World Congress on
Diabetes and Endocrinology

Biography:

Abstract:

In spite of solid evidence that risk for developing type 2 diabetes can be prevented by lifestyle interventions, it has been difficult to scale prevention research to address the growing public health demand. This study, conducted in Indianapolis, Indiana in 2013-16, investigated if a widely available weight management program (Weight Watchers- WW) could cost effectively achieve and sustain sufficient weight loss in persons with prediabetes to reduce diabetes risk for 24 months.
A previous, randomized controlled trial evaluated the effectiveness of the WW program in 225 persons with prediabetes on weight and metabolic regulation compared with a self-initiated program developed by the National Diabetes Education Program over a 12-month study period. This study assessed outcomes at 18 and 24 months and also evaluated cost effectiveness and 12 and 24 months. Since this study used a cross over design in which control subjects we provided access to the WW program, they were no longer randomized.
Intervention participants lost significantly more weight than the controls both at 18 (-5.1% vs -1.8%,
p ≤ .008)- and 24-months (-4.5% vs -1.8%, p ≤.032 ). Although both groups showed some improvement in CVD risk factors, the only significant difference between groups was that WW participants had greater reductions than controls in HbA1c at both 18 (-0.27 vs -0.17; p=.03) and 24 months (-0.3 vs -0.2; p=.04). Converting the weight loss into quality adjusted life years saved (QALYs) yielded an incremental cost effectiveness ratio (ICER) of $19,034 per QALY gained for the intervention. Sensitivity analyses showed the ICER was well below commonly accepted thresholds for cost effectiveness.
These data suggest that evidence-based, widely available weight management programs have the potential to cost effectively improve health outcomes for patients with pre-diabetes. Given their affordability and scalability, increasing access could result in a significant public health impact.

Biography:

Dr. Ahdy Helmy, has a MSc and a PhD from Alexandria University, Egypt, then finished a second residency in Internal Medicine, and a fellowship in Endocrinology and Metabolism at Indiana University, USA. He is triple board certified in Medicine, Endocrinology & Lipidology. Is a faculty at Indiana University School of Medicine, USA for the past 20 + years, a distinguished teacher, clinician, an author, and speaker within the USA and abroad.

Abstract:

Non-alcoholic fatty liver disease (NAFLD) as a broad category, it encompasses simple steatosis to that with hepatitis, fibrosis, cirrhosis, and even hepatocellular carcinoma. NAFLD is a growing health crisis, in the US, and the West, the prevalence is 20-40%. In part, due to visceral obesity, insulin resistance, metabolic syndrome, excess lipolysis, and atherogenic dyslipidemia.

The flying fatty acids like loose cannons, end up in multiple organs with subsequent collateral damage.  NAFLD is what results from the liver getting entangled in this metabolic mess. The pancreas gets burned as well, and many of those patients are either diabetics, or diabetics in training. NAFLD exacerbates insulin resistance contributing to worsened glucose tolerance. NAFLD patients are also at an increased risk of cardiovascular mortality, as cardiac steatosis hits the heart muscle, while atherogenic dyslipidemia clogs the coronaries. In this review, I summarize the current understanding of NAFLD pathophysiology, risk factors, non-invasive recognition, diagnosis, identifying the close entanglement with the Cardiovascular risk natural history.  New treatments, and risk modifications meant to salvage every organ to be collaterally damaged in the path of this metabolic hurricane.

Biography:

Dr. Lue Ping Zhao has earned his BS in Computer Science (Shanghai University of Science and Technology), MS-candidate in Health Statistics (Fudan Medical University), MS/Ph.D. in Biostatistics (University of Washington) and Postdoc training in Biostatistics (Harvard University).  Currently, he is a full member at Fred Hutchinson Cancer Research Center and an affiliated Professor at University of Washington.  As a senior investigator in Biostatistics, Dr. Zhao has participated in many national and international studies, and has published extensively in biostatistical applications to clinical, genetic and epidemiological studies.  In the past ten years, he has devoted major research interests in hematopoietic stem cell transplantation (HSCT) research, autoimmune disease etiology research, in particular, type 1 diabetes, and vaccine development for disease prevention and treatment.  As a data scientist, his research interests largely center on three topics: 1) investigation of MHC/HLA genes and their roles in development of autoimmune diseases, 2) development of novel data science strategies (designs and data analytics) to enable complex data analyses with real world data from clinics, and 3) building risk prediction models for early detection, screening or prognostic assessment.  Zhao's prolific developments have profited from his work at the finest research institutions, including Fred Hutchinson Cancer Research Center, University of Washington and Harvard University, and also from collaborating with prominent geneticists, biologists, physicians and epidemiologists, in addition to working with some best biostatisticians as mentors or collaborators.

