12^th European Diabetes Congress September 15-17, 2016 Berlin, Germany

Ana Maria Garcia Bellon has completed her PhD from Granada University and Post-doctoral studies from Malaga University School of Medicine. She currently works at the University Regional Hospital of Malaga, Spain.

Objective: To analyze the value of glycosylated hemoglobin (HbA1c), determined at admission, as predictor of developing type 2 diabetes mellitus in non-diabetic patients, hospitalized for coronary disease. Material & Methods: We collected 578 consecutive patients, admitted for (ACS) in our department, from May 2014 to September 2015. Their levels of Hb1Ac were requested at admission systematically. Finally, 199 patients (34%) were included with diagnosed coronary disease and without known diabetes. We collected clinical data, cardiovascular risk factors (CVRF), anthropometric and laboratory values (fasting glucose and HbA1c). Two months after hospital discharge, all patients were re-evaluated clinically and analytically undergoing an oral glucose tolerance test (OGTT). Patients were grouped into four categories according to the criteria of the American Diabetes Association (ADA): a) normal fasting glucose <110 mg/dL and OGTT <140 mg/dL, b) altered basal glucose (ABG): fasting glucose 110-126 mg/dL, c) glucose intolerance (GI): a 2-h OGTT 140-200 mg/dL, d) ABG + IG, e) DM: fasting glucose> 126 mg/dL and 2 hours OGTT> 200 mg/dL We conducted a descriptive analysis of the data. We determine the odds ratio (OR) of having DM or any disorder of carbohydrate metabolism in relation to the values of HbA1c at admission. Results: Mean age was 68.3 years. 69.2% were male and 30.8%, female. Mean body mass index (BMI): 28.4 kg/m². The prevalence of cardiovascular risk factors is: 74.6% hypertensive, 34.7% dyslipidemic, 32.9% active smokers. Prior history of heart disease: 26.5% acute myocardial infarction (AMI), 19.3% prior stable angina, 41.6% with no history of heart disease. Mean fasting blood glucose 104 mg / dL ± 24, and 6% on HbA1c. The evaluation at 2 months by fasting glucose and OGTT: Normal result 24.1%, 3.5% GBA, IG 33.7%, 11.1% GBA + IG, 27.6% DM. The OR of having any disorder of carbohydrate metabolism in terms of HbA1c levels was 6.65 (95% CI, 1.25-35) (p <0.029). The cutoff point that best discriminated Hb1Ac was Hb1Ac risk = 6.5%. Conclusions: HbA1c level at admission is a good predictor of the risk of developing DM or other alterations in carbohydrate metabolism. This small measure would be useful for an early detection of DM, allowing to start a suitable dietary and pharmacological prevention.

Andrea Pereira Rosa received her MSc in Biochemistry from Federal University of Rio Grande do Sul. She is currently a PhD student in Biochemistry. She has published 15 papers in prestigious scientific journals.

Diabetes is an endocrine disorder of carbohydrate metabolism characterized by hyperglycemia due to deficiency of insulin secretion or action. Recently, the impact of diabetes on the central nervous system (CNS) has been received great attention, but the mechanisms by which hyperglycemia can cause brain damage remain poorly understood. In addition, recent studies have shown that hyperglycemia induces brain damage in adult rat. In this regard, there is a paucity of studies addressing the deleterious effects of hyperglycemia on the rat brain during CNS development. Therefore, in the present study, we investigated if neonatal hyperglycemia was able to alter the expression of proteins associated with survival/death signaling. Seven-day-old Wistar rats were subjected to a single administration of streptozotocin (100 mg/Kg body weight) while controls received saline. Glycemia was verified every day (>200 mg/dL are considered hyperglycemic). Five days after injection of streptozotocin, animals were killed and the brain homogenates were utilized for analyses. The expression of proteins JNK, GSK3β, Bax, Bcl2, p38, Total AKT and phosphosforylated AKT (p-AKT) was quantified by “western blot”. No significant changes were detected in JNK, GSK3β, Bax and Total AKT protein expression. On the other hand, brain of neonatal hyperglycemic group presented increased p38 and Bcl2 protein expression. Furthermore, brain of neonatal hyperglycemic rats showed decreased p-AKT protein expression as compared to control group. Finally, these results suggest that neonatal hyperglycemia induces death signaling activation, indicating the potential harmful effect of hyperglycemia on the central nervous system.

Kisokanth G is pursuing his final year PhD degree at Faculty of Graduate Studies, University of Sri Jayewardenepura, Sri Lanka and he is a Lecturer at BSc Nursing degree program at Eastern University, Sri Lanka. He has published more than 15 papers in journals as well as international conferences.

