19^thAsia Pacific Diabetes Conference July 20-22, 2017 Melbourne, Australia

Diabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both. Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia).
The exact cause of type 1 diabetes is unknown. What is known is that your immune system — which normally fights harmful bacteria or viruses — attacks and destroys your insulin-producing cells in the pancreas. This leaves you with little or no insulin. Instead of being transported into your cells, sugar builds up in your bloodstream.
Type 1 is thought to be caused by a combination of genetic susceptibility and environmental factors, though exactly what many of those factors are is still unclear. In prediabetes — which can lead to type 2 diabetes — and in type 2 diabetes, your cells become resistant to the action of insulin, and your pancreas is unable to make enough insulin to overcome this resistance. Instead of moving into your cells where it's needed for energy, sugar builds up in your bloodstream.

Retinopathy. Microaneurysm formation is the earliest manifestation of diabetic retinopathy. Microaneurysms may form due to the release of vasoproliferative factors, weakness in the capillary wall, or increased intra-luminal pressures. Microaneurysms can cause vascular permeability in the macula, which can lead to macular edema that threatens central vision. Obliteration of retinal capillaries can lead to intraretinal microvascular abnormalities. As capillary closure becomes extensive, intraretinal hemorrhages develop.
Proliferative retinopathy develops due to ischemia and release of vasoactive substances, such as vascular endothelial growth factor, which stimulate new blood vessel formation as a progression of nonproliferative retinopathy. These vessels may erupt through the surface of the retina and grow on the posterior surface of the vitreous humor. These vessels are very friable and can lead to vitreous hemorrhages. The vitreous humor can contract and lead to retinal detachment.
Nephropathy. Two pathophysiologic pathways for diabetic nephropathy have been identified. First, diabetic nephropathy can result from increased glomerular capillary flow that, in turn, results in increased extracellular matrix production and endothelial damage. This leads to increased glomerular permeability to macromolecules. Mesangial expansion and interstitial sclerosis can ensue, which have the potential to cause glomerular sclerosis. A second pathway termed nonalbuminuric renal impairment is due to macrovascular and/or repeated unresolved episodes of acute kidney injury. Reduced glomerular filtration rate (GFR) and albuminuria are risk factors for cardiovascular events whereas albuminuria predicted death and progression to end-stage renal disease better than GFR loss.
Neuropathy. The pathophysiology of neuropathy is complex. Diabetes is associated with dyslipidemia, hyperglycemia, and low insulin and growth factor abnormalities. These abnormalities are associated with glycation of blood vessels and nerves. In addition, autoimmunity may affect nerve structure. Trauma and nerve entrapment can lead to structural nerve damage including segmental demyelination, axonal atrophy and loss, and progressive demyelination. These effects cause neuropathy.
Macrovascular. The macrovascular complications of diabetes result from hyperglycemia, excess free fatty acid, and insulin resistance. These cause increased oxidative stress, protein kinase activation, and activation of the receptor for advanced glycation end products, factors that act on the endothelium.

• First decreased nitric oxide, increased endothelin, and increased angiotensin II cause vasoconstriction that results in hypertension and vascular smooth muscle cell growth.
• Second, decreased nitric oxide, activated nuclear factor-KB, increased angiotensin II, and activation of activated protein-1 increase inflammation, which results in the release of chemokines, cytokines, and expression of cellular adhesion molecules.
• Third decreased nitric oxide, increased tissue factor, increased plasminogen activator inhibitor-1, and decreased prostacyclin result in thrombosis, hypercoagulation, platelet activation, and decreased fibrinolysis.

Blood tests are used to diagnosis diabetes and prediabetes because early in the disease type 2 diabetes may have no symptoms. All diabetes blood tests involve drawing blood at a health care provider’s office or commercial facility and sending the sample to a lab for analysis. Lab analysis of blood is needed to ensure test results are accurate. Glucose measuring devices used in a health care provider’s office, such as finger-stick devices, are not accurate enough for diagnosis but may be used as a quick indicator of high blood glucose.

Testing enables health care providers to find and treat diabetes before complications occur and to find and treat prediabetes, which can delay or prevent type 2 diabetes from developing. Diabetes is diagnosed when: symptoms are present and fasting blood test result is at or above 7.0 mmol/L or a random blood test result is at or above 11.1 mmol/L. HbA1c blood test result is ≥ 6.5% (48 mmol/mol) there have been no symptoms and two abnormal blood glucose tests (as above) on separate days.

The concept of 'new technologies' for type 1 diabetes and new discovery and advanced type 2 diabetes treatment has expanded in recent years at a rate that some might consider comparable to 'Moore’s Law', and the sheer number of new technologies entering into the type 1 diabetes marketplace is also growing at a remarkable rate. From the patient’s perspective, this is not only exciting but can lead to a sense of optimism. Technologies that today are growing commonplace (e.g. insulin pumps, rapid HbA1c monitoring, etc. come under new therapeutic mechanisms of diabetes. Indeed, it could be argued that the major advances in type 1 diabetes care made within the last quarter of a century have come from technology rather than biology. At the same time, not all new technologies succeed (e.g. the Glucowatch), regardless of their purported promise. Both type 1 diabetes patients and their healthcare providers will soon see a series of further advanced medical technologies used in hospital and new technologies and novel therapies in diabetes treatment whose basis is tied to the notion of improving the lives of those with the disease.