Abstract:

Aim: It is of interest to predict possible lifetime risk of type diabetes (T1D) in young children for recruiting high-risk subjects into longitudinal studies of effective prevention strategies. Methods: Utilizing a case-control study in Sweden, we applied a recently developed next generation targeted sequencing (NGTS) technology to genotype  class II genes, and applied an object-oriented regression (OOR) to build and validate a prediction model for T1D. Results: In the training set, estimated risk scores were significantly different between patients and controls (P=8.12*10^-92), and the area under the curve (AUC) from the receiver operating characteristic (ROC) analysis was 0.917. Using the validation data set, we validated the result with AUC of 0.886. Combining both training and validation data resulted in a predictive model with AUC of 0.903. Further, we performed a ‘biological validation’ by correlating risk scores with six islet autoantibodies, and found that the risk score was significantly correlated with IA-2A (Z-score=3.628, P<0.001). When applying this prediction model to the Swedish population, where the lifetime T1D risk ranges from 0.5% to 2%, we anticipate identifying about 20,000 highrisk subjects after testing all newborns, and this calculation would identify about 80% of all patients expected to develop T1D in their lifetime. Conclusion: Through both empirical and biological validation, we have established a prediction model for estimating lifetime T1D risk, using class II HLA. This prediction model should prove useful for future investigations to identify high-risk subjects for prevention research in high-risk populations.

Biography:

Department of Dermatology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Specialist of Dermatology, Goztepe Mahallesi, Fahrettin Kerim Gokay Cd.

Abstract:

OBJECTIVE: The neutrophil-lymphocyte ratio (NLR), determined from peripheral blood, is accepted as an available and practical indicator of the systemic inflammation. In this study, we aimed to determine whether the NLR was higher in euthyroid chronic autoimmune thyreotidis (CAT) patients compared to a healthy control group. METHODS: A total of 112 patients were enrolled in this study, including 59 patients with euthyroid CAT on any form of therapy and 53 healthy controls. Th e CAT patients were similar in age to the healthy control group (mean 33.9±12.8 years versus 30.2±12.4 years, p=0.10). Measurements were available for the white blood cells (WBC), neutrophils, lymphocytes, platelets, C-reactive protein (CRP), thyroid peroxidase immune antibody (anti-TPO), and anti-thyroglobulin immune antibody (anti-TG). The NLR and platelet-lymphocyte ratio (PLR) were calculated. Differences between the CAT and control groups were tested using the student's t-test and the correlations were determined using Pearson's correlation coefficients. RESULTS:There were no differences between the CAT and control groups for WBCs (7.9±0.3 and 7.4±0.2, respectively; p=0.1) or neutrophils (5.5±0.3 and 5.4±1.1; p=0.9), but lymphocytes were higher in the CAT group (3.1±0.5 vs. 2.04±0.1; p=0.05) as was the NLR (4.0±0.7 vs. 2.0±0.1; p=0.01). Th e NLR was positively correlated with CRP (r=0.6, p<0.001), anti-TPO (r=0.3, p<0.001), anti-TG (r=0.3, p=0.006), WBCs (r=0.4, p<0.001), and the PLR (r=0.73, p<0.001). The PLR was also higher in the CAT than the control group (p=0.02). CONCLUSIONS: In this study, we found that NLR values were higher in euthyroid CAT patients than in a healthy control group and that NLR correlated with autoantibodies used to diagnose the disease.

Biography:

He was born in 1980 at Erzurum, Turkey. He attended from Ataturk University Medical School, in 1999-2005.  He has completed the internal medicine residency at the same institute between 2005 - 2010. Dr Cadirci is working at Saglik Bilimleri University Regional Training and Research Hospital Erzurum, Turkey. 

Abstract:

Thyroid nodules are ovoid or spherical lesions with different radiological and consistency characteristics from surrounding normal thyroid tissue.  They are the most common disease of the thyroid, and their frequency increases with age.  Iodine deficiency is the most common cause of the nodule formation.  Etiology of thyroid nodules has a wide range from a simple benign nodular goiter to primer and secondary malignancies.

