Kokoeva J. M. Ph. D. MGTU im. N. Uh. Bauman
Laser therapy: past, present and future prospects
At the turn of the 60-80s of this century at the junction of biology, medicine, physics, chemistry,
technology, a new integrated direction in science – laser medicine. Due to the separation of lasers into
"cold" - low - energy and "hot" - high-energy-laser medicine developed in two directions: laser therapy and
laser surgery.
An unprecedented discovery in the world of therapeutic practice was the use of low-intensity
laser therapy. This nano-technology is ahead of its time, as the mechanisms of action are carried out at the
cellular level by quantum action (energy of light) and are calculated in nano-meters. This is the part of
medicine, which has long been an innovation and pride of our country, was developed by Soviet military
experts in the 70's, declassified in the 80's, and since that time, successfully developed-laser medicine,
which was defined-as the medicine of the future, which gave a magic weapon in the hands of a General
practitioner against the vast majority of diseases. Laser therapy, in fact, is today the most modern way
of improving the population.
Currently, in most countries of the world there is an intensive introduction of laser radiation in
biological research and in practical medicine. The unique properties of the laser beam have opened wide
possibilities of its application in various fields: surgery, therapy and diagnosis. Clinical observations have
shown the effectiveness of the laser ultraviolet, visible and infrared spectra for topical use on the
pathological focus and for the impact on the whole body.
In Russia, lasers have been used in biology and medicine for more than 30 years. Laser medicine
is one of the few areas in applied science where Russia still retains its leadership. The USSR invested a lot
of money in the study of non-medicinal methods of treatment. The Soviet "impulse" was so strong that
many Russian companies are actively selling laser equipment to the West until now, and not only because
it is of sufficient quality and is collected most often at enterprises where they still remember what military
acceptance is, but also because it is cheaper than Western analogues 3-5 times.
The developer of the first laser medical devices in the USSR was the research and production
enterprise "Istok" (Fryazino, Moscow region). In the early 60s at the "Source"under the guidance of
academician N. D.Devyatkov began the first work on the development of a new, at that time, class of
quantum devices – lasers, and after a few years, the company organized the mass production of the
country's first helium-neon lasers. During the 30-year period of development of this direction, a large range
of gas lasers and emitting elements was mastered – on Non-Ne, CO2, CO, Cu vapors. In the 1960s, the first
studies were carried out on the use of lasers in medicine, which were conducted in MMA clinics. I. M.
Sechenov, CITO, Central research Institute of balneology and physiotherapy.). The possibilities of using
helium-neon lasers with a wavelength of 0.63 µm in clinical practice were studied, the expediency of their
use for medical purposes was proved, and in 1972. permission was obtained from the Ministry of health of
the USSR for the use of low-power helium-neon laser radiation in therapy.[1] in the 1980s, the method of
intravascular laser irradiation of blood (ilok) was developed by helium-neon lasers for use in cardiology,
but proved to be effective in a number of other diseases.
The accumulated clinical data on the possibilities and mechanisms of vloc underlying the
therapeutic effects of this method of laser therapy indicate its unconditional influence on blood
hemorheology, on the cellular level of regulation and maintenance of homeostasis, followed by
multifactorial action: analgesic, antioxidant, desensitizing, biostimulating, immunocorrecting, detoxifying,
vasodilating, antiarrhythmic, antibacterial, anti-inflammatory, anti-inflammatory anti-sclerotic. A large
statistical material on the effectiveness of this method in the treatment of internal diseases has been
accumulated, which allows it to be successfully used in therapy : in cardiology, pulmonology, surgery,
neurology, gastroenterology, gynecology, endocrinology, urology, sports medicine.
Method Intravenous laser irradiation of blood is increasingly used in the treatment of diseases
such as cancer, radiation sickness, cardiovascular disease, diabetes mellitus, hypothyroidism, cerebral
palsy, asthma, infertility. The success of the method in cardiology was marked by the presentation of the
state prize of the USSR to the group of its developers: Agov B. S., bohua M. R., Kapustina G. M.,
Kipshidze N. N... Korochkin I. M., Marsagishvili L. A., Sergievskiy V. S., Stepanisheva N. And...

Chapidze G. E. "for the development and implementation in clinical practice of the method of treatment of
various forms of ischemic heart disease by helium-neon laser". Existing practical and scientific
developments of this method are the prerogative of our national medicine and today have no analogues in
the world. It is appropriate to note that the method of intravascular laser treatment is the pride of the Soviet
military medicine, which our scientists have developed, scientifically substantiated and the first in the
world health practice used to treat the General population. This is confirmed by numerous scientific works
of almost three generations of Russian scientists – specialists in laser therapy, which is essentially nano-
technology, as laser energy treatment is carried out at the cellular level and is measured in nano-meters.
Russia can be proud of their names. (Karu, T. I., Bohua M. R., Kapustina G. M., Kipshidze N. N.,
Korochkin I. M., Marsagishvili L. A., Sergievsky V. S., Kozlov V. I., Geinitz A. V. Avdoshin V. P.,
Gamalei N. F., Babushkina G. V., Kovalev I., Kovaleva T. V., and many others.etc.).
Successfully and widely used low-intensity laser therapy abroad – in Europe, USA, Japan,
where a huge practical and scientific experience, but such a possibility of using medical laser energy
directly in the bloodstream-at the nano – level-and no, it is still the prerogative of the Soviet, and
later, Russian medicine!
In the mid-1980s, academician G. A. Nikolaev, who was at the origins of the Department "Laser
technology" MSTU. N. Uh. Bauman recommended to pay serious attention to the possibility of using laser
radiation for the treatment of humans. The first active scientific developments were carried out by young
researchers, postgraduates and engineers of the Department under the direct supervision Of G. A.
Nikolaev. After the analysis of numerous experimental data obtained at the Department on the use of laser
radiation to stimulate the healing processes of the affected biological tissues, the need to develop
technological bases for both treatment and methods of objective control of regeneration processes was
revealed. In 1985, the staff of the Department "Laser technology" MSTU. N. Uh. Bauman and Kaluga
technical medical laser center was created, launched and commercially mastered the first pulsed infrared
laser therapeutic device on GaAs pumped with the title "Uzor".
The purpose of the device is to study the possibility of using low-intensity laser radiation in
medicine for therapeutic use. The first therapeutic tests were for military medical purposes for the
treatment of gunshot, mine blast and mechanical wounds in military hospitals of the Ministry of defense
and for the further rehabilitation of the wounded. The leading specialists of the Military medical Academy
(St. Petersburg), the Main military clinical hospital were medical co-executors in the scientific and
practical direction. N. N. Burdenko, Central hospital of FSB etc. For several years, the devices "Pattern"
used only in closed hospitals. They were used in Afghanistan, Chechnya, Spitak and other "hot spots" due
to its wound healing and aseptic properties. Then, the military medical experts have been really appreciated
by a wider the possibility of reducing the period of rehabilitation for the wounded 2-3 times.
The positive results obtained during clinical and field trials, such as a pronounced anti-
inflammatory and anti-edematous effect, stimulation of microcirculation, acceleration of wound healing
surfaces, neurotropic, analgesic effect and much more became the basis for serial production and practical
use of laser therapeutic devices "Uzor". In the following years, thanks to joint work with the Central
tuberculosis Institute, the 2nd Moscow medical Institute. N. And. Pirogov, Central research Institute of
dentistry, Central research Institute of balneology were issued the first in Russia official guidelines for the
use of the device "Uzor" in many areas of medicine.
Since that time, the era of empirical use of laser treatment and at the same time, the study of the
mechanisms of action of laser radiation in all areas of medicine and, accordingly, the development of laser
medicine and technology. Scientists have tried to influence the low-intensity laser radiation directly on the
diseased organs. So, the staff of pulmonology 2 MMI. N. And. Pirogov under the leadership of
academician A. G. Chuchalin in the 90s, carried out the experimental work in patients with asthma –
treatment of their red spectrum of laser radiation endobronchial. G. V. Dead-end, conducted the first work
on the use of a red-spectrum laser in patients with rheumatoid arthritis in the treatment of knee joints: on
the articular surface, or even inside the joints through the red-spectrum laser fibers. It is now known that
the intravascular laser exposure in a minute of the beginning of the procedure removes the patient from the
status of bronchial asthma, and as a result of the course of treatment – greatly facilitates the course of the
disease. And in patients with rheumatoid arthritis, a positive response to treatment begins to appear at the
3rd week, and not earlier, after a course of intravascular laser irradiation of blood (vlok) due to
immunomodulation. Of course, these first works, even if they did not have therapeutic success, as they
were more empirical, and knowledge of the positive, systemic effect of the laser on the entire body of the

patient, on the cause of these diseases was not yet - but they paved the way for the development of laser
therapy.
The progress of laser therapeutic technologies really began when in 1986 the Institute of laser
medicine was established under the leadership of O. K. Skobelkin, later renamed into the state scientific
center of laser medicine of the Federal medical and biological Agency (Director-D. M. N., prof.
During the development and implementation of laser devices, many certificates of authorship
and patents for the design and methods of laser application in various fields of medicine were obtained.
Thanks to the success of quantum electronics and optics, new types of laser emitters using pulsed
semiconductor lasers of therapeutic action of the infrared and red ranges have appeared.
Low-intensity laser radiation (NILI) has been used in the form of transcutaneous, intravascular, and
more often combined methods of treatment in practical application as an effective therapeutic agent. It had
a pronounced therapeutic effect on a wide range of degenerative-dystrophic and inflammatory diseases, as
it affects the main links of their pathogenesis. As a result, there was a separate direction in medicine – laser
therapy.
Over the past 30 years, the mechanisms of action of the NILE are largely disclosed and clarified.
The effect of laser radiation is based on its photobiological action due to the absorption of light quanta by
biological structures that change their energy state. As a result, there is a physical and chemical
restructuring of protein polymers, in particular, changes in the activity of enzymes and structural and
functional properties of cell membranes. NILI has versatile effects: it affects the main factors of the
inflammatory process-reduces damage, normalizes the processes of microcirculation and transcapillary
metabolism, stimulates tissue proliferation and specific immuno-biological reactivity. The effect of
low-intensity laser radiation leads to rapid subsiding of acute inflammatory phenomena, stimulates
reparative processes, improves microcirculation of tissues, normalizes overall immunity, increases
resistance (resistance) of the body. Careful studies have shown that the dosed light has the properties to
suppress allergic reactions, restore the protection system (immunity), activate the nervous system, improve
blood circulation, restore metabolism, release the body from salts and toxins, has a powerful analgesic and
anti-inflammatory action. Not only patients, but also many doctors ask: “Why does light have such a
diverse range of effects on humans?" For decades, scientific thought was concentrated around the chemical
(biochemical) model of the organization and functioning of molecules, membrane-cell apparatus, systems
and the body, which caused the development of pharmacological, traditional medicine.
At the same time, the accumulated knowledge has made it obvious that this biochemical model
should be expanded to deeper levels, including electromagnetic and quantum processes, which play an
important role in the self-organization of wildlife, in the energy and energy-information provision of
homeostasis of cellular activity of all its systems. As the Nobel prize winner, the German physicist V.
Heisenberg argued: "electromagnetic energy is the main energy on which the life of the body depends."
And therefore it is difficult to expect significant progress in the treatment of patients, as long as modern
medicine does not "catch up" quantum physics.
The discoveries of recent years have irrefutably proved that the body constantly produces laser
(light) energy, which fades under stress and various diseases. Therefore, the light introduced by the device
is a kind of therapeutic "shower", which cleanses the body and restores its energy.
Scientific studies in recent years have shown that as a result of the course of Intravenous laser
irradiation of blood increases the content of human DNA and RNA in the nuclei, indicating the
intensification of transcription (division). This is the first stage of the protein biosynthesis process. In this
regard, the question arises about the launch of mutations, but it is proved that the frequency of
chromosomal mutations in human cells caused by chemical mutagents, when exposed to a red laser on the
blood decreases. Vloc has an antimutagenic effect, activates DNA synthesis and accelerates the recovery
processes in cells subjected to neutron flux or gamma radiation.
From the late 80's to 2006, we saw a qualitative trend in the use of laser therapy in the outpatient
therapeutic service in Russia. Thanks to the creation of numerous offices and departments of laser therapy,
primary care doctors successfully used low-intensity laser therapy in the form of combined treatment
(method of intravascular laser irradiation of blood (ILIB) with the method of transcutaneous exposure).
The use of low-intensity laser energy both in the form of monotherapy and in combination with drugs, gave
amazingly successful results in the treatment of patients.

