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Day 1 : Jan-01-1970
Clinical Diabetes and Diagnostic Approaches
Session Introduction

Kirti Kain

University of Leeds
UK

Title: Increased absolute systolic ankle pressures and reduced estimated glomerular filtration rate
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






Szilard Voros

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
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
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
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.






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
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.






Komolafe O A

Obafemi Awolowo University
Nigeria

Title: Antioxidants status of stz-induced diabetic rats treated with extract of momordica charantia
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.






Gangula Pandu R

Meharry Medical College
USA

Title: Dental infection and systemic diseases: An overview
Biography:
Gangula has completed his Ph.D. at the age of 27 years from S.V University and postdoctoral studies from Vanderbilt University School of Medicine and UTMB. He is currently serving as the chairman of Oral Biology and Research, associate professor in the department of Physiology and Oral Biology and Research. He has published more than 50 papers in reputed journals and serving as an editorial board member of repute. He has research training in the area of vascular, uterine and gut smooth muscle relaxation as affected by oral bacteria, sex hormones, nitric oxide, and neuropeptides (such as calcitonin gene-related peptide).
Abstract:
Clinical studies suggest that poor oral health can causes periodontal disease (PD) and chronic illness such as respiratory disease, cardiovascular disease, and diabetes and lead to poor quality of life, overall health, and nutrition. African Americans are disproportionately affected by metabolic diseases such as high blood pressure and this may lead to significant mortality and morbidity. In addition, African Americans are twice-as-likely to have periodontitis than Caucasians. Although, the underlying mechanisms for this is still remain unclear; accumulating evidence suggest that impaired NO-dependent vasodilation may be one of the potential key factor(s) for observed vascular diseases in AA population. PD and Vascular Function: Recently, the American Heart Association supported an association between PD and atherosclerotic vascular disease (ASVD) but the data is insufficient to support a causal relationship. Endothelial dysfunction is the initial step in the development of ASVD. Reduced nitric oxide (NO) bioavailability as a result of endothelial nitric oxide synthase (eNOS) uncoupling and increased reactive oxygen species (ROS) has been known to play a detrimental role in cardiovascular pathologies. However the link between NO and PD with regards to systemic vascular function has not been yet demonstrated. PD and GI Motility Function: Understanding the role of the gut microbiome is among the most exciting areas of science today. To date, however, we know little about the oral microbiome and its association with gastrointestinal function, including motility. Here we sought to determine if induction of PD in mice by oral polymicrobial infection can alter BH4/nNOS/NRF2 pathways in vascular tissue, stomach and/or colon specimens. Our preliminary findings suggest that polymicrobial infection with periodontal bacteria can cause a significant change in the vascular colonic BH4/nNOS/NRF2 pathway which may lead to altered colonic motility and constipation.






Diabetes Mangement
Session Introduction

Ulrike Rothe

TU Dresden
Germany

Title: Innovative diabetes management – From managed care through disease management to a chronic care management model
Biography:
Ulrike Rothe is an Assistant Professor for Epidemiology and Health Care Research and a diabetologist and has been working as a principal investigator and senior researcher, respectively in some evaluation projects of integrated diabetes care in Saxony within the epidemiology and health care research group at the TUD. She is the vice-president of this Saxonian Diabetes Association (SGSE e.v.)as well as of the commission of experts for diabetes of the Saxonian Chamber of Physicians, and additionally she is the chairwomen of the epidemiology study group of the German Diabetes Association (DDG) and a board member of the epidemiological expert committee of the German Association for Medical Informatics, Biometry and Epidemiology (GMDS). She has more than 100 scientific publications, many national and international scientific presentations and some important national and European research projects in the field. She is leading the development of a Saxonian Chronic Care Management Plan and was the leader of the Saxonian disease management network – the globally largest evaluated disease management project currently.
Abstract:
Background
To describe the route away from managed care to an effective chronic care management (CCM) in a value-based health-care system. Thus, at present occurs an international paradigm shift in diabetes management: away from a focus on an indication-oriented management of a single chronic disease towards a disease-independent chronic care model, that includes the complexity of multimorbid conditions, e.g. of diabetic patient’s witha metabolic-vascular syndrome. Objective
To demonstrate the outcome of the Saxon Diabetes Management Program (SDMP) in Germany which was based on cross-sectoral practice guidelines, integrated care and cross-sectoral quality management and thus with approaches to a CCM model. Research Design and Methods
The evaluation of the SDMP in Germany represented a realworld study with all DSPs and about 75% of the GPs in Saxony between 2000 and2002. Finally, 291.771 patientswere included in the SDMP. Cross-sectional data were evaluated at the beginning of 2000and at the end of 2002. A subcohort of 105.204 patients was followedup 3 years. Results
The state-wide implementation of the SDMP resulted in better cooperation and therapeutic concepts. The median HbA1c at the time of referral to DSPs decreased from 8.5% to 7.5% and so the overall mean did. At the end, 78% and 61%achieved the targets for HbA1c and BP. Conclusions
The third revolution of health-care called value-based health-care“includes CCM. The SDMP was an efficient way to CCM and to improve diabetes care nationwide continuously and thus meet the challenges of the 21st century.






Hayam I Gad

King Saud University
Saudi arabia

Title: Effects of pravastatin or 12/15 lipoxygenase pathway inhibitors on indices of diabetic nephropathy in an experimental model of diabetic renal disease
Biography:

Abstract:
Objective
The present study aimed at attenuating the effects of early streptozotocin-induced diabetes on renal functions through supplementation of either pravastatin or 12/15-LO pathway inhibitors. Materials and methods
The current study was carried out on 88 male Wistar assigned to 3 groups (8 rats/group): Group I: included control rats receiving vehicle. Groups IIa, IIb, IIc, IId, IIe: included normoalbuminuric diabetic rats receiving vehicle, NDGA, NDGA + insulin, pravastatin or pravastatin + insulin respectively. Groups IIIa, IIIb, IIIc, IIId, IIIe included microalbuminuric diabetic rats receiving vehicle, NDGA, NDGA + insulin, pravastatin or pravastatin + insulin respectively. Renal function tests were measured and blood samples were analyzed for glycosylated hemoglobin (HbA1c), serum levels of cholesterol, triglycerides and lipid peroxide and plasma levels of VEGF, total nitric oxide (NO) products and homocysteine (Hcy). Results
The results of the present study demonstrated favorable effects of both NDGA and pravastatin to the same extent on renal functions and more favorable effects when diabetes is controlled. Microalbuminuri rats received NDGA experienced a decrease in urinary albumin creatinine ratio (ACR) to the same extent as did microalbuminuric rats received pravastatin. Indices of DN and oxidative stress as lipid peroxide, VEGF, and Hcy all were reduced by NDGA or pravastatin therapy with no statistical difference between the two lines of therapy. Conclusion
12/15-LO inhibition and statins like pravastatin may be useful as therapeutic strategies for prevention or amelioration of DN. Confirmation of these preliminary observations must await careful long-term studies on experimental DN.






Karsten Buschard

Bartholin Instituttet
Denmark

Title: Protection against type 1 diabetes by gluten-free diet: Which mechanisms are involved
Biography:

Abstract:
Studies have documented that type 1 diabetes (T1D) is a diet-influenced disease. The Bartholin Institute was first to show that gluten-free diet markedly lowers diabetes incidence in non-obese diabetic (NOD) mice (from 64% to 15%). Many others have confirmed these findings subsequently, and also in BB rats, gluten-free diet protects against diabetes. Furthermore, two human studies found an increased risk (odds ratio about 4) of islet autoimmunity when children were exposed to gluten-containing cereals early in life. Eight percent of T1D patients also develop celiac disease and they far most commonly acquire T1D before diagnosis of celiac disease, possibly due to the termination of gluten exposure following celiaci. Recently, we published a case report of a newly T1D patient started on gluten-free diet shortly after diagnosis and then being without need of insulin therapy. Now about 15 T1D patients have been enrolled in an open clinical trial. The results are promising for the first year after diagnosis with highly significantly better metabolic control at lower insulin dosage. C-peptide concentrations are improved during the first year also but then the values decline. Thus, at least some of the T1D patients may win a year on their diabetes disease with no or little insulin dose and with no hypos (hypoglycaemic accidence) or fear of that. The mechanisms behind the diet-mediated modification of diabetes are not known in all details but several possibilities have been elucidated. Firstly, gluten-free diet changes the composition of the intestinal flora and fx the diabetes-protective Akkermansia is popping up. Secondly, the intestinal is less permeable and, thirdly, the inflammation level is reduced. Fourthly, gliadin fragments, especially a 33-mer peptide, have direct effects on the beta-cells by enhancing their insulin-production that is not seen when the diet is gluten-free. Hopefully, a trial on pre-T1D persons can be performed using gluten-free diet, which is a safe and non-toxic product.






Mark T. U. Barone

Universidade de Sao Paulo
Brazil

Title: Interactions between diabetes and sleep, highlighting melatonin’s role
Biography:
Mark Barone has completed his Ph.Din 2011 from Institute of Biomedical Sciences, University of Sao Paulo (ICB-USP), and is currently working on his postdoctoral studies at the same University. He has been researching on type 1 diabetes and sleep since 2003, and has prominent work and publications on diabetes education, since 1999.
Abstract:
Strong associations of diabetes mellitus with sleep impairment have been frequently reported. Several groups have studied the associations between metabolic syndrome and type 2 diabetes with sleep disorders. In our group we have focused mainly on the relationships between type 1 diabetes and sleep. The associations found corroborate the previously vicious circle described in type 2 diabetes, where sleep disorders favor the development of type 2 diabetes or exacerbate the metabolic control of both types of diabetes, whereas diabetes itself, especially when associated with poor metabolic control, is often followed by sleep disorders. Our current interest is on the factor linking such conditions. Novel findings concerning the neuro-endocrine-metabolic mediation of the mentioned circle start to be revealed. Melatonin is surely one of those factors that deserve special attention. Our studies point toward a difference in terms of night melatonin levels in individuals with poor glycemic control, when comparing with control subjects. Moreover, insulin and melatonin were shown to have a complementary action in regulating each other and the metabolism as a whole. Therefore, our intention in this speech is to review the theme, present new data from our laboratory, and comprehend the importance of considering sleep and melatonin levels as part of the diabetes mellitus prevention and treatment.






