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Day 1 : Jan-01-1970
Keynote Forum

Zhengyuan Xia

University of Hong Kong
China

Keynote: Anesthetic cardio protection in diabetes
10:05-10:35
Biography:
Zhengyuan Xia had served as a cardiovascular anesthetist for more than 10 years in China before he completed his PhD study at the University of British Columbia, in Canada in 2004. He is now Assistant Professor and Honorary Associate Professor and Deputy Director, Anesthesiology Research Laboratory of the Department of Anesthesiology, University of Hong Kong. His major focus of research is post-ischemic cardiac protection in diabetes. He has published more than 96 papers in reputed journals (such as Diabetes, Free Radical Biology & Medicine, Critical Care Medicine) and is serving as an Executive Editor of Journal of Diabetes & Metabolism.
Abstract:
Either volatile anesthetic isoflurane preconditioning or high-dose propofol treatment has been shown to attenuate myocardial IRI (ischaemia/reperfusion injury) in patients undergoing coronary artery bypass graft (CABG) surgery. Further, our recent clinical and basic studies show that alternative administration of isoflurane preconditioning and propofol post conditioning can synergistically attenuate myocardial injury in patients undergoing CABG surgery, and activation/preservation of myocardial endothelial nitric oxide synthase (eNOS) during myocardial ischemia-reperfusion seems to be the major mechanism by which isoflurane preconditioning and propofol post-conditioning confer synergistic cardio protection. However, this synergistic cardio protection of volatile anesthetic and propofol is diminished in patients with diabetes. There is significant interference in cardio protection between the volatile anesthetic sevoflurane and the intravenous anesthetic propofol, which should not be used concomitantly during anesthesia if possible. Any type of ischemic \\\\\\\"conditioning\\\\\\\" appears to exhibit markedly reduced protection or completely loses protection in the presence of volatile anesthetics. Our recent study shows that propofol when used before inducing myocardial ischemia can confer cardio protection in diabetes. Multi-center clinical trial is needed to optimize the utilization of anesthetic in patients with diabetes that is less resistant to ischemic insults.






Keynote Forum

Sayon Roy

Boston University School of Medicine
USA

Keynote: Diabetes-Induced disruption of vascular homeostasis: Consequences in the retina
10:35-11:10
Biography:
Sayon Roy received his PhD from Boston University and completed his postdoctoral training at Harvard Medical School, Harvard University. Dr. Roy is currently a professor of Medicine, Section of Diabetes, Endocrinology and Nutrition, and a professor of Ophthalmology at Boston University School of Medicine. Recognized as an expert in retinal vascular biology, Dr. Roy’s seminal work led to the identificationof several genes in the retina that are abnormally expressed in diabetic retinopathy. His pioneering work resulted in the development of novel gene modulatory techniques in retinal vascular cells using antisense oligonucleotides via intravitreal injection. Dr. Roy has received numerous awards including the American Diabetes Association Research Award for the commitment and dedication towards the fight against diabetes, the 2006 Mentor of the Year Award from Boston University, and the 2008 Innovative Award from the Juvenile Diabetes Research Foundation. Research in Dr. Roy’s laboratory has been funded by several organizations including the National Eye Institute, NIH, National Medical Technology Testbed,American Diabetes Association, Juvenile Diabetes Research Foundation International, Fight for Sight, Research to Prevent Blindness, and the Lions Organization. Dr. Roy has been a chartered member of the NEI Study Section of the National Institutes of Health.
Abstract:
Increase in the worlddiabetic population forecasts a significant increase in the number of people with diabetes-related retinal diseases. An overwhelming cause of vision loss in diabetic individuals is the breakdown of retinal vascular homeostasis, contributing to excess permeability and the development ofmacular edema, aprominent clinical manifestationof diabetic retinopathy. Despite the use of laser photocoagulation, and available therapeutics, majority of the patients do not fully recover functional vision. Research into areas involving cell-cell communication and blood retinal barrier characteristics has uncovered a significant underlying factor that contributes to both these functional changes. Our studies indicate that abnormal thickening of the vascular basement membrane (BM) can contribute to excess vascular permeability, breakdown in cell-cell communication, and retinal vascular cell loss. It has long been established that vascular BM thickening is a characteristic hallmark of diabetic microangiopathy, however, it is unclear how vascular BM thickening promotes the characteristic lesions seen in diabetic retinopathy. Recent studies have begun to shed light on this subject suggesting vascular BM thickening as a key player that not only compromises the BRB characteristics but also affects vascular homeostasis and promotes cell loss associated with the development and progression of diabetic retinopathy. Importantly, our research has identified several BM genes, fibronectin, collagen IV, and laminin that are abnormally expressed under hyperglycemic condition and contribute to abnormal cell-cell communication and retinal vascular leakage. Astrategy for decreasing BM thickening and how this could prevent vascular leakage and contribute to the maintenance of vascular homeostasis in the diabetic retina will be the topic of this presentation.
Coffee Break 11:10-11:30 @ Atrium