Laser therapy has gained momentum in its development and in the public and private medical practice due
to factors such as:
1) the existence of vocational preparatory training base and the beginning of the courses of
training on the subject of "laser therapy" has been officially possible since 1991 at the state research center
of Laser medicine of the Ministry of health, now the FGU state scientific center for Laser medicine FMBA
of Russia, with the certificate of "Specialist in laser therapy" (in the presence of the physician specialty of
General practice and internship in specialty "Therapy") and subsequent possibility of licensing;
2) the Emergence of many centers or offices of laser therapy in both public and private clinics,
and thanks to education, high therapeutic effect and reduce pharmacological dependence as a result of
treatment with various methods of laser therapy - increased their demand among the population.
3) as a result of the widespread use of laser equipment, the demand for it has also risen. There
were conditions of creation and continuous improvement of domestic devices which were the hi-tech
science-intensive production based on nano-technologies
Here is an example of personal practical experience. My professional interest in laser treatment
coincided with the opening of the first courses of laser therapy in the Moscow laser medicine center in
1991, in the heyday of perestroika. During the month, the scientists of the Institute shared their knowledge
with great enthusiasm, as previously all studies on laser medicine were strategic, they were engaged in
military medicine and for a wide range of doctors the results were closed. But at that moment, in addition
to the restructuring around, the restructuring of his medical consciousness to other, "laser" opportunities, I
learned such an important fact. It turns out that the whole team of the SSC under the leadership of
Skobelkin O. K. was against invasive laser treatment - the method of vloc– intravascular laser irradiation
of blood, preferring the methods of nadvenny irradiation with red or infrared lasers projections of vascular
beams. At the same time, Korochkina I. M. and his students have successfully and widely used
Intravenous laser irradiation of blood in combination with infrared laser radiation in priority in
cardiology, as well as in a wide range of diseases.
To figure out which school to take, Skobelkin O. K. or Korochkin I. M. – was not easy. But at
this moment I get acquainted with the very I. M. Korochkin academician, cardiologist, received The state
prize for the use of laser treatment by vloc in cardiology. In one of the clinics, he gave me the opportunity
to communicate with patients treated there, and not for the first time. Information from patients with
various diseases about the results of treatment by combined laser therapy was the beginning of the
formation of ideas, or dreams about how I would like to work in the future. Soon I realized this dream to
treat patients more effectively, using the latest achievements of science and technology. For this reason, it
was necessary to obtain a license, the right to private practice, to open a medical laser center first in
Simferopol, then in Izhevsk, which is why - to resist the traditional foundations of colleagues in the
treatment of common patients. That is why – to earn personal experience in the treatment of a wide range
of pathology, to do research, to defend a thesis, to become a member of the European medical Laser
Association.
The accumulated medical experience of treatment of patients with the roads that was
difficult and exciting interesting. The use of combined laser therapy in the 90's became possible only with
the help of private practice, and for this it was a prerequisite - a successful business: the flow of patients
such as to ensure the cost of rent, a decent salary to employees, consumables. I had to work a lot, diagnose
without errors, to understand the cause of the disease and treat in the right direction. Therefore, the
cherished dream of our domestic medical luminaries – to treat not the disease, but the patient, to find the
necessary chain of pathology, which led the patient to the manifestation of the disease, and, ultimately, to
me at the center - came true in full thanks to the widespread use of laser therapy in conjunction with the
traditional. I do not remember that patients left with resentment after treatment: happiness to see grateful
eyes and forgotten sticks in the corner!
For more than 30 years experience method of combined laser therapy using low-energy lasers –
transcutaneous - infrared effects on the projections of the organs and intravascular laser irradiation of
blood (vlok), I have personally treated over 20,000 patients without a single complication, with excellent

therapeutic effect for all therapeutic diseases, defended his thesis on the topic: "Clinical and
hypolipidemic effect of combined laser therapy in ambulatory polyclinic conditions in patients with
secondary dyslipidemias". Since 2001. I am a member of EMLA, and all my colleagues from Europe
certainly applauded what was and is a reality in our country – the use of intravascular laser treatment. But
all these years, combining work in a public institution and private practice, - has always been an issue of
licensing: since 1991. - as a doctor of laser therapy, after 1996 - as a doctor of physiotherapy with courses
on laser therapy. Since 2001, I have introduced the method of combined laser therapy in GP number 36,
where I worked as a physician, physiotherapist, and since 2007-also a transfusiologist.
In connection with the next licensing problems since November 2005 in Moscow treatment of
patients by vloc was suspended, and a year later the achievement of 30-year scientific and practical laser
medicine, one of the methods of laser therapy – intravascular laser irradiation of blood solution of the
Ministry of health of the Russian Federation was assigned to the specialty Transfusiology. 2011. in CDB
Sciences, I continue to serve as physician laseroterapia with specialties – therapy, physical therapy and
blood transfusion. For many years in our clinical bases, we have used various methods of low-intensity
laser therapy, which helped in the treatment of many complex diseases, both in cardiology and
endocrinology, urology, pulmonology, gynecology, etc.in patients with postoperative complications,
wounds and burns, the recovery period is reduced by 2-3 times. In patients in the cardiology Department
of angina as a result of the method of Intravenous laser irradiation of blood goes to a lower class, in the
vast majority of patients with dyslipidemia, the coefficient of atherogenicity is significantly reduced
without statins.
When using combined laser therapy-on target organs and Intravenous laser irradiation of
blood in patients with type 1 diabetes mellitus – insulin dependence is reduced by 20-30% with each
course of treatment and for a long time it can be maintained by step-by-step treatment. In patients with
type 2 diabetes, the level of glycemia is more easily normalized, the number of sugar – correcting drugs is
reduced, the manifestation of diabetic angiopathy is reduced – vision, hearing, the work of the urinary
system, pain and convulsions in the lower limbs are reduced-the quality of life changes! In the treatment
of autoimmune diseases, the priority was undoubtedly preferred to hormonal therapy-laser low-intensity,
combined, stage-2-3 courses per year for diseases such as sarcoidosis, rheumatoid arthritis, autoimmune
thyroiditis, glomerulonephritis. Our experience of treatment and observation of such patients has shown
the reality of positive changes in the immune system (normalization of the helper-suppressor ratio in B-
lymphocytes) in such patients, both in biochemical parameters and in clinical manifestations and duration
of remission stages. Low-intensity combined laser therapy in a number of private applications we used in
the treatment of children with cerebral palsy, enuresis, reactive pancreatitis and mn. other diseases and
always proud of the excellent results! These results are proved both by statistics and by the mechanisms of
action of laser energy revealed by our scientists in tissues, at the level of cells, and in the cells themselves,
when the therapeutic action begins with the cure of the energy quantum of the cell affected by
inflammation.
Unfortunately, for the entire period of development and application of laser medicine, Laser
Clinical Therapy, as a whole in the domestic medicine, and was not created, as well as the specialty of a
laser physician. Today, it nominally exists in the form of "laser therapy method", which is included in the
range of medical services" (Order of the Ministry of health of the Russian Federation № 1664n from
27.12.2011) without specifying the methods and indications of its use, and practically-laser therapy is
disassembled in the specialty: Transfusiology and physiotherapy
The decline in the practical and scientific application of laser therapy began in 1997, when the
method of low-intensity transcutaneous laser exposure was referred to the Russian Ministry of health to
physical therapy, and the method of Intravenous laser irradiation of blood to Transfusiology (in 2006).
Training of specialists in the country is almost nonexistent, and if there are courses on laser therapy, they
are informative, not give the right to licensing activities as it was before 1997, as a result of disappearing
frames are not used scientifically-practical base.. The disappearance of the Russian achievements of laser
therapy became obvious. At the same time, the base of newly issued patents is sharply narrowing, the
Arsenal of previously issued inventions in the field of laser therapy is becoming obsolete, the state does

not receive funds through the possible implementation of the available scientific potential, including
know-how, in the foreign market.
Unfortunately, for the entire period of development and application of laser medicine, Laser
Clinical Therapy, as a whole in the domestic medicine, and was not created, as well as the specialty of a
laser physician. Today, it nominally exists in the form of "laser therapy method", which is included in the
range of medical services" (Order of the Ministry of health of the Russian Federation № 1664n from
27.12.2011) without specifying the methods and indications of its use, and practically-laser therapy is
disassembled in the specialty: Transfusiology and physiotherapy.
The decline in the practical and scientific application of laser therapy began in 1997, when the method of
low-intensity transcutaneous laser exposure was referred to the Russian Ministry of health to physical
therapy, and the method of Intravenous laser irradiation of blood to Transfusiology (in 2006). Training
of specialists in the country is almost nonexistent, and if there are courses on laser therapy, they are
informative, not give the right to licensing activities as it was before 1997, as a result of disappearing
frames are not used scientifically-practical base. The disappearance of the Russian achievements of laser
therapy became obvious. At the same time, the base of newly issued patents is sharply narrowing, the
Arsenal of previously issued inventions in the field of laser therapy is becoming obsolete, the state does
not receive funds through the possible implementation of the available scientific potential, including
know-how, in the foreign market.
Difficulties with the use of laser therapy methods in General therapeutic practice reduced the demand for
these services, which led to difficulties in the survival of enterprises producing laser devices, which are
high-tech science-intensive products based on nanotechnology. Today it is rare to find specialists who
have previous achievements and combined techniques, as the existing conditions do not allow to use their
experience.
This trend in medicine disappears, so the question of the early elimination of the causes of laser
therapy does not tolerate delay. The issues of laser therapy reorganization as an important and integral part
of laser medicine are real. It is necessary to consolidate scientists, practitioners for a wide public response
and appeal to the Ministry of Health to create appropriate conditions for the development of this area. This
is quite possible if you set the task for the Ministry of health of the Russian Federation on approval of the
specialty of a laser therapist in the register of medical positions and specialties or expansion of the concept
of "laser therapy method" and its introduction into the training programs of students and doctors,
especially therapists with their further licensing. The document of the Ministry of economic development
of the Russian Federation "Forecast of socio-economic development of the Russian Federation for 2012
and the planning period 2013-2014" Moscow September, 2011 said: "... in the health sector will be
implemented measures to ensure the modernization of the health system, more efficient use of available
financial and material resources... the introduction of standards of medical care, increasing the availability
of outpatient medical care, including provided by medical specialists." Why don't our officials apply what
has been said and planned in practice? And if specifically:
1) to restore discipline – "Laser therapy", by withdrawing low - intensity laser direction from disciplines-
physiotherapy (transcutaneous low-energy exposure method) and Transfusiology (Intravenous laser
irradiation of blood) and restore the use of laser therapy methods in a single direction.
2) allow licensing of therapists in the specialty " Laser therapy»
3) to Supplement the training programs in this specialty for training and post-graduate education
specialists at the existing facilities of the fgbu " SSC laser medicine FMBA of Russia»
These measures will help to preserve and restore the development of laser therapy in practical health
care, and laser therapy has direct prospects to improve the quality of medical care even in the most remote
areas of the country. The expansion of medical care by therapists who are able to replace the work of
doctors of narrow specialties due to the wide universality and effectiveness of laser therapy and thus "treat

