetic macropathy of lower limbs under the following scale: pain – sensitiveness to cold – walking, conjunctival biomicroscopy changes. The state of patients, suffering from IDDM and NIDDM complicated by diabetic angiopathy of pelvic limbs, improved in the main group after 2-3 sessions of CLT. Patients showed decrease or disappearance of pain, cramps and paresthesia, “getting warmer” of limbs. No dynamics of clinical picture in the control group have been revealed. By the end of treatment, symptoms of diabetic encephalopathy and asthenia disappeared in all patients. Mood and sleep also improved.

By the end of treatment fasting glycemia in NIDDM patients decreased from 14,21± 0,85 to 11,27± 0,67. In 3 weeks the level of glycemia in this group of patients decreased at most until 6,01± 0,35. Fasting glycemia in IDDM patients even increased from 10,46± 1,46 to 11,82± 1,65. And only after the third week it reduced to 7,45± 1,04. Thus, the distinctive positive effect in respect of carbohydrate metabolism has been reached. Consequently, dosages of insulin and sugarcorrecting medications have been considerably lowered.

The results of ophthalmologic investigation demonstrated the improved retinal blood circulation in the greater part of patients of the main group with diabetic retinopathy. It has been expressed in the normalization of arteriola/venule ratio, reduction of plasmarrhage, resorption of micromacular hemorrhages and retinal edema, improvement of retinal trophism. Under the influence of CLT the blood flow speed in retinal vessels increased by 35-38%, red blood cell aggregation lowered 1,3-1,4 times. Patients of the control group did not show any improvement of retinal blood circulation.

Thus, our experience of the ambulatory application of laser therapy demonstrated the distinct effect in respect of lipid profile normalization. No side effects and complications have been registered.

Conclusions

It is safe to say that:

  1. Combined laser therapy enables to avoid the intake of hypolipidemic and lipotropic agents, as in the result of treatment we observed the prolonged effect in respect of the most important, pathogenetically significant deviations of lipid metabolism: a true increase of HDL-c in the nearest catamnesis (which preserves up to 6-10 months) and decrease of LDL-c. Simultaneously we registered a true lowering of TC, TG to the norm or its upper limits. AR reduced more than 3 times and the LDL/HDL-c ratio – twice.
  2. The application of a staged CLT in treatment of patients with IDDM and NIDDM enables to obtain a distinct, long-term, positive effect in respect of carbohydrate metabolism, simultaneously reducing insulin and sugarcorrecting medications dosage. It also results in microcirculation improvement.

Tables

Table 1: Dynamics of lipid profile (mmol/l) in patients with diabetes mellitus (M ± m)

Observation periods Group of patients TG(0,40 – 1,53) TC(3,9-5,2) LDL(3,0-4,5) HDL(1,5-3,3) AR(2,5-3,5) Ratio LDL/HDL(do 5,0)
Initially I 2,11 ± 0,12 7,92 ± 0,44 7,80 ± 0,43 0,91 ± 0,05 7,70 ±0,43 8,57 ± 0,48
After therapy II (1)II (2) 2,14 ± 0,102,51 ± 0,11 8,20 ± 0,387,98 ± 0,37 7,87 ± 0,377,90 ± 0,37 0,99 ± 0,041,14 ± 0,05 7,28 ± 0,276,00 ± 0,23 7,94 ± 0,306,92 ± 0,26
In 3 weeks II (3)I 1,69 ± 0,072,10 ± 0,12 5,31 ± 0,257,91 ± 0,44 6,63 ± 0,317,79 ± 0,44 1,42 ± 0,060,92 ± 0,05 2,73 ± 0,107,59 ± 0,42 4,66 ± 0,188,46 ± 0,47
Changes, times p (1 – 2)p (2 – 3)p (1 – 3) 1,3> 0,05> 0,05> 0,05 1,54> 0,05< 0,05> 0,05 1,2> 0,05> 0,05> 0,05 1,4> 0,05> 0,05> 0,05 3,3> 0,05< 0,05> 0,05 2,0> 0,05< 0,05< 0,05
In 3 months:Before therapyIn 3 weeks IIIII 1,72 ± 0,081,51 ± 0,072,12 ± 0,12 5,42 ± 0,255,27 ± 0,247,94 ± 0,44 6,21 ± 0,295,42 ± 0,257,84 ± 0,44 1,61 ± 0,071,67 ± 0,070,90 ± 0,05 2,37 ± 0,092,15 ± 0,107,82 ± 0,44 3,85 ± 0,183,24 ± 0,158,71 ± 0,49
In 6 months:Before therapyIn 3 weeks IIIII 1,62 ± 0,071,54 ± 0,072,12 ± 0,12 6,01 ± 0,285,28 ± 0,247, 89 ± 0,44 5,82 ± 0,275,70 ± 0,267,80 ± 0,44 1,39 ± 0,061,42 ± 0,060,91 ± 0,05 3,30 ± 0,152,70 ± 0,127,67 ± 0,43 4,18 ± 0,194,00 ± 0,188,57 ± 0,48