In pancreatic islet transplantation, cells are taken from a donor pancreas and transferred into another person. Once implanted, the new islets begin to make and release insulin. Researchers hope that islet transplantation will help people with type 1 diabetes live without daily injections of insulin. Xenotransplantation is the transplantation of living cells, tissues or organs from one species to another. Such cells, tissues or organs are called xenografts or xenotransplants. A transplant of the pancreas is usually reserved for those with serious complications. Pancreas transplants are most often done when a patient also receives a new kidney. The pancreas transplant adds little further risk in this situation and offers big benefits. However, transplant surgery is risky. Each person needs to carefully weigh the potential benefits and risks.

The research on diabetes leads to focus more on the diagnosis and treatment of diseases with the new approaches yet to be discovered or under developments. Maturity onset diabetes of the young, Diabetic Dyslipidemia is one of the major issues for the concern which is due to mutation. Without the pancreas producing this insulin, the sugar will stay in our blood and begin to create serious health issues. High blood sugar can cause blindness, kidney failure, nerve damage, and other organ function problems. There are various metabolic  syndrome  which are to be treated with recent tools for obesity and weight management  is  Bariatric surgery , stem cell therapy. With the development of software’s, now the computational tools i.e bioinformatics are used for the analysis of data e.g. Sequence alignment, microarray analysis and specific tools mentioned.The researcher are also focusing on the metabolism of people with diabetes as it differs to the metabolism of people without diabetes.  In type 2 diabetes, the effectiveness of insulin is reduced and in type 1 diabetes, insulin levels in the body are very low. There is a strong correlation between BMI and body fat. One of the correlates of insulin resistance is the blood fatty acid (FA) level. FA levels are strong predictors of muscle insulin resistance. In diabetes for dummy's, it is vital to get tested regularly to make sure your normal blood sugar levels are safe. In the meantime, diabetes for dummies says to check your blood sugar levels, and know what they are.  Electron microscopy shows decreased mitochondrial size in muscle from individuals with type 2 diabetes.

The two most common forms of diabetes are type 1 diabetes (T1D, previously known as insulin-dependent diabetes or IDDM) and type 2 diabetes (T2D, previously known as non-insulin-dependent diabetes or NIDDM). Both are caused by a combination of genetic and environmental risk factors. However, there are other rare forms of diabetes that are directly inherited. These include maturity-onset diabetes in the young (MODY), and diabetes due to mutations in mitochondrial DNA. All forms of diabetes have very serious effects on health. In addition to the consequences of abnormal metabolism of glucose (e.g., hyperlipidemia, glycosylation of proteins, etc.), there are a number of long-term complications associated with the disease. These include cardiovascular, peripheral vascular, ocular, neurologic and renal abnormalities, which are responsible for morbidity, disability and premature death in young adults. Furthermore, the disease is associated with reproductive complications causing problems for both mothers and their children. Although improved glycemic control may decrease the risk of developing these complications, diabetes remains a very significant cause of social, psychological and financial burdens in populations worldwide.

Insulin is administered by two routes of delivery: Injection and Infusion.
Insulin syringe: This is the most common insulin delivery method. The classic injection device is an insulin syringe. The plastic, disposable syringes currently are available in three sizes, and hold up to 30, 50 or 100 units of insulin. The needles are fine (up to 31 gauge) with lengths ranging from 3/16th of an inch for infants, to ½ inch or more for adults. The insulin is injected into the layer of fat (subcutaneous tissue) just under the skin.
Infusion: Human regular insulin may be injected directly into the vein in a hospital setting under close medical supervision only. Insulin is added to intravenous fluids, and the insulin dose and blood sugar are strictly monitored. The intravenous route of delivery is only given under a doctor’s orders in a hospital to facilitate the management of diabetes during surgery or an intensive care stay.

Neuroendocrinology is the study of the interaction between the nervous system and the endocrine system, including the biological features of the cells involved, and how they communicate. The nervous and endocrine systems often act together in a process called neuroendocrine integration, to regulate the physiological processes of the human body. Neuroendocrinology arose from the recognition that the brain, especially the hypothalamus, controls secretion of pituitary gland hormones, and has subsequently expanded to investigate numerous interconnections of the endocrine and nervous systems.
The neuroendocrine system is the mechanism by which the hypothalamus maintains homeostasis, regulating reproduction, metabolism, eating and drinking behaviour, energy utilization, osmolarity and blood pressure.

