Day 1 :
University of Bergen
Keynote: Diabetes gastroenteropathy
Time : 10:00-10:40
Magdy El-Salhy is Professor of Gastroenterology and Hepatology at Bergen University, and consultant gastroenterologist at Stord Hospital, Norway. He is a member of the Editorial Boards of 9 international journals. Furthermore, he is on the referee list of a large number of international journals. He has evaluated grant applications for national and international research foundations. El-Salhy has also attended and contributed to several national and international meetings as invited speaker, or chairman. He authored 224 publications, which include original articles, invited reviews, book chapters, and books. His work has been cited in 4883 scientific articles. In 2013 and 2014, four of his highly cited papers are in the top 1% of world publications. His research field for the last 40 years has been the neuroendocrine system of the gut, from basic science to clinical applications.
Several gastrointestinal (GI) symptoms are common in patients with diabetes. These symptoms are referred to clinically as diabetes gastroenteropathy and include nausea and vomiting, heartburn, abdominal pain diarrhea, constipation and fecal incontinence. Diabetes gastroenteropathy not only reduces considerably the quality of life of diabetic patients, but also impairs metabolic control with increase risk of hyper-/hypoglycemia. The poorly controlled blood glucose level increases in turn the risk of the secondary diabetes complications such as retinopathy, nephropathy, neuropathy and cardiovascular affection. Diabetes gastroenteropathy may also cause malnutrition, which together with the disturbed immune defense in these patients may cause intercurrent infections. Diabetes gastroenteropathy is attributed to GI dysmotility, which is believed to be caused by autonomic neuropathy and/or hyperglycemia. The neuroendocrine system (NES) of the gut comprises the GI endocrine cells and the enteric nervous system (ENS). The NES of the gut secretes peptide/amines that regulate the GI motility through endocrine, paracrine and/or synaptic neurotransmission. The 2 components of the NES of the gut, namely the GI endocrine cells and the ENS has been found to be abnormal in patients with diabetes and in animal models of human diabetes. The abnormalities in the NES system of the gut can explain the GI dysmotility seen in patients with diabetes. The etiology of diabetes gastroenteropathy seems to be multifactorial, and autonomic neuropathy, hyperglycemia and abnormal gut NES appear to be important factors.
Amer Kamal Al Ansari
Keynote: The interaction of Diabetes mellitus and ageing on higher brain functions: Is diabetes mellitus an accelerated form of ageing?
Time : 10:40-11:20
Spent about 15 years of teaching (20%) and research activities (80%) in Rudolf Magnus Institue for Neurosciences in the Netherlands. The main work was devoted to exploring the effects of diabetes mellitus on the higher brain function, namely memory, and behavior. The work included an electrophysiological recording from the hippocampus (Extra- and Intracellular recordings), and also studying the behavior by water maze tests. This resulted into tens of published papers in top journals.
We also built a model of accelerated aging that could be caused by diabetes mellitus when we suggested that the effects of diabetes mellitus on the brain cognitive functions are very similar to the changes that take place during normal aging.
I moved about 10 years ago to Arabian Gulf University as a professor and chairperson of physiology department. Several research projects are running under my supervision including effects of DM on cognition, motor coordination and behavior.
The aim of the present study was to examine learning and hippocampal synaptic plasticity in ageing and diabetes, based on the hypothesis that the effects of diabetes and ageing on the brain could interact. This hypothesis stems from clinical observations that the effects of diabetes on the brain are most pronounced in the elderly. Moreover, many of the processes which have been implicated in the pathogenesis of brain ageing, in particular oxidative stress, microvascular dysfunction, non enzymatic protein glycation and disturbed intracellular calcium homeostasis, are also implicated in the development of diabetic complications. To find the possible interaction between diabetes and ageing, we investigated Morris water maze performance and examined hippocampal synaptic plasticity ex vivo in young adult and aged diabetic and non-diabetic rats. Because the study aimed to examine the additive effects of diabetes and ageing on the brain, an experimental protocol was chosen in which each of these two conditions in isolation produces only moderate deficits. Rats were examined after 2 months of diabetes, which produces half-maximum deficits in synaptic plasticity in young adult rats. Aged rats were examined at 2 years of age, when they have developed moderate changes in synaptic plasticity due to aging alone.
significant learning impairments were observed in young adult diabetic rats compared with controls. These impairments were even greater in aged diabetic animals. In hippocampal slices from young adult diabetic animals long-term potentiation was impaired compared with controls. In contrast, induced long-term depression was enhanced in slices from diabetic rats compared with controls.
It is concluded that both diabetes and ageing affect learning and hippocampal synaptic plasticity. The cumulative deficits in learning and synaptic plasticity in aged diabetic rats indicate that the effects of diabetes and ageing on the brain could interact.
- Diabetes Types and Symptoms | Genesis of Diabetes | Pathophysiology of diabetes | Screening of Diabetes | Technologies for the Treatment Of Diabetes
Location: Novotel Melbourne St Kilda
Md Faruque Pathan
Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Bangladesh
Title: Real-life effectiveness and tolerability of initial combination therapy with vildagliptin/metformin in drug-naïve patients with T2DM (Initial): A 24-week study from asia
Prof. Md. Faruque Pathan is an eminent Endocrinologist and Diabetologist. He is the Head of the Department of Endocrinology at BIRDEM General Hospital, Dhaka, Bangladesh. Prof. MF Pathan has published several research articles and review articles including the South Asian consensus guidelines on various aspects of management of diabetes, and presented research papers at various national and international conferences.