Keynote Forum

Ippei Kanazawa

Shimane University
Japan

Keynote: Bone fragility in diabetes mellitus and regulation of glucose metabolism by bone
11:30-12:00
Biography:
Ippei Kanazawa obtained PhD degree in 2009 from Shimane University Graduate School of Medicine and completed Postdoctoral studies at McGill University in Canada. He is now an Assistant Professor of the division of Endocrinology and Metabolism in Shimane University Faculty of Medicine. He has published more than 45 papers in international journals and serving as an Editorial Board Member of Journal of Diabetes & Metabolism.
Abstract:
Accumulating evidence has shown that the risk of osteoporotic fractures is increased in patients with diabetes mellitus although they have normal or increased bone mineral density (BMD). Since the incidence of osteoporotic fracture is related with morbidity and mortality, it became social issue especially in industrial countries. Advanced glycation end products (AGEs) are shown to be involved in diabetes mellitus-related bone fragility. AGEs inhibits osteoblastic differentiation. Moreover, AGEs-collagen crosslinks in bone matrix weaken bone strength. Recently, it was found that cortical porosity exists in diabetic patients with history of osteoporotic fractures. In clinical settings, it is required to clarify how to detect the diabetes-related bone fragility because BMD measurement is not useful for screening. On the other hand, it is reported that bone regulates glucose metabolism vice versa. Osteocalcin produced by osteoblasts stimulates insulin secretion in pancreatic beta-cells as well as adiponectin in adipocytes, resulting in preventing impaired glucose tolerance and fat accumulation. Most recently, osteocalcin is reported to stimulate secretion of glucose-like peptide-1 in small intestine. The author will review the diabetes-related bone fragility as well as the endocrine function of osteocalcin.






Track 1: Clinical Diabetes and Diagnostic Approaches
Track 4: Endocrinology: Patient-Oriented Case Management Discussions
Track 5: Advanced Technologies for Treatment of Diabetes
Session Chair

Sayon Roy

Boston University School of Medicine
USA




Session Co-Chair

Zhengyuan Xia

University of Hong Kong
China




Session Introduction

Kirti Kain

University of Leeds
UK

Title: Increased absolute systolic ankle pressures and reduced estimated glomerular filtration rate
12:00-12:20
Biography:
Kirti Kain is a fellow of Royal College of Physicians and Higher Education Academy. She completed her MD from the Universityof Leeds, UK.Her research interests include geneticand athero-thrombotic risk factors for prevention of diabetes and cardiovascular diseases in UK South Asians in the community. She has made principal contribution towards research & development for effective health service delivery comdis hsd for the chronic diseases element in Tanzania, Nigeria, China and Pakistan. She has published in reputed journals. She promotes UK, South Asian medical students to undertake research.
Abstract:
Both decrease estimated-glomerular-filtration-rate (eGFR)and high-ankle-brachial-index are associated with increased arterial stiffness and cardiovascular-risk in Europeans. South-Asians (a billion of them worldwide) have increased prevalence of severe kidney disease and diabetes but not hypertension and its association with cardiovascular-disease or ankle-brachial-index <0.9 when compared with Europeans. The increase in systolic-ankle-pressures is greater with diabetes in South-Asians. The main outcome measures in the study were Doppler systolic pressures of the left and right posterior-tibial and dorsalis-pedis arteries in 711 South-Asians and 397Europeans with or without GFRr