I – Control group (n=22) – patients with DM without application of LLLT

II – Main group (n=37) – patients with DM with application of LLLT

Table 2: Rates of glycemia (M ± m)

Observation periods Group of patients Glucose, mmol/l
NIDDM IDDM
Initially I 14,43 ± 0,86 9,97 ± 1,02
After therapy II (1)II (2) 14,21 ± 0,8511,27 ± 0,67 10,46 ± 1,4611,82 ± 1,65
In 3 weeks II (3)I 6,01 ± 0,3514,32 ± 0,86 7,45 ± 1,0410,12 ± 1,04
p (1 – 2)p (2 – 3)p (1 – 3) > 0,05< 0,05< 0,05 > 0,05< 0,05< 0,05
In 3 months:Before therapyIn 3 weeks IIIII 7,98 ± 0,476,03 ± 0,3614,41 ± 0,86 6,38 ± 0,895,72 ± 0,7910,24 ± 1,05
In 6 months:Before therapyIn 3 weeks IIIII 6,81 ± 0,406,02 ± 0,3614,37 ± 0,86 5,89 ± 0,825,54 ± 0,7710,31 ± 1,06

I – Control group (n=22) – patients with DM without application of LLLT –  (IDDM – 10 patients, NIDDM – 20 patients);

II – Main group (n=37) – patients with DM with application of LLLT – (IDDM – 10 patients, NIDDM – 27 patients).

Reference

  1. Bodiar P.N., Denish G.?., Panasyukova ?.R. // Endocrinol. problems. -1984. – ?3. – P.19-24.
  2. Yefimov ?.S. Diabetic angiopathies.- ?., 1989.
  3. Kozlov S.G., Lyakishev ?.?. Dyslipoproteinemias and their treatment in patients with non-insulin-dependent diabetes mellitus // Cardiology.- ?8.- 1999.- P.59-64.
  4. Roslyakova L.V., Roytman ?.P. et al. Blood plasma apolipoproteins spectrum in patients with non-insulin-dependent diabetes mellitus against a background of akarbosa treatment // Clin. med.- 1999.- ?10.- P.15-17.
  5. Sokolov E.I. Diabetes mellitus and atherosclerosis. – Moscow, 1996.- 404 p.
  6. Assmann G., Schulte H. The Prospective Cardiovascular Munster (PROCAM) Study: prevalence of hyperlipidemia in persons with hypertension and/or diabetes mellitus and the relationship to coronary heart disease // Am.Heart J.- 1988.- Vol.116.- P.1713-1724.
  7. Betteridge D.J. Lipids, diabetes and vascular disease: the time to act diabetic // Medicine.-1989.-N6.-P.195-218.
  8. Fontbonne A., Eschwege E. et al. Hypertriglyceridemia as a risk factor for coronary heart disease mortality in subjects with impaired glucose tolerance or diabetes. Results from the 11-year follow-up of the Paris Prospective Study // Diabetologia.- 1989.- Vol.32.- P.300-304.
  9. Haffner S.M., Stern M.P., Haruda H.P. et al. Cardiovascular risk factors in confirmed prediabetic individuals: does the clock for coronary heart disease start ticking before the onset of clinical diabetes? // JAMA.- 1990.- Vol.263.- P.2893-2898.