High blood glucose levels are damaging to blood vessels and can increase the likelihood of them narrowing through atherosclerosis. This damage also leads to poor supply of blood to nerves.
Poorly controlled hyperglycemia persisting for years can lead to complications affecting small blood vessels (microvascular complications), large blood vessels (macrovascular complications) or both.
The process by which vascular disease develops is complex and occurs via numerous pathways that scientists continue to investigate.
Microvascular complications - those resulting from damage to small blood vessels - are the most common complications of diabetes and include:
Retinopathy - disease of the eye
Nephropathy - disease of the kidneys
Neuropathy - disease of the nerves.
Macrovascular complications - those resulting from damage to large blood vessels - include:
Angina pectoris and heart attack
Transient ischemic attacks and strokes
Peripheral arterial disease.

Diabetes is a syndrome – literally a “running together” of associated conditions. Type 1 diabetes associates with a number of autoimmune disorders. Obesity, specifically central obesity, is prominent among these, and the combination of “diabesity” is associated with hypertension, dyslipidaemia and arterial disease – the so-called metabolic syndrome. More recently, it has been appreciated that certain types of cancer are more common in association with diabetes and obesity, and there has been controversy as to the extent to which treatments for diabetes can modulate the risk of cancer in one direction or the other.
The incidence of type 2 diabetes rises sharply in relation to obesity. The combination of obesity with insulin resistance or hyperinsulinaemia is however associated with all features of the metabolic syndrome, arterial disease and some types of cancer. Hypertension may arise as a complication of diabetic nephropathy, or (more commonly) as a feature of the type 2 diabetes syndrome. The prevalence of hypertension is increased in those with abnormal glucose tolerance, and it is commonly present at the diagnosis of diabetes. The association is independent of potential confounders such as age, glucose control or proteinuria. The dyslipidaemia of diabetes is characterized by high triglycerides and low HDL cholesterol. This is considered due to overproduction (or reduced removal) of VLDL particles, which is itself a feature of insulin resistance. Diabetes and obesity are associated with a similar range of cancers, including pancreatic, hepatic, endometrial, breast and colorectal cancers.

The prevalence of diabetes is rising globally. Poor glucose control results in higher rates of diabetes-related complications and an increase in health care expenditure. Diabetes self-management education (DSME) training has shown to improve glucose control, and thus may reduce long-term complications. Implementation of diabetes self-management education programs may not be feasible for all the institutions or in developing countries due to lack of resources and higher costs associated with DSME training. With the increasing use of smartphones and Internet, there is an opportunity to use digital tools for training people with diabetes to self-manage their disease. A number of mobile applications, Internet portal, and websites are available to help patients to improve their diabetes care. However, the studies are limited to show its effectiveness and cost-benefits in diabetes self-management. In addition, there are many challenges ahead for the digital health industry.
Recent attempts have been made to develop mobile software that can calculate nutritional information for the patients based on their food intake. Frøisland developed and tested a mobile-phone-based tool to capture (DiaMob) and visualize adolescents’ food intake aimed at understanding carbohydrate counting and to facilitate communication to daily treatment changes. Implementing a visualization tool is an important contribution for young people to understand the basics of diabetes and to empower young people to define their treatment challenges. It empowers patients’ independence and management of their disease.

The main goal of diabetes management is, as far as possible, to restore carbohydrate metabolism to a normal state. To achieve this goal, individuals with an absolute deficiency of insulin require insulin replacement therapy, which is given through injections or an insulin pump. Insulin resistance, in contrast, can be corrected by dietary modifications and exercise. Other goals of diabetes management are to prevent or treat the many complications that can result from the disease itself and from its treatment.
Modification of adverse lifestyle factors is an important aspect of the management of all types of diabetes. In particular, appropriate management of cardiovascular risk factors such as smoking, physical inactivity and poor diet is important for the prevention of macrovascular disease. Microvascular complications may also be affected by adverse lifestyle factors, eg smoking. However, helping patients to modify certain behaviors should take account of other factors such as the patient’s willingness to change, their perception of their diabetes, and factors which may be indirectly related to their diabetes, such as depression and adverse effects on quality of life.

A biomarker is defined as “any substance, structure, or process that can be measured in the body or its products and influence or predict the incidence of outcome or disease”.For the purpose of predicting type 1 diabetes, a biomarker should be present in a subset of the population, and this subset should have a bias in the proportion of people in whom type 1 diabetes develops. A biomarker should also present a quantifiable risk for the development of type 1 diabetes within a defined period or diagnose a “stage” in the progression to clinical or symptomatic type 1 diabetes. As described in this article, most of the biomarkers used for the prediction of type 1 diabetes are islet-specific supporting the concept that, before overt hyperglycemia, type 1 diabetes is predominantly a targeted disease rather than a systemic disease.
Atomic Biomarkers can be separated as "a trademark that is precisely measured and gaged as a pointer of typical natural methods, pathogenic methodology, or pharmacologic reactions to a pharmaceutical intercession.
Biomarkers have fundamental influence in driving clinical trials and treating patients. Progresses in sub-atomic diagnostics help medicinal experts make proficient, experimentally legitimate choices. All the more efficient disclosure and use of biomarkers in the development of antidiabetes medications will rely on upon quickening our comprehension of the pathogenesis of diabetes and particularly its macrovascular entanglements. Procedural upgrades from different fields, particularly tumor, are starting to demonstrate the way towards better models of diabetes pathogenesis and atomic biomarker revelation.