Stephen Varvel

Health Diagnostic Laboratory
USA

Title: Comprehensive biomarker testing of glycemia, insulin resistance and beta cell function is associated with improved glycemic control in clinical practice
12:20-12:40
Biography:
Szilard Voros was graduated from University Medical School of Pecs in Hungary, he completed his internal medicine internship and residency at University of Alabama at Birmingham where he served as a chief medical resident and at UVA, where he served as chief cardiovascular fellow. He served as chief scientific officer, chief of cardiovascular prevention and medical director of cardiovascular MRI and CT at the Piedmont Heart Institute. He currently serves as chief academic officer for Health Diagnostic Laboratory, Inc., CEO of Global Genomics Group LLC., and clinical associate professor of medicine in cardiology and radiology at Stony Brook University in NY.
Abstract:
Past approaches to managing diabetes risk have not been sufficient to stem the tide of the diabetes epidemic. Recent efforts have focused on providing tools to detect disease progression earlier, before loss of glycemic control and significant pancreatic beta cell destruction when interventions would likely be more effective. Health Diagnostic Laboratory, Inc. has recently introduced into routine clinical practice a biomarker panel that utilizes a multimarker approach to assess three dimensions of diabetes progression—insulin resistance, beta cell function, and glycemic control. A retrospective cohort study was recently conducted to investigate the utility of this panel in 1,687 consecutive patients receiving treatment at one of six outpatient clinics across the U.S. Laboratory data was matched with de-identified patient information obtained from chart review. Key findings from this study included identification of a substantial proportion of the cohort (40%) with actionable evidence of metabolic abnormalities who did not meet current definitions of prediabetes. No single biomarker was responsible for this increased sensitivity—diverse patterns of abnormalities were observed in the normoglycemic patients. After 6 months, a significantly higher percentage of prediabetic patients who underwent advanced biomarker testing had reverted to normoglycemia (34%) than had progressed (10%; P<0.0001); these rates of reversion are considerably higher than expected based on published progression rates for type 2 diabetes. These results suggest biomarker panels can be successfully integrated into clinical practice in order to identify at-risk patients earlier and stratify intervention efforts, leading towards individualized interventions that reflect the underlying biology of each patient’s disease.






Ranjna Garg

Barnet Hospital NHS Trust
UK

Title: Opportunistic screening on admission to hospital: A missed opportunity to detect early
12:40-13:00
Biography:

Abstract:
Aims & objective:
Screening for diabetes is recommended for those at risk. Stress hyperglycemia (SH) is a recognized risk factor but not detected or acted upon in non diabetic people, delaying the diagnosis of diabetes.Much need be done to increase early diagnosis of diabetes. Emergency room visits offer an opportunity to identify people at risk of diabetes. The aim of this study was to identify whether this opportunity to screen for diabetes is utilized effectively Method The clinical records of all people attending emergency room over two consecutive days accessed to see
1. Whether a random capillary glucose on admissions (RCGA) was recorded
2. Non-diagnostic RCGA was followed by a repeat glucose test
3. Primary care physician (PCP) were notified of abnormal results
Results:
N = 299. RCGA checked=74 (24.7%). Known diabetes 18 (6.1%). Non diabetic: 281 (93.9%).Non diabetic people with RCGA>/= 7.8 mmol/l = 31.1% New diagnosed diabetes: 3 (1%) Repeat Fasting glucose: 0 (0%) Non-diabetic people repeat glucose test was not performed in people with abnormal RCGA 23/281 (8.1%). PCP were not notified of the abnormality. 11/59 (20.9%) Non-diabetic patients had abnormal glucose homeostasis (RCGA ≥7.8mmo/l). New diagnosis of diabetes was missed in 3/281 (1%) Conclusion and discussion:
76.3% of patients attending Emergency room over two consecutive days missed out on screening test to diagnose diabetes early. New diagnosed diabetes was missed in 1%. No further testing was offered in non diabetic people with abnormal RCGA (8.1%). Abnormal results were not conveyed to the PCP Abnormal RCGA could mean SH or undiagnosed diabetes/impaired glucose homeostasis. People showing SH should have further repeat fasting or HbA1C. SH could mean undiagnosed diabetes or indicate people at risk of diabetes. Recommendations:
All patients attending emergency room should have a RCGA. People with SH should be considered “at high risk of diabetes”. All results should be conveyed to the Primary physicians. RCGA ≥7.8mmol/l should have repeat fasting glucose or HbA1C






Melina Claussnitzer

Harvard Medical School
USA

Title: Leveraging cross-species transcription factor binding site patterns: From diabetes risk loci to disease mechanisms
13:00-13:20
Biography:

