Scientific Program

Day 1 :

  • Diabetes Mellitus | Endocrine Hormones | Cardiovascular Complications | Endocrine Disorders
Speaker
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.

Speaker
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.

Speaker
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.

 

Havva Keskin

Department of Dermatology, Istanbul Medeniyet University Goztepe Training and Research Hospital

Title: The MPV is a New Marker to Predict the Menopause
Speaker
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.

Kenan Cadirci

Saglik Bilimleri University, Turkey

Title: What Is the Current Approach to Thyroid Nodules?
Speaker
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.

Speaker
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. 

Speaker
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.

Pizzol Damiano

Head of Operational Research Unit of Doctors with Africa in Mozambique.

Title: Diabetes and cataract in low- and middle-income countries
Speaker
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.

 

Speaker
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

Speaker
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.

 

Speaker
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.

Speaker
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.
  

  • Nephropathy | Pancreatic Cancer | Diabetic Therapies | Endocrine Cancer
Speaker
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.

  • Genomic Endocrinology | Reproductive Endocrinology | Diabetic Wound and Treatments | Diabetes and Oral health Problems |

Session Introduction

L Lateesh

Hand & Reconstructive Surgeon, India

Title: Surgical Outcome of Diabetic Foot Ulcers
Speaker
Biography:

Dr L Lateesh, is a practicing Hand & Reconstructive Surgeon with over 15 years of experience having excelled in successfully performing complicated surgeries. 

 

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.

 

Speaker
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.

 

Speaker
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.

Day 2 :

  • Obesity | Physical Activity and Rehabilitation | Diet Managements | Nutrition Development and Research
Speaker
Biography:

Dr. Kishor Mazumder has completed his PhD at the age of 34 years from Osaka University, Japan and postdoctoral studies from Charles Sturt University School of Biomedical Sciences, Australia. He is the Chairman and Associate professor as well as advisor, Research Cell of Jessore University of Science and Technology, Jessore Bangladesh, Bangladesh. In addition he is also an Adjunct Sr. Lecturer, School of Biomedical Sciences, CSU,NSW, Australia. He has published more than 35 papers in reputed journals and has been serving as reviewer of many reputed journals. He research interest in on antidiabetic and anticancer drug development and discovery from natural sources.

Abstract:

Australia is the largest producer of Lupin specially sweet lupin (Lupinus angustifolius) in the world, typically producing 0.75 million tonnes per year. Due to its unique nutritional value and chemical composition, Australian sweet white lupin is attracting worldwide attention as a new and healthy ‘Super Food’. The general aim of this research is to estimate the antidiabetic potential of the Australian Lupin cultivars for processed and unprocessed flours through in vitro, in vivo and in silico bioassays with aims to determine in vitro
enzyme inhibitions ( alpha amylase and alpha glucosidase), evaluate in vivo hypoglycemic and organ protective activities through biochemical and histopathlogical studies, in silico evaluation of mechanism of action of the selected metabolites of different cultivars isolated by LC-QTOF-MS/MS by exploring the α-amylase, α-glucosidase and DDP-4
inhibition activities through molecular docking analysis and ADME/T property studies also performed to measure the safety of the selected compound as drug of both processed and unprocessed lupin seed flour extracts of 9 cultivars . From In vitro, in vivo and in silico bioassay studies it was observed that all cultivars of L. angustifolius are found to be more potent against diabetes than L. albus cultivars. All the cultivars of L. angustifolius showed promising inhibition of alpha amylase and alpha glucosidase. Among them, extract of Jenabillup cultivar found to be most potent against both the enzymes. Janabillup extract also increase the glucose uptake into the skeletal muscle and played role against diabetes. From in vivo study it was observed that both unprocessed and processed (cooked) extracts of Jenabillop at a dose of 500mg/kg played effective role to control blood glucose level in alloxan induced diabetes rats. Both the extracts of Jenabillup also significantly protect alloxan induced organ damage. In silico ADME
and Molecular docking studies of the some of the isolated metabolites also correlate with the in vitro and in vivo results. The studies discussed above indicate that the impact of Lupin on carbohydrate or glucose metabolism is extensive. Lupin is not only super food but also have huge therapeutic potential like antidiabetic and organo-protective effects.

Speaker
Biography:

Saeko Imai, Ph.D. is Professor of Department of Food and Nutrition in Kyoto Women’s University, Japan. Previously, she was a Professor of Osaka Prefecture University and researched at Molecular Nutrition of Graduated School of Life and Environmental Science in Kyoto Prefectural University. Professor Imai is the Councilor of Japan Society of Metabolism and Clinical Nutrition, Japan Society of Nutrition and Food Science, and Japanese Society of Nutrition and Dietetics. She is also a member of JDS (the Japan Diabetes Society), ADA (American Diabetes Association), and EASD (European Association for the Study of Diabetes). She authored the book, “Eating vegetables before carbohydrate for patients with diabetes” in addition to more than forty publications in international journals.