Etiology of thyroid nodules has a wide range from a simple benign nodular goiter to primer and secondary malignancies.  The most important aspect of a nodule for a clinician is the elimination of cancer suspicion by evaluating the likelihood of cancer.  The prominence of thyroid nodules starts at this point.  Every thyroid nodule must be evaluated in terms of malignancy and absolutely must be followed at certain intervals.  When a nodule is detected by physical examination or radiological examination, it is necessary for the patient to be questioned regarding their thyroid cancer risk factors such as family history of thyroid cancer, and radiation application story regarding the whole body; especially the head and neck region.

Alarming findings in a patient with thyroid nodule include having a thyroid cancer positive family story, head, and neck radiation receiving story, childhood thyroid nodules and permanent dysphonia, dysphagia, or dyspnea.  Serum TSH measurement also should be evaluated in all patients with thyroid nodules detected.  The TSH result is an important criterion for approaching the patient who has the nodule.

Thyroid USG is the key test for thyroid nodule evaluation.  USG is an easily accessible, noninvasive and cost-effective test.  With thyroid USG, we can obtain many data such as nodule size, cystic-solid characteristic, calcification characteristics, settlement, echogenicity, edge organization, halo existence, and blood circulation characteristics.

Thyroid scintigraphy should be performed if TSH is suppressed in patient.  Certainly, thyroid fine needle aspiration biopsy (FNA) is the gold standard test for the discrimination of the nodule from benign.  There are the different approaches and different guidelines about which patient has to undergo FNA.  Today, we want to speak about these current guidelines.

Biography:

Abstract:

Diabetes and thyroid dysfunction found to exist simultaneously. In this regard, the present study looked into the prevalence of different forms of thyroid dysfunction and their risk factors among Type 2 diabetic Saudi patients. Methodology. A cross-sectional retrospective randomized hospital-based study of 411 Type 2 diabetic Saudi patients of >25 years of age was conducted to test the prevalence of different types of thyroid dysfunction and their risk factors. Results. The prevalence of different types of thyroid dysfunction is 28.5%, of which 25.3% had hypothyroidism, where 15.3%, 9.5%, and 0.5% are clinical, subclinical, and overt hypothyroidism, respectively. The prevalence of hyperthyroidism is 3.2%, of which subclinical cases accounted for 2.7% and overt hyperthyroidism accounted for 0.5%. Risk factors for thyroid dysfunction among Saudi Type 2 diabetic patients are family history of thyroid disease, female gender, and duration of diabetes of >10 years, while the risk was not significant in patients with history of goiter and patients aged >60 years. Smoking and parity show a nonsignificant reduced risk. Conclusion. Thyroid dysfunction is highly prevalent among Saudi Type 2 diabetic patients, and the most significant risk factors are family history of thyroid disease, female gender, and >10 years duration of diabetes. 

Biography:

Alaaeldin Y. T. Alhessi is a consultant and the head of Internal medicine department in Emirates hospital, Dubai, UAE.Dr. Alhessi was born in Cairo, Egypt where he graduated from Kasr Al Eni school of Medicine of Cairo university in 1994. He practiced medicine in Egypt until 2000 when he moved to USA. He was awarded as a diplomate of the American board in Internal Medicine in 2003, and he is still maintaining the degree. 2004, he practiced for 1 year in Australia before joining Emirates hospital group in Dubai in 2005. Dr. Alhessi is a member of the American association of clinical endocrinologist (AACE)- the gulf chapter. His major field of interest in diabetology is preventing complication and delaying its progression.

Abstract:

Type 2 Diabetes mellitus (T2DM) is one of the major known health hazards that causes increasing morbidity, mortality, and poor quality of life as well as increasing healthcare expenditure. Emirates hospital group, UAE. Diagnostic thresholds to define T2DM was laid by different international, regional, and local organizations utilizing the fasting plasma glucose (FPG), two hours plasma glucose (2-H PG) during a 75 G oral glucose tolerance test (OGTT), or glycated hemoglobin (HbA1c). Variations among different defining bodies remain minimal and there is a clear link to the threshold levels utilized to an adverse clinical outcome. Among the recognized risk factors for developing T2DM is a state of dysglycemia that does not yet meet the defining thresholds for T2DM. This is known as prediabetes. Prediabetes state does not only increase the risk of transformation into a full blown T2DM but also thought to be associated with different T2DM microvascular and macrovascular complications. We hereby suggest redefining T2DM diagnostic threshold values to include what is currently defined as prediabetes, especially when it is associated with other known risk factors for developing T2DM: visceral obesity, diabetic pattern dyslipidemia, metabolic syndrome, or polycystic ovary syndrome (PCOS). We believe that prediabetes, in such conditions, is indeed T2DM, and not a precursor of which, yet in a subclinical/ latent stage as per our current defining thresholds. With the recent advancement in treating T2DM aiming at preventing its complications as opposed to the previous glucocentric management, we believe that redefining T2DM at a lower threshold is clinically warranted as a priority.