not the disease, but the patient" will correct the deplorable situation in remote regions, the hinterland of
the country, where FAPs are closed from despair of providing one specialist - therapist - medical care to
the population. Having the appropriate knowledge and equipment, the therapist, laser therapist will be able
to provide extensive medical assistance to the population on the spot, within one office, without sending
patients to narrow specialists in the area or region. In addition, the increase in the number of specialists
authorized to operate various laser technologies will increase the demand and thus restore the production
capacity of enterprises. The existing equipment for laser technologies has been designed and has long
been produced taking into account the use of combined techniques, including Intravenous laser
irradiation of blood. Measures for the conservation and development of laser therapy will enhance the
development of scientific capacity in the national healthcare to increase innovation in the system of
standardization of treatment in various diseases and in a more timely manner to apply the achieved
research and development in the field of low level laser therapy in the practice of medicine.
From the state point of view on the importance of the development of laser therapy, it is
necessary to highlight the following points, namely::
- reduction of medical costs (less staff, less drugs) through the use of generic techniques for the
laser teppei ;
- a fundamentally new approach to the problem: professional development of therapists working
in rural and remote areas, in the army, in extreme situations in the conditions of shortage and lack of
pharmacological drugs;
- we have developed good devices for laser therapy, but the modernization of the equipment will
support the domestic instrument-making;
- it is possible to obtain economic effect by exporting our achievements abroad
Prospects for further development of low-intensity laser therapy are of great interest due to
such large-scale events as economic instability, frequent natural disasters, including the defeat of ionizing
radiation. It has become obvious relevance in improving the availability and quality of specialized,
including high-tech, medical care in the outpatient link of practical health care not only in large cities, but
also in remote areas, disaster areas, in the far North and on a floating ship, on Board the aircraft, in mobile
outpatient clinics, in isolated teams (duty points, search teams, expeditions), in field conditions, etc.
It is known that as a result of nuclear disasters, chromosomal aberrations occur in the cells of a
growing organism, which affects the increase in the development of cancer, especially in children around
the world. Therefore, scientific studies of the use of laser therapy in Pediatrics and the introduction of
methods of treatment with various types of laser energy are more relevant than ever.
It is known that as a result of nuclear disasters, chromosomal aberrations occur in the cells of a
growing organism, which affects the increase in the development of cancer, especially in children around
the world. Therefore, scientific studies of the use of laser therapy in Pediatrics and the introduction of
methods of treatment with various types of laser energy are more relevant than ever.
Low-intensity laser therapy, used in all areas of medicine as a highly effective, environmentally
friendly and perfect treatment, is compatible with all known methods of medicine, has no side effects and
carcinogenic properties. It replaces and complements traditional drug therapy, double the potentials of the
drug, thereby reducing the dosage or even freeing the patient from pharmacological dependence. Due to the
high therapeutic effect, with the complete absence of side effects – this type of treatment acquires a leading
position in many areas of medicine in developed countries. And now and in the near future can be
promising in Oncology, hazardous industries, in military medicine to extend the duration of human stay in
hypoxia, as well as both preventive and therapeutic factor in combination with drugs in gerontology.
1. Nine N. D. application of electronics in medicine and biology. Electronics. Ser. Microwave
technology. 1993. № 1 (455). P. 67-76.

2. ISSN 0236-3941. Herald of MSTU. N. Uh. Bauman. Ser. “Engineering.” 2012 159
3. Baibekov I. M., Kasymov A. H., Kozlov V. I. and others Morphological bases of low-intensity
laser therapy. - Tashkent: publishing house. Ibn Sina, 1991. - 223s.
4. Builin V. A. low level laser therapy with the use of a matrix of pulsed lasers. - M., Too firm
"Technics", 1996. - 118s.
5. Primbetov V. M. Modern equipment and the problems of low-intensity laser therapy //
Application of lasers in biology and medicine (Collection). — Kiev, 1996, Pp. 123 – 127.
6. Inyushin V. M. Laser light and living organism. - Alma-ATA, 1970. - 46c.

5)

Laser therapy application in diabetic patients with dyslipidemia
Kovaleva T., Kovaleva E., Ragimov A.
I.M. Sechenov First Moscow State Medical University

Abstract
The results of a three-year observation of 59 patients with diabetes mellitus in an outpatient
setting have been summarized. Among 37 patients receiving a combined laser therapy, a
significant and prolonged effect on the blood lipid composition was observed, including a
significant increase of the blood HDL level, and a decrease of HDL level. As a result, the
atherogenicity coefficient has been reduced by a factor of 3.3. The biochemical changes were
accompanied by serious improvement of clinical symptoms, including the diabetic retinopathy,
diabetic macropathia of lower extremities, conjunctival disorders, diabetic encephalopathy, and
asthenic syndrome. A pronounced positive effect on carbohydrate metabolism and the glycemia
levels was also achieved. There were no side effects and complications. At the same time, the
biochemical blood parameters and clinical symptoms of 22 patients from the untreated group
remained unchanged. The obtained results can be useful for the development of non-traditional
curative therapies for diabetes mellitus.

Keywords: diabetes mellitus, atherosclerosis, lipid metabolism disorders, combined laser
therapy, diabetic retinopathy.

Introduction
Atherosclerosis in patients with diabetes mellitus (DM) is characterized by early development
and rapid distribution, which allows some researchers to consider DM as a natural model of
atherosclerosis [5, 23]. DM and atherosclerosis are diseases with similar lipid metabolism
disorders accompanied by hypercholesterolemia, hypertriglyceridemia and hypo-alpha-
cholesterolemia [5]. It is well established that in DM type 1, hyperlipoproteinemia, as a rule, is a
secondary disorder which is developed due to absolute insulin deficiency and reduced activity of
the lipoprotein lipase. Therefore, this disorder can be reversible in the case of effective DM
treatment. Furthermore, it is found that any dyslipoproteinemia in DM is not only a cause of
early atherosclerosis but also a leading pathogenic factor of specific microvascular
microangiopathies [1, 2]. Another serious pathogenic factor at dis- and hyperlipoproteinemias is
the significant growth of hypoxia from levels which can be considered "normal" for patients with
DM. This effect dramatically increases the insulin deficiency and reduces the cellular receptor
sensitivity, thus complicating the treatment and contributing to progression of diabetic
microangiopathies.
The patients with DM type 2 are highly vulnerable to the isсhemic heart disease (IHD) which
appears as a result of quantitative and qualitative changes in blood lipoproteins (LP) [3]. The
quantitative LP changes in DM type 2 are characterized by hypertriglyceridemia and reduction of

high density lipoprotein (HDL) level [6, 8, 11, 15, 18, 20, 25, 27] in the very early stages of the
disease [9], which occur in 20% of patients [16, 22, 26]. According to other authors [4, 7, 14],
the mixed hyperlipidemia is a typical disorder of lipid metabolism in case of DM type 2. It is
manifested by the elevated levels of triglycerides (TG), total cholesterol (TC), and low density
lipoprotein (LDL), as well as the reduced levels of HDL. The most common lipid disorder in
DM type 2 is hypertriglyceridemia, typically of type IV, which is induced mainly by the
increased synthesis of very low density lipoproteins (VLDL) [5, 28]. The reduced HDL levels
can be observed in people with DM type 2 diagnosed for the first time, as well as in patients with
a long history of the disease and its pharmacological correction by hypoglycemic drugs or
insulin. A link between the insulin resistance and low HDL levels was also observed [17]. The
HDL level usually increases upon the treatment of patients with insulin [21] and the body weight
decrease [3, 13]. According to M. Laakso et al. [16], the reduced HDL level is an important
prognostic factor for morbidity and mortality due to IHD in patients with DM type 2. The
reduction of HDL level below 0.9 mmol/l has been accompanied by a fourfold increase in the
risk of death in IHD patients. According to several studies [10, 16, 22], hypercholesterolemia
due to increased LDL levels is found in 54-77% of patients. Correction of glycemia is
accompanied by a decrease in the TC and LDL levels [27]. One of the most significant studies
demonstrating a relationship between the TC level and cardiovascular mortality of diabetic
patients was the Multiple Risk Factor Intervention Trial (MRFIT) [12, 24]. The results of this
study demonstrated that the elevated cholesterol levels in patients with DM were closely related
to the risk of lethal cardiovascular pathologies. It was also found that at equal cholesterol levels,
the IHD-related mortality of patients with DM was 3-4 times higher than in disease-free groups.
Despite extensive investigations, there are still no optimal approaches to the treatment of lipid
disorders in DM. Moreover, for patients with diabetes, there is practically no dyslipidemia
correction procedures in the routine practice of outpatient facilities, mainly due to the high cost
of the effective lipid-lowering therapeutic drugs. Therefore, the development of alternative
approaches to the treatment of lipid disorders, including non-traditional ones, is a highly actual
task.
The aim of the study was to evaluate the lipid level dynamics and the clinical effects in patients
with DM types 1 and 2 treated with the combined laser therapy (CLT), a low-energy laser
radiation in the red and near-infrared ranges of the spectrum.
Materials and methods
A total of 59 patients with DM were observed for 3 years in a polyclinic hospital. A lipid-
normalizing effect of CLT combined with administration of Aevit (a combined form of vitamin
E and retinol in capsules, purchased from Bitra, Russia) was studied in 37 patients, which
formed the main experimental group (18 men and 19 women, ranging in age from 17 to 67
years). DM type 1 and type 2 was initially observed in 10 and 27 patients, respectively; the
disease was mild, moderate, and severe in 16, 14, and 7 cases, respectively. In the main group, 4
patients had diabetic coma in anamnesis. The diabetes experience was less than 5 years in 5
patients, 5-15 years in 18 patients, and over 15 years in 14 patients. The remaining 22
participants with DM type 2 formed the control group. These patients received only a traditional
treatment with the sugar level correcting drugs.

All the patients from the main and control groups were prescribed monotherapy by Aevit at a
dose of 600 mg/day for the purpose of prevention of the phenomenon of "secondary
exacerbation" in the process of CLT (in the main group).
The hypolipidemic action of CLT was assessed by the dynamics of TC, TG, HDL, and LDL, and
also using a calculated atherogenic coefficient (AC). The lipid profile was studied in the serum
of venous blood taken in the morning after 12-14 h of fasting. The study was performed on a
biochemical analyzer FP-901M ("Labsystems", Finland). TC level was determined using the
enzymatic CHOD-PAP method. TG level was measured by UVenzyme method. HDL TC was
measured after precipitation of VLDL TC and LDL TC by heparin in the presence of magnesium
ions. VLDL TC and LDL TC were calculated according to method of W. Friedwald: VLDL TC
= TG/5; LDL TC = TC - (HDL TC - VLDL TC). AC was calculated according to the following
formula: AC = (TC - HDL TC)/HDL TC.
Biomicroscopic study using an aperture lamp "Carl-Zeiss-Jena" was performed with the patient
sitting in a dark room. The vessels of lower limbs from the limbus to the fornix were studied.
The study of microcirculation was performed before treatment, then 0.5, 1, 3, and 6 months after
the treatment by CLT. The vascular, intravascular and perivascular changes were registered. For
the quantitative and qualitative evaluation of microcirculation disorders, a scoring method based
on partial assessment of perivascular (CI1), vascular (CI2) and intravascular (CI3) changes was
used.
Three courses of CLT treatment, with the time intervals of 3 months between the courses, were
carried out followed by a 6-month period of observation. Each course included 8-10 daily
procedures. Each procedure included a simultaneous treatment with anintravascularlaser blood
irradiation (ILBI), and a pulsed low-level laser irradiation (LLLI). As the radiation source, a
“Mustang-2000” device (SMLC “Tekhnika”, Russia) equipped with magnetic nozzles was used.
The ILBI had a wavelength of 630 nm and a power of 2 mW at the end of the optical waveguide,
the exposure time was from 30 minutes initially to 15 minutes to the end of each course. The
pulsed LLLI of near-infrared spectrum had a wavelength of 890 nm and a power of 10-15 W.
The following body areas were treated: the area of the gastrocnemius muscle of the calf
(frequency 80 Hz), the projections of the liver, pancreas, and spleen (frequency 150 Hz). The
LLLI exposure time was 4 minutes for each zone.