The present study aimed to determine the factors associated with good glycemic control of Diabetes Mellitus (DM) patients among the Tamils in a selected center in the Batticaloa District, Sri Lanka. An unmatched case control study was conducted among 339 patients with DM in medical clinics, Teaching Hospital, Batticaloa. The case patients (n=113) were those who had fasting blood sugar less than or equal to 110mg/dl and the controls (n =226) were those who had fasting blood sugar more than 110mg/dl in at least 3 clinic visits during last 6 months. The validated and pre-tested interviewer administered questionnaire was completed by interviewing patients and using medical records. Logistic regression analysis was carried out to predict the factors associated with good glycemic control. Duration of DM (OR 0.39, 95% CI=0.19 - 0.80), doing regular exercise (OR 5.96, 95% CI=3.08 – 11.51), fix time for consumption of medication (OR 4.22, 95% CI=1.59 – 11.24), regular clinic follow-up (OR 4.61, 95% CI=1.22 – 17.34) and normal body weight (OR 0.15, 95% CI=0.08 – 0.31) were found to be the factors associated with good glycemic control in the multivariate logistic regression model. Patients with DM need to have regular clinic follow-up and they should be consistently advised to adhere the medication instruction for achieving good glycemic control. Further, regularly involved any kind of exercise for 4 hours or more a week should be emphasized among Tamil patients with DM to maintain normal body weight as well as to achieve good glycemic control.

Kap Bum Huh, MD, PhD is a Chief Director of Huh’s Diabetes Center and 21st Century Diabetes and Vascular Research Institute. He served for more than 30 years as a Physician, Professor, and Primary Investigator in the Department of Endocrinology and Metabolism, Yonsei University College of Medicine. During his tenure, he served as Dean of the Medical School at Yonsei University, Head of Diabetes Center at Severance Hospital, and President’s Doctor in Korea. He authored the book, “Tailored Therapies of Korean Diabetes” and “Metabolic Syndrome” in addition to many scientific and public policy articles.

A limitation with randomized controlled trials is that, while they provide unbiased evidence of the efficacy of interventions, they do so under unreal conditions and in a very limited and highly selected patient population. Our aim was to provide data about the effectiveness of dapaglifrozin treatment in a real-world and clinical practice setting. In a retrospective and observational study, data from 210 patients (mean age : 53±9 yr, male 47%) with a minimum 6 months of dapaglifrozin therapy were analyzed, who visited Huh’s Diabetes Center from Jan. 2015 to Dec. 2015. Mean baseline glycated hemoglobin (HbA1c) was 8.4±1.2% and mean body mass index (BMI) was 28.3±3.3 kg/m2. After 6 months of treatment with dapaglifrozin, we observed a change in HbA1c of -1.2±0.9%, -2.9±2.4 kg in weight and -1.1±0.9 kg/m2 in BMI (p<0.001 for all). Compared to baseline, there was a significant reduction in systolic blood pressure (-7.4 mmHg, p<0.001), LDL cholesterol (-5.7mg/dl, p=0.005) and triglycerides (-24.3 mg/dl, p<0.001). In patients treated with dapaglifrozin as an add-on therapy, a decrease of -1.4% in HbA1c (p<0.001) and a weight reduction of -2.8 kg (p<0.001) were observed. In patients switched from other anti-diabetic drug, dapaglifrozin induced a decrease of -1.1% in HbA1c (p<0.001) and a reduction in weight (-2.9 kg, p<0.001). Our study confirms the effectiveness of dapaglifrozin in a clinical practice setting.

Aim: This study involves primary school teachers who are at risk of type 2 diabetes working at primary schools of Gaziantep Province, Sahinbey District. Web-based and individual education are given to them in order to assess effectiveness of cost and effectiveness of type 2 diabetes risk prevention with randomized controlled. Method: Totally 53 primary school teachers are participated in this study. 27 participant received web-based education and 26 participants received individual education. When collecting data, those are used: “Finnish Diabetes Risk Score”, “Social Demographic Data Form”, “Metabolic Control Evaluation Form” and the book of the expenditures for groups are recorded on a daily basis. With primary school teachers who are at web-based group, interview is made once. During interview, participants are informed about using of web site and about how to enter. Collecting data is conducted through the web page. With primary school teachers who are at individual education group, interview is made three times giving information about prepared training presentation. Training materials and collecting data are conducted by researcher. Expenditures on both education groups are recorded for the cost-effectiveness of both education and the effectiveness of diabetes risk prevention. Prior to research, approval is taken from Clinical Research Ethics Committee of the Faculty of Medicine of Erciyes University, written permission is taken from Gaziantep Provincial Directorate of National Education and informed consent was obtained from classroom teachers. When evaluating data, those are used: Shapiro Wilk and Kolmogorow-Smirnov test, Chi-square, independent-samples t test, paired samples t test. Results: FINDRISC point for web-based education group is found as 16.48 ±1.57 before education, 13.40±2.002 (p<0.05) after education; for individual education group as 16.34±1.29 before education, 13.65±2.38 (p<0.05) after education. Before and after education, FINDRISC point for web-based education group is determined as 3.07±1.20. For individual education group, reduction is found as 2.69±1.61 (p>0.05). With web-based and individually educated teachers, both form of education was found to be effective in providing metabolic control. Total cost is found as 1179.04 TL for web-based education group, as 2218.56 TL for individual education group. Average cost-effectiveness ratio is detected as 384.05 TL for web-based education group and as 824.74 TL for individual education group. Incremental cost-effectiveness ratio of web-based education is pound as -2735.57 TL with respect to individual education. Mean education cost per primary school teacher is determined as 43.66±3.36 TL for web-based education group and as 85.33±11.31 TL for individual education group (p<0.05). Conclusion: Conclusion of this study shows that both training methods are effective in preventing type-2 diabetes risk but web-based education is cost-effective.