10. Harris M.I. Hypercholesterolemia in diabetes and glucose intolerance in the U.S. population // Diabetes Care.- 1991.- Vol.14.- P.366-374.

11. Jaretti R.J., Shipley M.J. Mortality and associated risk factors in diabetics // Acta Endocrinol.-1985.- Vol.110.-P.21-26.

12. Kannel W.B., McGee D.L. Diabetes and cardiovascular risk factors: the Framingham Study // Circulation.- 1979.- Vol.59.- P.8-13.

13. Kennedy L., Walshe K., Hadden D.R. et al. The effect of intensive dietary therapy on serum high-density lipoprotein cholesterol in patients with type II (non-insulin-dependent) diabetes mellitus: a prospective study // Diabetologia.- 1982.- Vol.23.- P.24-29.

14. Krause H.P., Puls W. Effects of the alpha-glucosidase inhibitor acarbose on carbohydrate-induced hypertriglyceridemia in wistar rats // Arch.Pharmacol.- 1981.- Vol.11.- P.316.

15. Laakso M. Epidemiology of Diabetic Dyslipidemia // Diabetes Rev.- 1995.- Vol.3.- P.408-422.

16. Laakso M., Voutilainen E., Sarlund H. et al. Serum lipids and lipoproteins in middle-aged non-insulin-dependent diabetics // Atherosclerosis.- 1985.- Vol.56.- P.271-281.

17. Laakso M., Ronnemaa T., Pyorala K. et al. Atherosclerosis vascular disease and its risk factors on non-insulin-dependent diabetic and non-diabetic subjects in Finland // Diabetes Care.- 1988.- Vol.11.- P.449-463.

18. Laakso M., Sarlund H., Mykkanen L. Insulin resistance is associated with lipid and lipoprotein abnormalities in subjects with varying degrees of glucose tolerance // Arteriosclerosis.- 1990.- Vol.10.- P.223-231.

19. Lehto S., Ronnemaa T. et al. Dyslipidemia and hyperglycemia predict coronary heart disease events in middle-aged patients with NIDDM // Diabetes.- 1997.- Vol.46.- P.1354-1359.

20. Pyorala K., Laakso M., Uusitupa M. Diabetes and atherosclerosis: an epidemiologic view // Diabetes Metab. Rev.- 1987.- Vol.3.- P.463-524.

21. Rabkin S.W., Boyko E., Streja D.A. Changes in high-density lipoprotein cholesterol after initiation of insulin therapy in non-insulin-dependent diabetes mellitus: relationship to changes in body weight // Am. J. Med. Sci.- 1983.- Vol.285.- P.14-18.

22. Ronnemaa T., Laakso M., Kallio V. et al. Serum lipids, lipoproteins and apolipoproteins and the excessive occurence of coronary heart disease in non-insulin-dependent diabetic patients // Am. J. Epidemiol.- 1989.- Vol.130.- P.632-645.

23. Rosengren A., Welin L., Tsiopogianni A. et al. Impact of cardiovascular risk factors on coronary heart disease and mortality among middle-aged diabetic men: a general population study // Br.Med.J.- 1989.- Vol.299.- P.1127-1131.

24. Stamler J., Vaccaro O., Neaton J.D. et al. for the Multiple Risk Factor Intervention Trial Research Group. Diabetes, other risk factors and 12-year cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial // Diabetes Care.- 1993.- Vol.16.- P.434-444.