Abstract:
Genome-wide association studies have revealed numerous risk loci associated with diverse diseases. However, identification of disease-causing variants within association loci remains a major challenge. Divergence in gene expression due to cis-regulatory variants in noncoding regions is central to disease susceptibility. We show that integrative computational analysis of phylogenetic conservation with a complexity assessment of co-occurring transcription factor binding sites (TFBS) can identify cis-regulatory variants and elucidate their mechanistic role in disease. Analysis of established type 2 diabetes risk loci revealed a striking clustering of distinct homeobox TFBS. We identified the PRRX1 homeobox factor as a repressor of PPARG2 expression in adipose cells and demonstrate its adverse effect on lipid metabolism and systemic insulin sensitivity, dependent on the rs4684847 risk allele that triggers PRRX1 binding. Thus, cross-species conservation analysis at the level of co-occurring TFBS provides a valuable contribution to the translation of genetic association signals to disease-related molecular mechanisms.
Lunch Break 13:20-14:15 @ Atrium






Omobola Komolafe

Obafemi Awolowo University
Nigeria

Title: Antioxidants status of stz-induced diabetic rats treated with extract of momordica charantia
14:15-14:35
Biography:

Abstract:
The present study investigated the effects of M. charantia on hyperglycaemia and selected markers of antioxidants activities (which include thiobarbituric acid reactants (TBARS), Catalase, Glutathione, Superoxide Dismutase (SOD), Glutathione Peroxidase (GPx) in streptozotocin-induced diabetic Wistar rats and compared the effects with those of glimepiride, an oral blood-glucose-lowering drug of the sulfonylurea class. Forty healthy adult Wistar rats of both sexes were randomly assigned into five groups A, B, C, D and E of eight rats each. Group A were the control (normal rats); B were the experimentally-induced diabetic rats; C were diabetic rats treated with methanolic extracts of M. charantia for two weeks; D were diabetic rats treated with methanolic extracts of M. charantia for four weeks. E was diabetic rats treated glimepiride for four weeks. Results showed that extract have potent hypoglycaemic effects in diabetic rats and suggested that M. charantia could restore to within normal levels, the observed changes in antioxidants markers of diabetic rats and in more potent effect than glimepiride.






Mai Al-hazzaa

University of Reading
United Kingdom

Title: Randomized controlled trial of lifestyle intervention for type 2 diabetes patients in Kuwait and its impact on glycaemic control and the quality of life
14:35-14:55
Biography:
Mai Al-hazzaa is a medical doctor, she has completed a bachelor of Medicine and surgery from Faculty of Medicine at Kuwait University. She was working at Amiri hospital on 2005, then she was working at Qurtuba Polyclinic at the department of Family Medicine from 2006 until 2008. Later she was working as assistance physician at the Islamic Centre for alternative and Herbal Medicine. Before doing her master degree, she was working as assistance physician at the department of Food and Nutrition. She completed her Master degree of clinical Nutrition from Greenwich University, UK. She is now a Ph.D student at the University of Reading, UK.
Abstract:
Kuwait is among the countries with the highest prevalence of type II diabetes globally with 12.4%. Lifestyle modifications are important in the treatment and management of type II diabetes, and they are routinely recommended in general practice. However, lack of resources, especially time, as well as a resistance by patients to change their lifestyle, result in poor compliance and subsequently a greater risk of complications. The objective of this study is to investigate new methods of lifestyle interventions, which can be easily, implemented in general practice, and whether these interventions can improve glycaemic control in diabetes patients in Kuwait. Based on a detailed literature review, we have developed several group educational sessions, which focus on different aspects of lifestyle modifications, such as exercise and dietary changes. These interventions will be tested in a 18 months two-arm randomised controlled trial of 40 male Kuwaiti (age: 30 to 60 years) with glycaemic control as primary endpoint. All study participants were underwent detailed screening, including anthropometry and detailed diet and lifestyle assessment. Here, we will present preliminary screening results and the study protocol. The results of this study will allow a comparison of easily delivered, low cost lifestyle intervention in primary care with other treatment methods for type 2 diabetes. It will therefore be able to inform future public guidance for the management of diabetes in Kuwait.