Background: Type 2 diabetes mellitus (T2DM) prevalence in South-East Asia region is on the rise and there is currently limited evidence assessing early therapeutic interventions.1 We assessed the effectiveness and safety of Initial combiNation therapy with vildagliptin/metformin In drug naïve T2DM patients In a reAl Life (INITIAL) study.
Methods: INITIAL was a 24-week non-interventional, prospective study in drug-naïve T2DM patients across Asia (Bangladesh, India, Philippines, South Korea) with documented HbA1c >7.5% (>8.0% in India), who were prescribed vildagliptin/metformin initial combination within 4 weeks of study entry according to local label.2 The primary endpoint was change in HbA1c (DHbA1c) from baseline to week 24. Key secondary endpoints were achievement of HbA1c ≤7.0% and DHbA1c by baseline subgroups (varying HbA1c category and dosage).
Results: Out of 532 enrolled patients, 457 (85.9%) completed the study. Overall, study population was relatively young with mean age 49.6±11.27 years, mean HbA1c: 9.3±1.57%, diabetes duration: 0.8±2.47 years, BMI: 26.7±4.50 kg/m2. At baseline, approximately 30% patients had hypertension, dyslipidemia or diabetes family history, and 17.9% were obese. Most patients (70.6%) received twice daily vildagliptin/metformin (mostly 50/500 mg in 53.5%) with minimal dose changes. Overall, DHbA1c from baseline was statistically significant (p<0.001) both at week 12 (−1.6±1.59%), and 24 (−1.9±1.70%), and meaningful across baseline HbA1c categories and drug dosages (Table 1). Overall, 39.6% patients achieved HbA1c ≤7.0% and mean change in body weight was −1.1±2.62 kg. 48 (9.0%) AEs including 1 (0.2%) hypoglycemic episode were reported, with no SAEs or deaths.
Conclusion: Overall, in these relatively young drug-naïve T2DM Asian patients with high baseline HbA1c and often associated with CV risk factors vildagliptin/metformin combination was associated with significant and clinically relevant HbA1c reduction from baseline. This effect was seen early at week 12, was maintained over 24 weeks and was accompanied with good glycemic control and tolerability.
Md. Mizanur Rahman
Tokyo University, Japan
Title: Trend, projection, and appropriate body mass index cut-off point for diabetes and hypertension in Bangladesh
Time : 12:05-12:30
Dr. Rahman received his Bachelor and Master's degree in Demography in 2004 and 2005, respectively from Rajshahi University, Bangladesh. He received a PhD in Health Financing in 2013 from the University of Tokyo, Japan. After obtaining a PhD, he worked as a Postdoctoral Fellow at the University of Tokyo and is currently working as Project Assistant Professor in the same University. Before joining the University of Tokyo, Mr. Rahman worked as Assistant and Associate Professor in the Department of Population Science, University of Rajshahi, Bangladesh. He has experience researching universal health coverage progress assessment, health financing and policy evaluation, NCD risk factor identification, and systematic review and meta-analysis in public health, published in prestigious peer-reviewed international journals including The Lancet, JAMA, Bulletin of the World Health Organization, Diabetes Care, American Journal of Clinical Nutrition, Obesity Reviews, and others. Dr. Rahman received several awards including the best faculty award 2015 from the University of Rajahshi based on highest impact factor and best young investigator award for the 48th APACPH 2016.
Statement of the Problem: Rapid increasing of high body mass index (BMI) is a global health concern. Population with high BMI predicts an increased risk of diabetes and hypertension. The objective of the present study is to estimate the trend and prediction of diabetes and hypertension in Bangladesh, to examine the association of BMI with risk of diabetes and hypertension, and to ascertain an appropriate BMI cut-off point for screening diabetes. Methodology & Theoretical Orientation: We searched PubMed from inception to August 2016 and identified studies reporting diabetes and hypertension prevalence in Bangladesh. Bangladesh Demographic and Health Survey 2011 data was also included in this study. Bayesian model was used to estimate trend and projection in diabetes and hypertension prevalence by sex and residence. Findings: Prevalence of diabetes increased between 1992 and 2015 from 3·2% to 12·1% in men, and from 2·5% to 13·4% in women. Diabetes prevalence in 2030 is expected to reach 23·6 for men and 33·5% for women. Hypertension prevalence increased between 1992 and 2015 from 11·0% to 20·4% in 2015 in men, and from 14·0 % to 21·3% in women. Adults with BMI of 22·5 kg/m2 or above had a higher risk of diabetes and hypertension in this study. The optimal BMI cut-off point for screening diabetes was 23 kg/m2 for overall population, 22 kg/m2 for men, and 23 kg/m2 for women. Conclusion & Significance: Diabetes is more prevalent among women and rural population groups, while hypertension is more prevalent among men and urban population groups in Bangladesh. A BMI of 22.5 kg/m2 or more is risk factors for developing diabetes and hypertension. Screening for diabetes may be considered for all Bangladeshi adults with a BMI of ≥23 kg/m2.
