2^nd World Congress on
Diabetes and Endocrinology (Webinar)

Biography:

Dr. Milind Ruke is among the few Diabetologists in the country who specializes in Podiatry and foot care. He holds several qualifications in his domain, and apart from being a medical practitioner, he is also an academician.

Abstract:

The world is facing a major epidemic of diabetes mellitus (DM) & available reports suggest that all these patients are at risk of developing diabetic foot ulcer (DFU). Approximately 50 – 60% of all DFUs can be classified as neuropathic. Signs or symptoms of vascular compromise are observed in 40 to 50% of all patients with the vast majority having neuro-ischemic ulcers, and only a minority of patients has purely ischemic ulcers. Diabetic foot infections are usually polymicrobial in nature, involving both aerobes and anaerobes, which can decay any part of the body especially the distal part of the lower leg. However, one of the hidden barriers to wound healing is the presence of biofilm in chronic DFUs. Biofilms are difficult to identify & diagnose, recalcitrant to topical antibiotics & can reoccur even after sharp debridement. More than 90% of chronic wounds are complicated with biofilms. Hence, early identification and management of diabetic foot infections becomes imperative in order to prevent complications & amputation. Debridement is considered to be the gold standard treatment approach for managing DFU manifested with necrotic tissue. However, biofilm can reform even after sharp debridement and can delay healing & recovery. Also, antibiotics & few antiseptics have limited role in managing DFUs complicated with biofilm. Until recently, Cadexomer iodine, a new generation iodine formulation with microbead technology has taken a different profile in wound care. It can effectively manage biofilm along with exudate & possesses superior desloughing action. Additionally, appropriate ways of offloading, dressings & use of newer treatment strategies like negative pressure wound therapy (NPWT), hyperbaric oxygen therapy (HBOT) and / or use of growth factors can ensure faster healing & early wound closure. Although, commendable efforts in recent years have been taken in the diagnosis and treatment of DFU, it still remains a major public health concern.

Biofilm like infections are found to be an important cause of amputations in Diabetic foot patients, worldwide. In south-east Asia, especially in India, the incidence is increasing .This presentation on Management of diabetic foot Biofilms would go in a big way in explaining the evidence we have now to treat this aspect of Diabetic foot & helping in Limb salvage and hence prevent Amputation.

Biography:

Abstract:

This research was conducted under the research grant “Autoimmune endocrinopathies multiple organ failure that are genomic, postgenomic and metabolic markers. Genetic risk prediction, monitoring, early predictors, personalized correction and rehabilitation.” Project number is 17-75-30035.

Introduction: Autoimmune polyendocrine syndromes (APS) are a heterogeneous group of diseases characterized by the presence of autoimmune dysfunction of two or more endocrine glands and other non-endocrine organs.

The aim of the study was to determine the association of chronic adrenal insufficiency with polymorphism of HLA II, CTLA-4 and PTPN22 genes among patients with APS 2,3,4 types and patients with Graves’ disease. The focus of the study was on the revealing of protective genes for Addison’s disease in APS 3 type patients and in patients with Graves’ disease. 

Materials and methods: The case-control study involved 116 patients with APS 2, 3, 4 types, 95 patients with Graves’ disease and 109 healthy subjects. Alleles of the HLA II class genes, CTLA4 and PTPN22 were identified by the multiprimer allele-specific PCR method. The statistical analysis was carried out using the exact two-sided Fisher test. The association of the chronic adrenal insufficiency was determined by the value of the odds ratio (OR - odd's ratio), the value of 95% confidence interval (95% CI).

Results: Haplotypes DR3-DQ2 (p < 0,0001; OR = 4.06), DR4-DQ8 (p < 0,0001; OR = 5.78), DQA1*0301 allele (p=0.000; OR = 4.27), genotype DQA1*0301/DQA1*0501 (p=0.000; OR = 13.89), and especially genotype DR3/DR4 (p=0.000; OR = 19.7) HLA II class genes predispose to the development of APS type 2, 3 and 4 in adults compared to the control group.

Genotype DR3/DR4 HLA II genes found the strongest association with the development of adrenal insufficiency in patients with APS (p < 0,0001; OR = 4.28). It is an independent risk factor of the development of APS type 2, 4 in patients with APS type 3 and patients with one autoimmune disease - Graves' disease. 