Camila Cespedes

Pontificia Universidad Javeriana
Colombia

Title: Insulin pump therapy in children and adolescents: Educational program in Bogota Colombia
Biography:
Cespedes completed her studies in medicine and pediatrics at Universidad Javeriana in Bogota, Colombia. Then she passed three and a half years in Lyon France, in the service of pediatric endocrinology of Professor Pierre Chatelein where she completed her fellowship in pediatric endocrinology. Then she graduated as magister in clinical epidemiology. Now she is associate professor at Universidad Javeriana, and works at the university’s hospital located in the campus itself and at a center of pediatric endocrinology. Her field of research is clinical endocrinology.
Abstract:
Introduction
During the last decades there have been many improvements about how diabetes can be treated and insulin can be delivered. From the development of insulin analogues, pens and thinner needles to insulin pumps. These devices have became safer and more comfortable to be used even by infants and small children. So that, the use of continuous subcutaneous insulin infusion therapy in type 1 diabetic patients has increased. Objective
To describe the experience of a Center of Pediatric Endocrinology in Bogotá Colombia, where children and adolescents less than 18 years all over the country entered an educational program to learn technical skills to use insulin pump Methodology
Near 80 pediatric patients have been trained over 2 years. We describe the process of education, the follow up, facilitators and barriers Results
All patients completed three days of theoretical sessions, only a percentage completed the follow up and different reasons were given to explain difficulties, between them familial reasons, medical reasons and obstacles of the health system Conclusion
The success of the continuous insulin infusion therapy depends not only on medical reasons. In our country and our experience it depends also on social and administrative circumstances that allow or not an adequate follow up and adjustment of the therapy.






Karim Raafat

Beirut Arab University
Lebanon

Title: Antidiabetic and antinociceptive potential of selected eastern-Mediterranean medicinal plants
Biography:
Karim M Raafat Ramadan has completed his PhD at the age of 28 years from German University in Cairo, New Cairo, Egypt, under the channel system and joint supervision scheme between The German University in Cairo (GUC) and Johann Wolfgang Goethe-University Frankfurt, Germany and postdoctoral studies from Beirut Arab University (BAU) and German University in Cairo. He is a visiting Scientist of Johann Wolfgang Goethe-University, Frankfurt, Germany. He is the Head of Phytochemistry Research Team and Junior Research Team, BAU, Lebanon. He has published twenty four peer reviewed journal articles and presentations in scientific conferences. He has been honored with several national and international awards in the scientific field and public service.
Abstract:
Diabetes mellitus and its related complications are of the major chronic diseases affecting millions of people worldwide. Recently, there has been an increasing need in the use of medicinal plants to ameliorate and control DM. This is attributed to that most of the pharmaceutical products in the market induce severe complications following long term use. In response, many Eastern-Mediterranean patients use traditional herbs to treat DM. The purpose of using these herbs is the economical value and the fewer side effects of these herbs, compared to the marketed synthetic drugs. Our current work aims at standardization and evaluation of the antidiabetic and antinociceptive potential of two selected Eastern-Mediterranean plants. Bio-guided and RP-HPLC fractionation combined with acute (6 hrs) and subacute (8 days) administration of extracts and their most active fractions were assessed in alloxan diabetic mice (n=7/group). Likewise, the thermal antinociceptive effects were investigated chronically (8 weeks) to access the herbal plants ameliorating effect on alloxan-induced diabetic neuropathy. Our results demonstrated significant experimental anti-diabetic and antinociceptive effectiveness. It is strongly recommended to consider the Eastern-Mediterranean medicinal plants to the amelioration of chronic diseases, such as DM and its related complications.






Thomas A Mackey

University of Texas Health Science Center Houston
USA

Title: Nurse practitioner primary care practice improvement study outcomes in diabetic patients
Biography:

Abstract:
Purpose
The purpose of this quality improvement project was to transfer previous research knowledge about system change into action and then evaluate the results of those actions applied to process and outcomes of care for diabetic patients. Design
Prospective convenience sample design followed over time. Methods
Consisted of prioritizing our performance based on self-evaluation, involving all staff in the process of change and care of diabetic patients, redesigning our delivery system, activating patients to become more involved in the process of their own care and using our electronic medical records system (EMR). Results
A pre-intervention period query of the EMR revealed 92 diabetic/hyperglycemic patients. Only 44 medical records were study eligible. Pre-intervention data were collected from these records and recorded on a form. Of the original 44 usable records, only 26 (59%) had data available for the post intervention period. The remaining 18 medical records contained no entries indicating patients neither sought nor were provided care during the 6 month post intervention period. The only statistically significant patient lab outcome change using Wilcoxin Matched-pairs Signed-ranks Test (Z=-2.51, p= 0.01) was found in Low Density Lipoprotein (LDL) scores with the mean LDL of 122.0 pre-intervention and 97.9 post-intervention. However, all process of care parameters were improved with greatest gains made in vaccinating patients with pneumococcal vaccine (95% change from pre to post study), flu vaccination (73% change) and aspirin therapy (57% change). Other significant processes improvements were education related to exercise, alcohol usage and smoking cessation (35%, 34% and 30% respectively). Statin therapy and placement on angiotensin converting enzyme medications showed a 27% and 20% increase from pre to post study. Conclusion
System change significantly impacted the process of patient care and had limited impact on patient lab outcomes measures. More time is needed to evaluate the lab outcomes.






Manuel Rosety Rodriguez

University of Cadiz
Spain

Title: Exercise interventions for metabolic disorders in patients with chronic spinal cord injury
Biography:
Manuel Rosety-Rodriguez is a Spanish trained Sports Medicine Physician specialising in health promotion induced by exercise in handicapped populations. He has completed his Ph.D at the age of 28 years from University of Cadiz (Spain) and postdoctoral studies from School of Medicine (University of Athens, Greece). He is Associate Professor and the director of Internal Medicine Department at University of Cadiz. He has published more than 31 papers in top-ranked journals as well as several book chapters on sports medicine. Furthermore, he has visited several sports medicine research laboratories in Italy, USA, Brasil, Germany and Argentina.
Abstract:
Several studies have reported that morbidity and mortality from cardiovascular disease are greater and occur earlier among individuals with chronic spinal cord injury (SCI) compared to able-bodied population. After SCI, changes in body composition (reduction in muscle mass), changes in metabolic rate, and limited mobility might lead to an increased prevalence of obesity in this population. All these findings should be useful for prioritizing preventive health strategies and planning long-term care for people with chronic SCI However, the available evidence does not support that findings from studies conducted in able-bodied adults evaluating efficacy and harms of exercise interventions to prevent obesity-linked metabolic and cardiovascular diseases can be extrapolated to individuals with SCI. Fortunately, recent studies have demonstrated that both resistance and endurance training programs may improve metabolic disturbances such as insulin resistance in this population group. In a more detailed way, these findings could be explained, at least in part, by decreasing low-grade systemic inflammation and oxidative damage. These findings are of particular interest given that they both have been associated with an increased morbidity in this group 22. Lastly, it should be also emphasized that exercise interventions should be effective and safe given that injuries and discomfort may lead to participants to interrupt their training programs. In fact, erring on the conservative side of selected exercise durations and intensities are prudent and even more important for persons training with a disability than those without.






Imad M Taj Eldin

University of Gezira
Sudan

Title: Hypoglycemic activity and regeneration of pancreatic beta-cells produced by allium cepa in alloxan-induced diabetic rats
Biography:

Abstract:
Background
Diabetes mellitus is a chronic disease caused by inherited and/or acquired deficiency in production of insulin by the pancreas, or by ineffectiveness of the produced insulin. Objectives
The present study was carried out to investigate the effects of Allium cepa in diabetic rats. Methods
Alloxan-induced diabetic rats model was conducted to demonstrate the effects of the oral administration of Allium cepa ethanolic extract. Results
Allium cepa showed a moderate time dependent reductions in blood glucose, with a significant decline after 20 days. Furthermore, its clinical improvement and/or increased survival rates in alloxan-induced diabetic rats was evident and it was found superior to glibenclamide. Comparative histopathological studies of the pancreas of these animals revealed a remarkable regeneration of beta-cells caused by Allium cepa. Conclusions
Allium cepa extract produced hypoglycemic effects and restorative activity of the pancreas, thus it could be used as a dietary supplement in management of diabetes.






Badriya al Lenjawi

Weil Cornell medical college
Qatar

Title: Culturally sensitive patient-centered educational program for self management of type 2 diabetes: A randomized controlled trial
Biography:

Abstract:
Objective: To assess the effectiveness of a culturally sensitive structured education program (CSSEP) on biomedical, knowledge, attitude & practice measures among Arabs with type 2 diabetes.
Research designs and methods: A total of (430) patient with type two Diabetes Mellitus living in Doha - Qatar were enrolled in the study. They were randomized to either intervention (n = 215) or control group (n= 215). A baseline and one-year interval levels of biomedical variables including HbA1C, lipid profile, urine for microalbuminaria, in addition to knowledge, attitude and practice (KAP) scores were prospectively measured. The intervention was based on theory of empowerment, health belief models and was culturally sensitive in relation to language (Arabic), food habits and health beliefs. It consisted of four educational sessions for each group of patients (10-20 patients per session), lasting for three to four hours. The first session discussed diabetes pathophysiology and complications; while the second session discussed healthy life style incorporating the Idaho plate method; and the third session dealt with exercise benefits and goal setting and the fourth session concentrated enhancing attitude and practice using counseling techniques .outcomes were assessed at base line and 12 months after intervention.
Results: Participation in the intervention was shown after 12 months to have lead to a statistically significant reduction in HbA1C was observed in the (CSSEP) group (- 0.55 mmol/L, P = 0.012), fasting blood sugar (- 0.92 mmol/L, P = 0.022), body mass index (1.70, P = 0.001) and albumin/creatinine ratio (- 3.09, P < 0.0001) but not in the control group. The intervention group had improvement in diabetes knowledge (-5.91, P < 0.0001), attitude (-6.56, P<0.0001), and practice (-6.52, P = 0.0001) at 95% CI.
Conclusion: This study demonstrates the effectiveness of a culturally sensitive structured group based diabetes education in enhancing biomedical & behavioral outcomes in diabetic patients.






Michael B Strauss

Long Beach Memorial Medical Center
USA

Title: Tools for decision making in diabetic foot ulcers
Biography:

Abstract:
Introduction: When one hears of thousands being spent to salvage a diabetic foot problem only to go onto a lower limb amputation, the need for objective criteria for decision making between limb salvage versus amputation (SvA) is apparent. This presentation provides 2 objective scoring tools to justify the SvAdecision.
Methods: It was apparent that scoring tools were neededto provide guidance for making the crucial decision of SvA. A Wellness Score (WS) and a Goal Score (GS) I that I generated solved this problem. Each is based on 5 objective assessments graded from 2 (best) to 0 (worst). This generates a 0 to 10 score for each tool. We utilized these tools in a series of patients where the crucial decision of SvA needed to be made.
Findings: The use of the WS & GS provided justification for SvA and was especially useful for the diabetic with a limb threatening Charcot foot ulcer. All patients where a SvA decision needed to be made and an amputation was done scored less than 5 points on either or both of the WS &GS. When the patient (and/or person providing the durable power of attorney) was informed of the scores from these 2 tools decision making became easy.
Conclusions: Objectivity can be employed for making decisions whether to SvA a diabetic foot wound using the WS & GS tools. Information from these 2 scoring tools provides cost justification for decisions regarding patient management of diabetic foot ulcers.