Heon Jin Kang
Nanyang Technological University, Singapore
Title: The role of perceived exercise barriers in predicting exercise behaviour in patients with type 2 diabetes mellitus
Time : 12:30-12:55
Heon Jin is a PhD candidate in the Physical Education and Sport Sciences Department in National Institute of Education, Nanyang Technological University in Singapore. Her specialization is exercise psychology and she is interested in the psychological barriers affecting regular exercise participation in individuals with diabetes and using Self Determination Theory (Deci & Ryan, 1985) to promote participation within this population.
Understanding the major determinants of exercise behaviour in patients with type 2 diabetes mellitus (T2DM) may help promote exercise within this population. The present study examined the role of personality traits and perceived barriers to exercise in predicting exercise behaviour in patients with T2DM. The role of self-determined motivation was also examined.
Cross-sectional, questionnaire study
154 patients with T2DM (mean-aged 55.2 years) were recruited from the Diabetes and Endocrine Centre at a general hospital in Singapore. Participants completed questionnaires to assess three personality traits (neuroticism, extraversion and conscientiousness), ten exercise barriers (willpower, dislike, misconception, support, knowledge, health, environment, tiredness, time, and finance), self-determined motivation, and exercise behaviour. The relationship of personality traits, barriers to exercise and self-determined motivation with exercise behaviour were analysed by Pearson correlation and hierarchical multiple regression analysis.
Personality traits (extraversion and conscientiousness) accounted for 6% of the variance in exercise, R2 = .06, F (2, 150) = 4.38, p < .05. The addition of perceived exercise barriers to the model predicted an additional 35% of the variance in exercise behaviour, ΔR2 = .35, ΔF (9, 141) = 8.65, p < .001. The inclusion of self-determined motivation into the model provided no additional prediction to exercise behaviour, ΔR2 = .00, ΔF (1, 140) = .02, p = .876.
Perceived barriers to exercise are a strong determinant of exercise behaviour in patients with T2DM whereas personality traits predict only a small proportion of exercise behaviour. Self-determined motivation was not a determinant of exercise behaviour in these patients. Health was identified as the most powerful predictor of exercise behaviour in patients with T2DM which may suggest that the co-morbidities associated with the disease impact exercise participation in these patients.
Peoples' Friendship University of Russia, Russia
Title: Diabetic autonomic cardiac neuropathy and the effectiveness of antihypertensive therapy
Time : 13:55-14:20
Irina Kurnikova - MD, PhD, Professor of Medicine of RUDN University (Peoples Friendship University of Russia), Moscow, Russia, Curator of the Scientific Direction Endocrinology has extensive experience in the field of scientific and practical endocrinology for over 20 years. The main areas of research are the optimization of the system approach to the treatment and rehabilitation of patients with diabetes mellitus, diseases of the thyroid gland. The main directions of scientific research are the influence of disturbances in the system of regulation of the organism and other endogenous factors (comorbidity, disruption of the mechanisms of interstitial humoral transport) on the effectiveness of treatment and the quality of compensation for diabetes and other endocrine diseases.
Statement of the Problem: One of the most significant factors in the progression of internal organ pathology in diabetic patients is vegetative dysregulation, hypersympathicotonia with centralization of management processes, reflecting disruption in the mechanisms of adaptation and determining the rate of progression of concomitant diseases along with the quality of compensation of diabetes mellitus (DM). What effect do these factors have on the effectiveness of antihypertensive therapy is a matter requiring study. The purpose to study the relationship between indicators of cardiac rhythm variability and rehabilitation capabilities of the body of patients with diabetes complicated by cardiac autonomic neuropathy (CAS) and appraciate the effectiveness of antihypertensive therapy depending on the degree of diabetes compensation. Methodology & Theoretical Orientation: comparative analysis of spectral characteristics was carried out in 45 patients with diabetes and diagnosis of HTN. 19 patients with type 1 diabetes (mean age 37 ± 6.4) and 26 patients with type 2 diabetes (mean age 54 ± 5.9). The estimation of the indicators was carried out taking into account absolute and the relative power values of the spectrum of each frequency range (VLF, LF, HF), Index of vegetative balanced (IVB) = LF/HF, IC (index of centralization – ratio of the activity of the Central contour of regulation to Autonomous). Was assessed the prognosis of the disease - morpho-function index – MFI as component of the rehabilitation potential (patent № 2344751RU). Findings: The negative influence of metabolic disturbances on body reserves was reflected in the decrease in the effectiveness of antihypertensive therapy. Almost half of patients with diabetes mellitus with a low level of rehabilitation potential required combined antihypertensive therapy, which included three or more drugs. The efficacy of ACE inhibitors and moxonidine was evaluated in patients with type 1 and type 2 diabetes depending on the quality of diabetes compensation (satisfactory/unsatisfactory). In patients with DT1s, homeostasis was preserved due to the activation of energy mechanisms-an increase in the tone of the sympathetic nervous system. The worse the quality of DM compensation was, the higher