Day 2 :
Md. Faruque Pathan
Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Bangladesh
Keynote: Diabetes prevention in a resource constraint country: BADAS experiences
Time : 10:10-10:50
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.
The World is passing through a pandemic of type 2 diabetes (T2DM). It has been recognized pandemic initially by International Diabetes Federation (IDF), then by WHO and from 2006 by United Nations. Bangladesh played the most vital role for this UN resolution for the UN day on diabetes (Nov 14 every year). Currently, more than 80% of diabetic people live in developing countries, where lifestyle is changing fast due to ongoing rapid and unplanned urbanization. This is creating decreased physical activity, higher consumption of calorie-dense fast food and soft drinks, and increasing obesity. In the past, people did not realize that T2DM can be primarily prevented. A number of randomized clinical trials (RCTs) done in Finland, USA, China, and India have shown that both lifestyle and drug intervention strategies can prevent and delay the progression (50-60%) to T2DM among high-risk individuals, and this is likely to be cost-effective. For these reasons, early identification of people with undiagnosed diabetes or those at an increased risk for developing T2DM has been recommended to improve outcomes. It is particularly important for low resource societies. Diabetic Association of Bangladesh (BADAS) is the largest non-Government diabetes care provider in the world. Along with usual prevention programs, BADAS is also running several innovative programs like diabetes screening and education program in workplaces, awareness on preconception care through religious leaders, diabetes corners in religious places etc to prevent diabetes and also to reduce the complications related to diabetes in a budget constraint country like Bangladesh. Our data suggest that both lifestyle (60%) and drugs intervention (lifestyle + metformin-74%) are highly effective in preventing high-risk individuals (IGT subjects) in Bangladesh
Bond University, Australia
Keynote: Dietary management of type 2 diabetes – focusing on mitochondrial function
Time : 09:30-10:10
S Mcilvenny, MD, MBBCh, FRCGP(UK), FRACGP is CEO of the Food Coach Institute and President of the International Association of Health and Nutrition Coaches. Formerly she was Professor of Education at Bond University, Faculty of Medicine and Health Sciences, Australia and Head of Family Medicine at Faculty of Medicine and Health Sciences at Sultan Qaboos University, Oman. Her research includes Type 2 diabetes in a developing population and she received a research grant from His Majesty’s Research Fund in the Sultanate of Oman. Her focus of interest now is how diet and nutrigenomics can influence the prevalence and progress of type 2 diabetes, particularly influencing epigenetics.
The cost of health care is a major concern for both developed and developing countries. The rise of chronic diseases such as Type 2 Diabetes is a significant price to pay in terms of cost to the health system in medications, hospital treatment, and management of complications, not to mention the effect of loss of productivity in the workforce. Dietary modification is the cornerstone of therapy in Type 2 Diabetes, however, this strategy rarely works as patients are given advice which is not in line with up-to-date scientific evidence, is not contextualized for their situation and does not take into account their motivation to use diet as a therapy.
As the prevalence of Type 2 Diabetes skyrockets in developed and developing countries, increasing the cost of both therapy and diabetic complications, cost-effective solutions are of paramount importance. Recent research shows we can make an impact on the prevention of type 2 diabetes by 1) employing the right dietary advice based on scientific evidence, 2) using motivational skills to move the patient into taking action e.g. regular exercise, 3) using epigenetics and nutrigenomics to guide us in our targeted prevention strategy. This can may lead many patients in potential diabetes and pre-diabetes groups away from full-blown diabetes and its costs and complications.
This presentation focuses on the role of mitochondrial function in preventing and managing Type 2 Diabetes. The importance of dietary changes to improve mitochondrial function has been overlooked as a cost-effective way to prevent the deterioration from pre-diabetes to diabetes disease and also in reducing the need for medication. The science behind mitochondrial function in Type 2 Diabetes will be explained. Specific foods, nutrients, supplements and exercise to improve mitochondrial function will be discussed.