Carolee Dodge Francis

University of Nevada Las Vegas
USA

Title: Prevention of type 2 diabetes in urban American Indian/Alaska natives communities: The Life in balance Pilot Study
Biography:

Abstract:
Objective
The Life in BALANCE (LIB) study was a pilot translational study modeling the Diabetes Prevention Program (DPP) intensive lifestyle coaching intervention among an underserved, high-risk population: American Indians/Alaska Natives (AI/ANs) living in a large urban setting (Las Vegas, Nevada). Research Design and Methods
The LIB qualitative component used semi-structured one-on-one interviews to understand the experiences of 11 of the program participants who completed the core curriculum (n = 11 out of 15). Subjects who agreed to participate in the qualitative component ranged in age from 23 to 55 years with a mean of 39 years and included 9 women and 2 men. Interviews were transcribed and then coded and analyzed using Atlas.ti Qualitative Data Analysis software. Results
Eight thematic categories (motivation, limited health knowledge, lifestyle change options, etc.) emerged as the most relevant to the aims of the qualitative component. Conclusions
The qualitative data from the interviews reflects the Social Cognitive Theory (SCT), where key components of SCT are the interplay of personal, behavioral and environmental influences. The LIB intervention recognized that barrier/impediments in the built environment of the participants impacted or reduced positive health behaviors.






Hashim Mohamed

Weill Cornell Medical College
Qatar

Title: Natural honey as an adjunctive alternative in the management of diabetic foot ulcers
Biography:
Hashim Mohamed is an assistant professor at Weill Cornell Medical College-Qatar and senior consultant for Family Medicine in Doha, Qatar. His main interest is management of diabetic foot at primary care level . He is an invited guest speaker at many local, regional and international conferences, the last one was "The fourth International Diabetic foot conference in Dubai" .He has published many papers with regards to the use of natural honey in the management of diabetic foot and recently wrote a chapter about the efficacy of natural honey in the management of diabetic foot ulceration. "Cellular and molecular mechanisms of honey wound healing"
Abstract:
Diabetes –related foot complications are a major burden for society and the health systems. Patients suffering from diabetic ulcers are at increased risk of lower limb infection and hospitalization. As a result patients suffer from decreased function ,lower quality of life ,depression , and staggering health care cost. Worldwide, the majority of diabetic patients are being treated mainly at hospitals, but this option is costly, time consuming and lead to increased cost and over utilization of health care resources. We are proposing the management of diabetic foot conditions to be established at the frontline ,that is at primary care level. At a time and a place where interventions can be delivered early on in the disease progression rather than wait for further delay at secondary and tertiary level. We are presenting a case series which has been accepted for publications at the scientific journal “WOUNDS” in 2013 and some of the cases were already published in "Wounds practice and research"journal 2013,"Journal of lymphedema-UK"2013 and "Tissue viability journal "2014 and .These case series cover a multitude of acute and chronic wound for diabetic patients presenting at primary care level.The objectives of the presentation are: 1-highlight the feasibility and effectiveness of primary care interventions with regards to diabetic foot. 2-demonstrate the efficacy of natural honey in acute and chronic wounds 3-establish a discussion about the feasibility of including natural honey as a useful alternative and a cost effective wound dressing.






Monica Wilson

National University
USA

Title: Diabetes and the effects on emotional wellness of patients
Biography:

Abstract:
Diabetes is the 7th leading cause of death in the US and prevalence has more than doubled in 10 years. People with serious behavioral health diagnoses are twice as likely to develop diabetes with 25.8 million people in the UShave diabetes, of those7 million don’t knowthey have it and 79 million peoplein the UShave pre-diabetes. Recognizing that diabetes is severe chronic health condition that has many implications for a patients’ mental and emotional well-being is essential. Many of the health care systems do not address this major concern amongst patience and how it includes major associations between both the treatment of the illness and the patience life expectancy. Diabetes is considered one of the most psychologically demanding of the chronic medical illnesses. A meta-review of current research and literature review relating to diabetes and mental health of individuals with diabetes, suggest that researchers, providers, and policymakers must become more aware of the adverse psychological impact that diabetes carries and actively seek to intervene on the factors that may exacerbate diabetes-related emotional distress. Greater attention needs to be exploredaddressing diabetes and its psychological side through support and coping strategies, and not just the disease is essential. Additionally, effective therapeutic responses may reduce the inappropriate stigmatization that is associated with mental illness and diabetes and has important implications and the patients’ quality of life. A discussion of evidence-based treatment modalities and suggested service providers, along with challenges to implementation and evaluation, of diabetes and the emotional well-being of patients will be included.






Mae Sheikh-Ali

University of Florida
USA

Title: Update on diabetes management: Learn the update on glucose lowering agents
Biography:

Abstract:
Large clinical diabetes trials have demonstrated beneficial effects of lowering hemoglobin A1C on micro vascular complications. Lessons from these trials revealed that sustained intensification of medical therapy is difficult and pointed towards the progressive loss of beta cell mass over time. In the light of these results, nine new classes of drugs have been introduced over the last decade. In spite of this, the newer drugs were less potent in their efficacy to lower hemoglobin A1C than insulin therapy. Furthermore, there are yet no clinical data to demonstrate their ability to preserve beta cell function in humans. Besides that, serious adverse events were noted with the newer agents. Given all that, it important to lower hemoglobin A1C, then again the way to get there is as important learning what and when to add on therapies.






Ian Martins

Edith Cowan University School of Medicine
Australia

Title: Nutritional and genotoxic stress contributes to diabetes and neurodegenerative diseases such as Parkinson’s and Alzheimer’s diseases
Biography:
Martins is a Fellow at the Centre for Ageing and Alzheimer’s disease, Edith Cowan University and UWA. Prevention of overeating by food restriction improves liver lipid and xenobiotic metabolism with the nature of fat consumed improves brain health. Contribution to biology is related to sterol side chain length indicating cholesterol as a metabolic control of liver lipoprotein and xenobiotic metabolism. Publications, patents, books and chapters have been filed for evaluation of education for obesity, diabetes and AD. Dr Martins’ is the Chief Editor for Scientific and Academic Publishing (2013/2014) and a reviewer for international journals and Grant agencies.
Abstract:
The global epidemic indicates that one third of adults in the United States are obese and over 11% of these individuals have diabetes with the incidence of diabetes predicated to increase to 21% by 2050. In various continents, the rise in the global diabetes epidemic has been associated with cell suicide in various organs that are related to obesity, Type 2 diabetes and neurodegenerative diseases. Therapeutics to control and stabilize the severity of the metabolic syndrome and diabetes in various communities are required to prevent mental illness and early cellular senescence that is connected to the lifespan of diabetics. The increased cell senescence in diabetes has been associated with the limited ability of cells to divide with indication of telomere shortening and genomic instability is connected to cell suicide.Diet and liver diseases are closely connected and are of central importance with aging and programmed cell death pathways. Nutritional therapy and appetite control have become of central importance to nutrigenomics as early nutritional therapy may assist genes to delay liver and brain diseases associated with insulin resistance, cancer and aging. Interests in the global epidemic in Type 2 diabetes have been associated with accelerated dementia and even with progression to Parkinson’s disease (PD) and Alzheimer’s disease (AD). Anti-aging therapies such as diet, exercise and selective drug therapy early in life may prevent calorie overload and activation of calorie sensitive genes Sirtuin 1 (Sirt 1) that control genotoxic stress in cardiovascular disease and diabetes that accelerates aging, PD and AD






Abdul Hakeem Hamza

PHCC
Qatar

Title: Barriers to the effective management of diabetic foot in the middle east
Biography:
Abdul Hakeem Hamza obtained his medical degree from the Manipal Academy of Higher Education, India and further postgraduate qualifications from the Royal College Of General Practitioners, UK. During this period he also served as one of the lead family physicians in Liverpool Primary Care Trust. After almost 11 years experience in UK, he is currently undertaking a role of consultant family medicine in the Primary Health Care Corporation in Qatar. His keen interests lie in the fields of diabetes, diabetic research and medical education and he is a trainer for the MRCGP International candidates.
Abstract:
The incidence and prevalence of Type 2 Diabetes is increasing worldwide but developing economies will bear a disproportionate share of this burden. The expected alarming increase in the prevalence of Diabetes in this region also increases the risk of Diabetic complications such as Diabetic Foot. Diabetic foot ulcers are the most common cause of lower limb amputations worldwide as well as in the Middle East. 1 in 4 diabetic patients risk developing foot ulcers, half of them will become infected and 1 in 5 will require an amputation. The odds of developing this risk in the Middle East population is even higher due to higher prevalence of Diabetes, social and lifestyle characteristics of the population, lack of understanding in patients and professionals leading to defective screening and identification at primary care level. Within the remit of the available evidence we identify various barriers to the effective management of diabetic foot in the Middle East region. These factors range from patient perspectives and beliefs, lack of awareness among healthcare professionals, scarcity of services, expertise and a lack of understanding in priority setting and resource allocation at the organizational level. A massive up scaling of services and expertise in the Middle East region is urgently required to prevent a rise in amputation levels and to lessen the future health and economic burden. We shall explore and discuss these barriers, challenges in counteracting them and the grave consequences or expected outcomes if these barriers are not overcome.






Belahsen Rekia

Chouaib Doukkali University
Morocco

Title: Assessment of education impact on clinical, biological and nutritional status in type II diabetic population in El Jadida province of Morocco
Biography:

Abstract:
Background
Education is reported to have positive impact on health. In this study the aim was to investigate the effect of health education on the improvement of diabetes care in a group of Moroccan diabetic adults. Methods
A sample of 240 type II diabetic adults, of 20 to 65years old, visiting the Azemmour hospital between January 2011 and March 2012, was divided in two groups: an educated group that received a training (EG) and a non educated (NEG) that did not received any training on diabetes and the improvement of diabetes care. Data on anthropometric measurements, biochemical, demographics and food consumption using 24h dietary recall were collected in both groups. Results
The results show that HbAc1 was significantly higher in (NEG) than in the (EG) group (9.24% vs. 7.15% respectively). Globally 57.5% of diabetics cannot balance their diabetes; this rate reached 78.4 % in rural and 76.6% in NEG while it was 23.4% only in the EG. The prevalence of physical inactivity, abdominal obesity, Low HDL, hyper triglycerides, hypertension and metabolic syndrome were higher in the NEG. BMI was 29.56 ± 3.54 in NEG and 26.48 ± 3.43 kg/m2 in EG. The energy intake was 2411 ± 196.5 Kcal in the NEG and 1966.13 ± 221.16 in the EG. Carbohydrates, proteins and lipids intakes were respectively (37.39 ± 4.48 %) (22.88% ± 3.24) and (39.37±4.43 %) with a low fiber intake (16.84 ± 3,55 ) in NEG. Conclusion
This study results show that the diabetic patients status justify the fundamental role of patient education for an effective and efficient management of diabetes.






