20^th Asia Pacific Diabetes Conference July 16-17, 2018 London ,UK

Muhamad Shafiq Advani has graduated from Medical School in 2017 from University of Indonesia. He has also completed his Master’s degree in Medical Research in Stem Cells and Regenerative Medicine in 2015 from Newcastle University. He is currently a General Practitioner Intern.

Background: According to International Diabetes Foundation (IDF), there were 9.1 million people in Indonesia have type-2 diabetes in 2014, the fifth biggest in the world. In addition, since diabetes is a multifactorial disease, the treatment needs to be holistic and comprehensive to control the progressiveness of the disease. One of the treatment pillars is controlled diet as diabetic people have hyperglycemia. This raises a question whether ketogenic diet, that only includes low number of carbohydrate which responsible for blood sugar level is superior to conventional low-calorie diet to control blood sugar monitored by HbA1c level. Objective: To compare the effect of ketogenic diet and low-calorie diet in reducing HbA1c among people with type-2 diabetes with overweight to obese weight. Method: PubMed and Cochrane were used for literature browsing. Articles were then selected based on inclusion and exclusion criteria. Selected articles were assessed with Oxford CEBM critical appraisal tools. Result: One quasi-experiment study and one randomized controlled trial were obtained. Both studies are applicable with similar validity and show p-values: <0.0001 and <0.03, respectively in reduction of HbA1c in ketogenic diet group. Conclusion: Ketogenic diet can be applied as an alternative of conventional diet to reduce HbA1c level faster in type-2 diabetes patients with overweight to obese weight.

Uttam Kumar Dey has completed his MBBS from Dhaka Medical College in 2003. He has been serving diabetic patients in BIRDEM Hospital since 2005. He has received Fellowship from American College of Clinical Endocrinology in 2016. He is a Life Member of BSM, ISSM, AACE and has several publications to his credit.

50 cases of acute renal failure aged 21-80 years were prospectively studied in the Department of Nephrology, BIRDEM from November 2009 to September 2010 to know the clinical course and outcome in them. All patients were diabetic, out of them 22 were male and 28 were female. Acute diarrhea and vomiting was found to be the commonest cause of ARF (54%). Other causes being drug induced (34%), septicemia (6%), RPGN (4%) and obstructive uropathy (2%) in order of frequency. Pre-renal cause therefore constituted 80% etiology. Anuria (38%) and oliguria (20%) were the commonest mode of presentation. Gastrointestinal symptoms were present in 54% of cases and about 10% patients had neurological symptoms in the form of drowsiness. Hypertension was also a common accompaniment (24%). Blood biochemistry was the main parameter of diagnosis and management which included blood urea, creatinine and electrolyte estimation. Mean urea and creatinine level on admission being 133.44±80.88 mg/dl and 5.2±2.65mg/dl, respectively. Hyperkalemia was present in 46% cases and acidosis was a constant finding in all cases. Routine urine examination, plain X-ray abdomen, ultrasonography were all useful investigations in some cases for diagnosis. Hemodialysis (done in 52%) along with conservative therapy was the main and effective mode of treatment in our study. Rest of the patients were managed with only conservative therapy which was mainly fluid and electrolyte balance. Out of 50 patients 2 (4%) died. 7 patients suffered irreversible cortical necrosis and was on hemodialysis. 32 (64%) patients gained complete or near complete recovery while remaining 9 (18%) recovered with some residual damage without any renal replacement therapy.

Wicensius Parulian Hasudungan has completed his Medical Doctor degree from Faculty of Medicine, University of Indonesia. He is presently in the Indonesian’s Medical Doctor Internship Program in Kalideres District Primary Health Care, Jakarta, Indonesia.

One problem developed by Hepatitis C Virus (HCV) infection is the risk of developing diabetes mellitus in adult patients. Hypotheses stated about this relationship were the extrahepatic HCV infection and the inhibition of GLUT-4 transcription by HCV. There are controversies on the relationship of these two variables. The objective of this evidence-based case report was to search for scientific proofs on the risk of developing diabetes mellitus in adult patients infected with HCV. Literature search was conducted in several online databases, including Medline, Embase, Science Direct and Cochrane. One case-control study and one prospective cohort study were critically appraised with Oxford CBEM critical appraisal tools. In one case-control study, the odds ratio (OR) was 3.7 [95% CI: 2.70-4.74]. In one prospective cohort study, the relative risk (RR) was 1.69 [95% CI: 1.55-1.72]. In conclusion, the risk of developing diabetes mellitus in adult patients infected with HCV was increased.

Li-Heng Pao is a Professor of Graduate Institute of Health Industry Technology at Chang Gung University of Science and Technology, Taiwan. He is also the Director of Research Center of Food and Cosmetic Safety at the same university. He has completed his Doctorate in Pharmaceutical at the University of Michigan, USA in 1997. Currently, he is devoted in traditional Chinese medicine researches involved in herbal-drug interactions as well as their effects on neurodegenerative diseases; applying the mass spectrometry and NMR in metabolomics study on the effects of herbal drug in metabolic diseases.