the hypersympathicotonia. The appointment of an ACE inhibitor to patients with DT1u had no effect on vegetative imbalance, and in patients with DT1s it eliminated vegetative imbalance and brought it closer to the age norm. The activity of central regulatory mechanisms (decrease of VLF, IC) and adaptation voltage (MFI <1) decreased. In patients with DT2, hyperparasympathicotonia predominated of patients with unsatisfactory compensation of the disease. The low efficiency of monotherapy with ACE inhibitors in this group was associated with the effect of bradykinin in hyperparasympathetic tonus. Treatment with ramipril in patients with DT2s contributed to a decrease in activity of central humoral-metabolic processes of heart rate regulation (decrease in VLF) and extension of adaptation mechanisms (MFI=0.54±0.1). Unsatisfactory compensation of type 2 diabetes mellitus with activation of parasympathetic reactions reduced the effectiveness of moxonidine administration, and in some cases led to deterioration of the adaptation parameters (MFI increase). In this group, the level of ULF increased to 42.6 ± 7.1%, which makes it impossible to assess the effectiveness of the provided assistance as sufficient. Conclusion & Significance: The effectiveness of the use of antihypertensive drugs can be affected by autonomic cardiac neuropathy and the resulting autonomic dysfunction. The effectiveness of antihypertensive drugs varies depending on the orientation of vegetative responses and the quality of compensation
Sadi Konuk Training and Research Hospital, Turkey
Title: Management of Hypertriglyceridemia in Uncontrolled Type 2 Diabetes Mellitus Patients ; 2 Case Study
Time : 14:20-14:45
Betul Erismis, was born in Ankara, Turkey, in 1983. She was graduated from Medicine Faculty of Ankara University and completed her residency at the Ankara Baskent University Medical Faculty Hospital, Internal Medicine Department. Now she is working at the Bakirkoy Dr.Sadi Konuk Training and Research Hospital, Internal Medicine Department and responsible for the training of internal medicine residents. She loves her job, nature and sports like swimming and skiing.
Introduction: One of the known cause of hypertriglycerimidemia(HTG) is Type 2 diabetes mellitus(DM). We aimed to present two uncontrolled type 2 DM associated with severe HTG who were treated succesfully with insulin infusion. Case 1: A thirty-two-year-old woman previously healthy, was admitted to our outpatient clinic because of abdominal pain and polydipsia. Her physical examination was normal. Her laboratory investigations showed a fasting glucose (FG) 35 mg/dL, triglyceride (TGC) 1316mg/dL, C-peptide 0,78mg/dL, HbA1c %14,7, pH: 7.35, ketonuria and glycosuria. Her serum amylase and lipase levels were 27 U/L and 26 U/L respectively. There was no signs of acute pancreatitis (AP) on radiological examinations. Intravenous fluid therapy and continous insulin perfusion started to decrease glucose levels. With this treatment her TGC levels decreased as well. At 48th hour it dropped to 199mg/dL. To exclude type 1 DM; insulin and anti GAD antibodies were negative. Later her glycemic control was continued with subcutaneous intensive insulin. After achieving glycemic control, she had no recurrence of HTG during her follow-up visits. Case 2: A second case of 52 years old woman with type 2 DM and severe HTG. Before 5 years she had an attack of AP (3 years after diagnosis of DM). Her FG, TGC, and HbA1c were 393mg/dL, 9283mg/dL, and 14%, respectively. She also had ketonuria and glycosuria but no acidosis. AP attack was excluded and insulin infusion started. There was a progressive decrease in her TGC levels (380mg/dL at the 6th day of insulin treatment). Behind subcutaneous insulin therapy, omega 3 fatty acids and fibrate treatment were started too at discharge of hospital. After 3 months of follow-up, her TGC was 200mg/dL. Conclusion: Lowering blood sugar in DM may lower the increased TGC levels as well. Bearing in mind this point may help in managing DM assocaited HTG.
University of Notre Dame, Australia
Title: Culturally appropriate population strategies to reduce diabetes burden among the Middle East population in New South Wales, Australia
Time : 14:45-15:10
Richard has completed an honours degree in Pharmacy from the University of Sydney. He came first in his cohort for Drug Discovery and Design and received the Dean's award for Academic Excellence. Since then he has completed a postgraduate degree in Medicine and Surgery at the University of Notre Dame (Sydney) where he researched diabetes as his area of interest for his population health project to see whether preventative measures aimed at local populations in New South Wales could improve diabetic outcomes. Richard was recently appointed security and advisory committee member for the medico-legal indemnity company AVANT in 2017 and has been appointed as a clinical medical officer at St George Hospital, Kogarah.
Statement of the Problem: In Australia, 35% of Australians who reported having diabetes in 2001 were born overseas and of those born overseas, people born in the Middle East and North Africa had the second largest hospitalisation and death rates for diabetes. The top three suburbs in NSW with the highest incidences of diabetes include Liverpool, Blacktown and Hinchinbrook respectively, while the highest prevalence for diabetes was found in Fairfield (6.2 % of diagnoses of diabetes). Fairfield local demographics show that the greatest proportion of the migrant population (22 %) of the Fairfield population identified as Iraqis (Middle Eastern).The purpose of this analysis is to evaluate the contribution of culturally specific programs toward health outcomes, and whether diabetes and health outcomes could be improved by using culturally appropriate media or education.