Diabetes and its Complications
Session Introduction

Momoh A Yakubu

Texas Southern University
USA

Title: Cerebral hypoperfusion and cerebrovascular protein alterations induced by diabetes
Biography:

Abstract:
Morbidity associated with uncontrolled diabetes includes cardiovascular disease, loss of sight and renal dysfunctions. Despite recent advances in diabetes treatment, an estimated 40% or more of people currently on available treatment options are not in optimal control of their disease. Therefore, an increased risk of experiencing diabetes complications exists. My research interests amongst others focus on the molecular pathology of diabetic complications, in particular cerebrovascular complications characterized by hypoperfusion/cerebral insufficiency, predisposition to stroke and worst stroke outcome in diabetes. Experimental studies have revealed that chronic dysregulation of glycemic control leads to deficits in cerebrovascular structure and function which may explain some of the clinical complications observed. Such observations as edema, inflammations, neovascularization, protease expression, cerebrovascular remodeling accompanied by altered vascular functions suggesting potential therapeutic targets. We have investigated the effects of diabetes on cerebral blood flow, signaling molecules and essential protein expressions in cerebral microvessles. The identification of potential proteins that can mediate altered cerebrovascular structure and function will serve as therapeutic targets. These protein targets can provide cerebrovascular protection which would not be limited to prevention of diabetes-induced deleterious changes in cerebrovascular structure/function before the occurrence of cerebrovascular incidence but can also be targeted acutely to preventing vascular dysfunction and loss of vascular integrity. The attending consequences and complications of diabetes induce-stroke can be abated with targeted intervention. Therefore, the results from this study would provide an insight into the cerebrovascular changes that is induced by chronic hyperglycemia; identify profiles of proteins affected which contribute to the remodeling and the cerebrovascular complications as therapeutic targets.






Pratiksha G Gandhi

IPC Heart Care
India

Title: Emerging technologies for non-invasive diagnosis of risk profile for cardio-metabolic disorders
Biography:
Pratiksha G. Gandhi is the Chairperson of IPC Heart Care, Mumbai, a preventive heart care platform in Mumbai, India. USA/ Dr Albert Maarek is the inventor of the non-invasive multi-diagnostic cardiovascular risk profiler (TM-Oxi System). LD-Technologies , Miami, Florida.
Abstract:
Sixty-three patients, who were diagnosed with atherosclerosis and forty-seven subjects, who claimed to be healthy, were included in this study. The group one was further subdivided to Sub Group A: Atherosclerosis patients who had not undergone surgery (CABG) or percutaneous coronary angioplasty (PCI). Sub Group B: Atherosclerosis patients who had undergone interventional therapy. These patients and control subjects underwent examination with the TM-Oxi System. This system uses a blood pressure monitoring device as well as an oximeter to collect information and has a proprietary software for performing analysis of the collected data, to provide risk scores, PTG Index and EndoT Score. Statistical analysis was performed using the Receiver-operating characteristic curves (ROV) to determine the specificity and sensitivity of PTG index and Endo T score in detecting vascular dysfunction. PTG index had a sensitivity of 86% and specificity of 87% for the detection of endothelial dysfunction in these studies (P=0.0001). Endo T score derived from the data obtained in these studies correlated well with the PTG index analysis and had similar results with the sensitivity of 86% and specificity of 86%. Non-invasive TM-Oxi measurements of the vessel wall physiology and function and risk profiling, serves as useful tool to assess the early stages of the vasulopathy.






Lubov Kolesnikova

Russian Academy of Medical Sciences
Russia

Title: Ethnic aspects in lipid and carbohydrate metabolism in patients with type 1 diabetes mellitus
Biography:
Lubov Kolesnikova completed her PhD in 1994 and became Corresponding member of Russian Academy of Medical Sciences in 2000 year. Since 1999 until present she is a director of Scientific сentre of family health and human reproduction problems of Siberian brunch of RAMS (Irkutsk, Russian Federation). She has published more than 400 papers and serving as an editorial board member of some journals.
Abstract:
Scientific Centre of Family Health and Human Reproduction Problems, Siberian Branch, Russian Academy of Medical Sciences, Irkutsk, Russia Incidence, severity, and rate of complications of type 1 diabetes mellitus (T1D) associated with many factors including geographic location and ethnicity. Sixty-five patients of the Russian and Buryat populations having 1 type diabetes were examined. All patients examined were born in Buryat republic and were living there. It was revealed that the changes in indices of lipidogramms in patients of Russian population are atherogenic variant of dislipidemia. During the analysis of the indices of carbohydrate metabolism in the control and patients’ groups there was found reliable increase of lactic acid level and ratio of lactic acid/pyruvic acid in patients of Russian population. Lactic acid content and ratio of lactic acid/pyruvic acid in this group increased by 2.4. Thus, more significant increases in lactic acid blood levels in Russian with T1D indicates an anaerobic tendency of their metabolism with acidosis development.






Xu Jinjin

Wuhan University
China

Title: The anesthetic propofol for cardioprotection in diabetes: An update
Biography:

Abstract:
Diabetes mellitus is the fifth leading cause of death worldwide. Diabetic patients often die from diabetic complications, the majority of which are connected with cardiovascular disease. Following Surgery, patients with diabetes suffer higher rates of perioperative cardiovascular morbidity, mortality, and a lower rate of survival than non-diabetic patients. Anesthetics may change the mode of ventricular filling and often modify and attenuate the stabilization of cardiac hemodynamics during surgery in patients. Increase in oxidative stress under pathological conditions has been shown to make the heart more prone to insults. In diabetes, hyperglycemia increases reactive oxygen species(ROS) production and induces oxidative stress, which has been recognized as a major mechanism of myocardial injury. Thus, cardiovascular responses to anesthesia in diabetic patients can be less predictable, making these patients more susceptible to cardiovascular complications during surgery. which may be in part as a consequence ofincreased oxidative stress , and impaired endogenous myocardial protective pathway.. Increasing evidence shows that propofol, a commonly used general anesthetic with antioxidant potential, can confer cardioprotection in patients undergoing either cardiac or non-cardiac surgery. However, the cardioprotective effects of propofol in patients with diabetes is debatable. Although conventional low doses of propofol have not been clinically effective in reducing postoperative cardiac injury or improving cardiac function, our in vivo study suggest that high doses of propofol can improve cardiac function and inhibit oxidative stress in diabetic rats(Crit Care Med. 2014 May 7). In line with our results, Crespo et al( DiabVasc Dis Res. 2011 Oct;8(4):299-302) reported that propofol(50mg/kg IP) can increase cardiac output and systolic blood pressure(SBP) , which should improve tissue perfusion in diabetic patients undergoing surgical procedures. Propofol is known to cause vasodilation by increasing nitric oxide(NO)-mediated relaxation secondary to eNOS activation. In diabetic rats, however, NO-mediated relaxation is impaired, and oxidative stress is increased. However, Wickley and colleagues suggest that propofol should be administered cautiously to diabetic patients with limited inotropic reserve and /or diastolic dysfunction because propofol can cause a decrease in myofilament Ca2+ sensitivity via protein kinase C and nitric oxide synthase-dependent pathway in diabetic cardiomyocytes ,which may subsequently lead to hemodynamic instability( Anesthesiology. 2007 Feb;106(2):302-11). Therefore, it seems necessary that large-scale randomized clinical trials in diabetic patients be performed in the near future in order to answer whether or not propofol can confer cardioprotection in diabetic patients.






Vikram V Shanbhogue

Odense University Hospital
Denmark

Title: Impact of diabetic microvascular complications on bone structure in type 1 diabetes mellitus
Biography:

Abstract:
Aim
While most studies have consistently shown that patients with type 1 diabetes mellitus (T1DM) have an increased risk of osteoporosis and fracture, the structural basis for this is unclear. The aim of this cross-sectional in-vivo study was to gain insight into bone geometry, volumetric BMD (vBMD), microarchitecture and estimated bone strength in adult patients with T1DM with particular emphasis on those with and without micro-vascular complications using high-resolution peripheral quantitative computed tomography (HR-pQCT).
Materials and Methods
Forty-four patients with T1DM (mean age 45.5 ± 12.1 years; 19 females, 25 males) were recruited from the “Fyn Diabetes Database” and matched with respect to age, gender and height with 44 healthy subjects (mean age 46.1 ± 12.0 years). Twenty patients with T1DM had evidence of diabetic microvascular complications. HR-pQCT at the distal radius and distal tibia was performed in all participants.
Preliminary results
In weight-adjusted models, HR-pQCT revealed significantly lower total, trabecular (Tb) and cortical (Ct)vBMD (p<0.01, 0.03 and 0.03, respectively), and thinner cortex (p=0.03) at the radiusin T1DM patients in comparison to healthy controls.In multiple regression analysis, the presence of diabetic microvascular complications correlated negatively with Tb vBMD and Tb thickness at the radius and tibia and total vBMD at the tibia independent of age, weight, duration of diabetes and glycemic control.
Conclusions
This study showed that T1DM patients had compromised volumetric densities and microarchitecture predominantly at non-weight bearing bones like the radius. However, the presence of diabetic microvascular complications was an independent risk factor associated with a compromised trabecular compartment at both, the radius, as well as the tibia.






Muneeb A Faiq

All India Institute of Medical Sciences
India

Title: Glaucoma: Diabetes of the brain- A radical hypothesis about its nature and pathogenesis
Biography:

Abstract:
“Glaucoma: Diabetes of the Brain Hypothesis” is a comprehensive insight into the etiopathomechanistic aspects of diabetes and glaucoma. This hypothesis aims at generating a far-reaching understanding of glaucoma and diabetes and proposes a radical concept about the nature of both these disorders. It explains that diabetes is a collection of complex and intricately interwoven molecular derangements which can inflict brain in addition to pancreas. The theory explains that brain diabetes can occur independent of pancreatic diabetes. It recognizes that brain diabetes manifests as glaucoma and/or Alzheimer’s disease (AD) and can be understood by pathomechanistic parallels with pancreatic diabetes. The hypothesis also puts forth the idea of complementarities between glaucoma and AD (glaucoma - ocular AD and vice versa). All these concepts are being explained in terms of (a) molecular cross-talk between glaucoma and diabetes, (b) striking similarities between retinal ganglion cells (RGCs: cells that are affected in glaucoma) and β-cells, (c) insulin signaling in CNS/retina, (d) insulin signaling in glaucoma and RGC survival, (e) regulation of intraocular pressure (most important risk factor for glaucoma) by insulin, (f) use of streptozotocin in establishing diabetes as well as glaucoma, (g) Pax6 gene involvement in glaucoma and diabetes, (h) comprehensive similarities between glaucoma, AD and diabetes, (i) AD as type-3 and glaucoma as type-4 diabetes, (j) potential use of antidiabetics in glaucoma and AD and prospective effects of neuroregenerative regimens in diabetes. This theory has already made a paradigm shift in the current understanding of glaucoma and diabetes and is likely to make great impact in treatment and management of the relevant disorders.