Haplotype DRB1*01-DQA1*0101-DQB1*0501 has been determined as protective for the development of Addison’s disease. Frequency of DRB1*01-DQA1*0101-DQB1*0501 was significantly lower in the group of APS type 2, 4 comparing to the group of APS type 3 (Ñ€<0,01; OR=0.0769), Graves’ disease (p <0.05; OR=0.095) and the control group (Ñ€<0,01; OR=0.1138)

There were no significant differences in the frequency of occurrence of the haplotype - DRB1*01-DQA1*0101-DQB1*0501 - in the type 3 APS groups, in patients with Graves' disease and in the control group.

Gene polymorphisms CTLA-4+ 49A/G (rs231775) and PTPN22 +1858C> T (rs2476601) are predisposing to the development of APS 2, 3 types compared with the group of Graves' disease patients and the control group

A significant association between APS type 2, 3 and carriage of the CTLA-4 +49 A/G genotype (p < 0.01; OR 2.63) and PTPN22 +1858 CT genotype (p< 0.05; OR 3,96) was  confirmed

Conclusion: The revealing of predisposing and protective genes to Addison’s disease in patients with APS type 3 and Graves’ disease will allow better predicting the risks of developing of the chronic adrenal insufficiency and the sudden onset of potential life-threatening complications (adrenal crisis) within the syndrome.

Biography:

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‘Diabesity’ is a term for diabetes occurring in the context of obesity. The positive effect of LCHF diets (low carb, high fat diets) is well documented: LCHF diets are at least as effective as other dietary strategies for reducing body weight, improving glycaemic control and reducing both hyperinsulinaemia and blood glucose (reduction of HbA1c) in type 2 diabetes and have unique positive effects on blood lipid concentrations and cardiovascular risk factors1. Also, in obese insulin-resistant women, food fried in extra-virgin olive oil significantly reduced both insulin and C-peptide responses after a meal2. In this case study, I show how combining both dietary strategies produces a strong effect on blood glucose, resulting in a “forced” reduction of exogenous insulin injection to avoid the problem of hypoglycaemia. Blood tests after 3 months of this dietary treatment show how HbA1c, triglycerides and blood lipid profile (LDL, HDL, total Cholesterol) are improved despite reduction of exogenous insulin injection of 80%. Also, body weight decrease of 15%. For continuous glucose monitoring (CGM) the patient used FreeStyle Libre before and after the dietary treatment. In order to check general body functions and glycosuria the patient used the urine test Multistix 10 SG Siemens.

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Abstract

Accumulation of Reactive Oxygen Species (ROS) and methlyglyoxal (MG) causes endothelial dysfunction in diabetes-related complications. Endothelial function in high glucose (HG) is improved by resveratrol (RSV), however the mechanisms underlying such beneficial effect are still unclear. In particular, the role of sirtuin-dependent regulation of cytoprotective mechanisms remains unknown.

Here we investigated molecular details glycative/oxidative perturbations in HG-challenged endothelial cells, and whether SIRT1 was essential for RSV to protect cells against HG through the regulation of MG- and ROS-targeting defences.

Human umbilical vein endothelial cells (HUVECs) were kept in 5.55 mM glucose (CTR) or 30.55 mM glucose (HG), and co-incubated with either RSV (5 µM) or RSV+EX527 (SIRT1 inhibitor) (5 µM+13.4 µM, respectively). Through morphological, molecular and biochemical methods, we evaluated: cell viability, apoptosis, expression of SIRT1, CAT (catalase), SOD1 (Cu/Zn-superoxide dismutase), SOD2 (mitochondrial Mn-superoxide dismutase), glyoxalase 1 (GLO1), ROS- and MG-dependent damages, and redox balance of glutathione. The involvement of mitochondria was verified by investigating the expression of SIRT3 and acetylated SOD2.

We found that HG impaired MG/ROS scavenging activities in HUVECs, and that RSV effectively rescued such impairments by up-regulating SIRT1. Interestingly, the response involved mitochondria, as seen by both changed expression of SIRT3 and altered levels of SOD2.

Biography:

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Abstract

BACKGROUND: Egypt is among the world top 10 countries in diabetes prevalence. It is the first country among the MENA region. Healthy lifestyle education and support help people with diabetes to improve health outcomes. Many physical and psychological barriers can hinder patients from following a healthy lifestyle.

AIM: This study aimed to examine the effect of lifestyle modification educational sessions in helping Egyptian patients to overcome main barriers of diabetes self-management through improving nutritional behaviors, physical activity, medication compliance, and blood glucose monitoring.

METHODS: A cohort study included 205 patients with type 2 diabetes. Baseline assessment of patients' lifestyle behaviors and barriers using personal diabetes questionnaire of Louisville University, with both anthropometric and blood glucose assessment. Interventional lifestyle health education was provided weekly through multiple integrated techniques, followed by a post-intervention assessment to evaluate the effect of the health education sessions. Statistical analysis was done to identify any statistically significant difference before and after the health education intervention.