25. Steiner G. The dyslipoproteinemias of diabetes // Atherosclerosis.- 1994.- Vol.110.- P.27-33.

26. Stern M.P., Patterson J.K., Haffner S.M. et al. Lack of awareness and treatment of hyperlipidemia in type II diabetes in a community survey // JAMA.- 1989.- Vol.262.- P.360-364.

27. Taskinen M.R. Quantitative and qualitative lipoprotein abnormalities in diabetes mellitus // Diabetes.- 1992.- Vol.41.- Suppl.2- P.12-17.

28. West K.M., Ahuja M.M. et al. The role of circulating glucose and triglyceride concentrations and their interactions with other “risk factors” as determinants of arterial disease in nine diabetic population samples from WHO multinational study // Diabetes Care.- 1983.- Vol.6.-P.361-369.

The use of infrared laser therapy in patients with achrestic diabetes mellitus in sanatory conditions.

T.M. Zinkovskaya, L.A. Zavrazhnikh Perm State Medical Academy, Joint – Stock company “Oust-Kachka”

Infrared laser therapy (IRLT) was performed in the sanatorium in 48 patients suffering from achrestic diabetes mellitus accompanied by ischemic heart disease. All patients studied at school for patients with diabetes mellitus and leamt the methods of self-control and self-correction of the disease. 10 patients, who didn’t get IRLT and didn’t attend the school were included in the control group.

Blood cholesterol and lipids, blood pressure (BP), central hemodynamics (by the method ofechocardiography) and 24-hour ECG-monitoring were studied before and after treatment. Also the levels of glucose in blood and urine were determined repeatedly, and the body weight was controlled.

The statistically proven increase of minute volume, ejection fraction and cardiac index was found in patients who had undergone IRLT. The episodes of painful and painless miocardial ischemia. Levels of cholesterol and blood glucose and body weight decreased. Aglucosuria was marked as well. None of the above indices in the control group changed significantly.

The effect of low-level laser irradiation and preparation mexidol at the hemocoagulative system in patients with diabetes mellitus

 E.V.Lebedkov, V.A-Duvansky, M.P.Kalinin, M.P.Tolstykh, A.S.Tepljashin, A-G.Telinianidi, M.K.Yusubalijev Moscow

The present paper discusses the results obtained during our researches on changes which develop in the hemocoagulative and fibnnolythic blood system in patients with necrotic processes in soft tissues suffering of diabetes mellitus when they are treated with intravascular low-level blood irradiation and antioxidant Mexidol.

Infrared laser therapy influence on blood circulations in patients with diabet distal polyneuropathy

Protasyeva L.G., Burtsev E.M., Alekseyeva N.V., Osnovina I.P., Cheida A.A., Nazarov S.B.

I.S.M.A. Ivanovo. Russia.

96 patients with DDPNP received infrared lasertherapy. Their bloodflow including parameters of microcirculation issas carefeully exarnined.

Laser therapy stimulated microcirculation in both groups of patients with microcirculation disorders alone and with the combination of marked micro -and makrocirculation therapy disturbances. High effectiveness of Laser in DDPNP was proved.

Authors conclude that laser therapy is a pathogenic method of DDPNP treatment.

Dynamics of renal function in patients with acute pyelonephritis and diabetes treated with magnitolaserotherapy

Peoples friendship University of Russia. Moscow Avdoshin V.P. Andrukhin M.I.

Makarov O.V.

We studed 98 patients with acute pyelonephritis and diabetes, 62 (63,3 %) patients out of them with not complicated forms , with complicated 36 (36,7 %). The renal function was controled on the base of clinical sings, biochemical and radioimmunological data.  Renal disfunction was revealed in all patients. Reani disfiinrion of the first degree in patients with not complicated pyelonephritis was diagnosed in 36 (58%), the second degree – in 21 (34%), the third degree – in 5 (8%) patients. Rean] disfiinrion of the first degree in patients  with complicated pyelonephritis was diagnosed in 11 (30.6%),the second – in 17 (47.2 %), the third degree in 8 (22.2 %).