Biography:

Head of  Operational Research Unit on behalf of Doctors with Africa in Mozambique since 2015 and coordinator for Sofala provinces from 2017. From 2017 editor of Journal of Clinical and Experimental Endocrinology. He obtained the PhD on Endocrinology, Metabolism and Andrological Sciences in 2013 winning the Thesis Award 2014 at Sapienza University in Rome. He won the “Award for excellence in biomedical research” of Foresta Foundation and from 2014 to 2015 he was research fellow at the Department of Medicine, University of Padua.  He has more than fifty publications in international, peer-review journals.

Abstract:

Background: In people with diabetes, cataract is a major cause of visual impairment with a three to four-fold increased risk of cataract in patients with diabetes under the age of 65, and up to a two-fold excess risk in patients above 65. On the one hand, cataract has a particularly devastating consequence in low and middle-income countries where it remains the leading cause of blindness, accounting for 50% of blindness. On the other hand, in low and middle-income countries diabetes has reached epidemic levels but prevention, diagnosis, and treatment are generally inadequate. Methods: We performed a cross-sectional, community-based data from the Study on Global Ageing and Adult Health (SAGE) analyzing (n=42,469 adults aged ≥18 years). Information on self-reported diagnosis of cataract in the past five years was collected. Three definitions for cataract were used: (a) Self-reported diagnosis and/or past 12-month symptoms; (b) Solely self-reported diagnosis; and (c) Surgical treatment for cataract in the past five years. Diabetes was based on self-reported diagnosis. Multivariable logistic regression was conducted to assess the associations. Results: Overall, the prevalence of diabetes was 3.1% (95%CI=2.7%-3.5%) and that of cataract based on the three different definitions was: (a) 13.3% (95%CI=12.4%-14.3%); (b) 4.4% (95%CI=3.9%-4.8%), (c) 1.7% (95%CI=1.5%-2.0%). After adjustment for potential confounders, diabetes was associated with significantly elevated odds for cataract: (a) OR=2.10 (95%CI=1.59-2.76); (b) OR=2.62 (95%CI=2.00-3.42); (c) OR=2.80 (95%CI=1.78-4.40). These associations were particularly pronounced among those aged <50 years. Conclusions: A strong association between diabetes and cataract was observed in in low and middle-income countries and, considering the increasing prevalence of diabetes, it is mandatory to introduce health policies for prevention, early diagnosis, and treatment, as well as its complications such as vision diseases. Since diabetes is a chronic disease requiring therapy compliance and adequate follow up in order to obtain effective long-term control, it will be crucial to organize a multidisciplinary approach which takes into account of all aspects of comorbidity.

Biography:

Fernanda Paiva is a register nurse who loves working with elderly patients and chronic disease. She studied in the nursing program at Lehman College – CUNY (New York, USA) as an exchange student during one year (2014). Currently, she is a master's student in Sciences and Technologies in Health at the University of Brasilia, Brazil.

Abstract:

In addition to the evident increase in the number of elderly, there is also a higher prevalence of Non-Communicable Chronic Diseases (NCD), such as Diabetes Mellitus (DM). Poorly controlled DM causes several complications such as pain, which compromise the productivity, the life expectancy, and the quality of life (QOL). QOL is an important aspect of diabetes because a poor quality of life reduces the self-care, resulting in a worse glycemic control, and increasing the risks of complications. The purpose of this study is to evaluate the pain and its impact on quality of life of elderly patients with DM in a primary care unit in Brazil. Methodology & Theoretical Orientation: A descriptive and quantitative study, which data were collected from September to November 2015, through a semi-structured questionnaire and previously tested, composed of questions about the sociodemographic profile, and the WHOQOL-OLD and WHOQOL-BREF questionnaires. Findings: Through scores of WHOQOL-BREF questionnaires and WHOQOL-OLD shown in Table 1, it was observed that those people who did not report pain had better QOL scores than those reported pain, except in the physical domain and in the facet autonomy. Conclusion & Significance: The results of this study show that pain affects the QOL of the elderly with DM and enables the better planning of actions that meet the specific needs of this population.

