Day 1 :
Keynote Forum
Grant Brinkworth
Commonwealth Scientific and Industrial Research Organisation,Australia
Keynote: The role of very low carbohydrate diets for enhancing type 2 diabetes management
Time : 09:50-10:30
Biography:
Associate Brinkworth completed his PhD in nutrition/exercise science at the age of 25 years from the University of South Australia. He is a Principal Research Scientist at the Commonwealth Scientific and Industrial Research Organisation – Division of Food and Nutrition and leads clinical studies examining the effects of dietary patterns, foods, nutritional components and physical exercise on weight loss, metabolic disease risk management, and physical and mental functioning and performance in healthy and clinical populations, including diabetes. He has published more than 70 papers in reputed journals and recently completed his MBA to connect research with business and the commercialization of science outcomes.
Abstract:
Despite the popularity of very low carbohydrate diets, limited well-controlled studies have extensively examined their health effects in type 2 diabetes (T2D). In this outpatient study, 115 obese adults with T2D were randomly assigned to consume either an energy restricted, very low carbohydrate, low saturated fat diet (LC; 14% carbohydrate: 28% protein: 58% fat) or a planned isocaloric high unrefined carbohydrate, low fat diet (HC; 53% carbohydrate: 17% protein: 30% fat) combined with a structured exercise program (3x/week) for 52 weeks. Weight, body composition, glycemic control, cardiovascular disease (CVD) risk, renal function and psychological wellbeing were assessed. Both groups had similar completion rates (LC=41[71%],HC=37[65%]) and reductions in body weight (9.1%), fat mass, blood pressure (-6/-6 mmHg), HbA1c (-1%) and fasting glucose (-1.4mmol/L); no diet effect (P≥0.09). Compared to HC, LC achieved a 2 and 3-fold greater reduction in diabetes medication use and glycaemic variability, respectively. Triglycerides decreased (LC -0.4±0.1,HC -0.01±0.1 mmol/L;P=0.001) and HDL-C increased (LC 0.1±0.03, HC 0.06±0.04 mmol/L;P=0.002) more on LC, with no difference between groups for LDL-C reductions (LC -0.1±0.1, HC -0.2±0.1 mmol/L, P=0.76). Both diets produced similar responses in endothelial function (assessed by flow-mediated dilatation), mood state, quality of life, cognitive performance and renal function markers. Overall, both LC and HC diets achieved comparable weight loss and improvements in HbA1c, fasting glucose, psychological well being and maintained renal function. However, the LC yielded greater reductions in glucose lowering medication requirements, greater diurnal blood glucose stability and improved lipid profile suggesting LC are advantageous and safe for T2D management.
- Trends in Diabetes Complication
Session Introduction
Ping Gu
Nanjing General Hospital of Nanjing Military Command, Nanjing University, China
Title: Myeloid-specific deletion of SIRT1 impairs obesity and ageing-associated endothelial dysfunction
Biography:
Dr Ping Gu has completed her PhD from the Second Military Medicine University of China in 2007 and postdoctoral studies from the Hongkong University. She has published more than 20 papers in international journals and has been serving as associate chief physician in Jinling Hospital.
Abstract:
SIRT1 is a class III, NAD-dependent histone that plays a key role in curbing inflammatory responses in macrophages. However, whether SIRT1 controls macrophage polarization and its implication in vascular diseases is unclear. Aims. Here we aim to clarify whether SIRT1 deficiency biases macrophage polarization and contributed to endothelial dysfunction. Wild type (WT) and myeloid-specific SIRT1 knockout mice (MKO) were fed with standard chow or westernized diet for 12 weeks. Endothelium-dependent relaxation (EDR) in aortic rings was assessed by wire myograph. Macrophages were differentiated in vitro from bone marrow cells. Compared to WT mice, aortic EDR was significantly impaired in MKO mice under both obese and ageing conditions. In accompany, MKO mice were more susceptible to atherosclerosis in apoE-/- background. Macrophage were resistant to interleukin 4 (IL4)-induced polarization to M2 subtype. Moreover, endothelial cells co-cultured with MKO-derived macrophages exhibited higher inflammation and lower eNOS expression. SIRT1 plays a pivotal role in controlling macrophage polarization, which in turn causes impaired endothelial function.