- Transplantations in Diabetes | Rising Focus in Diabetes Research | Hereditary of diabetes | Methodologies to insulin administration | Neuro Endocrinology
Location: Novotel Melbourne St Kilda
Amer Kamal Al Ansari
Utrecht University, Netherlands
Title: Hippocampal synaptic plasticity and the role of psychostimulants on the higher brain cognitive functions and behavior in Streptozotocin-induced DM in rats
Time : 11:10-11:35
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.
National Center for Global Health and Medicine, Japan
Title: Serum 25-hydroxivitamin D3 and risk of type 2 diabetes among Japanese: the hitachi health study
Time : 11:35-12:00
Shamima Akter has her expertise in Nutritional Epidemiology. She is now working as a senior researcher in Department of Epidemiology and Prevention, National Center for Global Health and Medicine, Tokyo, Japan. Her publication covers epidemiological research on non-communicable diseases, especially type 2 diabetes and metabolic bio-markers. She published many papers on this field in prestigious international journal like BMJ, Diabetes Care, American Journal of Clinical Nutrition, Clinical Nutrition, and others. She also received best young investigator award in 13th International Conference on Endothelin.
Statement of the Problem: Women who have experienced intimate partnerviolence (IPV) are at greater risk for physical and mental health problems including posttraumatic stress disorder (PTSD) and alcohol dependency. On their own IPV, PTSD and alcohol dependency result in significant personal, social and economic cost and the impact of all three may compound these costs. Researchers have reported that women with these experiences are more difficult to treat; many do not access treatment and those who do, frequently do not stay because of difficulty maintaining helping relationships. However, these women’s perspective has not been previously studied. The purpose of this study is to describe the experience of seeking help for alcohol dependency by women with PTSD and a history of IPV in the context in which it occurs. Methodology & Theoretical Orientation: An inter subjective ethnographic study using hermeneutic dialogue was utilized during participant observation, in- depth interviews and focus groups. An ecological framework was utilized to focus on the interaction between the counselors and the staff to understand this relationships and the context in which it occurs. Findings: The women in this study were very active help seekers. They encountered many gaps in continuity of care including discharge because of relapse. Although the treatment center was a warm, healing and spiritual place, the women left the center without treatment for their trauma needs and many without any referral to address these outstanding issues. Conclusion & Significance: Women with alcohol dependence and PTSD with a history of IPV want help however the health and social services do not always recognize their calls for help or their symptoms of distress. Recommendations are made for treatment centers to become trauma- informed that would help this recognition.
University of Sharjah, United Arab Emirates.
Title: Physiological stress and sleep quality assessment: a new approach to improve glycemic control and enhance weight loss in type 2 diabetes
Time : 12:00-12:25
Dr Bashair Mussa is currently an Assistant Professor of Physiology (University of Sharjah, United Arab Emirates). She graduated from the University of Melbourne (Australia) with a PhD in Neurophysiology and Pharmacology. She has an extensive experience in diabetes research and she characterized the neural pathways and receptors that are involved in the control of insulin secretion. Currently she is a principal investigator of three projects that related to diabetes and Emirati patients. Her current research focuses on the central control of pancreatic secretion, glucose homeostasis and diabetes.
Optimal glycemic control and weight management involve several approaches including nutrition recommendations and physical activity. However, recent views have suggested that there are other factors including sleep deprivation and stress contribute to development of Type 2 diabetes mellitus (T2DM). Therefore, the present study was designed to investigate the effects of a novel intervention on weight and glycemic control in Emirati patients with type 2 diabetes.
The present study is a randomized controlled study. 27 Emirati patients with type 2 DM (18–60 years, BMI ≥ 25kg/m2) were included in the study; intervention group, n = 14 and control group, n = 13. Heart rate variability was used for real-life and long-term assessments of sleep, stress and recovery. The intervention group attended information session followed by an initial assessment of the stress and recovery levels, and sleep pattern and feedback sessions. Action plans were created for each patient based on the outcomes of the initial assessment. Follow-up procedures (Fig. 1).