Firdous memon

Liaquat University of Medical & Health Sciences
Pakistan

Title: Fuel metabolism in diabetic pregnancy
14:55-15:15
Biography:
Firdous Mumtaz worked as professor in Public University LUMHS of Pakistan and had 24 Publications in various national and International Journals. He was keenly interested in gestational diabetes and their consequences in pregnancy and labor leads to undiagnosed miscarriages and still birth in third world countries.
Abstract:
The effect of diabetic pregnancy on fuel metabolism is one of the underutilization of exogenous fuel and one production from endogenous source in the fasted state, result in impaired glucose tolerance (IGT) in some women which lack necessary B- Cell reserve to maintain Euglycaemia during pregnancy and have significantly lower insulin response as compared to glucose tolerant control in 1st and 2nd trimester of pregnancy. The response of C- peptide is reduce to oral glucagon and level of serum pro insulin concentrations are increased resulting for insulin treatment along with abnormalities of glycerol and nonestified fatty acids metabolism impaired lipolysis. All this leads to decrease B- Cell function and increase in insulin requirement to maintain euglycaemic state. Pregnancy induced lipolysis, dyslipidaemia abnormal glucose tolerance test is also associated with elevated serum (GGT) Glutamyl transferase Enzyme. Classification of Diabetes in Pregnancy • Pregestational diabetes: pre-existing type 1 or type 2 or secondary. • Gestational diabetes: diagnosis is made post gestationally: normal glucose tolerance • Any type of diabetes mellitus occurring first in pregnancy. Consequences of Changes in Fuel Metabolism during Diabetic Pregnancy Increased hyperglycemia effects both Mother & fetus in all three trimester. 1st trimester: Congenital malformations, spontaneous abortion, Growth retardation. 2nd trimester: Hypertrophic Cardiomyopatus. 3rdtrimester: Hyperinsulinemia leads to Macrosomia, RDS, hypomagnesemia, hypoglycemia, hypocalcaemia, hypoglycemia, polycythemia, hyperbilirubinemia, stillbirth. Maternal Complications are Placental insufficiency, Pre eclampsia, Eclampsia, poly hydramnios. Long term impact of GDM on maternal health Increased risk of development of diabetes later on, obesity, and premature cardiovascular risk.






Qingcheng Mao

University of Washington
USA

Title: Of pregnant women and mice: Maternal-fetal disposition of glyburide during pregnancy and implications for the treatment of gestational diabetes mellitus
15:15-15:35
Biography:

Abstract:
Gestational diabetes mellitus is a major complication of human pregnancy. The clearance (CL) of glyburide, an oral anti-diabetic drug, increases 2-fold in pregnant women during late gestation versus non-pregnant controls. However, the mechanism behind this pharmacokinetic change has not been fully understood. Therefore, in the present study,we examined gestational age-dependent changes in maternal-fetal pharmacokinetics (PK) of glyburide and metabolites in a pregnant mouse model. Non-pregnant and pregnant FVB mice were given glyburide by retro-orbital injection. Maternal plasma was collected over 240 min on gestation days (gd) 0, 7.5, 10, 15 and 19; fetuses were colleceted on gd 15 and 19. Glyburide and metabolites were quantified using HPLC-MS, and PK analyses were performed using a pooled data bootstrap approach. We found that maternal CL of glyburide increased ~50% on gd 10, 15, and 19 compared to non-pregnant controls. Intrinsic clearance (CLint) of glyburide in maternal liver microsomes also increased as gestation progressed. Although total fetal exposure to glyburide was < 5% of maternal plasma exposure, it doubled on gd 19 compared to gd 15. This is the first evidence of gestational age-dependent changes in glyburide PK. Increased glyburide clearance during pregnancy is attributable to increased hepatic metabolism. In the mouse model, fetal exposure to glyburide is gestational age-dependent, which can be explained by gestational-age dependent expression in the placenta of BCRP, a drug transporter that mediates efflux of glyburide from the fetal compartment back to the maternal circulation. These results suggest that adjusting maternal glyburide dosing regimens according to gestational age should be considered to achieve optimal efficacy and safety of the drug if the same PK changes occur in pregnant women.
Coffee Break 15:35-15:55 @ Atrium






Mawieh Hamad

Sharjah Institute of Medical Research
UAE

Title: Hepcidin mediates estrogen-dependent changes in serum iron availability in humans
15:55-16:15
Biography:

Abstract:
Elevated levels of estrogen (E2) often associate with increased serum iron concentration; however, the mechanism underlying this relationship is not well-understood. As the peptide hormone hepcidin is a major regulator of iron absorption and release, this study aimed at investigating whether it is involved in E2-dependent changes in serum iron levels. Serum samples from 163 young females were separately assayed for the levels of E2, hepcidin-25, ferritin, iron, and total iron binding capacity. The sample population was divided into four groups based on E2 concentration; 0-0.49, 50-99, 100-199, and >199 pg/ml. Levels of E2 negatively correlated with those of hepcidin in all E2 groups; correlation was weakest at E2 levels of 0-49 (P<0.039) and strongest at E2 levels >199/pg/ml (P<0.005). A positive correlation was noted between E2 and ferritin in the >199 pg/ml E2 group (P<0.05); ferritin negatively correlated with E2 in all other E2 groups. No clear relationship between E2 and TIBC or serum iron concentration was evident. These results suggest that elevated levels of estrogen increase serum iron concentration by downregulating hepcidin synthesis.