Results and discussion
As shown in Table 1, in 22 persons of the control group, the initial lipid content in plasma after
10-day administration of Aevit did not change. The same pattern was also observed after
subsequent courses of treatment by Aevit after 3 and 6 months, simultaneously with the surveyed
patients receiving CLT.
In both groups before the treatment, all the studied parameters demonstrated serious differences
from the normal levels thus clearly indicating a pathologic condition. Thus, the average TC level
in the main group of patients before treatment was 8.2 ± 0.38 mmol/l (3.9-5.2 in the norm); TG
level was increased to 2.14 ± 0.10 mmol/l (0.40-1.53 in the norm); HDL level was reduced to 0.99
±0.04 mmol/l (1.5-3.3 in the norm), LDL level was increased to 7.87 ±0.37 mmol/l (3.0-4.5 in the

norm), and the ratio LDL/HDL was 7.24 ±0.30 (5.0 in the norm); AC reached 7.28 ±0.27 (2.5-3.5
in the norm).
Immediately after the first CLT course (10 days from the start of treatment), no statistically
significant changes of lipid profile were observed. The TG level was even slightly increased to
2.51±0.11 mmol/l (a 17% increase from the initial level), and in some patients a temporary
insignificant increase in blood LDL levels was observed (the average increase in the group
<1%). At the same time, the HDL level increased from 0.99 ± 0.04 to 1.14 ± 0.05 mmol/l (a 15%
increase). Assumingly, these effects were associated with the increased biosynthesis of lipids due
to stimulation of liver metabolism. Accordingly, the calculated parameters, AC and LDL/HDL
ratio, were decreased by 10% and 12%, thus demonstrating a trend to normalization.
The hypolipidemic action of CLT was clearly detected 3 weeks after the end of treatment. All the
controlled parameters were clearly directed to normalization. Thus, TC and TG were reduced by
35% and 21%, respectively, from the initial levels; a 1.4-fold increase of HDL and 1.2-fold
decrease of LDL were observed, thus leading to significant, 3.3-fold and 2-fold, decrease of AC
and LDL/HDL ratio, respectively.
Table 1. Parameters of the blood lipid profile in DM patients (mean ± st. dev., mmol/l)

Time of
observation

Group of
patients

TG
(0.40-1.53)
TC
(3.9-5.2)

LDL
(3.0-4.5)

HDL
(1.5-3.3)
AC
(2.5-3.5)

LDL/HDL
(< 5.0)
Before treatment 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
II (1) 2.14 ±0.10 8.20 ±0.38 7.87 ±0.37 0.99 ±0.04 7.28 ±0.27 7.94 ±0.30
After treatment II (2) 2.51 ±0.11 7.98 ±0.37 7.90 ±0.37 1.14 ±0.05 6.00 ±0.23 6.92 ±0.26
After 3 weeks

II (3) 1.69 ±0.07 5.31 ±0.25 6.63 ±0.31 1.42 ±0.06 2.73 ±0.10 4.66 ±0.18
I 2.10 ±0.12 7.91 ±0.44 7.79 ±0.44 0.92 ±0.05 7.59 ±0.42 8.46 ±0.47

Difference,
число раз

1.3 1.54 1.2 1.4 3.3 2.0
Р (1—2) > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 > 0.05
Р (2—3) > 0.05 < 0.05 > 0.05 > 0.05 < 0.05 < 0.05
After 3 months: Р (1—3) > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 < 0.01
Before treatment II 1.72 ±0.08 5.42 ±0.25 6.21 ±0.29 1.61 ±0.07 2.37 ±0.09 3.85 ±0.18
After 3 weeks II 1.51 ±0.07 5.27 ±0.24 5.42 ±0.25 1.67 ±0.07 2.15 ±0.10 3.24 ±0.15
After 6 months: I 2.12 ±0.12 7.94 ±0.44 7.84 ±0.44 0.90 ±0.05 7.82 ±0.44 8.71 ±0.49
Before treatment II 1.62 ±0.07 6.01 ±0.28 5.82 ±0.27 1.39 ±0.06 3.30 ±0.15 4.18 ±0.19
After 3 weeks II 1.54 ±0.07 5.28 ±0.24 5.70 ±0.26 1.42 ±0.06 2.70 ±0.12 4.00 ±0.18
I 2.12 ±0.12 7.89 ±0.44 7.80 ±0.44 0.91 ±0.05 7.67 ±0.43 8.57 ±0.48
Notes. I — control group (п = 22) — DM patients, who didn’t receive CLT; II — main group (п
= 37) — DM patients, who received CLT. Here and in Table 2: parameters examined after 3 and
6 months did not differ significantly among themselves and were significantly below of the
baseline; the variations of the norm are shown in the round brackets.
The patients’ lipid profile was re-examined 3 months after the first course of treatment. To the
beginning of the second course, TC was at the level achieved after the first course (5.42±0.25
mmol/l), and after re-treatment it has not been significantly changed (5.27 ± 0.24 mmol/l, a 3%
decrease). To the beginning of the third course, 6 months after the first treatment, the TC level
was slightly increased (6.01 ±0.28 mmol/l), but the treatment reduced it again to 5.28 ±0.24
mmol/l, a 36% decrease from the initial level, which was very close to the normal values.

The content of TG in the serum after the first course of treatment was quite stable, 1.72±0.08
mmol/l on average, before the second course. The latter additionally reduced it to 1.51±0.07
mmol/l. After 6 months, the TG level remained practically the same: 1.62±0.07 mmol/l before
treatment, and 1.54±0.07 mmol/l after treatment. Thus, a 28% general TG decrease from the
initial level was achieved, and this parameter reached the upper values of the normal range.
Throughout the entire course of treatment, a gradual decrease of LDL level was observed, and
this effect was most pronounced after the second course of treatment when a minimal absolute
value of 5.42±0.25 mmol/l was achieved. After 6 months, the concentration of LDL was
practically unchanged before and after treatment (5.7-5.8 mmol/l on average). The reasons for
such dynamics remain unclear. Despite the observed improvements (a 27% general TG decrease
from the initial level), the LDL levels reached to the end of treatment still did not come to
normal values.
The HDL level demonstrated clear growth after the first and, in particular, after the second
course of treatment. The latter increased this parameter to 1.61±0.07 mmol/l and thus returned it
to normal values. However, the effect was not stable enough, and 3 weeks after the third
treatment HDL concentration lowered to 1.42±0.06 mmol/l.
Similar dependencies were noted for AC and LDL/HDL parameters: the best results were
achieved 3 weeks after the second treatment, while after the third course, a slight negative
correction was observed. Despite this effect, both parameters came into the range of normal
values as a result of treatment.
Throughout all stages of treatment, the lipid spectrum of blood plasma of patients from the
control group remained unchanged (see Table 1).
The following important clinical results can be emphasized. A statistically significant increase of
the blood HDL level was observed in patients of the main group both in the early catamnesis and
6 months after the start of treatment. A less active dynamics of LDL concentration decrease was
observed, with the signs of a delayed reaction (2-3 months) of the blood lipid composition on the
treatment. The AC parameter has been reduced by a factor of 3.3, and the LDL/HDL ratio
indicating the level of atherogenicity decreased approximately 2 times as a result of CLT course.
Insulin-like action of CLT (in combination with Aevit) allowed us to reduce the average daily
dose of the normal and prolonged insulin forms in patients with DM type 1 from 50 ± 5.6 to 29 ±
3.2 units (p<0.01), i.e. by 42% from the initial dose, to the end of treatment.
It is also important to note that the observed biochemical changes were accompanied by
normalization of general clinical picture. In particular, clear positive dynamics of clinical
symptoms of diabetes, including the diabetic macropathia of lower extremities on a scale of pain-
chill-walking, and conjunctival disorders measured by biomicroscopy indexes, were found
among the patients of the main group.

Table 2. Parameters of glycemia (М ± т)
Time of
observation

Group of
patients

Glucose, mmol/l
DM type 2 DM type 1
Before treatment I 14.43 ±0.86 9.97 ±1.02
II (1) 14.21 ±0.85 10.46 ±1.46
After treatment II (2) 11.27 ±0.67 11.82 ±1.65
After 3 weeks II (3) 6.01 ±0.35 7.45 ±1.04
I 14.32 ±0.86 10.12 ±1.04
Р (1 - 2) > 0.05 > 0.05
Р (2 - 3) < 0.05 < 0.05

Через 3 мес:

P>(1-3) < 0.01 < 0.05
Before treatment II 7.98 ±0.47 6.38 ±0.89
After 3 weeks II 6.03 ±0.36 5.72 ±0.79
After 6 months: I 14.41 ±0.86 10.24 ±1.05
Before treatment II 6.81 ±0.40 5.89 ±0.82
After 3 weeks II 6.02 ±0.36 5.54 ±0.77
I 14.37 ±0.86 10.31 ±1.06

Notes. I – control group (n = 30) – DM patients, who didn’t receive CLT (DM type 1 - 10
patients, DM type 2 - 20 patients); II – main group (п - 37) – DM patients, who received CLT
(DM type 1 - 10 patients, DM type 2 - 27 patients).

The clinical improvements in DM patients (both type 1 and type 2) with diabetic angiopathy of
lower extremities in the main group were noted already after 2-3 daily CLT sessions. The
patients mentioned a feeling of warmth in extremities, as well as decrease or disappearance of
pain and cramping. In patients of the control group during 3 courses of treatment, the clinical
picture was unchanged.
Just after the first treatment course, the levels of glycemia in a fasted state decreased in patients
with DM type 2 from 14.21 ± 0.85 to 11.27 ± 0.67 mmol/l, and 3 weeks later they decreased up
to 6.01 ± 0.35 mmol/l (Table 2). In patients with DM type 1, the average glycemia level in a
fasted state was slightly increased from 10.46 ±1.46 to 11.82 ±1.65 mmol/l immediately after the
treatment, but 3 weeks later it decreased to 7.45 ±1.04 mmol/l. Thus, a pronounced positive
effect on carbohydrate metabolism was achieved, with simultaneous reduction of doses of insulin
and peroral sugar-correcting drugs.

By the end of treatment, mood and sleep improved, and the signs of diabetic encephalopathy and
asthenic syndrome disappeared in all CLT-treated patients. Analysis of ophthalmic parameters
(Table 3) showed improvements in retinal circulation in most of the surveyed patients of the
main group with diabetic retinopathy, which were expressed in normalization of arteriole/venule
ratio, blanching of microaneurysm, decreased plasmorrhagia, resorption of spotted hemorrhages
and retinal edema, and improved trophism of the retina.