Biography:

Dr. Bernadette Dian Novita is a medical doctor and lecturer in Widya Mandala Catholic University Surabaya Faculty of Medicine, her major is Pharmacology and Therapy, focusing in diabetes mellitus, infection and immunology. She has completed her PhD from Airlangga University Faculty of Medicine. She has got several national and international publications in diabetes mellitus area.

Abstract:

Poor glycemic control in Diabetes Mellitus (DM) patients has the potential to modify the risk of TB. In our knowledge, high glycemic index increases superoxide dismutase (SOD) for balancing oxidative stress – reactive oxygen species (ROS) production. Metformin (MET), one of glycemic control drug, has effect in increasing SOD level and expects to contribute in the Isoniazid (INH)-induced bactericidal by increasing activation of INH pro-drug. However, the optimal glycemic control during anti TB therapy in DM-TB infection remains unknown. An observational clinical study was done in DM-TB infection outpatients at Surabaya Paru Hospital. Glycemic index (HbA1c) evaluation was obtained during a 2-month MET therapy accompanying with insulin and anti TB. As a comparison, control group, whom were not given MET, was also evaluated. The smear was measured two times as diagnostic and as evaluation. Superoxide Dismutase (SOD) level were also evaluated before and after this observation period. From 42 participants in this study, 22 participants of observation group that received additional MET therapy, 100% had sputum smear reversion conversion after 2-months intensive phase of anti TB therapy. Whereas 25% of 20 participants of comparison group did not undergo reversion inserts sputum smear and needed additional anti TB . Smear reversion was significantly difference, using Fisher’s exact test, between the MET group and the control group. Moreover, SOD level was significantly different between MET group and the control group in HbA1c around 8,35%. Thus we concluded that MET is a potential additive therapy to enhance the bactericidal effect of anti TB on DM infected patients. Slightly poor-controlled glycemic index might contributed in enhanced anti TB activity. However, since the number of samples was limited in this study, cohort study need to be applied to support this data.
Keyword : type 2 diabetes mellitus-tuberculosis co-infection, metformin, AFB smear reversion, glycemic index and SOD

Biography:

Allison Landa is a speaker, writer, and editor in Berkeley, CA, USA. She is currently completing a book based on her experience with Congenital Adrenal Hyperplasia and is represented by Miriam Altshuler of DeFiore & Co. Landa’s work has been featured in The Guardian US, The Washington Post, You and Me Magazine, The Mighty, and Salon Magazine, among other venues. She earned an MFA degree from St. Mary’s College of California, is a MacDowell Colony Fellow, and has held artist residencies at Playa Summer Lake, Kimmel Harding Nelson Center for the Arts, and The Julia and David White Artists’ Colony. She lives with her husband, young son, and two manic Lab mixes.

Abstract:

Statement of the Problem: Studies suggest that psychosocial factors – in addition to physical barriers – work to impair fertility and successful childbirth in women with Congenital Adrenal Hyperplasia. This includes a reluctance to consult medical professionals as to the scope of the problem and possible solutions. This was the case with Allison Landa, who was not even successfully diagnosed with CAH until the age of 30 due to parental negligence and the terror of discussing her symptoms with a doctor. When successful intervention finally took place, Landa was not only able to stabilize her condition but become pregnant at the age of 40 following a short-term disruption of birth control. Her son Baz was born on Sept. 6, 2015. Landa offers a personal perspective as both a patient and an advocate for fellow CAH sufferers.

Conclusion and Significance: Increased outreach to CAH sufferers on the part of the medical community is indicated to reach those who might otherwise not be served.

Biography:

Mr.Pradeep B. K is working under Medical Affairs at BIOCON, Bengaluru, INDIA.