Methodology & Theoretical Orientation: Six reports of pilot interventions in Australia were selected from 1995 onwards and were assessed for any qualitative reports of increased patient satisfaction, patient sense of self management, weight loss or changes in HbA1c. Interventions included a Dance Fitness Class for Arabic speaking women, bilingually trained diabetes educator communication, Arabic Nutrition Advertisement programs via radio and swimming lessons for Afghan women and Muslims. Findings: One intervention showed a reduction in body weight 3 months following a bilingually trained diabetes education session, two interventions reported increases in patient satisfaction and awareness of their diabetes, and three interventions were inconclusive. Conclusion & Significance: Data is overall inconclusive about whether culturally appropriate media have appreciable impacts on diabetes control, weight loss or HbA1c but seem to show increases in patient satisfaction and awareness of their diabetes.
Gamal Mostafa Mahmoud
Alexandaria Uninversity, Egypt
Title: Treatment of HFD induced Diabetes Mellitus by metformin and natural products in rats
Time : 15:10-15:35
Gamal Mostafa has finished the bsc of biochemistry science, 2005. Alexandria University Egypt. Diplome of analytical biochemistry, 2012. Master degree for treatment diabetes by combination therapy, 2017.
Background: Asphodelus microcarpus widely distributed over the coastal Mediterranean region. Traditionally used in the treatment of diabetic conditions. The aim of the present investigation was to evaluate the antioxidant, antihyperlipidemic and antidiabetic activity of ethyl acetate extract taken from Asphodelus microcarpus (Asphodelaceae).
Methods: Ethyl acetate extract taken from Asphodelus microcarpus tubers used for the study. Chemical tests of different extract, diabetic profile, lipid profile, kidney and liver functions, and antioxidant anti-inflammatory parameters were performed. Diabetes was induced in rat by HFD feed for 10 weeks. The rats were divided into following groups: Group I – normal control, Group II (Vehicle) – diabetic control, Group III diabetic rats–AM(10 mg/kg), Group IV diabetic rats–(AM 10 mg/kg+ MET 100 mg/kg), Group V diabetic rats–AM (20 mg/kg), Group VI diabetic rats–(AM 20 mg/kg+ MET 100 mg/kg), Group VII diabetic rats–(MET 100 mg/kg). Bodyweight of each rat in the different groups was recorded daily. Biochemical and antioxidant enzyme parameters were determined on day 16.
Results: The ethyl acetate extract of AM shown better glucose utilization and insulin resistance improvement. Orally treatment of different doses of AM tubers extract alone and/or with metformin decreased the level of serum glucose, activity of liver alpha glucosidase, activity of pancreatic alpha amylase, MDA, CRP and leptin. Treatment showed increased level of plasma insulin, Catalase, glutathione Peroxidase, liver GSH, total antioxidant capacity. HFD induced diabetes groups rat treated with different doses of AM tubers extract and metformin significantly increased muscle glucose transporter 4 (GLUT4), and remarked regenerative effect on the liver, kidney and pancreas.
Conclusion: The antioxidant, antihyperlipidemic and antidiabetic effect of ethyl acetate extract from Asphodelus microcarpus suggests a potential therapeutic treatment to antidiabetic conditions.
Hamdiye Arda Sürücü
Dicle University, Turkey
Title: Is the Religious Practice of Ablution a Factor Influential on Diabetic Foot Development?
Time : 15:35-16:00
Hamdiye Arda Sürücü has finished PHD education Internal Medicine Nursing at Dokuz Eylul University. Also she has got two master degrees (Internal Medicine Nursing and Publich Health). Her PHD’s thesis is about Type 2 diabetes and Diabetes Self-Management Education and the most of studies are about type 2 diabetes, empowerment, gestational diabetes mellitus and insulin. She has National diabetes certificate nursing. She has worked in the diabetes education center with diabetes as diabetes nursing for 10 years and has got a lot of article about diabetes. She has worked Nursing Department at Dicle University.
Background: It is not known whether ablution, a religious practice, has any influence on individuals’ diabetic foot development.
Purpose: The purpose of the study was to evaluate the influence of the religious practice of ablution and socio-demographic and disease-related features on diabetic foot development using secondary data analysis.
Method: The study was conducted in cross-sectional design with secondary data analysis. The research sample included a total of 323 type 2 diabetes patients receiving treatment between October 2015 and July 2016. The research data were collected with a Descriptive Information Form covering the socio-demographic and disease-related information about the diabetes individuals. For the analysis of the data stepwise logistic regression analysis were used.
Findings: The logistic regression analysis results demonstrated that diabetes individuals who regularly performed ablution were 3.61 times more likely to suffer from diabetic foot when compared to those who did not. In addition, the type 2 diabetes patients who perceived their health to be good and moderate were 48.8 times more likely to suffer from diabetic foot development than those who perceived their health to be poor. Also, the patients who suffered from diabetes for 10 years or less were 7.09 times more likely to have diabetic foot when compared to those suffering from diabetes for more than 10 years. Lastly, it was seen that all the variables found significant in the model explained 64.3% of the total variance.
Conclusion: Self-perception of illness, year of diabetes and the religious/cultural practice of ablution were found to be important risk factors for diabetic foot development. Diabetes nurses should certainly consider whether patients taking diabetes training perform ablution or not. In order to prevent diabetic foot development for diabetes individuals performing ablution, diabetes nurses are supposed to emphasize the importance of drying feet after performing ablution during diabetes training.
