Day 1 :
Sree Balaji Medical College, India
Dr. Aditya Vedula is a resident of Internal Medicine with aptitude for Diabetes and Nephrology. Hailing from India where Diabetes and Hypertension are on the rise at an alarming pace, Aditya believes in the immense necessity of primary prevention of the many dangerous complications of these two non-communicable diseases. He is undergoing residency in Sree Balaji Medical College in Chennai which conducted vast number of studies in various models involving multiple disciplines relating to diabetes and its complications.
Peripheral vascular disease (PVD) is a major complication and cause of morbidity in diabetic patients worldwide. Earlier detection of PVD could prove beneficial to the patients at risk. This is a prospective study done to find out whether inflammatory markers like hsCRP, Apo-A, Apo-B, homocysteine help in detecting peripheral vascular disease early. Diabetic patients for more than 3 years without other comorbid illness were included in the study. After getting the ethical committee’s approval, the selected subjects, were tested for hsCRP, Apo-A, Apo-B and homocystiene levels and doppler study of lower limb vessels were done. Of the 100 patients, only 25 patients had elevated levels of Apo-A (25%). Apo-B levels were elevated in 67 patients (67%). Highly sensitive CRP was elevated in 63 patients (63%). The mean age of the study population was 52 years and the mean duration of diabetes was 8 years. 15% of diabetic patients had normal HbA1C and did not have elevated biomarker levels. Patients were followed up for 2 years. Of patients who had elevated biomarkers, 30% developed PVD. This study shows that inflammatory markers like hsCRP, apo-A and apo-B are sensitive markers for early detection of peripheral vascular disease and thereby for reducing morbidity. Tight control of diabetes is quintessential to prevent occurrence of complications of diabetes.
Queensland University of Technology, Australia
Lan Nguyen has been working for ten years as a Nursing Lecturer in University of Medicine and Pharmacy in Ho Chi Minh City, Vietnam. She has obtained her Master of Advanced Nursing Practice in the Netherlands in 2010 with her masters’ thesis topic on quality of life and coping with diabetic foot ulcers among patients with diabetes. Currently, she is a PhD student at the Queensland University of Technology, Brisbane, Australia. Her research interest focuses on wound management and health prevention and health behavior change strategies.
Statement of Problem: The burden of diabetic foot ulcers is enormous and Vietnam is not exempt from this issue. Up to 85% of foot ulcers can be prevented, however, in most cases, early-stage prevention strategies have not been a focus.
Aim: The study aimed to evaluate the effectiveness of a self-efficacy theory (SET) based foot care education intervention program. The program examined foot self-care behavior and common minor foot problems among patients at low risk of diabetic foot ulcers in Ho Chi Minh City, Vietnam.
Method: A quasi-experimental design with 2 groups, using pre-and post-tests was used. From the 119 participants, 60 participants in the control group received usual care and a foot care brochure. Those in the intervention group received: 60-75 minutes of a small group intensive education and hands-on skills session; a foot care kit and documents and three regular booster follow-up phone calls over 6 months. A generalized estimating equations model was undertaken to examine the impact of the intervention on foot self-care behaviors and prevalence of common minor foot problems (i.e. dry skin, corns/callus) over 6 months from baseline after adjusting covariates.
Result: The intervention group had significantly improved outcomes compared to the control group over 6 months in the following aspects: Better preventive foot care behavior (p=0.001); decreased prevalence of common minor foot problems (i.e. dry skin, corns/callus) [OR: 0.04, 95% CI: 0.01-0.13, p<0.001). However, reduction in potentially damaging behavior was not found significantly different between groups over the study period (p=0.09).
Conclusion & Significance: The study’s findings provide evidence for the effectiveness of a theory-based education intervention on improving foot self-care behavior and preventing minor foot problems what commonly precede diabetic foot ulcers. Further study with a RCT design, in a larger sample of patients and longer follow-up time is recommended.