Abstract:

Diabetes mellitus is a chronic and progressive condition among thhe most common metabolic diseases in genneral medical practice. Intensive lifestyle intervention and metformin can prevent or delay progreession to diabetes. Over the past decade, lifestyle interventions have been translated across various settings, but little is known about the translation of evidennce surrounding metformin use. The purpose of this study is to evaluate the effect of metformin exxtended release formulation on the glyce mic control gastrointestinal tolerability and patient satisfactioon. Design: Retrospective analysis over a 1-year period. We examinned data from August 2016 to July 2017 from ESIC hospital Peenya, Bangaluru using a retrospective analysis of metformin prescription amon g adults. Data were analyzed in 80 patients with type 2 diabetes not well controlled by diet (glycated hemoglobin [HbA1c] .7.0% and 8.5%). Patients were given metformin XR (Metadoze IPR^® BIOCON) for a period of 4 months at the maximum tolerated dose. We evaluated, HbA1c, fasting, postprandial glucose and body weight. Moreover, at the baseline and after 4 months, we also validated the patients by SF 16 questionnaire to assess patients’ satisfaction toward treatments. After 4 mo nths, metformin XR gave a greater improvement in glycemic control. A reduction in total cholessterol (TC) and low-density lipoprotein (LDL) cholesterol was observed with metformin XR. Conclusion: Metformin XR formulation seems to be more effective in improving glyco-metabolic control, lipid profile in patients with type 2 diabetes mellitus. Fewer gastrointestinal side effects and a greater sense of well being and satisfaction were seen with this meedication.

Biography:

Irina Kurnikova - MD, PhD, Professor of Medicine, RUDN University (Peoples Friendship University of Russia), Moscow, Russia. She has extensive experience in the field of scientific and practical Endocrinilogy. Dealing with Problems of Endocrinology more than 20 years.  The main areas of her research are the optimization of the system approach to the treatment and rehabilitation of patients with diabetes mellitus, diseases of the thyroid gland, disturbances in the system of regulation of the organism and other endogenous factors (comorbidity, interstitial humoral transport et al.). Currently teaches at Peoples' Friendship University of Russia, curator of the scientific direction of endocrinology.  Has published more than 20 articles in well-known journals, the author of 25 books and manuals in Russian, 10 patents for inventions.

Abstract:

Statement of the Problem: the "complexity category" of patient management increases many times, if the somatic disease had combined with multi-organ systemic disease, such as diabetes mellitus (type 1 diabetes - DT1 and type 2 diabetes - DT2).  Simultaneous formation of several diseases in a patient: arterial hypertension, atherosclerosis, ischemic heart disease and diabetes mellitus, creates not only significant difficulties in diagnosis, but affects the quality of care and worsens the prognosis. The purpose of this study is to study the influence of somatic pathology on the level of glycemic control indices of patients with diabetes mellitus from the viewpoint of cause-effect relationships and mechanisms of polymorphic formation. Methodology & Theoretical Orientation: A special complex examination of patients was conducted.  The control of carbohydrate metabolism was provided in accordance with the recommendations of WHO by repeatedly examining the glycemic profile and glycated hemoglobin (HbA1c).  The comorbidity was assessed according to the CIRS - Cumulative Illness Rating Scale. Findings: in our study, the risk of developing concomitant cardiovascular disease had a positive association with DT 2 (RR = 3.4, p <0.001), and the chances of developing a cardiovascular pathology in DT 2 were significantly higher (OR = 15.7;  X² = 151.6).  The multiplicity of complications was significant in patients with DT1 (RR = 1.96, p = 0.095) and 3 times increased the risk of cardiovascular disease (OR = 3.47, p = 0.008), but for DT2 this criterion had a weak  negative association for RR (RR = 0.86, p <0.001) and influenced the increase in odds (OR = 0.39; p = 0.03).  The duration of the course of DT1 for more than 10 years contributed to an increase in the relative risk and odds ratio (RR = 3.43, p <0.001, OR = 8.29, CI 95% 4.36-15.76) for pathology formation.  Almost 3 times increased risk of cardiovascular disease in patients with DT2 with a BMI more than 30 (RR = 2.95, p = 0.063).  The risk of cardiovascular disease in case of unsatisfactory compensation of CD1 (RR = 1.16, p = 0.021, OR = 1.27), DT2 (RR = 1.39, p <0.001, OR = 2.28).  However, to assert that the risk of developing concomitant cardiovascular pathology increases the fluctuations in the level of glycemia in patients with diabetes (OR DT1 = 2.19, CI 95% 0.46-10.45, ORSD2 = 5.93 CI 95% 0.75-46,  91) with the obtained CI level of 95% is not possible.  The significance of lipid metabolism disorders (atherogenicity index) in the development and progression of coronary pathology in diabetic patients was confirmed, and this factor was much more significant in patients with DT1 (OR DT1 = 11.4; OR DT2 = 30.9).Compensation of diabetes by glycemic values depended on the duration of the disease of DT 2 (r = 0.42, p <0.05), the severity of comorbidity, and corresponded to the degree of comorbidity (r = 0.67, p <0.05) in Cumulative Illness Rating  Scale (CIRS). For basal glycemia, at the beginning and after treatment, the correlation coefficient (r) is 0.56 and 0.67, respectively. For postprandial glycemia - 0.45 and 0.35, respectively (p <0.05).  The relationship between the values of basal glycemia and the indicators of comorbidity after the completion of the course of treatment is strengthened, and postprandial - decreases.  Rates of basal glycemia reached normal values only in patients with low CIRS.  At high values of CIRS (14 or more points), it was not possible to normalize the parameters of carbohydrate metabolism in the majority of patients Conclusion & Significance: somatogenic pathomorphological disturbances have a fundamental effect on the course of diabetes, which in turn is a risk factor for the development and progression of somatic pathology. The level of comorbidity should be taken into account when determining the target level of glycated hemoglobin. One of the options for a quantitative criterion can be the definition CIRS. The higher the comorbidity, the less rigid the target values of HbA1c.
  