Hao Zhu

University of Kansas Medical Center
USA

Title: Can iron and mitochondrial defects cause diabetes
Biography:
Hao Zhu received his PhD degree from the University of Texas at Austin and postdoctoral training at Brigham and Women's Hospital, Harvard Medical School. He has published more than 30 original research papers and review articles in reputed journals, including Science, PNAS, JBC and Biochemical Pharmacology. He has reviewed grant proposals for Diabetes UK and Portuguese Foundation for Science and Technology and various manuscripts for numerous journals.
Abstract:
Contributions of iron and mitochondrial defects to the pathogenesis of diabetes have long been debated but unresolved in general population due to the polygenic nature of most diabetes cases. Limited numbers of monogenic diabetes have been identified and allow us to examine the underlying cellular pathways and molecular mechanisms of diabetes. Involvement of iron and mitochondrial defects in the dysfunction and loss of insulin-producing beta-cells have been confirmed in Friedreich's ataxia and animal models that are deficient in TFAM (transcriptional factor A, mitochondrial) and NCB5OR (NADH cytochrome b5 oxidoreductase. My laboratory has been studying how Ncb5or functions to maintain iron homeostasis and mitochondrial function, as well as their relationship to lipid metabolism, in diabetes and neurodegeneration. The new knowledge will provide potential therapeutic target(s) for both diseases.






Domenico Merante

Daiichi Sankyo Development Ltd
UK

Title: Impact of the nocebo effect in clinical studies of painful Diabetic Peripheral Neuropathy. Can this effect masquerade a safety signal of a new investigational compound?
Biography:
Domenico Merante completed his medical degree in 1988 at the age of 25 and in 1993 he became specialist of endocrinology and diabetes, obtained both the degrees at Pisa University/Italy and St. Chiara Hospital, Pisa. He is currently senior director of clinical development of Daiichi Sankyo Development Ltd. in the UK. He previously worked at GSK, Eli Lilly, Novo Nordisk and Lab. Guidotti. He has dedicated over 20 years in the pharmaceutical industry mainly working in diabetes, endocrinology, hypertension and neuropathic pain areas of research. He has published 21 papers and 18 abstracts in reputed journals as main or co-author.
Abstract:
Randomized, double blind, placebo controlled studies are `the gold standard` of Painful Diabetic Peripheral Neuropathy (DPNP). The nocebo effect represents the manifestation of side effects in clinical setting during placebo treatment. This can be considerable with side effects of any kind and severity within those in the label of an active study comparator, which is also recommended in confirmatory study designs. Accordingly to a recent analysis in 62 studies involving 5,095 patients with DPNP this effect contributed to 5.8% of subject`s discontinuations. Any attempt to mitigate the nocebo effect may improve the overall tolerability profile of placebo and ultimately the retention rate of subjects in a clinical setting. In addition and no less importantly, the nocebo effect can potentially masquerade an early safety signal from a newly tested compound. Side effects of currently available pain medications as well as newly tested molecules can be with high rate of incidence and severe by intensity. Typically the most relevant side effects are CNS-related including somnolence, dizziness, and abuse potential, gastrointestinal, cardiovascular, edema, weight gain, ophthalmological disturbances, impotence and increased risk of suicide. The danger from these side effects is considerable. It is vital to define a clinical safety plan with an Independent Safety Monitoring Committee to assess side effects of relevance in un-blinded fashion during the course of clinical studies and to ultimately establish causality relationship based on patient history and concomitant medications. This may allow the early detection of a safety signal, which otherwise might be obscured by the nocebo effect.






John S D Chan

Universite de Montreal
Canada

Title: Intrarenal Renin-Angiotensin System (RAS) and tubular atrophy in diabetic nephropathy
Biography:
John S D Chan is currently a professor of medicine at the Université de Montréal and the chief of the laboratory of Molecular Nephrology and Endocrinology at the research centre of Centre hospitalier de l’Université de Montréal (CRCHUM). His research program seeks to understand the role(s) of intrarenal renin angiotensin system (RAS) and oxidative stress in the pathogenesis of diabetic nephropathy. He has published over 100 papers in scientific journals and presented more than 250 abstracts in various scientific societies and he is editor of the ebook entitled: Diabetic Nephropathy, ISBN 978-953-51-0543-5
Abstract:
Diabetic nephropathy (DN) and retinopathy represent the major causes of end-stage renal disease and blindness in developed countries. DN is associated with an increased risk of hypertension, adverse cardiovascular events, chronic kidney diseases and haemodialysis. Efforts are therefore being made to find ways of preventing and/or slowing down the progression of DN worldwide. DN is initiated by glomerular changes, namely hypertrophy, then thickening of the basement membrane with subsequent expansion of the mesangial matrix and glomerulosclerosis. This is associated not only with microalbuminuria, an early clinically detectable lesion, but also with tubulointerstitial fibrosis and tubular atrophy. Oxidative stress, hyperglycemia and renin-angiotensin system (RAS) dysfunction have been linked to the development of these lesions. Although albuminuria is a useful clinical marker, tubulointerstitial fibrosis and tubular atrophy represent a better predictor of nephropathy progression because of their close association with declining renal function. Many randomized controlled trials have shown the efficacy of optimal glycemic control and RAS blockade in the primary and secondary prevention of DN. The former is easily understood, as decreased “glucotoxicity” reduces end-organ damage. However, the mechanisms underlying the protective action of RAS inhibition, notably angiotensin II (Ang II) receptor blockade, are not well understood. In this lecture, we present the recent results of studies aiming to understand the consequences of RAS blockade at the molecular level, with an emphasis on intrarenal RAS activation and tubular lesions in DN.






Sebastian Oltean

University of Bristol
UK

Title: Alternative splicing in diabetic nephropathy
Biography:
Sebastian Oltean studied clinical medicine at “Iuliu Hatieganu” Medical School in Cluj-Napoca, Romania followed by residency training in Nephrology. He then moved to USA where in 2004 obtained a Ph.D. in biochemistry from the University of Nebraska-Lincoln, followed by postdoctoral training at Duke University Medical Center, where he studied connections between alternative splicing regulation and disease. In 2008 he moved to University of Bristol (UK) where he is now a University research fellow and principal investigator. One of his main research themes is the understanding of therapeutic potential of targeting alternative splicing in diabetic nephropathy.
Abstract:
Diabetes is increasingly common in all regions of the world and diabetic complications represent an important burden on the health system. Though diabetic nephropathy (DN) is the main cause of end-stage renal failure in UK and worldwide, no specific treatment is yet available. Alternative splicing (AS) is one of the main determinants of proteomic diversity with more than 90% of genes being estimated to be alternative spliced in humans. In recent years a plethora of AS events have been described to be associated with specific diseases but their contribution to pathogenesis is very little understood. Several AS events have been described recently to be associated with diabetes and/or DN progression. Our research shows that splicing isoforms may be manipulated in vivo to slow progression of DN. The ultimate goal of this work is to identify molecules (e.g splicing factors, kinases, signaling molecules) that are master regulators of this process and could represent attractive therapeutic targets.






Frank Thies

University of Aberdeen
UK

Title: Can increased lycopene consumption reduce cardiovascular risk in diabetic patients
Biography:
Frank Thies completed his Ph.D. in nutritional physiology at the University of Burgundy in 1991. After working at NIH, Oxford University and the University of Southampton he joined the University of Aberdeen in 2001. Currently he is the secretary of the Scottish section of the nutrition society and a member of the scientific committee and council of the Nutrition Society. His research mainly relates to the influence of various dietary components on cardiovascular function and cardiovascular risk with particular emphasis being placed on the role of inflammatory processes.
Abstract:
Type-2 diabetes is associated with an increased risk of stroke, heart disease and peripheral arterial disease, which are the leading cause of mortality and morbidity in Western countries. In the UK, the incidence of diagnosed type 2 diabetes significantly increased over the last 10 years, reaching 515 cases per 100,000 in 2010. Epidemiological evidence indicates that high consumption of fruits and vegetables reduces the risk of chronic disease such as CVD and increased intake of tomato-based products has been associated with a significant reduction of relative risk of CVD, which could be of particular benefit for diabetic patients. Such potential benefits to cardiovascular health from a tomato-rich diet are often ascribed to high concentrations of lycopene in tomato products. Lycopene is carotenoid which constitutes 80-90% of the pigments present in tomato. It is readily bioavailable and represents one of the main carotenoids found in human plasma blood. Elevated systemic concentrations of lycopene correlate with a reduction in CVD incidence, and are inversely associated with markers of CVD risk, such as c reactive protein and vascular endothelial dysfunction. Potential mechanisms by which lycopene could protect against heart disease include the reduction of serum total and low density lipoprotein cholesterol concentrations, modulation of inflammatory markers, and by reducing oxidative damage. This presentation will review the evidence for the cardiovascular benefits of high lycopene consumption and new aspects on the mechanisms of action will be presented.






Judith Aponte

Hunter-Bellevue School of Nursing
USA

Title: Prevalence of normoglycemic, prediabetic and diabetic A1c Levels: NHANES 2007-2008 and NHANES 2009-2010
Biography:
Judith Aponte completed herPhD from Columbia University.She is an Associate Professor and coordinator of the Community/Public Health (MS) and Community/Public Health/Urban Health (MS/MPH) programs at Hunter College, Hunter-Bellevue School of Nursing. She also is a doctoral faculty member at the Graduate Center, City University of New York. Dr. Aponte has numerous published papers inpeer-reviewed journals and has been serving as an editorial board member of repute.
Abstract:
Purpose
The purpose of this study was twofold: (1) investigate A1c levels for normoglycemia, prediabetes and diabetes prevalence in those with self-reported prediabetes; and (2) investigate A1c levels for prediabetes and diabetes in those with self-reported non-prediabetes (i.e., self-reportnot ever had prediabetes). Methods
The National Health and Nutritional Examination Survey (NHANES) 2007-2008 and NHANES 2009-2010 were utilized to examine and compare trends and differences among five ethnic groups (Mexican Americans, Other Hispanics, Non-Hispanic Whites, Non-Hispanic Blacks, Other/Multi-racials) among two groups: 1) with normoglycemic, prediabetic and diabetic A1c levels with self-reported prediabetes; and 2) with prediabetic and diabetic A1c levels in those with self-reported non-prediabetes. The sample includedonly those 20 years of age and older, who completed the diabetes questionnaire and had A1c levels drawn. Descriptive statistics were computed for all variables. Chi-squareswere performed for significant differences of normoglycemic, prediabetic and diabetic A1c levels in those with self-reported prediabetes, and in those with self-reported non-prediabetes. Results
Chi-square analysis showed significant differences when examining the different ranges of A1c levels (normoglycemic, prediabetic and diabetic) amongeach of the five ethnic groups (P≤ 0.0001- 0.0222). For all combined ethnic groups who self-reported not having prediabetes (non-prediabetes), 19.9% of those in NHANES 2007-2008 and 22.4% in NHANES 2009-2010 showed to have prediabeticA1c levels. When separately examining each of the five ethnic groups who self-reported not having prediabetes, all showed an increase in prediabeticA1c levels from NHANES 2007-2008 to NHANES 2009-2010. Conclusion
Pre diabetes awareness and educational programs are urgently needed.