Magna Centres For Obesity, Diabetes and Endocrinology, India
Dr Ramakrishnan Santosh is a practicing clinical endocrinologist for ten years. He has 34 papers in various journals and has authored three text book chapters. He has presented in more than 400 scientific forums which include many international conferences of repute. His significant extracurricular activities include lecturing in management schools and having authored 3 fiction novels.
Self Monitoring of Blood Glucose (SMBG) plays an extremely important role in management of Gestational Diabetes Mellitus. The hallmark of Gestational Diabetes is the constantly changing blood glucose values till delivery due to changes in the insulin resistance. Confusion exists about the frequency of monitoring, timing of monitoring (whether preprandial or postprandial, one or two hour postprandial) and sample preferred (venous or capillary). We also review the acceptance and adherence to SMBG in various studies. In this presentation, we review the historic and the latest guidelines on the same. Remote monitoring of blood glucose values is now possible with the use of technology. We review the different ways of doing so. We also present the improvement in compliance to SMBG, acceptability of remote monitoring of glucose and the improvements in the trend of blood glucose control in our centre using email and mobile applications as tool for the same.
Irina Kurnikova - MD, PhD, Professor of Medicine of RUDN University, Moscow, Russia. Dealing with Problems of Endocrinology for over 20 years. Currently she is curator of the Scientific Direction Endocrinology in RUDN University. She had published more than 30 articles in well-known journals, the author of 25 books and tutorials in Russian language, 10 patents for inventions. The main areas of research are the optimization of the system approach to the treatment and rehabilitation of patients with diabetes, thyroid diseases. The main directions of scientific research: influence of disturbances in the system of regulation of the organism and other endogenous factors (comorbidity, disruption of the mechanisms of humoral transport) on the effectiveness of treatment and the quality of compensation of diabetes and other endocrine diseases.
Type 2 diabetes (DT2) combined with other diseases often, which affects the features of the progression of diabetes. What mechanisms the realization of this influence is a question for study. We made a comparative analysis of the spectral characteristics of the heart rhythm of DT2 patients with concomitant diseases: 28 patients (group 1) with an arterial hypertension (HTN) and 17 patients (2) with gastrointestinal tract diseases (GIT). Comparison group (3) - 25 patients with CD2 without concomitant diseases. The power of the frequency spectrum was estimated for HF, LF, VLF, ULF, IC-centralization index. In the group 1, increase in LF and decrease in HF were observed, which is characteristic of chronic stress. ULF was higher than in the group 3 (p = 0.0002; r = 0.48), which is characteristic for the failure of vegetative regulation. In two patients from this group, the values of ULF occupied almost the entire spectrum (76% and 91%). In both cases, patients died from vascular accidents for half a year, despite active therapy with antihypertensive drugs. In the group 2, activation of central ergotropic and humoral metabolic processes was observed, exceeding the value in the group 3 (p = 0.001; r = 0.37). This indicator demonstrates the practically direct effect of HTN on metabolic homeostasis, explains the reasons why it is difficult to achieve compensation of DT2 with concomitant hypertension, and explains one of the mechanisms of progression of complications of diabetes. The increase IC in the group 2 confirmed the high activity of the central contour of regulation in relation to the autonomic. Moreover, this, in prognostic terms, indicated the depletion of regulatory mechanisms and a high risk of developing "vascular accidents" (OR = 2.7, p = 0.001).In the group 2, the directionality of the regulatory processes indicated chronic stress also.
James Cook University, Australia
Nisha Nangrani is a final year medical student at James Cook University in Townsville, QLD, Australia. As part of her Bachelor of Medicine/Bachelor of Surgery (MBBS) Honours Research project, she has joined the team at Translational Research in Endocrinology and Diabetes (TREAD) at James Cook University. TREAD has recently commenced the Telehealth for Diabetes Project which aims at making healthcare more accessible to patients suffering from diabetes in rural and remote North Queensland. She is guided and supervised by Dr Usman Malabu, Consultant Endocrinologist at the Townsville Hospital and Dr Venkat Vangaveti, Senior Research Officer at James Cook University.