Biography:

Yasser M Hafez has completed his PhD at the age of 35 years from school of medicine, Tanta University. He is a lecturer of internal medicine, Diabetes and Endocrinology unit. He has published this paper in reputed journal.

Abstract:

Diabetic  nephropathy  (DN)  is  one  of  the  major  causes  of  end-stage  renal  disease.  Nod-like receptors  nucleotide-binding  domain  and  leucine-rich  repeat  pyrin-3  domain  (NLRP3) inflammasome  displays  a  considerable  role  in  the  chronic  inflammatory  state  observed  in diabetic patients. Urinary heat shock protein 72 (uHSP72) is a sensitive and specific biomarker for the early detection the acute kidney injury.  The  aim  of  this  study  was  to  evaluate  NLRP3 relative  gene  expression, its correlation with inflammatory  and oxidative stress markers,  and to assess the value of uHSP72 in the early detection of DN in type 2 diabetic patients with different degrees  of  DN.  Forty-five type 2 diabetic patients were enrolled in this study:  15 normoalbuminuric; 15 microalbuminuric; 15 macroalbuminuric patients in addition to 15 healthy controls. Clinical examination and routine laboratory investigations were done.  NLRP3 mRNA expression was assessed by real time PCR. Serum 8-hydroxy-2’-deoxyguanosine (8-OHdG), IL-1β and uHSP72 levels were estimated by enzyme-linked immunosorbent assay.  Serum chitotriosidase  (CHIT1)  activity  was  examined.  Significant  higher  NLRP3  mRNA  expression, serum  8-OHdG,  IL-1β  and  uHSP72  levels,  in  addition  to  CHIT  1  activity were  documented  in the  macroalbuminuric  patient  group  as  compared  to  the  other  two  diabetic  and  control  groups. They  were  significantly  positively  correlated  and  to  urinary  albumin/creatinine  ratio,  serum creatinine  and  HA1c.  Multiple  linear  regression  analysis  using  UACR  as  dependent  variable, confirmed that uHSP72, and relative NLRP3 mRNA expression were the independent predictors of  DN  (β  were  0.432  and  0.448  respectively,  P<0.001).  Receiver  operating  characteristic analyses  revealed  that  both  NLRP3  mRNA  expression  and  uHSP72  levels  were  useful biomarkers  discriminating  DN  patients  from  T2DM  patients  (AUC  were  0.957  and  0.983 respectively) Conclusion: uHSP72 may be considered as a novel potential diagnostic biomarker for  the  early  detection  of  DN.  Moreover,  these  data  support  the  pivotal  role  of  NLRP3  in  the development and progression of DN.

Biography:

Abstract:

Foot ulcers  are a serious complication of diabetes;  arising due to neuropathy, angiopathy ,arthropathy , tendinopathy leading  to altered  biomechanics of the foot  .The ulcers  will risk the patients with infections, amputations  and will have significant socioeconomic impact .The aim of the study is to setup  guidelines in the approach and treatment of diabetic  foot ulcers and  reduce the risk of amputations . An  analysis of  200 patients  from  2013 to 2017  who presented   to our podiatry  clinic  was grouped based on the location of the ulcers ,severity  of the ulcer , causative factors and co morbidities . The patients who underwent surgical offloading and reconstructive procedures were  followed up (average follow up 2.3Years)  and outcomes evaluated  based on the wound healing and complications . The study proves that appropriate surgical offloading has a significant role to play in reducing the incidence of amputations and complications in diabetic patients.