The results have shown that the percent change in body weight was significantly greater (p < 0.05) in the intervention group (- 3.18%) compared to the control group (- 0.02 %). The percent change in the BMI of the intervention group was - 4.50% whereas the control group exhibited less change in BMI (- 0.0003%, p < 0.05). In addition, a significant reduction in HbA1C was observed in the intervention group (-5.3%) and an increase of 9.9% was observed in the control group (p < 0.01). Moreover, stress levels were decreased in the intervention group (-2.2%) whereas the percent change in the stress levels in the control group was 25.3 %.
The interventions that reduce the levels of stress, enhance the recovery levels and maintain healthy sleep habits play an important role in weight management and glycemic control in type 2 DM.
Hamdiye Arda Sürücü
Dicle University, Turkey
Title: Factors affecting the empowerment of the diabetic individual and how we can empowerment diabetes patient?
Time : 12:25-12:50
Hamdiye Arda Sürücü has finished PHD education Internal Medicine Nursing at Dokuz Eylul University. Also she has got two master degreeses (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 have got a lot of article about diabetes. She has worked Nursing Department at Dicle University.
Introduction: Empowerment is defined as providing power or bringing in authority, the skill and competence to accomplish something and to grant permission. Empowerment consists of two processes as “process” and “outcome”. The objective of these two processes is development of potential of individual with diabetes at the first stage and maturation of this potential at the last stage. There is a limited amount of research investigating the factors influential on empowerment. Purpose: Examining the factors influential on empowerment in diabetes is thought to shed light on the planning and management of diabetes education. In addition we discuss how we can empowerment diabetes patient. The factors influential on empowerment in diabetes studies revealed that the number of diabetes-related symptoms, age, gender, educational background, disease duration and perceived family support, diabetes education, employment status are among the factors influential on empowerment. Consequently, in an attempt to empower individuals with diabetes through empowerment strategies in diabetes self-management education; “1. Instructor should not be the decision maker in decisions regarding diabetes management of patient, 2. Daily self-management decisions should be checked and their responsibilities should be confirmed, 3. Information should be provided for continuity of the situation of life-long decision making in diabetes, 4. Patients’ efforts should be facilitated in order to determine, implement and result of behavioural goals that are individually chosen, 5. Chances of social and emotional support should be created and individuals with diabetes should be included in a group which is created for problem-solving,
6. Instead of controlling patient, patient should be given responsibility in diabetes care, 7. Instructor should have a constant communication with its patients through telephone, mail etc., and 8. Instructor should make individual with diabetes feels important and valuable. 9. Diabetes literacy should be increased/encouraged and 10. Instructor should make individual with diabetes feels important and valuable.
Chetna A Shamkuwar
Government Medical College, India
Title: Medication pattern and adherence to Type- 2 diabetes treatment at university hospital of central India
Time : 13:50-14:15
Chetna A Shamkuwar trained in Clinical Pharmacology by Indian Council of Medical Research, She has wide experience of teaching clinical pharmacology since last ten years. She is a recipient of travel fellowship grant by international union against tuberculosis and lung disease for immune-modulation research in tuberculosis. Her area of interest is research in rational drug use, adherence to treatments and its effects on clinical outcomes in chronic diseases. Her passion about clinical research and compassionate approach in patient care made her most sought after health personnel in designing chronic diseases treatment protocols in the region.