Patients with complicated pyelonephritis were treated after restoration of urine outflow by upper unnary tract. Kidney catheterisation was performed in 32 (88.9%) patients, trancutaneal kidney puncture – in 4 (11.1%) patients. Besides antibiotics, detoxical therepy all patients were threated with magnitolaserotherapy  useing “MILTA” apparatus.

bi patients with not complicated pyelonephritis the renal function has normalized in 21 patients (33,9 %), first degree renal disfunction was found in 26 (41,9 %), second – in 15 (24. %). The improvement of renal disfunction by one degree was revealed in 29 (46,7 %) patients, in 8 (12,9 %) by two degrees. In patients with the complicated pyelonephritis the renal function has normalized in 7 (19 %), the first degree renal disfunction – inIO patients (27,7 %), the second – in 13 (36 %),the third -in 6 (16,6 %), improvement of renal disfunction by one degree was revealed in 11 (30.6%), by two degrees – in 2 (5.6%) patients.

The results received are explained by positive medical effect of magnetolaserotherapy on inflammatory process in kidneys and renal function. Such effect is caused by improvement of microcirculation and reduction of kidneys tissue edema.

Application of medical laser for diabetes mellitus complex treatment.

LV.Tcreschenco, G.A.YacovIeva

Medical Academy, Perm, Russia

We have a many years experience of I and II type diabetes mellitus complex treatment when medical laser (ML) is used, have elaborated the indications and the contra-indications to apply intravessel laser blood irradiation (ILBI), transskinlascr irradiation, lascracupunture. The optimum exposition has been motivated for each method ML. We have drawn a conclusion about necessity of two weeks patients preparation for ML by contra-agregations and contra-oxidantes. Without this, spontaneous thrombocyte agregation increases and disorders offibrinolysis increase too. The threat ofthrombohemorragic complications rises. ILBI influence upon carbohydrate metabolism depends on glycemia initial level: if it is decompensation, ILBI redoubles it; if it is compensation, hypoglycemia is possible after procedure. ML removes asthenia, polyneuritis, makes hypotensive effect when arterial hypertension takes place, promotes lowering of the excessive body massa. ML is effective in case of diabetic macroangiopathy, in particular it is managed to lower the dose of antianginal remedies or to abolish them, when ischemic heart desease occurs; lipidogramma improves or normalizes. After ILBI positive dynamics of diabetic retinopathy was discovered, that proves the effectivness ML for treatment and prophylaxis of microangiopathy. ML removes lipoid necrobioses completely. So, ML roust be used for diabetes mellitus complex treatment.

In-vein laser blood irradiation (ILBI) in comples treatment for patients with diabetes (D).

Suhovcrova N.O., Molashcnko N.P., Daniltchenko A.G., Soloviova

L.A. Clinic Hospital N 3 of the President of Russia Medical Center, Moscow, Russia.

Diabetes is generalised pathological metabolic disorder which leads to the affection of the vascular system including all the capillary blood vcscls. Further vascular complications (diabetic foot, rctmopahy, ne-phropathy, insult) cause early disability and high death rate. The increase of the level ofglickcr blood proteins (HbA I, Hb Ic) is correlated with the disorder in the system of hacmostasis and hacmorcologi (the growth of aggregation of blood sticking elements) and dislipidcmy (growth of atcrogcnic fractions of the lipidogram, especially of the total cholesterol and triglyccrids). The correction if the disruption of the peripheral blood circulation is one of the most important factors in D complications treatment. Improving microcirculation at the expense of lowering the spontaneous aggregation level, increasing the crythro-cytc deformation and consequently, normalising the level of effective metabolism is one of the major effects the helium-neon laser low intensity irradiation produces on biological tissues. The ILBI was included in the complex treatment of 107 D patients ( 15% of DI type, 85% of D2 type) with different dcgrics of heaviness. 22% had suffered from D for less 10 years, 78% for more than 10 years. The treatment was performed with ALOC-1 and ALOU-2 (wavelength 630 nm with the light guide output power 1,5-3 m\V during 15-30 min). The drug treatment consisted of the correction jf the carbohydrate metabolism, dctoxica-tion treatment, vitamins treatment, angioprotcctors and diagrcgants. As a result, together with the subjective rehabilitation of the patients, the total cholesterol and triglyctrids were reduced as low as the norm or its limit which distinguished these patients from those without the ILBI. Thus the application of in-vein laser blood irradiation in complex treatment for patients with D can be regarded as an important and necessary component of angiopathy prophylactic (D-l type) and reaching a longer remission in cases of micro- and macroangiopathy ( D-2 type).