Gundu H R Rao

University of Minnesota
USA

Title: Non-Traditional approaches for management of cardio metabolic risks
Biography:
Gundu H. R. Rao is an Emeritus Professor at the Lillehei Heart Institute, University of Minnesota. He has over 350 peer-reviewed publications. He is on the advisory board of many preventive cardiology journals. He is the founder CEO of SASAT and International Society For Prevention of Atherosclerosis and Thrombosis.
Abstract:
Modern medicine has failed to reduce or prevent the rapid increase in Cardio-Metabolic Disorders worldwide. According experts at NIH/USA, the disease driven approach to care, has resulted in spiraling costs, as well as a fragmented health system. Current Diagnostic methodologies identify “at risk” patients at a point that it is too late, to account for the damage already caused by underlying pathologies. For instance, if we consider the type-2 diabetes detection, monitoring standards such as HbA1c, fasting plasma glucose, aid in identifying irregular blood glucose in circulating blood. However, using these markers would result in management of just palliative treatment of the disease and its symptoms and the damage already done is not reversible. We at IPC Heart Care Center, Mumbai, feel that early detection of the underlying pathologies, and effective management of the observed lesions or dysfunctions, is the best choice for reducing the health care costs. Non-invasive methods are available, to monitor blood glucose, autonomic and peripheral sympathetic neuropathy, endothelial dysfunction and 3D imaging of carotid artery. We have screened over 1200 subjects, using this technology (TM-Oxi), in our clinics in Mumbai. Use of such technology has identified autonomic, sudo-motor and endothelial dysfunction reliably, to distinguish diabetic populations from non-diabetic subjects. We will present an overview of our work at Mumbai, India.






Noel C Barengo

Observatorio de Diabetes de Colombia
Colombia

Title: The pattern of the rules of halves in diabetes mellitus tested with data from Colombia
Biography:
Noel C Barengo has received his academic training at the University of Kuopio (Finland), the Karolinska Institute (Sweden) and the University of Zurich (Switzerland): MD (1999); Master in Public Health (2001); PhD (2006); adjunct professor in Public Health at the University of Helsinki (2009). His research interests are prevention of diabetes mellitus and cardiovascular diseases. He currently works at the Colombian Ministry of Health and Social Protection as expert in diabetes mellitus. Furthermore, he is a research consultant at the University of Tolima. He has published more than 50 peer-reviewed papers and acts as academic editor for PLOS ONE medicine.
Abstract:
The rule of halves in diabetes mellitus (DM) refers to the pattern that half of people with the disease is undetected, half of those diagnosed are untreated and half of those treated patients are not controlled. The objective of this study was to test whether the rules of halves applies to the Colombian setting using local data. Information regarding distribution of the Colombian population was retrieved from the National Administrative Department of Statistics. Data on the number of diagnosed DM was obtained from the National Risk Factor Survey 2007 (ENS 2007), an organization of the healthcare insurers to trace high expenditure diseases. Data on number of patients treated for DM was obtained by the Integral Information System of Social Protection and the High Cost Account (CAC), an organization to trace high expenditure diseases. In addition, a systematic review of studies conducted in Colombia in regard control of DM was performed to receive the respective estimates. According to recent estimates, there may be up to 2 000 000 cases of DM in Colombia among 25-79 years-old people with 1 200 000 cases officially diagnosed (60%). The number of DM patients receiving treatment was 500 000 (42%). The percentage of people with DM reaching the treatment targets of HbA1C <7% ranged between 43-59%. Our study showed that the rule of halves fits rather well into the Colombian setting. However, further research is needed to get more recent estimates in order to test the concept of the rule of halves more precisely.






Hiroaki Satoh

Fukushima Medical University
Japan

Title: Adiponectin may improve diabetic nephropathy
Biography:
Hiroaki Satoh, M.D., Ph.D. is Associate Professor of the Department of Nephrology, Hypertension, Diabetology, Endocrinology, and Metabolism at Fukushima Medical University. Dr. Satoh received his M.D. from Akita University and his Ph.D. from University of Tokyo Graduate School of Medicine. Before coming to Fukushima Medical university, he was a resident in Internal Medicine at the University of Tokyo hospital, a graduate student at University of Tokyo Graduate School of Medicine, a research in Jerrold M Olefsky's lab at University of California, San Diego. Dr. Satoh has been on the Fukushima Medical University faculty since 2004.
Abstract:
Diabetic nephropathy is a major microvascular complication. However, there are no entirely effective remedies to prevent the progression of diabetic nephropathy. Adiponectin has been shown to exert largely beneficial effects on insulin resistance and atherosclerosis. Recently, it has been reported that plasma adiponectin levels are inversely correlated with the degree of albuminuria in obese patients, and that adiponectin-deficient mice exhibit albuminuria and podocyte dysfunction. This suggests that adiponectin may play a protective role in improving kidney disease. However, the effects of adiponectin in diabetic nephropathy are still unknown. To investigate the effects of adiponectin in diabetic nephropathy, we used an adenovirus to chronically overexpress adiponectin (Ad-Adipo) in streptozotocin (STZ) induced diabetic nephropathy rats. At 10 weeks of STZ injection, diabetic rats were injected with Ad-Adipo or Ad-lacZ. At 2 weeks of adenovirus injection, fasting glucose levels was similar in two group, whereas the degree of proteinuria significantly reduced by 24.3% (P<0.05) in Ad-Adipo rats compared with Ad-lacZ rats, suggesting the improvement of early stage diabetic nephropathy in hyperadiponectinemia animals. Nephrin, a protein found in podocytes, is crucial for maintaining the integrity of the intact glomerular filtration barrier. Nephrin mRNA expression level was significantly increased by 68.0% (P<0.01) in the renal cortex of Ad-Adipo rats. Furthermore, endothelial dysfunction correlates with progression of diabetic nephropathy. ET-1 and PAI-1 mRNA expression levels were significantly decreased by 33.4% (p<0.01) and 34.7% (P<0.01) in the renal cortex of Ad-Adipo rats, respectively, whereas eNOS mRNA expression level was significantly increased by 117.2% in the renal cortex of Ad-Adipo rats (P<0.01). In conclusion, we have shown that chronic hyperadiponectinemia inhibits the progression of glomerulo-endothelial dysfunction in early stage diabetic nephropathy. The mechanism whereby adiponectin decreases proteinuria involves an increase of nephrin expression, and an improvement of the endothelial dysfunction due to decreases of ET-1 and PAI-1, and an increase of eNOS expression in the renal cortex. Thus, chronic overexpression of adiponectin has beneficial effects on early stage diabetic nephropathy.






Khaled Alswat

Taif University
Saudi Arabia

Title: Metformin benefits exceeded glycemic control
Biography:
Khaled A Alswat, MBBS, CCD, FACP is an assistant professor of medicine at Taif University and a consultant physician of endocrinology and diabetes at King Abdulaziz Specialist Hospital, Tertiary and Referral Center in the Western Region, Saudi Arabia. With outstanding educational and research activities, he received his post-graduate training in internal medicine and endocrinology from the George Washington University, Washington DC, USA. He is certified clinical densitometrist by the International Society for Clinical Densitometry (ISCD). Active member of numerous endocrine organizations. He actively participated in many endocrine meetings including the Endocrine Society 2011 & 2012 meetings where some of his research was selected to be in the presidential session and amongst the top studies that received special mention in US media coverage.
Abstract:
Metformin is from the biguanide family which founded in 1920. The first clinical trial of its use as a treatment for diabetes was published in 1957. The A1c reduction by~ 1.5%, insulin sensitizer mechanism of action and due to its being a weight neutral agent, all made it a logical first line option in treatment of type 2 diabetes. Subset analysis of the overweigh type 2 diabetics in the UKPDS trial has shown that metformin decreased the cardiovascular complications as well as all-cause mortality compare to other comparators. Numerous studies showed that the overall risk of cancers is significantly greater in the diabetic’s compared to those without diabetes. Metformin has an anti-proliferative effect through activation of the adenosine monophosphate activated protein kinase. Retrospective studies showed lower risk of certain cancers in diabetics who were treated with metformin, but yet most of the prospective trials failed to document that benefit. Studies showed that patients with diabetes or impaired glucose metabolism have significantly increased thyroid volume and nodule prevalence. Metformin in a small prospective study showed promising effect in decreasing thyroid nodule size in patients with insulin resistance and small thyroid nodule. Recent data demonstrated the inhibitory effect of metformin on incident of goiter in type 2 diabetics. Benefits of metformin extended to thyroid cancer patients, as it showed a smaller tumor size and increasing the likelihood for complete response compare to those weren’t treated with metformin. Diabetes and even hyperglycemia have been shown to increase risk of dementia. Recent cohort with 5 years follow up, looked at diabetics who were started on a single agent for treatment of type 2 diabetes revealed that metformin use is associated with decrease risk of developing dementia compare to other comparators. Diabetes also increases the risk of affective disorder, the combination of metformin and sulfonylurea minimizes this risk. Adding metformin to sildenafil in overweight patients with erectile dysfunction and insulin resistance who had poor response to sildenafil resulted in improved erectile function comparable to placebo. In a small report of 3 cases with unexplained hot flashes whom had negative related work up, normal oral glucose tolerance test but with hyperinsulinemia, metformin resulted in improvement of their symptoms with metformin usage. Controversies do exist in some of the above evidence, but the potential benefits with the limited side effects are the reasons behind making metformin first line of treatment.