Table 3. Dynamics of microcirculation parameters (M± т)

Parameter Group of
patients

Time of observation

baseline 2 weeks 1 month 3 months 6 months
CI 1, scores I 1.29 ±0.09 1.28 ±0.08 1.27 ±0.08 1.28 ±0.08 1.29 ±0.08
II 1.22 ±0.08 1.20 ±0.08 1.19 ±0.08 0.91 ±0.06 0.74 ±0.05

CI 2 , scores
баллы баллы

I 7.81 ±0.52 7.80 ±0.52 7.80 ±0.51 7.82 ±0.51 7.81 ±0.50
II 7.76 ±0.52 7.62 ±0.51 7.28 ±0.49 7.03 ±0.47 6.48 ±0.44

CI 3 , scores
баллы

I 2.98 ±0.20 2.96 ±0.19 2.97 ±0.18 2.98 ±0.16 2.99 ±0.16
II 2.89 ±0.19 2.58 ±0.17 2.04 ±0.14 2.00 ±0.13 2.00 ±0.13

CI G , scores
баллы

I 12.08 ±0.81 11.82 ±0.80 11.87 ±0.79 11.93 ±0.76 12.01 ±0.74
II 11.80 ±0.80 11.40 ±0.77 10.51 ±0.71 9.94 ±0.67 9.22 ±0.62

Notes. 1 – control group (n=17) – DM type 2 patients, who didn’t received CLT; II — main
group (п=17) - DM type 2 patients, who received CLT.
CI 1 , - perivascular changes, CI 2 – vascular changes, CI 3 – intravascular changes, CI G — general
conjunctival index
It was also revealed that the average blood flow increased in the retinal vessels by 35-38%, and
aggregation of erythrocytes was reduced by a factor of 1.3-1.4. In all patients of the control
group, no improvements of retinal blood circulation during the 3 courses of treatment were
detected.
Similar results were obtained by Бурдули Н. М. et al. who studied influence of CLT on the
biochemical parameters of blood in Patients Having Stable Angina Tension with diabetes
mellitus type 2 [3]. The authors note that the traditional drug therapy of patients with stable
angina and diabetes is not accompanied by a significant improvement in the lipid content in the
blood plasma, and, therefore, does not eliminate the effect of one of the risk factors for the
progression of the disease. The picture was quite different in the patients of the main group after
complex treatment with the inclusion of vlok. In this group of patients, all indicators
characterizing the lipid spectrum significantly decreased compared to the baseline. The level of
OHS decreased from 5.61±0.17 mmol/l to 3.96±0.22 mmol/l (p<0.001). The indices of LDL-C
also changed before treatment-3.73 ±0.19 mmol/l, after -2.17 ±0.22 mmol/l (p<0.001); TG
before treatment - 1.93±0.12 mmol/l, after - 1.36±0.05 mmol / l (p<0.001). HDL increased
slightly before treatment-1.0±0.05 mmol/l, after treatment - 1.17±0.05 mmol / l, (p<0.05) and
approached the indicators of healthy. When comparing the coefficient of atherogenicity (KA) to
(4.61±0.25) and after treatment (2.38±0.22 (p<0.001) with the use of vloc, the authors noted that
CA in this group of patients significantly and significantly decreased, which is a significant sign
of normalization of lipid metabolism.
Conclusion
In this paper, we summarized the results of a three-year observation of 59 patients with diabetes
mellitus in an outpatient setting. Among 37 patients receiving a combined laser therapy, a
significant and prolonged effect on the blood lipid composition was observed. Thus, a significant
increase of the blood HDL level, and a decrease of HDL level were achieved. As a result of CLT
course, the atherogenicity coefficient has been reduced by a factor of 3.3, and the LDL/HDL

ratio indicating the level of atherogenicity decreased approximately 2 times. Throughout all
stages of treatment, the lipid spectrum of blood plasma of 22 patients from the untreated group
remained unchanged. The biochemical changes were accompanied by normalization of general
clinical picture. Thus, CLT in combination with Aevit possessed an insulin-like action, which
allowed us to reduce the average daily dose of insulin by 42% to the end of treatment. Clear
positive dynamics of many clinical symptoms of diabetes were found among 37 patients of the
main group, including the diabetic retinopathy, diabetic macropathia of lower extremities,
conjunctival disorders, diabetic encephalopathy, and asthenic syndrome. A pronounced positive
effect on carbohydrate metabolism and the glycemia levels was also achieved, with simultaneous
reduction of doses of insulin and peroral sugar-correcting drugs.
There were no side effects and complications. This is especially important since it is known that
many lipid-lowering drugs give serious side effects [3, 7, 19].
The obtained results can be useful for the development of non-traditional curative therapies for
diabetes mellitus.
References
1. 1. Bobrovnitsky I. p. Methodology of development and implementation of innovative
technologies of rehabilitation medicine. Mate. Forum's. "Health resort 2008"., 2008. P.11.
2. 2. Burduli N. M. Kireeva, E. Y. Changes in the level of homocysteine, lipid profile,
peroxidation of lipids in endothelial function in patients with stable angina under the
influence of laser radiation // Laser medicine. - 2010. - №14 (2). - P. 26-31.
3. Burduli N.M., Gireyeva E.Y. The Dynamics of Changes of Homocysteine Levels, Lipid
Blood Spectrum, Processes of Lipids Peroxide Oxidation with Patients Having Stable Angina
Tension under the Influence of Low-Intensive Laser irradiation
4. 4. Burduli N. M. Kichaeva A. Y. Effect of low intensity laser radiation on some indices of
lipid peroxidation, antioxidant protection and lipid profile of IHD patients with diabetes
mellitus of the 2nd type. // Laser medicine. - 2010. - №14 (3). - P. 23-26.
5. 5. Volkov B. C., Rudenko E. V. state of microcirculation and endothelial dysfunction in
patients with type 2 diabetes mellitus and hypertension // Clinical medicine. 2008. - №3. -
Pp. 41-43.
6. 6. Volotovskaya A. B., Slobozhanina E. I., ulaschik B. C. membrane Cell effects of blood
laser irradiation / / Laser medicine. 2005. Vol. 9, issue. 1.- P. 15-18.Roslyakova JV, Roitman
AP. // Clin. med. - 1999. - № 10. - P. 15-17.
7. Sokolov EI //Diabetes and atherosclerosis. - M., 1996.
8. Ganic A. B., Moskvin C. B., Azizov G. A. Intravenous laser irradiation of blood. M.,
Tver.Triad, 2006. 144 p.
9. Dedov I. I., Shestakova M. V. diabetes and hypertension. A guide for doctors. M.: Universum
Publishing.; 2006.
10. Kovaleva T. V. Therapeutic effect of laser therapy on various types of metabolic
dyslipidemia for primary it secondary prevention of atherosclerosis // Laser .medicine. 2001. No.
1. - S. L 8-22.

11. Korochkin I. M: application of low-energy lasers in the * clinic of internal diseases / /
Russian cardiology" journal. 2001. - №5.-Pp. 85-87.
12. Leontieva N. B. Influence of indirect helium-neon laser irradiation of blood on the vessels of
the microcirculatory bed / / Laser medicine. 2005. Vol. 9, issue.1. Pp. 31 -37.

13. Marsagishvili, L. A. Clinical efficacy of low level laser therapy / Laser medicine. 2004. -
Vol. 8, issue. 4. - P. 45-48.
14. Tsyb A. F. the Possibility of low-intensity infrared laser therapy of atherosclerotic lesions of
the cardiovascular system / A. F. Tsyb, M. A. Kaplan, N. P. Tkachenko, O. E. popovkina //
Vestnik RAMN. -2004.- №12.- P. 45-52.15. Laakso М, Voutilainen E, Sarlund H et al. //
Atherosclerosis. - 1985. - Vol. 56. - P. 271-281.
16. Laakso М, Ronnemaa Т, Pyorala K et al. // Diabetes Care. - 1988. - Vol. 11. - P. 449-463.
17. Laakso М, Sarlund H, Mykkanen L // Arteriosclerosis. - 1990. - Vol. 10. - P. 223-231.
18. Laakso M // Diabetes Rev. - 1995. - Vol. 3. - P. 408-422.
19. Lehto S, Ronnemaa T et al. // Diabetes. - 1997. - Vol. 46. - P. 1354-1359.
20. Pyorala K, Laakso М, Uusitupa М // Diabet. Metab. Rev. - 1987. - Vol. 3. - P. 463-524.
21. Rabkin SW, Boyko E,Streja DA // Am. J. Med. Sci. – 1983. - Vol. 285. - P. 14-18.

6) 

CLINIC-PATHOGENETICAL ASPECTS OF COMBINED LASER
THERAPY OF PATIENTS WITH DIABETES MELLITUS AS
COMPARED WITH PHARMACOLOGIC THERAPY
Kovaleva T., Kovaleva E., Bayramalibeyly I, Salimov E., Ragimov A.

Abstract

Sorbitol accumulation in vascular wall and irreversible glycosylation result in
hemorheologic failure, endothelium function disorders, and disorder of vascular wall
morphology. In this connection, the use of aldosoreductase is one of the update directions in
the treatment of diabetic angioneuropathies. It has been observed that introduction of insulin
may lead to hyperglycemia and overdosing does not normalize the carbohydrate metabolism.
Epidemiologic and experimental researches showed that hyperinsulinemia is a strong risk
factor for the development of atherosclerosis.
The use of combined laser therapy (CLT) in the treatment of patients with diabetes
mellitus (DM) is a method of choice, which allows to lower the pharmacologic dependence
or, even, to avoid the numerous drugs intake. According to our long-term observations, the
use of CLT allows to decrease the doses of sugar-correcting medications in patients with DM
type I and DM type II by 1,5−2 times, in the result of the first course of treatment already.
The application of CLT in patients with diabetic angiopathies of the lower limbs vessels
corrects the disorders of macro- and microdynamics, hemorheology and immunity. The
course treatment of such patients (in 3 and 6 months) allows to preserve the stable
compensation of DM and, to stop the progress of diabetic angiopathies.
Thus, the wide application of CLT in medical practice gives the real possibility to
reduce the death rates of patients with DM of cardio-vascular diseases, ischemic heart disease,
severe renal pathologies, gangrene and other complications of DM. It also improves the
quality of life and capacity for work.

Currently life and work capacity of patients suffering from diabetes mellitus (DM), depend on
the presence and severity of diabetic angiopathy (DA). This is confirmed by the fact that the
death rate of cardiovascular disease among diabetes patients is 12 times higher than among
people of the same age without diabetes. More than 50% of patients die of coronary heart
disease, 50% of the patients, ill since childhood and adolescence die of heavy damage of
kidneys , about 1/3 of chronically ill lose vision; gangrene in the case of diabetes develops 50
times more often than in the general population [ 8, 5, 25, 45]. It is hardly complete list of the
serious consequences of diabetes, which speaks of insufficient effectiveness of diabetic
angiopathy treatment.
Long-term study of diabetes and diabetic angiopathies allows us to consider diabetes as
metabolic and vascular abnormalities, whereas DA is as a manifestation, an integral part of
the disease process, but not "late diabetic syndrome". Clinical manifestations of DA are
diagnosed in 45−100% of patients, including those in the case of metabolic syndrome, while
20−67% of patients are diagnosed with complaints typical for decompensation of
carbohydrate metabolism. This interpretation of DA dictates tactics of medicamentous and
other correction therapies, having preventive and complex character. Combined therapy of
vascular disorders is determined by their pathogenesis and development stage. In various
periods of MD and DA some mechanisms of the diseases remain constant, whereas other ones
lose their relevance or, vice versa, progress. This requires a correction of the therapeutic
approaches. Steady compensation of the disease is a basis for treatment and prevention of DA.
This implies the normalization not only of glycemia, but also of other types of metabolism
[35, 44, 48]. However, a good metabolic control is not always prevents the development of
diabetic nephropathy and retinopathy [33, 41], and sometimes a normalization of glucose
even contributes to their progression [34], which may be due to hyperinsulinemia.
Hyperglycemia is closely connected with the leading damaging factors such as sorbitol bypass
activation of glucose metabolism and glycosylation of protein and components of blood and
vessel walls [28, 40, 43]. Main processes, developing in patients and the underlying
pathogenesis of microangiopathy are protein glycosylation, impairment of cell functions in
insulin-independent tissues, changes in the rheological properties of blood and
hemodynamics. In the 70s of the last century, it was found that the content of glycated
hemoglobin in patients with decompensated diabetes increases compared to healthy subjects.
Glucose reacts with the N-terminal amino group of the B-chain of hemoglobin A molecule by
non-enzymatic process to form ketoamin. This complex is in the red blood cells for 2−3