Statement of the Problem: The estimated number of diabetics in India was 62.4 million in 2011 projected to rise 101.2 million by 2030. Rational medication pattern and adherence to treatment are key components diabetes control. Study purpose is to evaluate medication pattern and assess adherence to treatment. Methodology & Theoretical Orientation: Prospective, observational and questionnaire based study. Medication pattern evaluated from prescriptions and adherence assessed with Morisky Medication Adherence Scale. Findings: Total 194 prescriptions were studied. 96 (49.48%) and 98(50.51%) were male and female respectively. Majority were above 60 years of age. Co-morbid conditions were found in 169 (87.11%) patients with Hypertension (74%), being more common. Patients were prescribed 1216 medications. The average number of drugs per prescription was 6.20. Oral hypoglycemic drugs were 22.69%. Commonly prescribed drugs were anti-hypertensive (15.70%), drugs for coronary artery disease (10.36%), Antibiotics, NSAID, PPI, Vitamins and Minerals (31.99%). High, medium and low adherence were observed in 47%, 38% and 15% of patients. Males (62%) adherence more than females in high adherence group. Conclusion & Significance: This study demonstrates the variability of drug utilization in diabetics. More than fifty percent patient have medium and low adherence which affects control of diabetes. Factors leading to poor adherence should be studied for better control of diabetes.
University of Melbourne, Australia
Title: A comparison between islet and stem cell transplantation for treatment of type 1 diabetes mellitus: A systematic review
Time : 14:15-14:40
Astrid Sugiantol is a 22-year-old Medical Doctor candidate with Bachelor of Medical Science degree from the University of Melbourne. She was nominated as one of the 300 young brightest scientists by Ministry of Education of UK in 2013. She was also the former Ambassador of the year for Harvard Project of International Relations in 2014 and also the only female representative of Indonesia for ASEAN Youth in 2014. She was previously involved in breast cancer stem cell research, before decided to focus on cellular based therapy research in 2015. She is interested in politics, international relations, psychology, and science. She wants to be a surgeon (and an astronaut) in the future. She loves reading books, watching movies, hiking, playing softball, diving, and traveling. She is a big fan of Leonardo DiCaprio, Justin Trudeau, Weeknd, and Quentin Tarantino
Introduction. The incidence of Type 1 Diabetes Mellitus (T1DM) has been increasing rapidly worldwide, while the current standard therapy – exogenous insulin supply – is considered unsustainable and highly associated with poor glycemic control that may lead to a life-threatening condition. On the other hand, cellular-based therapy including either islet cell or stem cell transplantation has been recently developed, making it pertinent to compare the effectiveness between the two alternative treatments. The aim of this systematic review is to compare the safety and effectiveness between islet cell transplantation and stem cell transplantation for future practice change.
Methods. Literature search using two databases, PubMed and Ovid Medline, was conducted for primary studies published from January 2000 to November 2015. A quality assessment of identified studies were conducted using ARRIVE, NOS, and MINORS assessment tools. The comparison between treatments were done based on the mean values of insulin independence period and blood glycemic level of the subjects in the studies.
Results. In 15 out of 17 included studies, the average insulin-independent period in T1DM patient post-islet cell transplantation was proven to be four years longer compared to post-stem cell transplantation that could only achieve one year at most. The studies also found and support that islet cell transplantation has better blood glycemic control, observed through random blood glucose level ranges from 140mg/dL to 200mg/dL and c-peptide levels ranges from 0.3ng/ml to 4.5ng/ml which marks the presence of insulin production. However, certain challenges – eg, donor shortage and poor engraftment – hinders the widespread application. The studies also revealed that stem cell transplantation differentiated into b-cell-like cells that produce insulin, glucagon, and somatostatin, as well as acting in glucose-stimulated manner, imitating the physiologic mechanism of b-cells, this is in fact considered as a major potential for future development.
Conclusion. The current studies had proven a conclusive result in which islet transplantation has relatively higher effectiveness and better outcome compared to stem cell transplantation for treating T1DM patients.