People’s College of medical sciences & research Centre, India
Title: Diabetes: An encroached danger: A study from central India
Time : 16:20-16:45
Dr.Neeraj Chhari 34 years is an assistant professor in department of community medicine in Peoples college of medical science & research Centre, Bhopal, India. He has done his MBBS(2008) MD(2012).
He has done his “Certificate course in evidence Based Diabetes Management”(CCEBDM) in 2016 which is recognized by Public Health foundation of India(PHFI) & International diabetes Federation(IDF).
He is life member of Indian association Preventive & Social Medicine (IAPSM) and World Non communicable disease (WNCD) federation.
INTRODUCTION: As the WHO report the Diabetes epidemic is more pronounced in India than anywhere else. Glycated hemoglobin is a form of hemoglobin that is measured primarily to identify the three-month average plasma glucose concentration. The test is limited to a three-month average because the lifespan of a red blood cell is four months (120 days). But RBCs do not all undergo lysis at the same time, so HbA1C is taken as a limited measure of 3 months.
OBJECTIVES: To study the level of A1C level in Diabetic and Non diabetic patients in the suburban area to give recommendations on that basis METHODOLOGY: Cross sectional study was done on the patients coming to clinic during Diabetic camp organized in suburban area of city.
RESULTS: Out of 143 T2DM patients the 112(78%) have HBA1C level within the range of 7-9%.Only 7(4.9%) patients have level >11%.37 patients out of 78 who were non diabetic has Hba1c level of more than 6.5%.
CONCLUSION: The observational study was conducted in diabetic camp and it was observed that diabetes has encroached the society with large spectrum and Life style modification is needed to prevent.
Roustem N Miftahof
Arabian Gulf University, Bahrain
Title: Co-transmission by nitric oxide, substance P and acetylcholine in the pathophysiology of diabetic gastroparesis
Time : 16:45-17:10
Prof. Dr. Roustem N Miftahof is the director of Computational Biology and Medicine Centre at Arabian Gulf University, Manama, Bahrain. He has published numerous books and more than 150 papers in peer-reviewed international journals and has been invited to give speeches at international congresses, conferences and meetings worldwide.
The aims of the study were to investigate the role of nitric oxide (NO), substance P (SP) and acetylcholine (ACh) in the pathogenesis and to evaluate the effectiveness of existing drugs on the treatment of diabetic gastroparesis. Computer models of a muscle fiber connected to a ganglion, and a segment of the human stomach based on morphostructural, biochemical and physiological data, obtained from in vivo and in vitro experiments, were developed. Diabetic gastroparesis was reproduced by altering levels of NO and SP in the system. NO acting alone hyperpolarized the smooth muscle membrane, decreased the amplitude and increased the frequency of slow waves, and abolished action potentials. However, application of prokinetic drugs restored the spiking activity and motility in the segment at reduced frequency and amplitude compared to the norm. SP and ACh released conjointly caused a prolonged depolarization and tonic contraction of smooth muscle. The combined effects of SP, ACh and NO on the segment were the decrease in the resting membrane potential, preservation of slow waves and the development of low intensity phasic contractions. Further treatment with prokinetic drugs abolished slow waves and spikes, and induced long-lasting contractions. The model quantitatively and qualitatively reproduced electrical and mechanical patterns of activity of the normal, adynamic, and pharmacologically modulated stomach. Multiple neurotransmission and respective receptor polymodality are the main contributing factors while each neurotransmitter per se plays a limited role in pathogenesis of diabetic gastroparesis. Erythromycin and metoclopramide do not restore motility and “worsen the paralysis”. Co-localization and co-transmission by multiple neurotransmitters should be taken into consideration when new drugs to treat diabetic gastroparesis are designed.
Bangladesh University of Health Sciences and Diabetic Association of Bangladesh, Bangladesh
Title: Pregnancy outcome in depressive and gdm subjects in bangladesh: a hospital based study
Dr Khurshid Natasha is currently working as Assistant Professor in the Department of Health Promotion and Health Education, Division Public health, Bangladesh University of Health Sciences, an enterprise of Bangladesh Diabetic Association (DAB). She has been involved in research and health promotional activities on Public Health from 2004 with DAB. After passing MBBS she has completed her Masters in Public Health in Health Promotion and doing her PhD at the University of Oslo, Norway now. She has experienced several health promotional activities in collaboration with national and international bodies like Ministry of Education Govt. of Peoples Republic of Bangladesh, World Diabetes Foundation, Swiss collaboration for Public Health etc. She is an Active member of International Union for Health Promotion and Education and Excecutive Board Member of Asian health literacy Association. She has visited countries like Thailand and Nepal as health promotional expert.