THEORETICAL BACKGROUNDS FOR LIGHT APPLICATION IN DIABETES

Makela A.M.

Glucose can act as an oxidizing agent in glycation breakdown depending on the composition of surrounding molecules. Glucose reacts nonenzymatically with protein amino groups to initiate glycation, the early stage of the Maillard reaction, leading to crosslinking and browning of the proteins via the formation of advanced glycation end products (AGEs). The AGEs are responsible for various biochemical in tissues which can lead to the development of several complications in diabetes: neuropathy, angiopathy.

The monocyte macrophage plays an important role in this process both by removing the senescent molecules that have accumulated AGEs over time and by initiating the steps that lead to new protein synthesis and tissue remodelling. One of the most important features of the macrophage is its ability to produce and release NO and SOD. The irradiation of macrophages by red light result in a dose-dependent increase in NO production and SOD activity and, laser irradiation of cells in the red range activates the synthesis of SOD and inducible NO-synthase de novo due to photosensitized initiation of free radical reactions.

NO synthase is primarily a cytosolic enzyme which has similarities with cytochrome P450 enzymes. These all have absorption maxima between 446 nm and 452 nm. Several isoforms of the enzyme occur in endothelial cells, as well as in platelets, macrophages, vascular smooth muscle cells, and the brain.

The start of pathogenic levels of Islet cell antibodies (ICA-IgG) may precede the clinical onset of diabetes by several years, even in children. Several attempts have been made to influence the course of type I diabetes by immunotherapy. Plasmapheresis, prednisone, and interferon have proven unsuccessful or only partially successful. Successful methods of preventing diabetes in Worchester rats have been neonatal thymectomy, antiserum to lymphocytes, bone marrow transplantations, and cyclosporine. This demonstrates the strong immunological background of the disease process. Type I diabetic patients have been shown to have inhibition of migration of leucocytes specific for antigens of the endocrine pancreas. Phagocytic white blood cells employ the myeloperoxidase H202 system to generate reactive oxygen intermediates that kill invading bacteria, viruses, and tumour cells. Partially reduced oxygen species are also potentially damaging to cellular lipids, nucleic acids, and proteins; the production of such species by activated phagocytes has been implicated in the damage of normal tissues under pathological conditions. The initial pathway for oxidant generation involves a membrane associated NADPH oxidase that reduces oxygen to superoxide anion, which then dismutates to form H202 . Myeloperoxidase, a secreted heme protein, amplifies the toxic potential of H202 by producing reactive intermediates. Production of myeloperoxidase is inhibited by irradiation at 633 nm 660 nm, 820 nm, 880 nm and 950 nm, of which 660 nm appears to have the strongest effect.

By regulating the amounts of active macrophages, NO, SOD, Myeloproxidase, and the activity of cytochrome P450 and many other substrates by light, it is possible to regulate glucose and AGE breakdown and prevent development of complications of diabetes

THE LOW INTENSIVE LASEROTHERAPY OF THE LATE COMPLICATIONS OF DIABETES MELLITUS?