Gallic Acid (GA) is a polyphenol compound present in vegetables, fruits, red wine, tea and various types of food and exhibits a relatively simple structure compared with other polyphenols in food. Although numerous studies have reported that GA facilitates alleviating metabolic diseases, previous studies have mainly employed conventional biomarkers and histopathological sections to conduct analysis, thus gaining only unilateral understanding concerning the functions of GA. Therefore, the functions and mechanisms of GA in alleviating metabolic diseases should be reexamined. In this study, a pharmacodynamics mouse model was used to examine the use of GA to alleviate diabetes and Nonalcoholic Fatty Liver Disease (NAFLD) induced by High Fat Diet (HFD) and Streptozotocin (STZ). Moreover, a 1H nuclear magnetic resonance-based metabolomics analysis was adopted to investigate metabolites changes in mouse serum, urine, liver and muscle tissues, thereby verifying the therapeutic effect and potential mechanisms of GA in alleviating diabetes and NAFLD. The results revealed that HFD and STZ induced severe metabolic disorders in the diabetes and NAFLD mice, including metabolic disturbance related to glucose, lipids, amino acids, purines and pyrimidines as well as changes in intestinal microbiota. GA treatment alleviated the high blood glucose of the mice, decelerated the progression of NAFLD and partially reversed the disordered metabolic pathways in the diabetes mice. This study was the first to report that GA mechanism in alleviating lipid accumulation was related to the up-regulations of β-oxidation and ketogenesis. This finding accords with those of previous pharmacodynamics studies and facilitate identifying new mechanisms of GA in alleviating metabolic diseases.

Ihsan Azka Adriansyah is a graduated Doctor from Faculty of Medicine, University of Indonesia. His research interest is in nephrology and urology.

Statement of the Problem: Diabetic nephropathy is one of global health problem that keep increasing in the recent years. It is one of the common complications of diabetes mellitus and one of the main cause of chronic kidney disease. Golden standard for diabetic nephropathy examination is quantification of albuminuria in 24-hour urine; however, this examination is difficult and there are frequent sampling errors. Several studies show that examination using albumin-to-creatinine ratio in spot urine sample could be proposed as another method to diagnose diabetic nephropathy since it is more convenient for the patient. Therefore, the purpose of this study is to find out if the albumin-to-creatinine ratio in spot urine could be used to diagnose diabetic nephropathy. Methodology & Theoretical Orientation: A structured internet literature search was conducted using 4 databases, PubMed, SCOPUS, Cochrane library and Science Direct. Titles and abstracts were screened using predetermined selection criteria and yield three relevant articles. Selected articles were critically appraised based on its validity, importance and applicability. Findings: All three journals show that albumin-to-creatinine ratio in spot urine have good sensitivity that is comparable with quantification of albuminuria in 24-hour urine to diagnose diabetic nephropathy. Conclusion & Significance: Examination using albumin-to-creatinine in spot urine can be used for screening and diagnosis of diabetic nephropathy. Recommendations are made for further study to be done in patient in primary health care as a method to do screening in diabetic patients.

Shinn-Ying Ho is a Professor in the College of Biological Science and Technology and Institute of Bioinformatics and Systems Biology at the National Chiao Tung University, Taiwan. His major research fields are bio-inspired optimization methodologies, bioinformatics, computational biology, bio-image informatics and biomedical engineering, especially in the field of machine learning on high-dimensional medical data. He has developed some prediction systems for protein functions, biopsy and liquid biopsy-based disease/cancer and has produced more than 80 papers in peer-reviewed journals as a first author or corresponding author.

Symptoms of Diabetes Mellitus (DM) may develop rapidly in type-1 DM but much more slowly or even absent in type-2 DM. The diagnosis of DM is based on measurements of fasting plasma glucose level, glucose tolerance test or serum glycated hemoglobin. The awareness of DM ranges on 36.9-77.6%, increasing with ages. Risk factors of DM include family history, cardiovascular disease, hyperuricemia, obesity, physical inactivity, smoking and Western diet. Life-style is an important cause of DM occurrence. This study aims to develop a fast screening method to identify high-risk DM people by questionnaire, which is closer to life-style change than study using blood sample. Supervised machine learning approach to modeling for predicting DM needs a training cohort consisting of subjects with DM and subjects without DM. However, due to low DM awareness rate in young people, some respondents who already have DM may answer themselves DM-free and were categorized into subjects without DM. This work proposes a novel prediction method (Pred-DM) based on support vector machine and an optimal feature selection method. Pred-DM considers respondents who answer themselves DM-free as uncertain-disease subjects, which include DM subjects and non-DM subjects. This study cohort consists of 3464 subjects and 119 features chosen from a national-wide questionnaire study of the National Health Interview Survey of Taiwan. Pred-DM identified 26 of 119 features, including family history, smoking, hypertension, hyperlipidemia, eye problem, missing teeth, physical activity, eating habits, mental status and seeking medical service. Considering respondents who answer themselves DM-free as uncertain-disease subjects enhanced the screening test sensitivity of DM from 0.71 to 0.93. The questionnaire-based method Pred-DM is helpful to identify high-risk DM patients for early detection.