RESULTS: There was a significant improvement of the post-education mean scores of the studied behaviors when compared with the pre-education scores of the participants’ behaviors (p < 0.001). There was also a significant reduction in the barriers facing patients to diabetes self-management including nutritional barriers (P < 0.001), medication compliance barriers (P < 0.001) with a percent change (43%), physical activity barriers (p < 0.001), and blood glucose monitoring (p < 0.001) with a percent change (44%).There was a statistically significant positive correlation between improvement of medication compliance (P = 0.027), blood glucose monitoring(P = 0.045), and glycated haemoglobin of the study participants

CONCLUSION: lifestyle modification education of type 2 diabetic patients can overcome the main barriers of following a healthy lifestyle and improve their anthropometric measures and blood glucose level

Biography:

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ABSTRACT

Background: The increasing magnitude of overweight among type 2 diabetes mellitus patients in developing countries is due to rapid dramatic lifestyle changes. Despite the impact overweight among type 2 diabetes mellitus patients, study on magnitude of overweight and its predictors are limited in Ethiopia. So the aim of this study was to assess magnitude of abdominal obesity and associated factors among type 2 diabetes mellitus patients at Mekelle public hospitals.

Methods: Health facility based cross-sectional study was conducted from February to April 2018.Systematic sampling method was used to select the study participants. Anthropometric measurements and pretested structured questionnaire through face to face interview were used to collect the data. Data were cheeked, coded and entered in to Epi data manager and cleaned for implausible and missed values. Then the data were exported to Statistical Package for Social Sciences version 21. Odds ratio along with 95% confidence interval was estimated to identify predictors of overweight using multivariable logistic regression analysis. Level of statistical significance was declared at p-value < 0.05.

Results: Three hundred sixty five participants were enrolled in this study. The magnitude of overweight was 149 (40.8%). Besides to this the magnitude of central obesity was 194(53.2%). Overweight was higher in study participants from urban setting than their counterparts 92.6% vs. 7.4%) [AOR = 3.4, 95% CI 1.26–9.4].Respondents who drank alcohol had significantly highest prevalence of overweight compared to non-drunker 93(62.4%) [AOR= 2.9, 95% CI (1.5 – 5.5)] and 302(82.7%) had poor vigorous activity level.

Conclusions and recommendations: Overweight was high among type 2 diabetes patients. Factors such as residence area, alcohol consumption, physical activities, central obesity and dietary practice were the determinant factors for overweight. Therefore, well organized health education program on life style modification should be implemented.

Key words: Overweight, determinant factors and type 2 diabetes mellitus.

Biography:

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Abstract

Background: Type II Diabetes Mellitus (T2DM) is a heterogeneous group of metabolic disorders characterized by insulin resistance & impaired insulin secretion. Metformin is first line treatment oral hypoglycemic agents for patients with T2DM. Conversely, it has been found that the use of metformin is associated with malabsorption of vitamin B₁₂, which may lead to more detrimental effects on peripheral nerves.

Objectives: To compare/correlate the nerve conduction study (NCS) parameters of peripheral nerves and serum vitamin B₁₂ levels in type 2 diabetic patients (with and without metformin exposure) and healthy subjects (control).

Materials and methods: A comparative cross-sectional study was conducted enrolling type II diabetic patients(Group A) with metformin therapy for more than 6 months (n=30), type II diabetics (Group B) without metformin exposure (n=11) and healthy controls (n=30). Nerve conduction study parameters of median, tibial, common peroneal & sural nerves, serum glucose and serum vitamin B₁₂ levels were measured. One way ANOVA (post hoc: Tukey) test was used to compare the variables using SPSS. 22.0.

Results: T2DM with metformin therapy showed significant longer latencies and lower amplitudes of both sensory and motor nerves when compared to healthy controls and T2DM without metformin therapy. NCS parameters showed more deleterious effects on median, tibial and sural nerves of diabetic patients with metformin therapy. Diabetics undergoing metformin treatment had reduced vitamin B₁₂ levels as compared to those without metformin therapy [194.03 (164.86-223.53) vs. 297.82 (258.99-363.00), p=0.001] and healthy controls [194.03 (164.86-223.53) vs. 287.50 (204.25-351.50), p=0.001]. Serum vitamin B₁₂ level showed strong negative correlation (significant at p<0.01 level) with duration of metformin exposure/treatment in metformin exposed diabetics.