V.A.Galenok, O.V.Sazonova, S.P.Thechova,O.N.Nikiforov

Novosibirsk Medical Institute, Russia

The results of the low intensive laserotherapy (LILT) were assessed in patients with diabetic angiopathies. The authors used infra-red laser, worked in impulse regime with outcome capacity of 5 watt. Biological active points were found with the help ofElectrone Marker of Acupuncture Points and were influenced for 16-20 seconds each, 3-15 minutes in general. The course of the laserotherapy (LT) consisted from 10-12 treatments. The results were analysed according to the clinical and laboratory methods, including the study of the lipid peroxidation (LP) with the help ofmalonil dialdehyd (MDA) level in serum. The functional status of the blood flow was tested by the retrobulbar conjunctivas biomicroscopy, rheoencephalo- and rheovasography. After LT clinical improvement (grow warmer of the extremities, decrease or disappearance of pain, cramps and parastesies) was marked in 89% of patients. Normalisation of the small arteriole tonus, improvement of the pulse curve form and configuration, as well as pulse blood filling in caroted and vertebral arteries, decrease of the irregularity of the retrobulbar conjunctivas vessels gauge with partial or total disappearance of sladge-phenomenon were shown. The restoration of the blood flow promoted improvement of the electro-, enchephalo- and miographical indexes. The tendency to the normalisation ofLP was marked as well. MDA level decreased from 13.4±0.56 to 10.9±1.2 mmol/1, but stayed higher than in donors (5.5±0.17 mmol/1). These data confirm the positive influence of LILT at LP, function of the central and peripheral blood flow and permit to use LILT in the complex therapy of the vascular complications in diabetes mellitus.

QUANTUM THERAPY OF DIABETIC NEPHROPATHY

V.Soklakov, S.Bouglova, V.Finin, Ye.Belskaya

Belarusian Science Research Institute of Cardiology of Mmisfay of Health, Belarusian State University, Minsk, Republic of Belarus

The influence of low energy helium-neon (HN) and infrared (IR) laser irradiation on the clinical laboratory indications of 33 patients with insulin dependent diabetes mellitus was studied. It was shown that laser therapy must be prescribed strictly individually for each case taking into account the immune status of the organism. Laser therapy is effective only at the early stages of renal disorder. HN laser irradiation of kidneys is accompanied by activation indications of primarily humoral immunity while in case ofIR laser irradiation these are activation indications of cell-bound immunity. Considering the partially auto-immune nature of kidney affection this phenomenon can be regarded as a positive factor which liquidates immunity deficit on the one hand and as a dangerous tendency of the activation of some nephron alteration mechanisms on the other. The difference in the therapeutic effectiveness of the two kinds of lasers is connected with the different penetrating power of the rays and changes in the organism’s photochemical processes which depend on the wavelength and irradiation power.


Low Power Laser Therapy is the best non -invasive and more expensive treatment for D.A.

DR. CRISTIAN ZAHARIA, M.D., Ph. D,
PRESIDENT OF “LASER MEDICAL & PRAXIS MEDICAL MODERN”
ASSOCIATION
(BRASOV – ROMANIA)

PHOTO:”The effect of laser irradiation for D.A.”


@ We hava a pleasure to introduce an editorial by Dr.Christian Zaharia from Romania.
The lower limbs diabetic arteriopathy ( D.A.) is the most frequent place of mellitus macroangiopathy, with evolution towards aggravating:
Ulceration, necrosis and finale apopthosis of tissues. With all accomplished progress in medical treatment of arteriopathy, especially in distal complications, the resultats are not encouraging. On the basis of the clinical experience, the author consider that the LOW POWER LASER therapy is a future in treatment of ulceration and necrosis.
Personal I used a HE-NE laser (type Laser Instruments-Poland );
– wave length 630 ~ 670 nm, output 35 mW, energy dose J/cm 4, time 4 min. (progressive 6 min., 4 sessions / week, 20 sessions continous beam. The last 6 sessions was combined with sessions of ORIENTAL MEDICINE ( laser acupuncture – biostimulation therapy).
LP Laser Therapy induce arteriolar vasodilatation, suppress pain and vascular spasm. The values of paraclinical parameters ( Doppler examination, cutaneous temperature, etc.) are changed.
The patient can be rehabilited in 3-4 months.
Conclusion : Low Power Laser Therapy is the best non -invasive and more expensive treatment for D.A.