months (the period of the life of a red blood cell) in the form of small hemoglobin fractions
Alc or Alabc. Currently, possibility of glucose addition to A-chain of hemoglobin molecule to
form ketoamine is proved [29]. A similar process of increased incorporation of glucose into
the blood serum proteins (with fructosamine production), cell membranes, low-density
lipoproteins, [49] and peripheral nerve proteins, collagen, elastin, eye lens is discovered in the
majority of diabetic patients and experimental diabetic animals. Changes of the basal
membrane proteins, increased content of these proteins in endothelial cells, aortal collagen
and basal membrane of renal glomeruli, can not only disrupt the function of cells, but also
promote the production of antibodies against the changed proteins of the vessel wall (immune
complexes), which may participate in the pathogenesis of diabetic microangiopathy [20, 26,
29]. A result of sorbitol accumulation in the vessel wall and irreversible glycozilation is a
violation of hemorheology, endothelial function and morphology of the vessel wall.
In this regard, one of the modern trends in the treatment of diabetic angioneuropathies is the
use of the blockers of sorbitol metabolism enzymes, in particular aldose reductase [30, 38]. At
present, it is believed that insulin demand of patients with diabetes is equal to 0.5−0.7 IU per
1 kg of body weight in the stable course of the disease [4, 22]. However, in some cases, the
doses used for treatment are higher than those that lead to the labile course of the disease.
This state is defined as a chronic overdosage of insulin. It has long been found that insulin
introduction can cause hyperglycemia and that therapy with large doses of insulin does not
lead to the normalization of carbohydrate metabolism [36, 38]. Epidemiological and
experimental studies have shown that hyperinsulinemia is an important factor in the
development of atherosclerosis [15, 17, 46].
For 20 years, the author used the method of combined laser therapy (CLT) in patients with
diabetes type I and type II, using the serial treatment courses (1−2 times per year). CLT
method involves 2 types of laser treatment at the same time: 1st is a treatment of patient with
intravascular red laser (wavelength is 0.63 μm) exposure (continuous exposure mode) to the
blood (ILBI) by introducing a disposable sterile optical fiber with a needle (KIVL-01) and the
2nd method is a treatment with infrared irradiation in pulsed mode transcutaneously on the
projection of target organs. We used laser therapeutic semiconductor equipment "Mulat" and
"Mustang-2000", produced by SPLC "Tekhnika". The treatment was carried out daily for
8−10 days using ILBI with the parameters: power at the end of the optical fiber was equal to 2
mW, exposure was from 30 to 15 minutes. Simultaneously pulse laser therapy on Zakharyin-
Ged zones was carried out − cutaneous effects of low-intensity near-infrared laser (LLLT)

with wavelength of 0.89 μm, power was from 5 to 20 mW. When assigning а therapy, we
took into account the general condition of the patient, the specificity of the pathological
process and its clinical manifestations, stage and phase of the disease, sex, age, professional
characteristics of the patient. Choice of the pulse repetition rate depended on the degree of
damage. Exposure was carried out on the zones: gastrocnemius muscle (dose was 4.5 J,
frequency was 80 Hz, exposure was 4 min), the projections of the liver, pancreas, spleen (4
minutes per zone at a frequency of 150 Hz). CLT was combined with Aevitum administration
in a dose of 600 mg per day in order to prevent the phenomenon of relapse [13, 18].
When using the combined laser therapy (CLT), there is a normalization of glycemic level
because of reducing the insulin dose by 1.5−2 times [14]; that replaces the use of the blockers
of sorbitol metabolism enzymes. According to the study, parameters of lipid metabolism in
DM patients depended on insulin dose. The excess of the produced hormone not only led to
the atherogenic changes in the lipid composition of the blood, but also aggravated them in
patients with DM and coronary artery disease [19, 20, 23, 27, 29, 30, 32, 50, 52]. It was found
[11], that changes in serum proteins, increased levels of lipids, low-density lipoprotein (LDL),
total cholesterol (TC) and triglyceride (TG) affect rheological properties of blood and
promotes platelet aggregation. A common approach to the integrated treatment of diabetic
patients with various forms and stages of angiopathy is an administration of drugs that
regulate lipid metabolism. Elevated blood levels of low-density lipoprotein (LDL) and very
low-density lipoprotein (VLDL) has a damaging effect on the endothelium; the activation of
lipid peroxidation (LPO), which is characteristic for DM, promotes vasoconstriction,
disruption of cell membranes and hypercoagulation [27, 42, 50, 52]. Pharmacological therapy
is based on the use of hypolipidemic agents and lipotropic (clofibrate, nicotinic acid
preparations, lipamid et al.), which reduce the blood viscosity and improving
microcirculation. However, one of the well-described side effects of said treatment is a
mitogenic effect of clofibrate. Research carried out under the auspices of WHO [31] and the
Coronary Drug Project Research Group [47] showed that the widespread use of the drug has
led to the increasing of incidence rate of cholelithiasis by 2 times. According to WHO
investigations, in some European countries, mortality non-associated with vascular disease
increased for this reason, reflecting an increase of death-caused cholecystectomy [22].
CLT allows to discontinue or significantly reduce doses of the hypolipidemic and lipotropic
agents, because the investigations carried out in the process of ILBI therapy have
demonstrated a prolonged effect of low-intensity laser therapy (LLLT) on the lipid

metabolism changes of pathogenetic importance: a reliable increase in the level of the blood
high-density lipoproteins (HDL) and decrease in LDL concentration in the nearest catamnesis,
which persists up to 6−8 months [3, 5, 6, 14, 26]. In our studies, there were a significant
decrease in the levels of total cholesterol, LDL cholesterol (LDL-C) and triglycerides (TG) up
to the norm or its upper limits with an increase in HDL cholesterol, along with decreasing the
blood sugar in the process of the serial (2−3 times per year) use of CLT in the patients with
DM [14, 15]. Other authors have shown hypolipidemic effect of CLT in patients with
coronary heart disease, resistant to lipid-lowering therapy [26].
It is known that high doses of insulin therapy usually results in hypoglycemia. Hypoglycemia
is a stress syndrome, mobilizing sympathetic-adrenal system towards the release of a large
number of hormones, primarily adrenaline, into the blood. It is proved that an excess of
adrenaline causes, on the one hand, intensification of lipid peroxidation and, on the other
hand, can suppress the oxidation enzymes [18]. Thus, the exogenous hyperinsulinemia leads
to stress syndrome, thereby activating the processes of lipid peroxidation. This is manifested
in the reduction of antioxidant activity in DM patients with the syndrome of insulin overdose.
Reduction of the anti-oxidative defense can result in accumulation of lipid peroxidation
products [24]. It has been shown in clinical and experimental studies that over-activation of
peroxidation processes plays an important, and sometimes crucial, role in the development of
a number of diseases, especially those, which have predominant local hypoxia followed
reoxigenation of tissue regions in their pathogenesis. Toxic peroxides, formed in the processes
of LPO activation, impair the normal course of oxidative phosphorylation and energy
production in the cells; induce the damages of microcirculation system; that results in the
irreversible structural changes in organs. In these circumstances, as a rule, permeability of the
cytoplasmic and lysosomal membranes rises and the activity of membrane enzymes
dramatically increases, and as a result, a cytolysis occurs in the individual tissue locuses [35,
39, 40, 41, 44].
A number of practical aspects of the LLLT application is associated with its sufficient
effectiveness in the cases of hypoxic conditions, especially in terms of normalization of tissue
antioxidant status and stabilization of membrane component in the interstitial compartment of
the microcirculatory system [3, 5, 6, 7, 9,10 12, 26].
As a result of the ILBI treatment, the cell membrane stability towards lipid peroxidation
products rises both by increasing the superoxide dismutase activity (an enzyme which inhibits

lipid peroxidation) and by increasing the stability of the enzyme complex, that provides
oxidative phosphorylation, as well as due to accumulation of phosphate bond energy [3, 9,
12]. The studies have shown that an increase in the activity of antioxidant defense enzymes
after a course of intravenous laser therapy was found in the patients with coronary heart
disease with concomitant DM type 2. There is a decrease in the level of lipid peroxidation
products under influence of ILBI; that reduces the manifestations of oxidative stress in
patients with coronary heart disease with concomitant diabetes type II [3, 5, 6, 7, 26].
It is known that a monochromatic red light, having low intensity, activates the antioxidant
defenses of the organism in the case of ILBI use, but the process is biphasic and thiosulfate
system often exhausts after activation. To prevent this phenomenon the use of a natural
antioxidant vitamin E (AE-VIT) or mexidol is recommended [13, 18, 21].
Some studies have shown that before introduction of the intravenous laser blood irradiation
(ILBI) treatment into therapeutic measures, malondialdehyde (MDA) and xanthine oxidase
(XO) levels in patients with type 2 DM were drastically increased (by 3−4 times), and the
antioxidant defense (AD) index was reduced by 2−3 times as compared with the normal level.
Against the background of the carried out therapy MDA gradually reduced and by the end of
ILBI treatment MDA was higher than normal levels by 1.6−1.8 times, being reaching normal
level to the 14th day. MDA level in the patients treated mexidol became normal by the end of
ILBI therapy. In the study of XO the same trend was observed. In parallel, there was an
increase of peroxidase and catalase, indicating an enhancement of antioxidant defense [3, 6,
22].
Hypercoagulable syndrome and development of microtrombosis are pathognomonic for DA
[21, 24, 29, 32]. Increased aggregation activity of platelets, tendency to sludging of the red
blood cells in combination with reduced anticoagulant and fibrinolytic activity of blood
necessitate an extensive use of reocorrectors (hemodez, rheopolyglucinum) in combination
with anticoagulants and antiplatelet agents (heparin, dipyridamole), and drugs, that reduce an
aggregation potential of the blood cells (heparin, trental, doxium, dipiridamol, ibustrin) [9].
In the groups of patients treated with ILBI, platelet aggregation rates decreased by 5−7 days
towards the normal range than in the control group of patients, who was not exposed to laser
irradiation; and the parameters such as deformation properties of erythrocytes and blood
viscosity in the control group patients could not be corrected by conventional treatment at all,

whereas in patients undergoing laser treatment these parameters became normal after the 3rd
session of treatment [3, 10, 21, 26].
We has found more significant normalizing effect of the carried out laser therapy on
transcapillary exchange and redox processes compared to traditional means of treatment.
Under the influence of laser irradiation the histohematic permeability and colloid osmotic
pressure recovered after 3 sessions, while in the patients of control group only at the end of
treatment. Positive changes of redox processes after carried out laser therapy were found after
3 sessions of treatment, while in the patients of control group a significant positive dynamics
was not observed throughout the course of treatment.
A large number of works are devoted to the study of the effect of low-intensity laser therapy
(LLLT) on the blood coagulation system. It is noted that upon irradiation of donor blood in
vitro a decrease of coagulation and slowing of the clot formation are observed, that are
associated with the inhibition of the thromboplastin activation (I phase of coagulation) and
delay of transformation of prothrombin to thrombin (II phase) in absence of substantial effect
on the fibrin production (III phase). A decrease in the functional activity of platelets,
expressed in the decreasing of their adhesion, aggregative ability and limitation of release
reaction have been found. It was shown that intravenous administration of the irradiated He-
Ne laser blood cells result in hematopoiesis stimulation, enhancing the reactions of cellular
and humoral immunity. As a result, there are activation of kallikrein production and
fibrinolysis, and thereby hypocoagulation shift in the coagulation cascade of hemostasis
occurs. There is also a clear disaggregating effect and normalization of the non-specific
immune defense [12].
Changes of prostaglandins in particular, the vasoactive forms of prostacyclin and
thromboxane play an essential role in the pathogenesis of diabetic coagulopathic syndrome
[32]. Thromboxane level increases along with progression of DA, especially, diabetic
nephropathy. In the case of expressed stages of nephropathy associated with hypertensive
syndrome there is a tendency to a decrease in the ratio of prostacyclin/thromboxane.
Correction of the impairments is carried out by activating the synthesis of prostacyclin
(tocopherol, dipyridamole), reducing the synthesis of thromboxane (indomethacin,
acetylsalycilic acid). Tissue hypoxia is a characteristic pathophysiological factor of DM, that
resulting in widespread use the drugs, which improve the tissue oxygenation (solcoseryl,
aktovegin) at all stages and localizations of DA [8, 20, 21, 22, 23, 24, 28, 29, 30, 31, 33].