Conclusion: Long term metformin therapy in diabetic patients is associated with significant vitamin B₁₂ depletion, leading to alteration in motor and sensory NCS parameters. Thus, we recommend regular vitamin B₁₂ screening and oral/ parenteral vitamin B₁₂ supplementation to the diabetic patients on metformin therapy.

Keywords: Diabetes, Metformin, Nerve Conduction study, Serum vitamin B₁₂.

Biography:

Abstract:

Abstract: To study the anti-diabetic effects of the crude leaves extract and fractions of Thymus schimperi Ronniger in normal and steptozotocin induced diabetic mice. The crude extract and the fractions were screened for antidiabetic activities in streptozotocin induced diabetic mice. A normoglycemic mice model and oral glucose tolerance test were also undertaken to assess the hypoglycemic and antihyperglycemic effect of the crude extract in normoglycemic and glucose loaded mice, respectively. The methanolic crude extract has significantly reduced blood glucose level in streptozotocin induced diabetic mice at all given doses compared to the negative control and the percentage reduction observed was in a dose dependent manner i.e. [250 mg/kg (14.76±6.1%), 500 mg/kg (25.12±11.5%) and 750 mg/kg (27.15±10.0%)]. The crude methanol extract was devoid of hypoglycemic effect in normoglycemic mice but significantly reduced post prandial hyperglycemia starting from 1 h post glucose administration. Among the fractions, higher percentage reduction was recorded in the n-butanol fraction at a dose level of 500 mg/kg (36±7.3%) compared to 250 mg/kg (22.2±4.3%). The aqueous fraction 250 mg/kg and 500 mg/kg also reduced the blood glucose level by 17.6%±6.0% and 18.4±5.0%, respectively. This study revealed that methanol extract as well as butanol and aqueous fractions of T schimperi possess anti-diabetic activity. Keywords: Thymus Schimperi Ronniger, Diabetes mellitus, Hypoglycemic, Streptozotocin

Biography:

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Abstract

Pituitary germinomas are difficult to be differentiated from lymphocytic hypophysitis due to similar clinical, radiological and even histological findings. However, it is of great importance to make the distinction between them because of different therapeutic approaches of the two diseases. We report a case of neurohypophysial germinoma who initially was misdiagnosed as lymphocytic hypophysitis. The patient was a 26-year-old man who first presented with central

diabetes insipidus and subsequent pan-hypopituitarism. Magnetic resonance imaging (MRI) of the pituitary which first had shown mild pituitary enlargement, revealed a pituitary mass of unusual feature after 1 year. Pathological diagnosis of the lesion, biopsied through

trans-sphenoidal route, was lymphocytic hypophysitis. Corticosteroid was initiated for him. Despite, intensive treatment clinical symptoms worsened and the patient developed visual field defect. Follow-up MRI revealed enlargement of the pituitary mass with suprasellar extension and involvement of optic chiasm. Surgical resection of the mass was performed, and the second histological examination confirmed the diagnosis of germinoma. Subsequently, the patient underwent radiotherapy, and complete remission was achieved; however, pan-hypopituitarism persisted. In conclusion, the possibility of neurohypophyseal germinoma should be considered in patients with the diagnosis of lymphocytic hypophysitis who do not respond to corticosteroid therapy.

Key words: Germ cell tumor, Pituitary germinoma, Hypophysitis.

Biography:

Dr. Satish Kumar David working as Researcher & Head of the Information Technology Department in the Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia. Over 23 years of professional experience as a department head, assistant professor, researcher, IT specialist. Research interests include data mining, mHealth, computer networks, AI. Several publications in reputed international journals and has been a reviewer for few journals. Also, co-author with Mohamed Rafiullah, of Novel Health Mobile Technology as an Emerging Strategy in Diabetes Management (IntechOpen, 2017) and co-author with Saeb, A. T., Rafiullah, M., & Rubeaan, K. of Classification Techniques and Data Mining Tools Used in Medical Bioinformatics (IGI-Global,2019). Take up higher responsibilities to grow with the organization.

Abstract:

Diabetes is a chronic disease that needs patient awareness, education, and self-management of the disease by patients. Mobile revolution and the availability of IT technologies can serve as a connecting bridge in healthcare system to facilitate the treatment of lifestyles diseases such as diabetes. However, the effectiveness of these techniques needs to be assessed rigorously. Therefore, the authors have systematically reviewed the recent clinical studies using Mobile Health applications for diabetes management.  