Premanidhi Panda

Dr. Panda Diabetes Centre
India

Title: Pioglitazone vs Voglibose on glycemic control study in type II diabetes in Indian population
Biography:
Premanidhi Panda, M.D(MED), HON Ph.D, in diabetes,MRCP, FRCP has completed his M.B.B.S at the age of 24 years from Berhampur University, India and postdoctoral studies,M.D(MED) from UTKAL University School of Medicine. He is the director of Dr. Panda Diabetes Institute, India, a premier Diabetes hospital cum research centre, India. He has worked in Tisco hospital, India, Benghazi Medical(Libya),Medwin Hospital With Repute. He has been awarded as “India’s Best doctor award:-2013(Diabetes)” by Medgate Today Survey. He has published more than 20 papers in reputed journals and serving as an editorial board member of repute.
Abstract:
Type 2 diabetes mellitus consists of an array of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagons secretion. It is with both Micro vascular & macro vascular complications. Type II diabetes is a progressive disease. It requires two to three drug combinations produce good effects and less side effects. Therefore these two drugs taken into consideration like Pioglitazone and Voglibose.It shows good glycemic control FBS, 2hr PPBS & HbA1C and Cholesterol and Triglyceride. Particularly study has been seen whose Blood sugar was not controlled by Glimiperide and Metformin. Intent: Intent of the study done By Author from 2012 February to July 2012over a period of 6Months over 200 Cases Type –II Diabetes shows tremendous result in reduction of blood sugar, Maintenance of Blood sugar very stable as compared to with Pioglitazone or voglibose who are under Uncontrolled blood sugar with Glimeperide and Metformin .It shows good glycemic control Constant maintenance of HBA1C 5.8 to 6.5 range. Reduction in Lipid Profile Serum Cholesterol , Serum Triglyceride,LDL& VLDL. Method:-Two randomised group within the age group 30-70Years of Type II either sex given Pioglitazone and Voglibose with the FBS> 130mg/dl,HbA1C between 7-10 selected at random.All the parameters like FBS,2hr PPBS,HbA1c,Lipid profile cholesterol,Triglyceride,LDL & VLDL observed time to time.It was observed within 6months FBS,2hr PPBS,HbA1c,Cholesterol ,TG,LDL&VLDL was greatly effected with Pioglitazone than Voglibose.Non of the patient complaint anything with pioglitazone except weight gain.With Voglibose few patient shows Flatulence, abdominal distension, Increase in LFT. Conclusion:-In my study shows Pioglitazone has got more effective drug than Voglibose Without any side effect.Better control of FBS,2hr PPBS,Lipid Profile.In my study shows Pioglitazone has got minimal sideeffects than voglibose. ****I HAVE GOT >40,000 Diabetes Patients .More than 20,000Patients are under Pioglitazone since 2009..Even I had given my view to Govt of India not to banned Pioglitazone.






Mark R Rigby

Indiana University
USA

Title: Lost in Translation? Progress in immunotherapy for type 1 diabetes
Biography:
Mark Rigby received his MD and Ph.D. at the University of Massachusetts. His Ph.D. studies focused on the immunology of Type 1 diabetes. He then conducted clinical training at Johns Hopkins University in pediatrics and critical care. He is now on faculty at Indiana University. He is the national protocol chair of an NIH sponsored study using a drug called alefacept (LFA3-Ig) to try to reverse disease in newly diagnosed type 1 diabetes and has been involved in many other basic and clinical research projects related to understanding the pathogenesis of and treating this condition.
Abstract:
Although Type 1 diabetes mellitus is clinically considered an endocrine disorder and patients require insulin supplementation for survival, it is at its origin an autoimmune disorder. Research over the past few decades indicate that a combination of the adaptive and innate immune system attacks and destroys the pancreatic beta cells – thus rendering the body unable to produce insulin. Both cells (i.e., T cells and B cells) and soluble mediators (i.e., inflammatory cytokines) appear to have critical roles in the initiation and progression of this process. In the past, non-selective immune suppressants and immune modulators have been shown to stabilize or even reverse the disease. But as Type 1 diabetes occurs primarily in children, these harsh, non-specific treatments cannot be adopted clinically. In the past decade there has been advancement of technology and success of novel biologic agents, such as monoclonal antibodies and fusion proteins, for other immune mediated disorders. Due to the specificity and low side effect profile of these agents, a number of trials have been undertaken using them to target specific, putative intermediates in diabetogenesis. Although many of these therapies have been very useful in other immune and inflammatory disorders, there has been limited success in Type 1 diabetes. This discussion will review the promise, progress and difficulties in using novel immune therapies in Type 1 diabetes and give a look to what’s ahead.






Subrata Chakrabarti

Western University
Canada

Title: Chronic diabetic complications: An accelerated aging process resulting from DNA damage and epigenetic alterations
Biography:
Subrata Chakrabarti received MBBS from Calcutta University in India. He received M.Sc and Ph.D. and completed residency training at the University of Manitoba. He received FRCP(C) in Anatomical Pathology. Following completion of a fellowship from Yale University, he joined Western University in 1994. His research focuses on chronic diabetic complications. He has published more than 170 peer-reviewed articles and a large number of review articles and book chapters. He is currently chair of department of pathology at Western University and chief of pathology and laboratory Medicine at London Health Sciences Centre & St. Joseph's Health Care, Canada.
Abstract:
Chronic diabetic complications are major causes of mortality and morbidity. Hyperglycemia activates several signaling pathways producing oxidative stress. These pathways converge on the nucleus causing DNA damage and changes in the transcription machinery of endothelial cells. Such process is further regulated post-transcriptionally by small, non-protein coding microRNAs. The cells and tissues ultimately develop an aging-like phenotype with impaired function. DNA damage activates nucleotide excision repair enzymes, including ERCC1, ERCC4 and PARP. In addition, augmented production of histone acetylator P300 and alterations of several histone deacetylases including class III deacetylase, sirtuins(SIRTs) occur. There are also extensive interactions and interregulations among these molecules. In this study, we examined three different endothelial cells and tissues from diabetic animals and human and found that such above mentioned processes cause activation of several transcription factors; subsequently resulting in increased transcription of multiple vasoactive factors and extracellular matrix proteins. The list includes collagen, fibronectin, TGFβ1, endothelin 1, vascular endothelial growth factor etc. Here we show alterations of specific miRNAs, namely miR200b, miR146a and miR195 regulating vascular endothelial growth factor, fibronectin and SIRT1 respectively. Furthermore, we have demonstrated relationship of specific miRNA production with p300 and histone acetylation. Detailed study further revealed that, through these mechanisms, hyperglycemia causes accelerated aging-like changes in the endothelial cells and in the tissues affected by chronic diabetic complications such as retina, kidney and the heart. Exploration of such mechanisms has potentially identified novel treatment options for chronic diabetic complications using microRNAs and targeting epigenetic mechanisms.






Sergio Henrique Sousa Santos

UniversidadeEstadual de Montes Claros
Brazil

Title: Nutrition, sirtuins and renin-angiotensin system: Cross talk in metabolic regulation
Biography:
Sérgio Henrique Sousa Santos has completed his Ph.D at the age of 27 years from Federal University of Minas Gerais (Brazil) in collaboration with Max-Delbruch Center in Berlin (Germany) and postdoctoral studies from Nano-Bio Pharmaceutical Institute of Federal University of Minas Gerais. He is the coordinator of Metabolic Pharmacology Lab, and member of American Obesity Society. He has published more than 30 papers in reputed journals and serving as an editorial board member of Motricidade journal and is the editor in chief of the Book: “Hepatic Steatosis: Clinical Risk Factors, Molecular Mechanisms and Treatment Outcomes” that will be published in 2014 by Nova Science. Recently he received the Brazilian government recognition through a production fellowship by CNPq. Currently, he advise 5 PhD students and 4 master students with recognized scientific projects.
Abstract:
The Renin- Angiotensin System (RAS) is one of the most important biological systems involved in cardiovascular and hydroelectrolytic balance regulation. ClassicallyAngiotensin II acting through AT1 receptor produces vasoconstriction and proliferative effects while Angiotensin–(1-7) [Ang-(1-7)]acting through Mas receptorproduces vasodilation and antiproliferative effects. Recently was demonstrated that Ang-(1-7)/Mas axis also can improve lipid and glycemic profile preventing and reversing diabetes and obesity. Sirtuins are the most known enzymes activated by caloric restriction, which also can be activated for natural compounds such as Resveratrol. Recent studies showed that both RAS and Sirtuins could be modulated by diet composition. Our group recently demonstrated that high-fat diet produces RAS unbalance and increases Sirt4 expression in adipose tissue.Furthermore, ourrecent study showed that high-fat feed mice treated with resveratrol and (or) an oral formulation of Ang-(1-7) associated to the food, present an improved metabolic profile with reduced body-fat and improved glucose metabolism. The same study pointed out for a cross talk between RAS and Sirtuins in adipose tissue, once one system was able to modulate each other in adipocytes. In conclusion we recently demonstrated that RAS and Sirtuins are key biological enzymes modulated by diet-composition and able to improve metabolism when selectively activated.






Naim Akhtar Khan

Université de Bourgogne
France

Title: A taste for fat: Signaling mechanisms on lipid taste perception
Biography:
Khan obtained his PhD degree in India. He did his post-doc at National Institute of Neurology (Mexico). He worked as assistant professor. in Rennes and then associate Professor in Limoges and finally as full professor in Dijon. He has been the head of immunology, physiology and neurosciences department. He has been visiting professor in Chiba in 2002 and was also awarded the Innolec Lecturership (Czech Republic) in 2010. He has been Vltava Laureate, conferred by French Embassy in Prague. In 2012, he obtained the prestigious Robert Naquet prize for his out-standing contribution in lipid taste neurobiology by the National French Society of Physiologist. He is expert in the field of nutritional physiology. At present, he investigating the molecular and cellular mechanisms of the newly discovered 6th taste modality destined for “a fatty taste”.
Abstract:
It has been well propounded that there exists five basic taste modalities, e.g., sweet, sour, bitter, salty and umami. Recent compelling evidence from rodent and human studies raise the possibility for an additional sixth taste modality devoted to the oro-sensorial perception of lipids. A number of studies have recently suggested that lingual CD36, a glycoprotein, mainly expressed by circumvallate papillae of the tongue, might be implicated in the perception of dietary fat taste. Our recent studies have not only supported the existence of the 6th taste modality, destined for the perception of fat, but also explored the intracellular signalling mechanisms, involved in this phenomenon. We have shown that lingual CD36, after activation by free fatty acids, induces increases in free intracellular calcium concentrations, ([Ca2+]i), phosphorylation of protein-tyrosine kinase (PTK) and release of the neurotransmitters like serotonin and nor-adrenaline into synaptic clefts. This signalling cascade is likely responsible for physiologic responses, induced by the detection of lipids in the oral cavity. Our results help understand the lipid-mediated regulation of feeding behaviour which is very critical in the development of several diseases like obesity and other metabolic disorders. Besides, the lingual CD36 might be a target for controlling feeding behavior of obese subjects. We have obtained the results on the single nuecleotide polymorphism (SNP) of fat taste receptor CD36 in Tunisian obese women.