Abstract:

Aims: Reducing the postprandial glucose level is important to decrease the risk of cardiovascular diseases even before onset of diabetes. we reported that the glucose excursions was significantly lower when the subjects ate vegetable before carbohydrate compared to the reverse regimen in both individuals with and without diabetes. In this study we explored the acute effect of the late-night-dinner and the divided-dinner on postprandial glucose levels in people with and without type 2 diabetes. Methods: Sixteen patients with type 2 diabetes and 14 healthy women were randomly assigned to this crossover study. Each participant wore a continuous glucose monitor for 5 days and consumed identical test meals from the second to the fourth day at home. Each participant consumed the test meals of breakfast at 08:00h, lunch at 13:00, and the half of the participants consumed dinner at 21:00 (D21) on the second day, 18:00 (D18) on the third day, and divided dinner (DD: carbohydrate at 1800h, and vegetable and the main dish at 21:00) on the fourth day. The rest of the participants consumed DD on the second day, and D21 on the fourth day. Results: D21 demonstrated higher incremental glucose peak (IGP) and incremental area under the curve for glucose (IAUC) than D18. On the other hand, DD ameliorated IGP, IAUC, and the mean amplitude of glycemic excursion than D21 in both patients with type 2 diabetes and young women without diabetes. Conclusions: This study demonstrated that consuming late-night-dinner led to postprandial hyperglycemia, and this postprandial hyperglycemia can be ameliorated by consuming a divided dinner. Our findings demonstrate that the new dietary approach should be taken into consideration not only on the amounts of energy, and macronutrient proportion, but also on how and when it was eaten in people with and without type 2 diabetes.

  • Women and Diabetes | Diabetic Surgeries | Conventional Treatments | Challenges and Applications
Speaker
Biography:

Marija Glisic is completing her PhD in Epidemiology and Internal Medicine  departments  at Erasmus Medical Center, Rotterdam, the Netherlands. Her mentor is Dr Oscar H. Franco. She earned her MSc in Clinical Epidemiology at the Netherlands Institute for Health Sciences, while her MD was obtained at the University of Belgrade in Serbia. Marija is investigating the associations between sex hormones and various cardiometabolic diseases, among which type 2 diabetes has a central role. She is also involved in several experimental studies in the field of vascular aging. After she completes the PhD in Epidemiology, Marija is planning to pursue a postdoctoral position to further investigate the underlying mechanisms of sex differences previously observed in cardio-metabolic diseases. She hopes to contribute more to the global understanding of gender differences in aging-associated diseases and help people to age. 

Abstract:

Phytoestrogens might have advantageous effects on diabetes in women. We performed a systematic review and meta-analysis to determine the effect of phytoestrogens on glucose homeostasis and risk of type 2 diabetes (T2D) among women. Randomized clinical trials (RCT) and prospective observational studies that assessed associations of phytoestrogens (supplementation, dietary intake or biomarkers) with fasting glucose or insulin, homeostatic model assessment of insulin resistance (HOMA-IR), or with risk of T2D were included. We identified 18 RCTs (n=1,687 individuals) investigating the effect of phytoestrogen supplementation on glucose homeostasis, and 9 prospective population-based studies (n=212,796 individuals) examining the association between phytoestrogen intake and risk of T2D. As compared to placebo, phytoestrogen supplementation resulted in improvements in fasting glucose and HOMA-IR, the pooled mean differences of changes were –0.12 mmol/L (95% CI -0.20 to -0.03) and -0.24 microU/mol/L (95%CI: -0.45 to -0.03) respectively. While there was no significant decrease in insulin levels with overall phytoestrogen supplementation, pooled mean difference of changes was -0.98 pmol/L (95%CI: -4.64 to 2.67). However, the results of RCTs would vary by type of phytoestrogens, soy derived isoflavones and genistein improved glucose homeostasis, isoflavone mix and daidzein had no or were associated with adverse glycemic profile. Higher dietary phytoestrogen intake was associated with a 10% lower risk of developing T2D in observational studies (pooled relative risk; 0.90 [95% CI, 0.85 to 0.96] for highest versus the lowest quantiles). Results were similar when the analyses were restricted only to medium and high-quality studies.  Overall phytoestrogens may have a positive influence on glycaemia and could be used for diabetes prevention in women. However, for some individual types of phytoestrogens, such as mixed isoflavones, caution is needed in demonstrating their use in women, as their use could lead to adverse glycemic profile in women.  

 

Himanshu Nayak

Assitant Professor AMC MET Medical College, India

Title: Gestational Diabetes Awareness & Screening Project (GDMAS), Ahmedabad
Biography:

Himanshu Nayak is an Assistant Professor of the Department of Community Medicine in AMCMET Medical College, Ahmedabad, India

Abstract:

Gestational Diabetes Mellitus (GDM) may have severe life-threatening consequences for mother and unborn baby if not diagnosed and managed. Awareness, screening and treatment can reduce worst consequences and provide opportunity to prevent future diabetes. There are 69.2 million people with diabetes in India during 2015, which is projected to increase 123.5 million by 2040. Current community based study is carried out in urban slum & outreach rural areas of Ahmedabad, catering population of 72 lakh. 300 doctors (125 centers) are trained as training of trainers (TOT). Further capacity building of 3400 paramedical staff & grass root level workers is done to effectively deliver services in remote areas. Pregnant women (50,000) of 24-28 gestational weeks are screened for GDM during one year period. Health worker measures blood glucose of pregnant women two hours after ingestion of 75gm oral glucose solution (diluted in 300ml water). All pregnant women of remote periphery areas are approached through the existing outreach sessions (Mamta divas) of Reproductive & Child Health system & health centers. Women, having sugar ≥ 140mg/dl, are advised and referred to higher center for appropriate care and delivery and given special consideration to prevent perinatal morbidity and mortality and poor fetal outcome. Women are being followed till the delivery to know and compare the outcome. Three lakh women are sensitized about lifestyle modification during awareness camps. This project will do capacity building of primary health care personnel, increase community awareness, reduce burden of diabetes & help the authority to incorporate GDM screening as component of antenatal care.