Original articles that were published in ISI indexed journals from PubMed database from 2007 to 2014 were collected using search specific key phrases. Selected papers were classified into ‘mobile applications for diabetes management’ which included applications related to diabetes management, ‘mobile applications for patient education’ which included all the articles where smart phone was used as a tool for health education and ‘mobile applications for patient behavior modifications’ which included studies that looked into mobile applications which would affect and contribute to behavior changes.

Mobile health interventions resulted in significant clinical improvement in most of the studies. Educational SMS produced significant results but was inferior to the apps or teleconsultations which are more engaging with patients. It seems phone calls are less preferred, as there were only two studies where phone calls were used as intervention. Most of Smartphone apps were evaluated for patient management and education. Implementing reliable mobile health platform in real-life setups may be a challenging task and would require adequate infrastructure. Cost benefit and cost-effectiveness analysis are essential before implementation of such systems.

Biography:

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Abstract

Background

Chronic conditions including mainly diabetes mellitus are negatively impact quality of life, disability, morbidity and mortality. Health coaching has emerged as a possible intervention to help individuals with chronic conditions to adopt health supportive behavior that improve both quality of life and health outcome. The few published randomized controlled trials using health coaching for patients with diabetes have reported mixed results.

Objectives

To determine the effectiveness of health coaching on modifying health status and quality of life among diabetic patients and to clarify the characteristics of coaching delivery that make it most effective.

Search methods

We searched the COCHRANE, MEDLINE, PubMed, TRIP database and EMBASE in the last 15 years.

Selection criteria:

We included randomized controlled trials (RCTs) of health coaching interventions among type 2 diabetic patients aimed to improve their health status and life style and published in English language from January 2005 to the end of December 2018

Data collection and analysis

Two authors independently assessed trials eligibility, risk of bias, quality and extracted data. We combined dichotomous data using risk ratios (RRs) and continuous data using mean differences (MDs) and presented all results with 95% confidence interval (CI).

Main results:

We found that health coaching intervention has a significant effect on HbA1c (MD = -0.17, CI=-0.31, -0.03, I² = 94%, P<0.00001), weight (MD = -3.20, CI = -5.90, -0.49, I² = 88%, P< 0.00001) and triglyceride trials (MD = -2.58, CI = -5.07, -0.09, I² = 57%, P >0.02). We found also that the most effective strategy for health coaching delivery associated with improvement of HbA1c was decreasing number of sessions with increasing duration of each session. Mixed results were recorded for the effect of health coaching on the quality of life of diabetic patients.

Authors’ conclusions

Health coaching intervention has a significant effect on glycemic control, weight and triglyceride and the most effective strategy is the decreasing number of sessions with increasing their duration. However, these results should be taken with caution as the evidence comes from studies at some risk of bias with considerable heterogeneity and imprecision.

Biography:

Ms. Sabyata Gautam has completed her M. Pharm on 2010 from Kathmandu University and doing doctoral studies from Shri JJT University, Institute of Pharmacy. She is the associate professor, in National Model College for Advanced Learning (NMCAL), NIST college. She has published more than 5 papers in reputed journals and has been involved in social works too.

Abstract:

This study aims to find impact of pharmacist’s counselling on medication adherence among diabetic patients in Kathmandu valley. Data collection was done from Jan 2017 till June 2018. In our descriptive cum exploratory study, of total 321 patients, the mean age of diabetic patients was 57.5 ± 12.47years. Metformin 500mg was found to be prescribed mostly (n= 107 patients). When calculated in per day cost of OHAs, minimum was Rs.2 and maximum was Rs. 103.42 with average cost of Rs. 25.10. While undergoing KAP assessment, the knowledge score wasn’t found to be satisfactory, though results on practice and attitude were satisfactory. MARS 5 and MARS were used to measure compliance before and after counselling. MARS-5 contains likert scale questions with total score of 25. MARS 5 scoring after counseling had mean of 24.06 ± 1.54, which was 23.17 ± 2.40 before counselling (P ≤ 0.000). Similarly, the study found the mean values of 8.21 ± 1.24 (before counselling) and 9.03 ±0.89 (after counselling) while using 10 item MARS questionnaire (P ≤ 0.000). Thus, counselling from pharmacist is effective in improving the compliance among diabetic patients. Knowledge and attitude scores of the patients were found to be statistically significant with medication compliance (P< 0.05). Notable improvement in patient’s blood sugar levels (F, R, PP) were also observed after counselling. Since most of the patients, with reference to the self, admitted that lack of knowledge regarding disease was major reason for non-adherence, awareness programs are much in need.

Key words: Diabetes, Adherence, Causes of Non-adherence, Counselling, KAP, MARS