Numerous studies have shown that already in the beginning of laser treatment by LLLT
methods a vascular system responds to changes in blood flow state. The most significant
reaction is a physiological vasodilation of both large and small arterial and venous vessels [8,
9, 10, 12, 15, 16, 18]. For example, in the kidneys the small vessels demonstrate more
pronounced reaction at low doses (4−5 J), while in 70% of cases there is a rapid elimination
of the contrast substance from the large blood vessels; that is confirmed by the lack of their
contrast pattern at the X-ray picture. Microangiograms show an intensive functioning of the
kidneys. In the liver, with identical doses of LLLT, vascular anastomoses are revealed so fast
that some portal vessels turn out to be excluded from the flow and do not show the contrast
pattern at the X-ray picture [10, 12]. There were no changes in the patients of the control
groups, who received medicamentous therapy without the use of laser therapy, either in the
diameter of the arteries, or in cross-sectional area, or in respect of thickness of vessel wall as
in the patients with I type so in patients with type II diabetes [10, 12, 15, 17, 18].
Complex of conservative measures for correction macrohemodynamics changes,
hemorheology and microcirculation, which is available at present, does not always lead to
good results. It was found that conventional medical treatment significantly affects only the
secondary components of the hemostatic system. Whereas the effectiveness of the
pharmacological exposure under the necessity of complex correction of existing impairments
of the platelet component of hemostasis, hemorheology, hystohematic permeability and redox
processes remains insufficient. As a result, the complete restoration of the microcirculation in
the affected organ with the help of medication is almost an impossible problem.
Convalescence itself depends on the state of homeostasis and regulating system of the
concrete patient. These parameters are usually impaired in the case of the disease. Therefore,
the possibility of the effect of laser treatment on the microcirculation system in the lesion
focus gives the doctor a unique tool to improve the effectiveness of treatment and
rehabilitation of patients [8, 9, 10, 11, 12, 15, 17, 18, 43]. So, it was found [23, 43], that the
effect of the laser is manifested in the dilatation of internal permeable part of the vessel and
blood flow acceleration. Most sensitive to the laser exposure compartments of the arterial
system of the lower extremities were proximal parts of superficial femoral arteries and the
deep femoral arteries. The most increasing of the cross-sectional area of vessel was noted just
in these compartments (it was by 11.1% greater in patients with the type I and by 17.3%
greater in the patients with type II than in the case of complex treatment without the use of
laser). These compartments are characterized by the greatest acceleration of blood flow a

compared with those in the group of patients treated by conventional methods (24.8% for
patients with type I and 41.6% for patients with type II, respectively).
The data [1, 2, 3, 4, 7, 19, 20] about the important role of immune status changes in the
formation and progression of DA has been received. This is the data about disorders of
quantitative ratios of T and B lymphocytes and their mutual interactions, the accumulation of
circulating immune complexes, reduction of the total complement activity. So, DM is
characterized by a decrease of absolutely and relative number of T-lymphocytes, reducing
their functional activity, disorders of the immune regulatory index and, as a result, the
pathology of cellular and humoral immunity. In addition to endogenous factors, insulin
administered for therapeutic purposes may participate in damages of vessels, in particular, by
activating the helper function of T lymphocytes with subsequent synthesis anti-insulin
antibodies and the formation of immune complexes. These circumstances require curative
measures aimed at reduction of the autoimmune reactions and activation of the phagocytic
system, which is responsible for removal of immune complexes from the circulation (the use
of levamisole, T-activin, activators of phagocytosis, retinol, prodigiozan).
Application of CLT allows to avoid the use of the drugs, mentioned above, since it is known
that under the exposure of low-energy red (wavelength 0.63 μm) and infrared (wavelength
0.89−1.3 μm) laser the changes occur in the body. These changes can be realized at all
organization levels of living matter (subcellular, cellular, tissue, organ, system and organism
levels) [3, 4, 20]. Positive immune-modulation effect of the laser irradiation is manifested not
only under the direct, local or intravenous exposure, but also under the irradiation of the
thymus area, the biologically active points and Zakharyin-Ged zones, corresponding to the
damaged organs. Under exposure of the laser exposure there is an increase in the number of
mature T-lymphocytes against the background of decreased reserve of immature T-
lymphocytes; as well as the increasing of the functional activity of T-lymphocytes, as
indicated by the level of proliferation and differentiation of immune-competent cells [12].
Emerging neuro-reflectory and neurohumoral responses together with activation
sympathoadrenal and immune systems, and an increase of the concentration of adaptive
hormones are reflected in the multiform complex of adaptive and compensatory reactions,
aimed at the restoration of the disordered homeostasis.
The main action mechanism of low-energy laser irradiation of biological tissue in the laser
therapy (LT) of a wide range of major diseases is a foto-acception of light quantum by the

photoreceptors of intradermal macrophages (Langerhans cells). The absorbed energy of the
quanta is converted into photochemical processes in the form of conformational changes of
protein structure, ionic changes, production of neuro-peptides and hormones, etc. Local
increase in temperature of the cell membranes causes to the temperature gradient in the
juxtamembrane spaces. It causes the thermodiffusion outflow of Na + and K + ions from the
membrane with the opening of protein channels and the activation of ion transport and
cellular mediators, mainly, histamine and serotonin. The result of this is a signal (trigger)
activation of the microcirculation in the papillary dermis, which then becomes generalized.
The activation mechanism of regional microcirculatory processes involves the increase in the
number of actively functioning capillaries that were previously in the standby state. Reaction
of microvasculature is biphasic. During the first 2−3 sessions of LT only the arterial part of
the microvasculature actively functions, while venous and lymphatic parts of microcirculation
are involved at the subsequent sessions of LT [10, 16].
The mechanism of the so-called acute clinical manifestations of the disease becomes clear
after the first LT sessions, since activation of arterial part of microvasculature leads to an
increase of exudative processes with the development of perivascular edema and irritation of
neuro-receptor apparatus; that clinically manifested as "aggravation" of disease. Activation of
the venous and lymphatic drainages at the subsequent sessions of percutaneous LT leads to
the resolution of the manifestations described above.
At the same time, there is the activation of the cellular elements of the mononuclear
phagocyte system (histiocytes of loose connective tissue) that stimulate angiogenesis, the
processes of cell proliferation and collagen synthesis; that serves as a manifestation of the
onset of proliferative phase of inflammatory reaction as the final stage of the reparative
process. The increase in synthetic activity of cellular elements of the system of mononuclear
phagocytes as an important component of the immune system leads to the activation of the
first six components of the complement, T and B-cell immunity, the increasing of
phosphoinositides in blood and tissues, which play an important role in the regulation of
proliferative and synthetic processes in the cells of various tissues. Thus, the study of
immunological parameters in DM patients with critical ischemia of the lower limbs in the
process of the complex treatment, using a combined laser therapy, have shown that the
introduction of laser therapy into the complex treatment of the patients has the active and

positive effect on phagocytic immunity and phenotype characteristics of lymphocytes,
reducing eventually the degree of immune disorders [1, 2, 4, 7, 18].
Therapy of diabetic cerebral angiopathy includes nootropics (piracetam, nootropics),
stimulating redox processes (enhancing the glucose utilization, improving the regional blood
flow in ischemic areas of the brain), as well as antispasmodics, selectively improving the
cerebral circulation (cinnarizine, stugeron, cavinton). Currently, vaso-active drug Sermion
(nicergoline) having alpha-adrenolytic and metabolism-activating effect is successfully used
as a cerebral angioprotector [15, 36, 38, 41, 42]. Meanwhile, many studies of CLT application
in the treatment of neurological diseases and in psycho-endocrinological practice, including in
DM patients, as well as our long-term observations of these groups of patients have shown the
groundlessness of additional application of nootropic drugs, so CLT itself was a highly
effective treatment [9, 11, 13, 14,15, 18].
In view of the foregoing, we conclude that CLT in patients with DM is pathognomonic, as the
treatment of choice, which allows to reduce pharmacological dependence in the patients or
avoid a multi-drug administration in connection with a variety of pathological changes in
patients with DM. According to our long-term observations, as a result of CLT it is possible
to decrease by 1.5−2 times a dosage of sugar-correcting drugs in patients with DM type I and
type II already in the result of the first course of treatment. Disordes of the macro- and
microdynamics, hemorheology and immunity in patients with DA of the vessels of the lower
extremities can be corrected. Treatment of these patients by the cycles (after 3 and 6 months)
allows to keep a stable compensation of DM, thereby to suppress the progression of DA. This
means that the widespread use of CLT in the practice give a real opportunity to reduce death
rates in patients with DM of cardiovascular diseases, coronary heart disease, severe renal
lesions, gangrene and other serious complications of DM, and to improve their the quality of
life and capacity for work.
Literature
1. Александрова О.Ю. Клинические и медико-организационные аспекты лазерной
иммунокоррекции больных с патологией иммунной системы. Автореф. дис….д-
ра мед. наук. М., 2001. 39 с.

2. Алексеев Н.В., Левенец А.Я., Лоскутов А.В. Влияние низкоинтенсивного
лазерного излучения на состояние иммунологической активности больных
сахарным диабетом // Мат. Всесоюз. Симп. Обнинск, 1991. С. 5-7.
3. Бабушкина Г.В. Клинико-патогенетические аспекты терапевтической
эффективности низкоэнегретического лазерного излучения у больных
различными формами стенокардии / I Интернациональный Конгресс “Лазер и
здоровье’97”: Тез. докл.- М.,1997.- С.78-80.
4. Бобровницкий И.П. Методология разработки и внедрения в практику
инновационных технологий восстановительной медицины. Мат. Форума.
«Здравница 2008»., 2008. С. 11.
5. Бурдули Н.М., Гиреева Е.Ю. Изменения уровня гомоцистеина, липидного
спектра крови, процессов перекисного окисления липидов в эндотелиальной
функции у больных стабильной стенокардией напряжения под влиянием
низкоинтенсивного лазерного излучения // Лазерная медицина. – 2010. - №14 (2).
– С. 26-31.
6. Бурдули Н.М., Кехоева А.Ю. Влияние низкоинтенсивного лазерного излучения
на некоторые показатели перекисного окисления липидов, антиоксидантной
защиты и липидный спектр крови больных ИБС с сопутствующим сахарным
диабетом 2-го типа. // Лазерная медицина. – 2010. - №14 (3). – С. 23-26.
7. Елисеенко В.И., Бускин В.Д., Балюх Н.В. Низкоэнергетические лазеры в
механизме стимуляции неспецифического иммунитета / IV Межд. Конгресс
“Проблемы лазерной медицины”: Мат.- М.,1997.- С.251.
8. Ефимов А.С., Карабун П.М., Скробонская Н.А. и др. Некоторые аспекты
патогенетической терапии диабетических ангиопатий // Клин. мед.- 1994.- №1.-
С.20-23.
9. Гейниц А.В., Москвин С.В. Ачилов А.А. Внутривенное лазерное облучение
крови. М.: Изд-во «Триада», 2008. 144с.
10. Жуков Б.Н., Лысов Н.А., Панфилов К.А. Применение низкоинтенсивного
лазерного излучения при лечении больных с диабетическими ангиопатиями
нижних конечностей / I Поволжская научно-практическая конференция “Лазеры
в медицине и экологии”: Материалы.-Самара, 1998.-С.94-95.