At the start of lpl therapy

 

 

The management of diabetic neuropathic ulceration by HeNe laser.
The following photo sequence has been contributed by Dr. Ali Abaci, Turkey

Webmaster comment: Sometimes pictures illustrate better than words what
laser therapy is all about.

Please note that the dose is 0.4 J/cm2, not 4 J/cm2 as indicated in the text on the photos below.

Treatment parameters for the diabetic neuropathic ulceration are given below : He-Ne Laser, wavelength 632 nm. Continuous Wave Beam Area(cm2)= Diameter(cm)2 x 0.7854 = (3.1 x 3.1) x 0.7854 = 7.547 cm2 Laser Output Power = 5 mW= 0.005 W Laser Output Power(W) Power Density(W/cm2)= Beam Area(cm2) 0.005 == 0.0006625 W/cm2 7.547 Energy Density(J/cm2)= Power Density(W/cm2) x Time(sec) = 0.0006625 x 600 = 0.3975 J/cm2 = ~ 0.4 J/cm2. Treatments were given once a day, 5 days a week, totally for 4 weeks.

Laser and Plaquex treatment on cryoglobolic vasculitis on diabetic foot (Case report summary)

 

By Anita Baxas, Binningen, Switzerland

A 53-year old male patient presented himself with non-insulin-dependent diabetes mellitus since 5 years as well as an active hepatitis C infection of unknown cause and duration. He developed inflamed and swollen blisters on his first and second toes of his right foot over night. The head of the dermatological outpatient clinic at the University hospital of Basel, Switzerland diagnosed a vasculitis due to cryoglobulins caused by the hepatitis C infection. Within a few days the tips of the toes turned purple and the danger of an amputation increased due to the reduced capillary blood flow caused by diabetes (left photo). We treated the patient locally with Low Level Laser therapy to promote wound healing and intravenously with Plaquex infusions to improve capillary blood circulation. After 3 weeks of treatment with a total of 10 Plaquex infusions and daily application of laser therapy (in-office and with home care laser) we could promote granulation to the point that the wounds healed completely without sequel (right photo, after 3 weeks).
Material and Method: – Doctor’s Office:
Laser Model Med-2000 (LASOTRONIC Baar Switzerland), Output 120 mW (3 Diodes plus red pilot light) approx. 30° divergence. Wavelength: 830 nm (infrared). Mode c.w. (continuous wave), distance from wound: 0.5 – 1 cm. Dose: 4 joules/ cm2. Frequency: daily treatments (5 x per week) for 3 weeks (15 treatments). Duration per toe: approx. 30 minutes total.
– Home treatment:
Laser Model Med-130 (LASOTRONIC Baar, Switzerland). Output: 45 mW 830nm (1 Diode, approx. 30° divergence). Mode c.w. (continuous wave), distance from wound: 0.5 – 1 cm. Dose: 4 joules / cm2, 3 – 4 treatments daily for 3 weeks.
Vopr Kurortol Fizioter Lech Fiz Kult. 2002 Jul-Aug;(4):9-11.

Use of infrared laser therapy in patients with ischemic heart disease associated with diabetes mellitus type 2 in health resort

 [Article in Russian]
 

Zin’kovskaia TM, Zavrazhnykh LA, Golubev AD.

Infrared laser therapy (300 Hz) combined with balneotherapy and patients’ education is more effective than standard sanatorium rehabilitation in patients with ischemic heart disease associated with diabetes mellitus type 2. 81.8% patients showed good response manifesting in less frequent anginal attacks, episodes of pain and painless ischemia and lower doses of antianginal drugs. Systolic and diastolic arterial pressure lowered by 18 and 10 mm Hg on the average, respectively. Multimodality rehabilitation of IHD patients with type 2 diabetes mellitus improves hemostasis, carbohydrate and lipid metabolism. Coronary circulation response lasted for 24 weeks.