In Bangladesh the prevalence rate of depression in adults is 4.6%. Diabetes (7.4%) is also alarming but the actual prevalence rate of both diseases in pregnancy is still lacking, though they are common and result in serious consequences for mother and foetus. To our knowledge there has been a little research regarding this even in South Asia. This study tried to find out the outcome of pregnancy with depression and Gestational Diabetes Mellitus (GDM). Method: A total of 748 pregnant women participated. They were followed up from their 1st visit to 1st week after delivery for at least 3 checkups. Depressive symptoms was scored following MADRS scale (0-12=not, 13-19=mildly, 20-34=moderately, 35-60=severely - depressed). Blood glucose was measured following WHO criteria. Delivery procedure, Birth weight and APGAR score at 1st and 5th minute were assessed for the neonate. Results: Prevalence of depression among subjects was 12.69%. The rate was higher in GDM (n 366) (21.73%) than NGDM (n 382) subjects (7.73%). Over all mean depressive score was higher at 3 stages in GDM group. Rate of caesarean section, number of live birth, and birth weight was higher but APGAR score at 2 stages were lower in GDM group than NGDM. Mean age, parity and birth weight were higher but mean education years, mean APGAR scores at both time period was lower in depressed groups (all 3 stages) than non-depressed. Pregnant who were depressed specially in last trimester seem to have more rate of CS. There was significant association with depressive scores with gestational age and birth weight. Conclusion: Elevated prevalence rate of depression in pregnancy which was greater than assumed. And pregnancy outcomes were strongly associated with GDM and Depression. Developing countries do not focus much on mental health but it is becoming ultimate necessity for future.
Biswaroop Roy Chowdhury
Indo-Vietnam Medical Board,India
Title: Diabetes reversal by plant-based diet
Post Graduation in Diabetes Education - International Diabetes Federation
Cardiovascular Life Support Instructor - American Heart Association
Diploma in Echocardiography- Medical University of Vienna (Austria)
B.E. Production - Punjab University (India)
Specialization in China Study- Cornell University (USA)
Author of 25 books on Mind & Body
Doctorate in Public Health (Vietnam)
Certificate (Cochrane Protocol Development) Penang Medical College, Malaysia
Diabetes leads to a never-ending medicine and or insulin treatment for the diseased. Our goal was to establish and observe the effects of plant-based diet on the sugar levels of the diabetes patients. The major portion of plant-based diet consisted of raw fruits and vegetables. The clinical trial on 55 diabetes patients with a team of 6 medical associates was practiced for 3-days at Zorba, The Buddha, 10 – Tropical Drive, Ghitorni, New Delhi from 29th April to 1st May, 2016.
Medicines were eliminated from the first day of the trial. Both fasting and post-prandial readings were measured each day along with the weights of the participants. The subjects with varying diabetes history, age groups, type of diabetes, insulin dependency and demographic profiles were part of the trial.
Through the trial, 84% of patients reported controlled blood glucose levels and 16% of patients reported partially-controlled levels. Those with controlled levels could attain a healthy blood glucose range without medicines and or insulin, along with the prescribed diet in 3-days. Those with partially controlled levels could attain a healthy blood glucose range with less than 50% of insulin than prescribed earlier.
Among diabetes type-2 patients the study reported 100% results with all the patients maintaining a healthy blood glucose level. While among diabetes type-1 patients, 43% reported healthy blood sugar levels through the diet and insulin reduction.
The weight reduction for 55 patients in 3-days was reported as 1.14kgs of average weight loss per individual. The plant-based diet has been found effective to cure and control diabetes, eliminating or reducing the medicine or insulin requirements.
MD, PhD since 1986, Teaching in medical colleges for more than 30 years. Head of department of Physiology in AGU since 5 years. Professor and researcher in Utrecht University/ College of Medicine/ Rudolf Magnus Institute for Neurosciences/ The Netherlands (1994-2005). Leading author of more than 50 articles on electrophysiology of DM (and others) in international journals.MD, PhD since 1986, Teaching in medical colleges for more than 30 years. Head of department of Physiology in AGU since 5 years. Professor and researcher in Utrecht University/ College of Medicine/ Rudolf Magnus Institute for Neurosciences/ The Netherlands (1994-2005). Leading author of more than 50 articles on electrophysiology of DM (and others) in international journals.
The aim of this study was to investigate the effect of Caffeine consumption in learning and memory in Streptozotocin (STZ, 60 mg/ kg i.p) -induced DM in mice.
First; the NMDA (N-methyl-D-aspartate) component of the field excitatory post synaptic potential (fEPSP) was determined by extracellular recording from hippocampal slices prepared from STZ-induced DM and control animals. Later, 40 animals were randomly divided into 5 groups (n=8 in each group): (1) Normal control (Cont) (2) Diabetic group (DM); (3) Diabetic pretreated with caffeine group (PreCaf). (4) Diabetic acute caffeine treated group and (5) Diabetic chronic caffeine treatment group. Learning and memory were assessed by Morris-Water maze. The latency to reach the platform reflects the learning and memory of the tested animals.
Recording from hippocampal slices showed a significant reduction in the NMDA-component of the fEPSPs responses compared to the control. The behavior study; all the DM-groups demonstrated defects in learning and memory tasks, only acutely administered caffeine (Ac Caf) could reverse the deteriorating effect of DM on the learning and memory functions. Animals of this group showed lower latency values (72.4 ± 8.6 s) to reach the hidden platform in the water maze compared to the other diabetic groups (DM= 116.67 ± 3.33, Pre Caf= 101.8 ± 7.1, and Ch Caf= 94.13 ± 7.8) (ANOVA, p< 0.05). The performance of this group was not significantly different than the control animals.
We concluded that the NAMD-receptor component of the fEPSP was significantly reduced in the STZ-induced DM. This resulted in deterioration in memory tasks. Acute administration of caffeine could reverse this defect. Pre-treatment of the mice with caffeine before the induction of DM may partially protect these animals from the cognitive- induced defects by the induced DM.