Biography:

Dr. Subbiah Ramasamy is working as  Sr. Assistant Professor in Madurai Kamaraj University, India 

Abstract:

Organophosphates (OP) are the largely used insecticides in the world and every human is being exposed to OP via food, water and air. Due to their biodegradable nature OP are considered comparatively harmless but studies exposed their association with neuronal and other disorders. Here, we demonstrate that cronic exposure to OP is associated with hyperglycemia and glucose intolerance mediated by OP metabolizing potential of  gut microbiota. Interstinal metatranscriptomic and metabolomic analyses revealed that gut microbial degradation of OP produces acetic acid, which induces interstinal and hepatic gluconeogenesis and thus accounts for glucose intolerance. We also identified a similar association of plasma OP residues and fecal acetate level with diabetic status of humans. We demonstrate a high prevalence of diabetes among people directly exposed to organophosphates in rural India (n = 3080). Correlation and linear regression analysis reveal a strong association between plasma organophosphate residues and HbA1c but no association with acetylcholine esterase was noticed. Collectively, our results implicate gluconeogenesis as the key mechanism behind organophosphate-induced hyperglycemia, mediated by the organophosphate-degrading potential of gut microbiota. This study reveals the gut microbiome-mediated diabetogenic nature of organophosphates and hence that the usage of these insecticides should be reconsidered.

Biography:

Mohamed M. Aboelnaga, M.D A Graduate of Mansoura faculty of medicine, Egypt, Nov 2000. Trained in endocrinology unit at the Mansoura university general hospital and specialized medical hospital, Egypt during residency period from 2002 till Feb 20006. Received Master degree in internal medicine ( Endocrinology and diabetes) from Mansoura faculty of medicine in May 2005, and M.D degree in internal medicine ( Endocrinology and diabetes)  from Mansoura faculty of medicine in May 2011.  Recently, in Dec 2016, promoted to assistant professor of endocrinology and diabetes at Mansoura faculty of medicine.  Published researches in thyroid disorders, Parathyroid disorder, Pituitary gland disorders, vitamin D relation to endocrinal disorders, diabetes mellitus, male hypogonadism, PCOD and others endocrinology disorders.

Abstract:

Background and objective: Several studies reported correlation between hypogonadism and vitamin D deficiency. But most of these studies investigated hypergonadotropic hypogonadism patients. Hypogonadism complicating diabetes was predominately hypogonadotropic reflecting pituitary dysfunction. We evaluated the relationship between vitamin D status with testosterone and gonadotropin deficiency among patients T2DM, Also we aimed to determine the risk factor for male hypogonadism among those patients. Methodology: We enrolled 95 male T2DM patients in this cross-sectional study. Vitamin D insufficiency was settled as 25(OH) D level < 30 ng/mL while deficiency < 20 ng/ml.

Result: Testosterone deficiency prevalence in T2DM patients was 41.1% and hypogondotopic hypogonadism prevalence was 87.2 %. T2DM patients with hypogonadism had significant lower 25(OH)D levels than patients without hypogonadism. T2DM patients with testosterone deficiency had significant higher prevalence of vitamin D deficiency (61.5 % and 28.6 %), and non-significant higher prevalence of insufficiency (84.6 % and 82.1 %) in comparison with patients withouthypogonadism. Vitamin D deficient T2DM patients showed significant lower total testosterone levels, on the other hand Vitamin D deficient diabetic patients showed non-significant lower gonadotropin as compared to those without deficiency. In linear regression analysis, we found that 25(OH)D was a significant predictor of total testosterone levels among T2DM patients.In logistic regression analysis, vitamin D deficiency but not insuficiency was a significant risk factor for male hypogonadism among T2DM patients.

All previous results showed a postive correlation between vitamin D and testosterone levels but not gonadotropin. Conclusion: Diabetic patients with testosterone deficiency had significant lower 25(OH)D levels and higher prevalence of vitamin D deficiency and insufficiency as compared to those without testosterone deficiency. Vitamin D deficient patients had lower testosterone levels but not gondotopin. 25(OH)D was a significant predictor of total testosterone levels. Vitamin D deficiency was a significant risk factor for male hypogonadism in among T2DM patients.