11. Ицкович А.И., Шапкина Л.А., Колодочка Т.И., Вербицкая Н.Н./ IV Межд.
Конгресс “Проблемы лазерной медицины”: Мат..- М.,1997.- С.178.
12. Каплан М.А., Степанов В.А., Воронина О.Ю. Физико-химические основы
действия лазерного излучения в ближайшей ИК-области на биоткани //
Взаимодействие высоко- и низкоэнергетического лазерного излучения с
биотканями.- М., 1989.- С.85-86.
13. Капустина Г.М. Лечение различных форм ишемической болезни сердца
излучением гелий-неонового лазера // автореферат диссертации д-ра мед. наук в
форуме научного доклада. – М., 1990. – 42 с.
14. Картелишев А.В., Игельник М.В., Вернекина Н.С., Марченко Л.Ф., Суслов Л.С.
Возможности низкоинтенсивной магнитолазерной терапии в сомато-, нейро- и
психоэндокринологической практике у детей и взрослых / IV Межд. Конгресс
“Проблемы лазерной медицины”: Материалы.- М., 1997.- С.186.
15. Ковалева Т.В. Лечебное воздействие лазерной терапии на различные типы
метаболических дислипидемий с целью первичной и вторичной профилактики
атеросклероза // Лазерная медицина. 2001. - №5 (1). – С. 18-22.
16. Ковалева Т.В. Динамика гиперлипидемии и периферического кровотока у
больных сахарным диабетом при лечении методом комбинированной лазерной
терапии в амбулаторно-поликлинических условиях / Т.В. Ковалева, А.В.
Фарваева, Л.Т. Пименов, С.М. Денисов // 2-й Международный конгресс “Лазер и
здоровье-99”: Мат. - М., 1999. - С. 313.
17. Козлов В.И., Буйлин В.А., Самойлов Н.Г., Марков И.И. Основы лазерной физио-
и рефлексотерапии / Под ред. О.К. Скобелкина. – Самара – Киев: Здоровье, 1993.
– 216 с.
18. Корочкин И.М., Бабенко Е.В. Механизм терапевтической эффективности
излучения гелий-неонового лазера // Сов. мед. – 1988. - №3 – С. 38.
19. Кривихин В.Т., Подымова Н.Г., Доценко Н.М. и др. Биохимический мониторинг
больных сахарным диабетом II типа с гнойно-некротическими поражениями
стоп при применении лазерной терапии и мексидола / IV Международный
Конгресс “Проблемы лазерной медицины”: Материалы.- М.,1997.- С.271.

20. Косаев Д.В., Ахмедова Л.М., Гаджиева Г.К. Мониторинг иммунологических
показателей у больных с критической ишемией нижних конечностей при
комплексном лечении с применением лазеротерапии.// // Лазерная медицина.
2010. - №14 (1). – С. 4-7.
21. Мазовецкий А.Г., Сунцов Ю.И., Герасимова Е.Н. и др.// Сов.мед.-1983.-№1.-С.7-
11.
22. Маньковский Б.Н., Потыкевич В.А.// Эндокринология.-Киев, 1990.-Вып.20.-
С.12-15.
23. Руководство по клинической эндокринологии / Под ред.проф. Н.Т.Старковой.-
СПб.: Питер, 1996.- 544 с.
24. Толстых П.И., Баженова Г.Е., Лебедьков Е.В., Толстых Г.П. Влияние
внутривенного лазерного облучения крови на перекисное окисление липидов у
больных сахарным диабетом / I Интернациональный Конгресс “Лазер и
здоровье’97”: Тез.докл. - М., 1997.-С.308.
25. Туев А.В., Смирнова Е.Н. Влияние сахароснижающей терапии на атерогенез у
больных сахарным диабетом // Клин. мед.-1992.-№1.-С.57-59.
26. Усмонзода Д.У., Ачилов А.А., Лебедева О.Д., Тошматов Д.Х., Ачилова Ш.А.,
Котов С.А, Саженина Е.И. Применение лазерной терапии при нарушениях
липидного обмена, рефрактерных к гиполипидемической терапии, при
ишемической болезни сердца // Лазерная медицина. – 2011. - №15 (1). – С. 25-28.
27. Alessandrini P., McRae J., Feman S., FitzGerald G.A. Thromboxane biosinthesis and
platelet function in Type I diabetes mellitus // N. Engl. J. Med. -1988. Vol.319. P.208-
212.
28. Andersen A.R., Sandahl H., Christiansen J. Diabetic nephropathy in type 1 (insulin-
dependent) diabetes: An epidemiological st. // Diabetologia.-1983.-Vol.25, №6.-
P.496-501.
29. Bassiouny A.R., Rosenberg H., McDonald T.L. Glycosylated collagen in antigenic //
Diabetes.- 1983.- Vol.32.- P.1182-1184.
30. Borch-Jehnsen K., Andersen P.K., Deckert T. The effect of proteinuria on relative
mortality in type I (insulin-dependent) diabetes mellitus // Diabetologia. 1985. Vol.28.
P. 590-596.

31. Brownlee M., Cerami A., Vlassara H. Advanced Glycosylation End Products in Tissue
and the Biochemical Basis of Diabetic Complication // New Engl.J.Med.-1988.-
Vol.318, №20.-P.1315-1321.
32. Bunn H.F. Nonenzymatic glycosylation of protein: relavance to diabetes //
Amer.J.Med.- 1981.- Vol.70.- P.325-330.
33. Carmassi F., Morale M., Puccetti R. et al. Coagulation and fibrinolytic system
impairment in insulin dependent diabetes mellitus // Thromb. Res. 1992. Vol.67.
P.643-654.
34. Collier A., Tymkewycz P., Armstrong R. . Increased platelet thromboxane receptor
sensitivity in diabetic patients with proliferative retinopathy // Diabetologia.-1986.-
Vol.29, №8.-P.471-474.
35. Craven P.A., DeRubertis F.R., Kagan V.E. et al. Effects of supplementation with
vitamin С or E on albuminuria, glomerular TGF-beta, and glomerular size in diabetes.
// J. Am. Soc. Nephrol. 1997. -V. 8, № 9. - P. 1405-1414.
36. Feldt-Rasmussen B.O., Mathiesen E.R., Deckert T. Effect of Intensive Therapy on
Early Macrovascular Disease in Young Individuals With Type 1 Diabetes // Diabete
Metab.-1988.-Vol.14, №2.-P.226-227.
37. Paris J., Vagn Nielsen H., Henriksen O., Parving H.-H. et al. Impaired autoregulation
of blood flow in sceletal muscle and subcutaneous tissue in long-term type I (insulin-
dependent) diabetic patients with microangiopathy // Diabetologia. 1983. Vol.25.
P.486-488.
38. Greene D. Screening for Type 1 and Type 2 Diabetes // Metabolism.-1988.-Vol.37,
№2.-Suppl.1-P.25-29.
39. Genes W.S. Cybernetic analysis of regulatory mechanisms of metabolism in the
etiology, pathogenesis and treatment of diabetes mellitus (DM) // Constituent Cong.
Int. Soc. For Pathophysiol., Moscow, May 28 June 1, 1991: Abstr. -Kuopio, 1991.-P.
209.
40. Inoguchi Т., Xia P., Kunisaki M., Higashi S. et al. Insulin's effect on protein kinase С
and diacyiglycerol induced by diabetes and glucose in vascular tissues // Am. J.
Physiol. 1994. Vol.267. P.E369-E379.

41. Jaspan J., Towle V., Maselli R., Herold R. Basal metabolic rate // Metabolism.-1986.-
Vol.35, Suppl.1.-P.83-92.
42. Jain S.K. Should high-dose vitamin E supplementation be recommended to diabetic
patients? // Diabetes Care. 1999. - V. 22, № 8. - P. 1242-1244.
43. Kaviani A, Djavid GE, Ataie-Fashtami L, Fateh M, Ghodsi M, Salami M, Zand N,
Kashef N, Larijani B. A randomized clinical trial on the effect of low-level laser
therapy on chronic diabetic foot wound healing: a preliminary report // Photomedicine
and laser surgery - 2011 Feb.-Vol.29,.-P.109-14.
44. Levy J., Gavin J.R.III., Sowers J.R. Diabetes mellitus: a disease of abnormal cellular
calcium metabolism // Am. J. Med. 1994. Vol.96. P.260-273.
45. Monnier VM, Bautista O, Kenny D. et al. Skin collagen glycation, glycoxidation,
and crosslinking are lower in subjects with long-term intensive versus conventionel
therapy of type 1 diabetes: relevance of glycated collagen products versus HbA1c as
markers of diabetic complications. Diabetes. 1999;48870- 880 N Engl J Med.
1993;329977- 986
46. Mustard J.F., Packham M.A. Platelets and diabetes mellitus // N. Engl. J. Med. 1984.
Vol.311. P665-667.
47. Rubinstein A., Pierce C.E. Rapid healing of diabetic foot ulcers with meticulous blood
glucose control. // Acta diabetol.lat.-1988.-Vol.25, №1.-P.25-32.
48. Singh BM, Palma MA, Nattrass M. Multiple aspects of insulin resistance. Comparison
of glucose and intermediary metabolite response to incremental insulin infusion in
IDDM subjects of short and long duration. //Bailliere’s clin.Endocr.Metab.-1988.-
Vol.2, №2.-P.342-358
49. Sowers J.R., Sowers P.S., Peuler J.D. Role of insulin resistance and hyperinsulinemia
in development of hypertension and atherosclerosis // J. Lab. Clin. Med. 1994. Vol.23.
P.647-652.
50. Testamariam B., Brown M.L., Cohen R.A. Elevated glucose impairs endotelium-
dependent relaxation by activating protein kinase C. // J. Clin. Invest. 1991. Vol.87.
P.1643-1648.
51. Zatz R., Brenner B.M. Pathogenesis of diabetic microangiopathy: the hemodynamic
view // Am. J. Med. 1986. Vol.80. P.443-453.

52. Witztum J.L., Mahoney E.M., Branks M.J. et al. Nonenzymatic glucosylation of low-
density lipoprotein alters in biological activity // Diabetes.- 1982.- Vol.31.- P.283-286.
Сведения об авторах
Ковалева Татьяна Викторовна
Кандидат медицинских наук
Врач терапевт, трансфузиолог,
Доцент кафедры Клиническая трансфузиология ИПО
ГБОУ ВПО Первый МГМУ им. И.М. Сеченова Минздрава России
laserlow@yandex.ru
Ковалева Екатерина Владимировна
Ассистент кафедры Превентивная, персонализированная и трансляционная
медицина ГБОУ ВПО Первый МГМУ им. Сеченова Минздрава России
katekisker@gmail.com
Байрамалибейли Имнара Энверовна
Доктор медицинских наук
Профессор кафедры Клиническая трансфузиология ИПО
ГБОУ ВПО Первый МГМУ им. И.М. Сеченова Минздрава России
imnara2005@rambler.ru
Салимов Эмин Львович
Кандидат медицинских наук
Доцент кафедры Клиническая трансфузиология ИПО
ГБОУ ВПО Первый МГМУ им. И.М. Сеченова Минздрава России
dc93@mail.ru
Рагимов Алигейдар Агаалекпер оглы
Доктор медицинских наук, профессор
Заведующий кафедрой Клиническая трансфузиология ИПО
ГБОУ ВПО Первый МГМУ им. И.М. Сеченова Минздрава России

ra50@mail.ru