Arnon Blum

Ilan Univeristy
Israel

Title: A decrease in VEGF and inflammatory markers is associated with diabetic proliferative retinopathy
Biography:
Arnon Blum, MD is a cardiologist who is head of a department of medicine in Baruch Padeh hospital affiliated to Bar Ilan University, Israel. His research is vascular biology, endothelial function and stem cell research and stem cell transplantation to the cardiovascular system.
Abstract:
Diabetic retinopathy is the most severe ocular complication of diabetes mellitus (DM), is associated with micro-vascular damage. The more advanced stage, proliferative diabetic retinopathy, has been linked to an increased risk of cardiovascular morbidity and mortality. Our hypothesis was that inflammatory and angiogenic markers will detect the different stages of type 2 diabetes, and may predict development of micro-vascular damage. Seventy three type II diabetic patients were randomly assigned to three groups (A - 25 patients {12 males], no diabetic retinopathy; B - 25 patients {19 males], non-proliferative retinopathy; and C - 23 patients {13 males], proliferative retinopathy) when they came for a routine follow-up visit in the ophthalmologic outpatient clinic. Twenty-three healthy subjects (14 males) served as controls. High-sensitivity C reactive protein (hs-CRP), soluble vascular cell adhesion molecule 1(sVCAM-1) and vascular endothelial growth factor (VEGF) were studied. The duration of type II diabetes differed between group A (9 ± 6 years) and B (17 ± 9 years) patients (p = 0.001). No such difference was revealed between groups B and C (19 ± 6 years) (p = 0.30). A difference in hemoglobin A1C (HBgA1C) levels was detected between groups A (7.1 ± 2.7%) and B (8.5 ± 1.5%) (p = 0.02), but none was found between groups B and C (8.5 ± 1.6%) (p = 0.98). Only six patients (out of 23) used insulin treatment in group A, compared with 16 in group B (out of 25) and 17 in group C (out of 25) (p = 0.004). All three groups of diabetic patients were older (62.8 ± 10.8, 61.9 ± 9.4, 59.2 ± 10.3 years, respectively) than controls (44.3 ± 11.6 years) (p≤0.001). Hs-CRP levels were higher in diabetic patients (4,391 ± 4,175, 4,109 ± 4,533, 3,005 ± 3,842 ng/mL, respectively) than in controls (1,659 ± 1,866 ng/mL); however, only the levels in patients of groups A (p = 0.01) and B (p = 0.03) were significantly different from those of the controls, in contrast to group C, which did not differ (p = 0.180). Similar findings were observed for sVCAM-1 (706 ± 347, 746 ± 328, 638 ± 208 ng/mL, respectively, vs. controls {552 ± 143 ng/mL]); sVCAM-1 levels of groups A and B, but not C, differed from the controls (p = 0.05, p = 0.01 and p = 0.125, respectively). With the exception of group B (p = 0.03), soluble VEGF DM type II levels (493 ± 353, 625 ± 342, 368 ± 223 pg/mL, respectively) did not vary from those of the controls (392 ± 355 pg/mL, p≥0.05). However, as the disease progressed, there was a significant decrease in VEGF levels, accompanied by a significant difference between groups B and C (p = 0.006). Patients with diabetes type 2with no-retinopathy and with non-proliferative retinopathy had high levels of inflammatory and angiogenic markers, which decreased in patients with diabetic proliferative retinopathy. Biomarkers of inflammation and angiogenesis may detect the progression of diabetic vascular disease and may lead towards earlier interventions that would prevent systemic complications.






Meghit Boumediene Khaled

Djillali Liabes University
Algeria

Title: Effect of gender and body weight on postprandial glucose and lipid metabolism in adults with type 2 diabetes
Biography:

Abstract:
Background: Massive health problem is caused by the increasing worldwide prevalence of type 2 diabetes in both developed and developing countries. The magnitude of the healthcare problem of type 2 diabetes is the result of the disease itself and its association with several risk factors for cardiovascular diseases such as obesity and postprandial dyslipidemia.
Objective and Methods: This study took place in two cities from the northwestern region of Algeria (Sidi-Bel-Abbes and Mascara). The main goal was to assess the effect of body weight and gender difference on postprandial lipid and glucose responses in type 2 diabetes patients. Ninety-three adult patients with type 2 diabetes aged 55.65 (13.81) years were studied. Weight, height, waist circumference and body mass index (BMI) were measured. Fasting and postprandial glucose and lipid (total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, apo A-I and apo B) profiles were evaluated.
Results: Our results indicated a positive correlation between postprandial glucose and BMI in women (r2 = 0.041). Negative correlation with BMI was noticed for PP TG in both males (r2 = 0.011) and females (r2 = 0.021). A significant difference (p = 0.019) was observed for PP HDL-c in women 0.39 (0.10) g/L vs. men 0.33 (0.12) g/L and for PP apo A-I (women: 1.33 (0.27) g/L vs. men: 1.09 (0.34) g/L; p = 0.0003). According to gender and weight groups (normal weight, overweight and obese), our results indicated that female gender and overweight are associated with elevated PP HDL-c and PP apo A-I levels. However, obesity in women is related to high concentration of PP TG.
Conclusion: Results of the present study suggest that gender difference and weight classes are important factors that contribute to determining the postprandial responses, both for glucose and lipids, in type 2 diabetic patients.






Pallab Paul Ganguly

Alfaisal Faisal University
Saudi Arabia

Title: Diabetes, Hyperhomocysteinemia and stroke
Biography:
Ganguly completed his medical degrees before joining a Cardiovascular Group at St. Boniface Hospital Research Centre, Winnipeg, Canada. He worked several years at the University of Manitoba as a Postdoctoral fellow and then as a faculty. He is presently the Chairman of the Department of Anatomy at Alfaisal University and is heavily engaged in research in medical education and understanding homocysteine-induced pathophysiology of heart disease. He has edited two books: Catecholamine and Heart Disease (CRC press) and Education in Anatomical Sciences (Nova Publisher). He has also over 125 original publications in peer reviewed International Journals. Dr Ganguly is a well-known scientist and has received several awards for his scholarly work.
Abstract:
Until recently it has been unclear whether non-insulin dependent diabetic (NIDD) people with the methylenetetrahydrofolatereductase (MTHFR) mutation have an increased risk of cardiovascular disease; however a recent meta-analysis has shown a significantly higher risk of ischemic heart disease in people with the MTHFR mutation. Prospective studies confirm that hyperhomocysteinaemia and MTHFR mutation are independent risk factor for cardiovascular morbidity and mortality in end-stage renal disease. Therefore, hyperhomocysteinaemia in NIDD patients with both incipient and clinical nephropathy may partly contribute to the increased risk of vascular disease.Elevated plasma levels of homocysteine are associated with the development of stroke but the mechanistic association of stroke with hyperhomocysteinemia is unclear. Because hyperhomocysteinemia is related to the development of atherosclerosis, this may explain the association of homocysteinemia with a stroke. However, the relationship of homocysteine with atherosclerosis has been questioned recently. In addition, hyperhomocysteinemia has now been associated with a variety of brain disorders including dementia and Alzheimer's disease. Thus, the search for mechanisms to explain the neuronal effects of homocysteine is an important, valid avenue of study in many neurological disorders. It is possible that the additional effects of homocysteine may involve a more direct action on the brain itself that could augment neuronal damage in a stroke (Ganguly et al. Brain Research 1226: 192-198, 2008). In support of such a hypothesis, homocysteine can induce direct neurotoxicity by activating the N-methyl-D-aspartate (NMDA) subtype of the glutamate receptor.Our research is based on a hypothesis that increased level of homocysteine in blood can trigger the release of excitatory amino acids and catecholamines in specific areas of hypothalamus. The effect may be more predominant in hypertension superimposed with NIDD. Therefore, both catecholamines and excitatory amino acids are detrimental factors in hyperhomocysteinemia, the missing links for the development of stroke in NIDD.






Tetyana L Vasylyeva

Texas Tech University Health Sciences Center
USA

Title: The gut-kidney axis, chronic inflammation and endothelial dysfunction in patients with diabetic nephropathy and end stage renal disease on dialysis
Biography:
Tetyana Vasylyeva, MD, Ph.D., doctor of medical science (Ukraine), is a professor in the department of pediatrics, nephrology section, at Texas Tech University Health Sciences Center, Texas. The scope of her research includes diabetes and cardiovascular health. She is the author of 85 research papers and multiple book chapters. She is a member of the American Society of Nephrology and American Academy of Pediatrics. Her direct efforts towards translational research and is the principal investigator on multiple projects. She is also the managing editor for the International Journal of Integrative Pediatrics and Environmental Medicine.
Abstract:
Patients with Type 2 diabetes (T2DM) are a distinguishable group of the patients, who have additional risk factors for cardiovascular morbidity and mortality. They experience persistent low-grade inflammation leading to micro-vascular deterioration and vascular complications. T2DM is one of the leading causes of end-stage renal disease (ESRD). The degree of chronic inflammation increases with deterioration of renal function as diabetic nephropathy progresses to ESRD. The important contributable factors that support chronic inflammation, decline of endothelial integrity, and progression of renal disease may link to gut-kidney axis function. T2DM patients have a unique gastrointestinal flora, with significantly fewer copy numbers of total Bifidobacterium and B. adolescentis compared to healthy individuals. The significant alteration of the colonic bacterial flora in humans and animals with advanced CKD has been demonstrated. In addition, gut advance glycation end-products can change gut microbial flora that contribute to persistent chronic inflammation leading to endothelial dysfunction and compromising cardiovascular health. The intestinal microbiome provides a large reservoir of potentially toxic molecules, including bacterial endotoxins (i.e. lipopolysaccharide). Other uremic toxins, particularly indoxyl sulfate and p-cresyl sulfate can lead to CKD progression independent of other factors. Since uremic patients have high intestinal mucosal permeability, bacterial products could be absorbed to a greater degree from the uremic bowel and lead to translocation of large toxin loads into the patients’ blood. Disturbance of the dynamic equilibrium can become an amplifier of pathological effects. Modulation of endotoxin release into the circulation presents a potentially important target for interventions aiming to improve cardiovascular outcomes.






Ajay Kumar

Diabetes Care & Research Centre
India

Title: Combination therapy at the time of diagnosis in type 2 diabetes
Biography:
Ajay Kumar is an MD, FRCP and is a consultant physician and diabetologist at Diabetes Care & Research Centre, Patna, India. He has completed 14 phase 2 and phase 3 clinical trials on newer insulins, GLP-1 based treatments, SGLT 2 inhibitors etc. He has more than 10 papers published in peer reviewed journals and has delivered more than 500 lectures on diabetes across the world.
Abstract:
Type 2 diabetes is characterized by inexorable decline in beta cell function. Multiple pathogenetic mechanisms are responsible for the abnormal glycaemic milieu and consequent micro vascular and macro vascular complications. Traditional approach to treatment with monotherapy and life style modification followed by addition of multiple OADs and insulin has failed to address the underlying pathogenetic mechanisms. As a natural corollary, almost 50 percent of these subjects never achieve glycaemic targets and are doomed to develop unwarranted complications and poor quality of life. Combination therapy at the onset has the potential to target underlying pathogenetic mechanisms and prevent progressive decline in beta cell function. Judicious selection of anti diabetic agents based upon individual patient’s profile and overall metabolic milieu should help achieve glycaemic and other metabolic targets. Furthermore it should ensure good metabolic memory and thereby help prevent complications. Type 2 diabetics with HbA1c less than 10% should start on 3 drug combination of GLP-1 analogues/DPP-4 inhibitors with metformin and SGLT2 inhibitors/pioglitazone. Decision regarding triple drug combination should be based upon subject’s anthropometric profile, age, concomitant diseases and other metabolic abnormalities. Subjects with HbA1c more than 10% should begin with Insulin along with two other OADs mentioned above in triple drug combination. Sufficient data is now available to substantiate this approach and is easy to translate into clinical practice. This approach ensures short term use of multiple drugs followed by withdrawal of insulin and other drugs based upon individual requirement. On a long term basis this should also be cost economical.