Gunhu is a Food and nutrition lecturer at the Great Zimbabwe University, school of education. Completed an Med in Human Nutrition in 2007 (University of Zimbabwe) and a Master of Education Degree in Psychology. Currently, Gunhu is doing Doctoral Studies in Human Nutrition and Dietetics with the University of KwaZulu Natal, South Africa.
Study objective: To use the health belief model to establish the barriers to effective type 2 diabetes management among indigenous karanga individuals.
Design: A case study research design was used understand the factors that affected compliance to self care management requirements. Data on frequency and quality of food consumption and medication were collected using three 24 hour diet recalls and structured in depth interviews. A 12 point health belief model interview guide was used to gain insights regarding participant perceptions about the disease and the reasons for the low level of compliance to dietary, physical activity and medication intakes among six diabetic patients.
Study setting: An urban suburb of Mucheke in Masvingo city.
Results: Reported and observed dietary data showed a high a high frequency of meat and alcohol diet among three of the six participants. A grazing eating pattern was observed noted from the diet recalls. In terms of calorie intakes, consumption of dietary fat was higher than recommended among the meat and alcohol group. The use of ultra-processed meats was significantly higher. Data from self reports showed that the blood sugar levels were higher in four of the patients. Peer influence and failure to shake of old habits and tastes was a key barrier among three of the six patients. Two of the patients believed the disease was caused by witchcraft and as a result a solution outside self care management was needed to address the problem. Two of the participants noted that their spouses were not given education on diabetes management; as a result unhealthy diets were served at home.
Conclusion: Glucose control was poor among the participants. The level of diabetes knowledge of complications, risk factors and preventive self care management practices was low. Patient levels of self efficacy related to patient confidence regarding effectiveness of self care interventions was poor. To that end, the study recommended for more empowering diabetes education protocols.
Problem statement: Diabetic emergencies should be looked at with great caution as to be detected and treated immediately. Hypoglycemia and DKA (diabetic ketoacidosis) cause serious complications if left unseen. Given the fact that school-aged children spend most of their day in school under their teachers care, it’s important that teachers must be trained to deal with such emergency cases.
Objective: In this study we aimed to assess the knowledge, attitude and practice of primary school teachers towards diabetic emergencies (hypoglycemia and hyperglycemia) in school-aged diabetic children.
Methodology: This is a cross-sectional study in which 88 teachers out of 13 primary schools were recruited to participate in the study. Data were collected through self-administered questionnaire. In Khartoum state 2017
Results: Regarding hypoglycemia; (40.9%) of the participants had very poor knowledge about symptoms of hypoglycemia. In case of suspected hypoglycemia, (30.7%) of the teachers would take the child to hospital without immediate intervention. Surprisingly, (33%) of teachers participated stated that they don’t know if hypoglycemia should be treated with insulin or not, while (15.9%) of the teachers would actually give the child insulin dose. Generally, (30.7%) of the participants did not know how to handle a case of hypoglycemia in the class. Which means that, 30 out of every 100 diabetic children will be at risk of coma or even death.
Regarding hyperglycemia; while (39.8%) of teachers had very excellent knowledge about the symptoms of hyperglycemia yet (30.7%) of them had very poor knowledge. In the case of suspected hyperglycemia, (82.9%) of teachers stated that they would prefer to take the child to the hospital. Generally,(60.2%) of teachers didn’t know how to handle hyperglycemia.
Conclusion: There were many misunderstandings about the symptoms and signs of hypoglycemia. The attitude and practice both are generally positive but still, we must increase the level awareness among teachers by the establishment of scientific and educational courses to fill the gaps and create a healthy society.
Imam University School of Medicine, Saudi Arabia
Title: Improving the viability of pseudo-islet for efficient insulin production
Ali Howaidi a 2nd year medical student at Imam University has a Fluency in English and stands Top 10 Percentile in his Class and he is Interested in Medical Research.
A novel solution for Type 1 diabetes mellitus (T1DM) is the formation of pseudo-islet cell. Which are beta cells aggregations that mimic the basic function of beta cells. Central necrosis of pseudo-islet cell due to the lacking the oxygen and nutrient transportation has been an obstacle to introduce this solution for T1DM. This study aims to overcome this problem by removing the central area and replacing it with the cell-friendly alginate hydrogel gelatin beads type B (GBs), which characterized by providing a high diffusion rate, and capable to functions as a drug carrier. In order to maximize the diffusion rate and avoid the dissolution of the beads in the water solution, it is important to control the right size and shape of GBs and the cross-linking time. Increased viability and morphology are seen in the 30μm GBs cross-linked for six hours. The rat pancreatic β cell line BRIN-BD11 cells were grown in RPMI 1640 media and showed similar morphology to the native human islet cells after the GBs incorporation. Alexa fluor 568 conjugated used as a secondary antibody in the fluorescence test to examine the drug releasing capability of the GBs. The beads with secondary antibody displayed more fluorescence from these without. The effect of the anti-inflammatory cytokine IL-10 on pseudo-islets can be determinant using dose response which reveals the best response at 10 ng/ml concentration. Improving our understanding of the methods used to remodel pseudo-islets should widen the gaze of possible strategies obtainable for developing de novo islets for therapeutic applications.