Sayon Roy

Boston University School of Medicine
USA

Title: Role of intercellular communication in diabetic retinopathy
16:15-16:35
Biography:
Sayon Roy received his PhD from Boston University and completed his postdoctoral training at Harvard Medical School, Harvard University. Dr. Roy is currently a professor of Medicine, Section of Diabetes, Endocrinology and Nutrition, and a professor of Ophthalmology at Boston University School of Medicine. Recognized as an expert in retinal vascular biology, Dr. Roy’s seminal work led to the identificationof several genes in the retina that are abnormally expressed in diabetic retinopathy. His pioneering work resulted in the development of novel gene modulatory techniques in retinal vascular cells using antisense oligonucleotides via intravitreal injection. Dr. Roy has received numerous awards including the American Diabetes Association Research Award for the commitment and dedication towards the fight against diabetes, the 2006 Mentor of the Year Award from Boston University, and the 2008 Innovative Award from the Juvenile Diabetes Research Foundation. Research in Dr. Roy’s laboratory has been funded by several organizations including the National Eye Institute, NIH, National Medical Technology Testbed,American Diabetes Association, Juvenile Diabetes Research Foundation International, Fight for Sight, Research to Prevent Blindness, and the Lions Organization. Dr. Roy has been a chartered member of the NEI Study Section of the National Institutes of Health.
Abstract:
Breakdown of the blood-retinal barrier (BRB) is a prominent pathophysiological event in diabetic retinopathy diabetic retinopathy. Studies have linked this cellular event to be regulated, at least in part, by reduced expression of tight junction proteins. Recent studies suggest that connexin 43 (Cx43), a gap junction protein, is required to maintain endothelial barrier function. However,its role in retinal vascular leakage is currently unknown. In this presentation, the importance of cell-to-cell communication in diabetic retinopathy will be discussed. In particular, the effects of high glucose and diabetes on Cx43 expression, and how breakdown in cell-cell communication in diabetes promotes retinal vascular abnormalities in diabetic retinopathy will be presented. Additionally the relationship between gap junctions and tight junctions in the context of vascular permeability in diabetic retinopathy will be highlighted. Overall, our findings indicate that hyperglycemia-induced Cx43 downregulation compromises retinal vascular homeostasis, compromises BRB, and promotes vascular lesions.






Mohd Fazil

Title: Assessment of the probable causes of affective disturbances in diabetes mellitus-II
16:35-16:55
Biography:

Abstract:
Affective disturbances are common and most frequent in diabetics among all other psychiatric disorders. The prevalence of such affective disturbance is found to vary among different individuals, due to various factors like inherent temperament of the patient, type of medication used and severity of disease etc.According to literature, inherent temperament plays an important role in determining behavioural patterns in health and disease. At large-intelligence, activeness, bravery, optimism, pleasing personality, stable thoughts and a talkative nature signify a hot temperament, which may be sanguineous or bilious; while the opposite of these indicate a predominance of cold temperament, which may be phlegmatic or melancholic. These personality characteristics tend to be reflected in illness behaviours in case the person falls ill. Such behaviourstend to affect both-the outcome of disease, as well as the quality of life of the patient, which is of special significance in chronic disorders.In view of the significance of behavioural changes in diabetes mellitus, a study was planned to evaluate whether temperament and certain other factors play a role in such change. The data was collected by interview and observation method with Illness Behaviour Questionnaire and Temperament Assessment Format. Affective disturbance was found to be higher in persons having raised blood sugar, those taking injectible medication and patients having cold temperament, which corresponds to phlegmatic and melancholic temperament described in classical Unani medicine. The mean positive response to Affective disturbance questions was 65.2% in the oral group and 73.6% in the injectible group.The mean positive response to Affective Disturbance questions was 55.36% in Sanguineous temperament, 74.53% in Phlegmatic, 72.32% in Bilious and 100% in Melancholic temperament. The results indicate that the behavioural changes in a disease are not only influenced by the temperament, but in keeping with the literature review, may be determined by them as well. The behaviours may also be affected by the route of administration of medication and severity of disease.