Jember University, Indonesia
Title: The effect of thymoquinone extract of black seeds toward socket new blood vessels formation process after extraction in diabetic-induced rats
Time : 14:40-15:05
1 - Student at Faculty of Dentistry, Jember University, Jember, Indonesia
2 - Professor of Pathology Anatomy, Faculty of Dentistry, Jember University, Jember, Indonesia
3 - Lecturer of Biomedicine, Faculty of Dentistry, Jember University, Jember, Indonesia
Statement of the Problem: Hyperglycemia elevates the advanced glycation end product (AGEs) formation which induced complication after tooth extraction, such as endothelial dysfunction. Thymoquinone (Tq), the active compoud of black seeds (Nigella sativa L.), has been known to stimulates new blood vessels activity also for its anti-diabetic properties. The purpose of the study is to determine the effect of Tq towards socket new blood vessels formation process after extraction in diabetic-induced rats. Methodology & Theoretical Orientation: 27 male rats were injected STZ intravenously and rats with blood glucose level ≥250 mg/dl were divided into three groups (K, P1, P2). Rats were given aquadest (K), Tq (P1) and Metformin (P1). On 7th day after treatment, its lower first left molar teeth was extracted. 3 samples from each group were sacrificed on 3rd, 7th, and 10th day after axtraction. HE and Immunohistochemical staining was used to observe the new blood vessels formation. Conclusion & Significance: We found the lowest blood glucose in P1 group on 10th day after extraction. The new blood vessels formation in P1 showed the progressive formation significantly compared to P2 and K group (p<0,05). We conclude that Tq treatment may improve the socket new blood vessels formation process and prevent the complication.
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.
Kyung Yul Hur
Soonchunhyang University Seoul Hospital, South Korea
Title: Pylorus preserving total duodenal exclusion for non-obese type 2 diabetes mellitus
Dr. Kyung Yul Hur, is a Professor and Chief of General Surgery at Soonchunhyang University Hospital, Seoul, Korea.
He adopted laparoscopic TEP hernia repair procedure in year 2003, and bypass surgery in Korea in September 2009, which was the first metabolic surgery performed in Korea. Presently He is a pioneer of laparoscopic surgery society in Korea.
Concerning to the bariatric and metabolic surgery, Dr. Hur has a different basic concept compare to another surgeon in Korea. He considers that the surgery is merely a beginning of the treatment for type 2 DM thus the procedure should remain simple, safe and reversible. Recently, Dr. Hur invented a new modified procedure aiming better quality of life for patients with comparable to antidiabetic effectiveness of previous surgical procedure.
We have experience of laparoscopic single anastomosis gastric bypass for non-obese type 2 diabetic subject since 2009. There had been minor problems which led to patients having to undergo annoying discomfort frustrates its clinical application. To improve postoperative QoL, we modified our established procedure since December 2015.
Most symptoms or complaints are linked to the absence of pyloric sphincter function. To recover this function, the entire stomach including sphincter should be preserved. While preserving the pyloric sphincter, we completely removed the duodenal tissue from the distal end of the stomach. We carry out our procedure based on three principles strictly:
(1) Preservation of the pyloric ring
(2) Total duodenal exclusion
(3) The biliopancreatic limb should be more than 200 cm
Most importantly, duodenal mucosa should be removed. Remained duodenal mucosa is possible cause of recurrent hyperglycemia 6 months after surgery. Compensatory hypertrophy and unique pattern of epithelial regeneration of short cut end of jejunum is answer of enigma. More than 200㎝ of biliopancreatic limb is mandatory. Alimentary limb is not necessary in metabolic surgery, Mere existence of nutrients enough to stimulate enteroendocrine cell. In metabolic surgery, alimentary limb is functional segment. Single anastomosis between pyloric ring and small bowel does not make any problem. Postoperative sphincter function was excellent.
From December 2015 to date, a total 40 patients have undergone this procedure. Postoperative GIQOL is highly satisfactory, with no significant discomfort in most subjects, and some patients have equal quality with their preoperative GIQOL.
Nine patients who were followed up for more than 12 months after surgery showed no evidence of recurrence. The clinical course of glycemic control was equal to or better than that of previous surgery