Dipak Mall
National Academy of Medical Science, Nepal
Title: Role Of A Doctor In Management And Educating Patients With Diabetes Mellitus In Nepal
Time : 11:00-11:30
Biography:
I Dr. Dipak Mall have completed my MBBS Degree from Peoples friendship university of Russia in year 2004 and MD from Yangze University of China in year 2015.After my graduation I have been working in the department of endocrinology in one of the tertiary center in Kathmandu, Nepal. We as a team have been working to promote and encourage our patients to have early detection of diabetes mellitus and to prevent the complications.
Abstract:
After 10 years of Maoist insurgency in Nepal and political instability lots of people have moved from their home in village to big cities like Kathmandu. With this urbanization and change in life style Diabetes mellitus is one of the high burden disease in Nepal. With changing political situations and unstable government, ministry of health and population in Nepal is not being able to address and priorities diabetes on public health case agenda in Nepal through the promotion of preventive measures such as dietary pattern, exercise and periodic checkup. Several studies conducted in Nepal shows that the increasing trend of prevalence of diabetes mellitus with increasing age in Nepal is may be due to lack of public awareness regarding the problem and poor medical service in Nepal. As a Doctor in Nepal, we have loads of challenges to detect and prevent the complications of Diabetes mellitus who visit us for initial management. For most of the patients living in villages of Nepal to visit a diabetic specialty center in Nepal he or she has to travel for at least 24 hours on various modes of transport. In our center, which is the only tertiary and endocrine specialty hospital, every day we have few patients with severe complications like diabetic retinopathy, nephropathy and diabetic foot as an initial presentation. We doctors have a great responsibility to take care of our patients suffering from Diabetes mellitus and we must educate them to make our society healthy. At the same time we must encourage the government of Nepal to give more diabetic awareness program in Nepal.
Ensieh Shahvazian
Shahid Sadoughi University of Medical Sciences, Iran
Title: Resequencing of KLF14 gene in population based family study with type two diabetes
Time : 12:00-12:30
Biography:
Ensieh Shahvazian has completed her MSc at the age of 25 years from Shahid Sadoughi University of Medical Sciences, Iran. She has accomplished several organized and valuable projects on Diabetes and Diabetic retinopathy. She is also a Genetic R&D researcher at ROJETechnologies.
Abstract:
KLF14 belongs to Krȕppel-like transcription factor family. It has been reported as main transcription factor of adipose tissue, which regulates ten genes. KLF14 is an intronless gene with high CG content (around 74%), which is hot spot for mutations. Since 2010, many GWAs report SNPs near KLF14 gene as a susceptible loci related to T2D, it was reasonable to resequence this locus to find out important associated SNP with T2D. To accomplish this purpose, we selected 50 nuclear families with individuals older than 35 years, included probands, who were registered in Yazd Diabetes Research Center with at least one of their parents and their available siblings. DNA was isolated from peripheral blood. KLF14 gene was amplified by CG-Rich PCR in two overlapping parts. The gene parts were sequenced by Sanger method. Among 220 SNPs of the gene, Rs76603546 with OR=2.15, (CI: 1.08-4.30) and Pvalue= 0.02 was associated with type two diabetes. To our knowledge, it is the first time that the association of Rs76603546 SNP with T2D is reported. As Rs76603546 is located in CG Island at KLF14 gene, it is probable that it have significant influence on methylation of KLF14, which may effect on the expression of KLF14. That is the subjects of our ongoing studies, although the association of Rs76603546 should be confirmed in future studies with higher power, which is in progress.