Eric Felner

Emory University School of Medicine
USA

Title: Insulin delivery using solid micro needle patches in diabetic rats
16:55-17:15
Biography:
Felner received his Doctor of Medicine (1994) and Master of Science in Clinical Research (2008) degrees from Emory University, completed training in Pediatrics (1997) and Pediatric Endocrinology (2000) at the University of Texas Southwestern, and served as Division Chief (2001-2003) of Pediatric Endocrinology at Tulane University. He is an Associate Professor of Pediatrics at Emory University and directs the following programs: Pediatric Endocrine Fellowship, Pediatric Clerkship, and Endocrine Teaching Modules. His research focuses on delivery devices and immune-modulating therapy for patients with diabetes. He has published more than 50 manuscripts and book chapters and, has written an endocrine textbook.
Abstract:
Diabetes mellitus is the 6th leading cause of death in the United States. In 2011, 17 million patients received treatment for type 2 diabetes and 700,000 additional patients begin treatment each year. The US annual economic burden for diabetes care reached $218 billion in 2007, and continues to rise. Insulin is delivered by subcutaneous injection, but this route has a negative effect on glycemic control in two ways. First, insulin uptake from the subcutaneous space is slow and often results in post-meal hyperglycemia and delayed hypoglycemia. Second, many patients resist insulin therapy due to a fear of needles and subcutaneous injections. Therefore, an alternative insulin delivery method may become paramount in maintaining adequate glycemic control.Current efforts to develop alternative insulin delivery methods (e.g., oral or inhaled) have had limited clinical impact due to variable uptake, poor bioavailability, long-term safety concerns, and poor acceptance from patients and clinicians. As an alternative novel approach, we developedsolidmicroneedle patches for insulin delivery. Microneedlesrange in length from 150 – 900 mand have been developed to create transport pathways for small drugs, macromolecules, and fluid flow in a painless manner. The microscopic length permits delivery of fluid to capillaries but limits the extension into the abundant nerve-ending region of the dermis, thereby minimizing pain. Fluid delivery through a microneedle has been shown to be relatively painless as compared to a hypodermic needle. We delivered insulin to diabetic rats subcutaneously and through a solid microneedle patch and found that rats receiving insulin via the microneedle patch achieved statistically higher insulin levels and a greater reduction in glucose levels.






Nirmala Chauhan

Government College Kullu
India

Title: Dietary fiber psyllium based hydrogels for use in insulin delivery
17:15-17:35
Biography:

Abstract:
The present article is related to the development of psyllium based oral insulin delivery systems that could release insulin in a controlled and sustained manner. Psyllium is a medicinally important gel, forming glucose lowering dietary fiber and drug delivery system developed by its functionalization will have the double potential of curing diabetes. Psyllium and acrylamide/methacrylamide based hydrogels were prepared, and the effect of pH on the release dynamics of insulin from drug loaded hydrogels has been studied to evaluate the drug release mechanism. Non-Fickian diffusion mechanism has been observed for the release of insulin in the pH 7.4 buffer for which the rate of drug diffusion and rate of polymer chain relaxation are comparable. Therefore, drug release depends on two simultaneous rate processes, water migration into the device and drug diffusion through continuously swelling hydrogels. In each release medium, the earlier stage of the diffusion coefficient has been observed more than the late time diffusion coefficient.






Nicolette N Houreld

University of Johannesburg
South Africa

Title: Laser therapy speeds up healing of chronic diabetic ulcers
17:35-17:55
Biography:
Nicolette Houreld, D.Tech (UJ) Biomedical Technology, is a full time senior lecturer and researcher in the Laser Research Centre, Faculty of Heath Sciences, University of Johannesburg. As a NRF (National Research Foundation, South Africa) Y2-rated (young) scientist, her field of research is laser tissue interaction and focuses on the biochemistry and molecular effects of lasers used in therapy, particularly in diabetic wound healing. She has numerous accredited publications and serves on various research-related university and science council committees, executive committees including the World Association for Laser Therapy, and the editorial board of internationally accredited journals.
Abstract:
Diabetes is the leading cause for non-traumatic amputations and hospitalization. Current treatments are challenging, lengthy, costly and associated with failure to heal and relapse. In recent years emphasis has been directed at using low level laser therapy (LLLT), or phototherapy, to accentuate cellular processes to contribute to more efficient resolution of wound healing. This study aimed to determine the effects of laser irradiation on diabetic wound healing. An in vitro diabetic wound model was irradiated with visible red (636 or 632.8 nm) and near infra-red (830 nm) light at a fluence of 5 J/cm2. Various cellular and molecular events were evaluated post-irradiation. A pilot study was also conducted on chronic ulcers in diabetic patients using a combination of red and infra-red light. Patients were treated twice a week for a maximum of 12 weeks with standard podiatric care and phototherapy. In vitro studies showed that laser irradiation stimulated cellular viability and proliferation, and increased collagen production. Treating patients with LLLT in combination with standard treatment of care was advantageous over treating ulcers with podiatric methods alone, and some ulcers resolved completely within 8 weeks. It is evident that a combination of conventional podiatric intervention and phototherapy has the ability to improve wound regeneration. Phototherapy can be an important tool in speeding up the healing process as well as alleviating pain and inflammation. There is a need to study the underlying mechanisms involved in LLLT so that this form of therapy, which has no reported side-effects, can be used as an adjunctive therapy for the treatment of diabetic ulcers.