Aim: This study involves primary school teachers who are at risk of type 2 diabetes working at primary schools of Gaziantep Province, Sahinbey District. Web-based and individual education are given to them in order to assess effectiveness of cost and effectiveness of type 2 diabetes risk prevention with randomized controlled. Method: Totally 53 primary school teachers are participated in this study. 27 participant received web-based education and 26 participants received individual education. When collecting data, those are used: “Finnish Diabetes Risk Score”, “Social Demographic Data Form”, “Metabolic Control Evaluation Form” and the book of the expenditures for groups are recorded on a daily basis. With primary school teachers who are at web-based group, interview is made once. During interview, participants are informed about using of web site and about how to enter. Collecting data is conducted through the web page. With primary school teachers who are at individual education group, interview is made three times giving information about prepared training presentation. Training materials and collecting data are conducted by researcher. Expenditures on both education groups are recorded for the cost-effectiveness of both education and the effectiveness of diabetes risk prevention. Prior to research, approval is taken from Clinical Research Ethics Committee of the Faculty of Medicine of Erciyes University, written permission is taken from Gaziantep Provincial Directorate of National Education and informed consent was obtained from classroom teachers. When evaluating data, those are used: Shapiro Wilk and Kolmogorow-Smirnov test, Chi-square, independent-samples t test, paired samples t test. Results: FINDRISC point for web-based education group is found as 16.48 ±1.57 before education, 13.40±2.002 (p<0.05) after education; for individual education group as 16.34±1.29 before education, 13.65±2.38 (p<0.05) after education. Before and after education, FINDRISC point for web-based education group is determined as 3.07±1.20. For individual education group, reduction is found as 2.69±1.61 (p>0.05). With web-based and individually educated teachers, both form of education was found to be effective in providing metabolic control. Total cost is found as 1179.04 TL for web-based education group, as 2218.56 TL for individual education group. Average cost-effectiveness ratio is detected as 384.05 TL for web-based education group and as 824.74 TL for individual education group. Incremental cost-effectiveness ratio of web-based education is pound as -2735.57 TL with respect to individual education. Mean education cost per primary school teacher is determined as 43.66±3.36 TL for web-based education group and as 85.33±11.31 TL for individual education group (p<0.05). Conclusion: Conclusion of this study shows that both training methods are effective in preventing type-2 diabetes risk but web-based education is cost-effective.

Suganthi Jaganathan has completed her BDS (2004-09) and Mater’s in Public Health (2012-13). She started working with Centre for Chronic Disease Control, New Delhi as Clinical Research Officer from February 2014 until December 2014. She took charge as Program Coordinator for Certificate Course in Gestational Diabetes Mellitus (CCGDM) program with Public Health Foundation of India from January 2015 -till date to train doctors in Gestational Diabetes Mellitus Management.

Introduction: According to IDF over 24.2% of all live births are affected by hyperglycaemia during pregnancy in South East Asia with 6 million contributed by India. Identifying and optimally managing GDM can improve maternal, foetal outcomes and prevent future diabetes. However primary care physicians (PCPs) and Obstetricians/gynaecologists (OBGYs) are inadequately trained to tackle GDM. To address, Public Health foundation of India in collaboration with Dr. Mohan’s Diabetes Education Academy and grant support from Johnson & Johnson Medical Companies has developed and implementing nationwide program. Methods: The program began in 2013 and now covers 16 states, 216 districts of India. Through this, we have trained >2800 PCPs and OBGYs till date. It comprises of four modules delivered through once a month contact sessions across the country by 2 regional faculties (endocrinologist/diabetologists and OBGYs). It is accredited by South Asian Federation of Endocrine Societies. State governments of Gujarat and Madhya Pradesh under National Health Mission have adopted this model to train their medical officers. Results: One-fourth (39%) of the trained pool are from Government sector, half of them (52%) were post-graduates with 11 years of average clinical experience. We have standardized monitoring mechanism and well-defined certification process with >90 pass percentage. Knowledge improvement of doctors was 1.6 unit score increase in pre and post-test. 92 percent of physicians said that program helped in better diagnosis, management and timely referral of GDM patients. CCGDM model is robust approach for emulation across low and middle-income countries that face shortage of PCPs/OBGYs in GDM management.