Dipak Mall
National Academy of Medical Science, Nepal
Title: Financial burden and outreach of Diabetes clinics for patients in Nepal
Biography:
I Dr. Dipak Mall have completed my MBBS Degree from Peoples friendship university of Russia in year 2004 and MD from Yangze University of China in year 2015.After my graduation I have been working in the department of endocrinology in one of the tertiary center in Kathmandu, Nepal. We as a team have been working to promote and encourage our patients to have early detection of diabetes mellitus and to prevent the complications.
Abstract:
Financial burden and outreach of diabetes clinics for patients in Nepal: In the capital city of Nepal,there are only two hospital based endocrinology referal centers,which is run 6 days a week with loads of around 120 patients a day with 2-3 doctors handling the burden. Most of the patients visiting higher centers are from remote areas of Nepal who travel for around half a day or whole day o reach doctors clinics. As per trend from 2006 to 2014 the per capita income of Nepal is increased by $327 to $ 426.48 according to world bank.Now we can see how much is a burden for patients who need oral hypoglycemic agents and insulin therapy everyday to fight with diabetes. Only few studies are being studies carried out in Nepal which states that the cost of intial visit to doctor with laboratory investigations and treatment cost around Nepalese Rupee 3000 to 4500($20 and $35) which patiens have to bear on self, which dosent include personal and travel cost. Though the tertiary centers are located in centers of the capital,most of the patients visiting government hospitals are from remote and nearby villages,who visit tertiery centers not as a initial presentation but with complications.Which states that the financial burden to the patients are increased more with screening for Diabetes retinopathy,Nephropathy,peripheral vascular diease,diabetes foot examination and use of insulin therapy.
Niru Khatiwada
Kathmandu University, Nepal
Title: Treatment adherence among patients undergoing hemodialysis
Time : 14:10-14:40
Biography:
Niru Khatiwada has completed her Master of Nursing in 2015 from Maharajgunj Nursing Campus and this theses has been completed as a partial requirement of the degree and is currently working as a lecturer in Kathmandu University affiliated Nepal Medical College, Attarkhel, Jorpati, Kathmandu.
Abstract:
Treatment adherence with four domains: hemodialysis schedule, diet restriction, fluid restriction and medicine adherence, is a crucial factor that influences morbidity and mortality of hemodialysis patients. The aim of the study was to assess treatment adherence among patients undergoing hemodialysis and the associated factors in the year 2014. Methods: A total of 166 patients undergoing hemodialysis for at least 3 months in National Kidney Center, Kathmandu were interviewed. Patients with communication problems and those who were too sick for interview were excluded. Relationship between four domains and various factors were identified using inferential statistics. Results: The self-reported treatment adherence was found to be 73.5%, 32.5%, 39.8% and 78.9% in hemodialysis schedule, diet restriction, fluid restriction and medicine adherence respectively. Adherence to hemodialysis schedule was significantly associated with duration of hemodialysis (p=0.050), companion to reach the center (p=0.038), time to reach the center (p=0.020) and type of transportation (p=0.004). Fluid restriction had significant association with marital status (p=0.034), adequacy of treatment expenditure (p=0.015) and Interdialytic Weight Gain (IDWG) (p=0.012). Adherence to diet restriction had significant association with counseling on the same (p=0.013). Medicine adherence was significantly associated with age (p=0.017) and duration of hemodialysis (p=0.049). It also showed association of age (p=0.001), Hepatitis C infection (p=0.013), Diabetes mellitus (p=0.012), duration of hemodialysis (p=0.010) with IDWG. Conclusion: There is an immediate need for strategies to promote the treatment adherence of the patients under hemodialysis with focus on diet and fluid restriction adherence.