You-Gui Li

Zhejiang Academy of Agricultural Science
China

Title: 1-deoxynojirimycin inhibits glucose absorption and accelerates glucose metabolism in streptozotocin-induced diabetic mice
17:55-18:15
Biography:

Abstract:
We investigated the role of 1-deoxynojirimycin (DNJ) on glucose absorption and metabolism in normal and diabetic mice. Oral and intravenous glucose tolerance tests and labeled 13C6-glucose uptake assays suggested that DNJ inhibited intestinal glucose absorption in intestine. We also showed that DNJ down-regulated intestinal SGLT1, Na+/K+-ATP and GLUT2 mRNA and protein expression. Pretreatment with DNJ (50 mg/kg) increased the activity, mRNA and protein levels of hepatic glycolysis enzymes (GK, PFK, PK, PDE1) and decreased the expression of gluconeogenesis enzymes (PEPCK, G-6-Pase). Assays of protein expression in hepatic cells and in vitro tests with purified enzymes indicated that the increased activity of glucose glycolysis enzymes was resulted from the relative increase in protein expression, rather than from direct enzyme activation. These results suggest that DNJ inhibits intestinal glucose absorption and accelerates hepatic glucose metabolism by directly regulating the expression of proteins involved in glucose transport systems, glycolysis and gluconeogenesis enzymes.






Zhong-Yuan Xia

Renmin Hospital of Wuhan University
China

Title: Antioxidant N-acetylcysteine improves cardiac diastolic function in diabetic rats by attenuating PKCβ2 activation and improving caveolae function and Enos signaling
18:15-18:35
Biography:

Abstract:
Objective: Hyperglycemia induced oxidative stress is implicated in the development diabetic cardiomyopathy, which is also associated with excessive activation of protein kinase C (PKC) β2, caveolae dysfunction and impaired endothelial nitric oxide (NO) synthase (eNOS)/NO signaling. We tested the hypothesis antioxidant N-acetylcysteine (NAC) could attenuate myocardial dysfunction in diabetic rats by suppressing hyperglycemia induced oxidative damage in the myocardium subsequent to inhibition of myocardial PKCβ2 activation and caveolae dysfunction and rescuing eNOS/NO signaling. Methods: Controlor streptozotocin (STZ)-induced diabetic rats were either untreated or treated with N-acetylcysteine (NAC, 1.5 g/kg/day) or the PKCβ inhibitor LY333531 (LY, 1 mg/kg/day) by oral gavage for four weeks. Results: Diabetes decreased heart rate (HR) and the ratio of peak velocity of early and late diastolic filling (E/A) and increased left ventricular isovolumic relaxation time (IVRT), as well as the ratio of heart weight to body weight, all of which except HR were attenuated by NAC or LY. Levels of 15-F2t-isoprostane, superoxide anion (O2-) and nitrotyrosine production were increased, whereas NO levels decreased in diabetes. Diabetes induced increase of O2- levels was blocked by the nitric oxide synthase (NOS) inhibitor L-NAME, indicating “NOS uncoupling”. In addition, diabetes elevated cardiac levels of p-PKCβ2, Caveolin-1 and inducible NOS expression, and decreased levels of caveolin-3, p-Akt (Ser 473) and p-eNOS (Ser 1177) expression in diabetic heart. All these alterations were attenuated or reversed by NAC or LY. Conclusions: Antioxidant NAC treatment improves cardiac diastolic dysfunction by attenuating PKCβ2 activation, caveolae dysfunction and eNOS signaling.