Ensieh Shahvazian
Shahid Sadoughi University of Medical Sciences, Iran
Title: Heritability and familiality of Type 2 Diabetes in Yazd population, Iran
Time : 14:40-15:10
Biography:
Ensieh Shahvazian has completed her MSc at the age of 25 years from Shahid Sadoughi University of Medical Sciences, Iran. She has accomplished several organized and valuable projects on Diabetes and Diabetic Retinopathy. She is also a Genetic R&D researcher at ROJETechnologies.
Abstract:
Type2 diabetes (T2D) is the growing health problem in Yazd population, having a prevalence of 16.3% among adolescent. The level of consanguineous marriage is high (46%), hence a high level of homozygosity is predictable. Besides, this population have special predisposing life style of low relocation rates, a relatively high standard of living, large family sizes. To direct association and linkage studies in Yazd, we decided to calculate the heritability of type2 diabetes in a population based family study. 2065 individuals were participated in The Yazd Diabetes family Study (YDS). The study was conducted among diabetic probands between 35-80 years, whose disease were confirmed in Yazd Diabetes Research Center, and their expanded families. Heritability was calculated for type2 diabetes in SOLAR software package and was adjusted for common covariates (age, sex, age × sex, age2 and BMI). The strongest heritability for type two diabetes (h2 = 0.56±0.28, Pvalue= 0.016) was seen in age group 40-60 years. However, in age group 20-60 years, heritability reduced to 0.22±0.2. The heritability for 40-75 years was 0.28±0.11. λR = 2.4 and λR (nuclear family) = 3.42 and λS= 3.14 was seen in age group of 35 to 80 years. As a conclusion, for detecting high influenced genetic risk factor with OR≥2, it is recommended to conduct studies on individuals between 40 to 60 years. To cover all genetic risk factor either with less OR, it is better to limit the sample study on individuals with onset 40 to 75 years.
Rasha Mosa
University of Queensland, Australia
Title: Effects of growth hormone secretagogue receptor agonist and antagonist in non-obese Type 2 Diabetes MKR mice
Time : 15:10-15:40
Biography:
Rasha Mosa, a third year PhD student at University of Queensland, School of Biomedical Sciences, Australia supported by competitive Egypt Government International Scholarship and UQ International Scholarship. She was an assistant lecturer of Medical Physiology at Sohag University, Faculty of Medicine, Egypt since 2009. She was awarded Master degree in Physiology from Sohag Faculty of Medicine in 2009 and a Bachelor of Medicine and Surgery from Sohag Faculty of Medicine in 2004. She is interested in studying the pathophysiology of type 2 diabetes and its potential therapy. Recently, she published a review in endocrine: “Implications of ghrelin and hexarelin in diabetes and diabetes-associated heart diseases”.
Abstract:
Ectopic lipid deposition is a high risk factor for insulin resistance and its associated diseases such as type 2 diabetes (T2D). Peroxisome proliferator-activated receptor gamma (PPARγ) plays a key role in adipocyte differentiation, lipid metabolism and is a therapeutic target for the treatment of insulin resistance. Recent evidence suggests that Hexarelin, a ghrelin synthetic analogue that acts through GH secretagogue receptor (GHS-R), promotes PPARγ activation in macrophages and adipocytes. However, whether Hexarelin impacts the fat and glucose metabolism in diabetes remains unclear. By using the MKR diabetic mouse model, which is characterized by hyperinsulinaemia, hypertriglyceridaemia and ectopic fat deposition, we assessed the effects of Hexarelin and the GHS-R antagonist, D-Lys GHRP-6, on glucose homeostasis, energy balance, hormonal and metabolic profiles in MKR diabetic mice. Our data demonstrated that chronic treatment with Hexarelin for 2 weeks improved glucose and insulin tolerance in diabetic mice. This effect is likely through activation of fatty acid metabolism and adipocyte proliferation, as well as increased insulin sensitivity. In conclusion, our results suggest that long-term treatment of Hexarelin benefits glucose and fat metabolism via reducing ectopic lipid deposition.