Background: The outcomes of telehealth in the management of Type 2 diabetes (T2DM) have not been evaluated since the publication of recent clinical trials. The objective of this study is to conduct a systematic review and meta-analysis of recently published randomized controlled trials (RCTs) to assess the biochemical, clinical and psychosocial outcomes of telehealth in subjects with T2DM.
Methods: Electronic databases, MEDLINE, CINAHL, INFORMIT, SCOPUS and the Cochrane Central Register of Controlled Trials and reference lists of existing systematic reviews were searched until August 2017 to identify relevant studies. Study search and selection were performed by two independent reviewers. 4791 articles were retrieved of which 11 RCTs (n=3772) were included. A meta-analysis with random effects model was applied to estimate the pooled results.
Results: Telehealth was associated with a statistically significant and clinically relevant absolute decline in glycosylated haemoglobin (HbA1c) compared to usual care (mean difference -0.17%; 95% CI -0.25 to -0.09%; p<0.0001), especially if participants had a mean baseline HbA1c≥8.0%; were less than sixty years of age or received telehealth for less than one year. There was no clinically significant reduction in LDL-cholesterol (LDL-c), body mass index (BMI), systolic (SBP) or diastolic blood pressure (DBP).
Conclusion: Telehealth interventions were associated with improved glycaemic control (HbA1c) in T2DM diabetic patients. However, no clinically relevant impact was observed on lipid profile, blood pressure, body mass index and psychosocial well-being. Future studies should seek to evaluate the effect of intervention duration on HbA1c, psychosocial outcomes and the effectiveness of telehealth in rural and underserved populations.
Mae Fah Luang University, Thailand
Anongnad Mee-inta, physical therapy lecturer, has the experience of evaluation and treatment in physical therapy. She has teaching, research, evaluation, and treatment in the cardiopulmonary physical therapy management. Both clinical and research that she is interested involved with noncommunicable disease especially in diabetes mellitus. This research is based on the data from patients of Somdet Prayannasungworn Hospital, Thailand. This result of this study might be advantage for the policy of pulmonary complication prevention in patients with diabetes mellitus in Thailand.
Diabetes mellitus (DM) is a chronic disease which frequently found in the world population. The complications of diabetes mellitus can lead to other comorbidities and mortalities. In addition, pathology of diabetes can cause microangiopathy in alveoli which have contributed to restrict lung volume, capacity, and change in pulmonary functions. However, little is known about the mechanisms of lung dysfunction and there is controversial about relation among duration of diabetes, HbA1c, and pulmonary function in patients with type 2 diabetes mellitus. Thus, the present study was aimed to evaluate the correlation among duration of diabetes, HbA1c, and pulmonary function in patients with type 2 diabetes mellitus. A cross-sectional study was conducted at Somdet Prayannasungworn Hospital, Chiang Rai, Thailand. Forty participants had diagnosed of type 2 diabetes mellitus from physician, both men and women, and aged between 40-70 years old. All participants were interviewed for demographic data and duration of diabetes. They also were tested HbA1c and pulmonary function tests (PFTs) from trained physical therapist. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and ratio of FEV1 and FVC (FEV1/FVC), and forced expiratory flow at 25-75% (FEF 25-75%) were measured by spirometry. The results showed that diabetes duration was statistical significantly negative correlated with forced expiratory volume in one second (FEV1) (r= - 0.323, p-value< 0.05) and forced vital capacity (FVC) (r= - 0.349, p-value<0.05) while HbA1c was not correlated with pulmonary function. Diabetes duration was significant associated with pulmonary function reduction in patients with diabetes mellitus. The relationship among HbA1c and pulmonary function in patients with type 2 diabetes mellitus were not found in this study.
Joseph Asante Obeng is a medical laboratory scientist by profession and academic qualification. In his quest to promote healthy living among the people in his community, his passion in this profession is geared towards endocrinology; diabetes and its management to be specific. Under my supervision, he has successfully conducted researches in this direction of his profession. This abstract been one of his recent works was inspired by the desire to use readily available materials to manage diabetes through careful scientific investigations and evaluations. This approach he believes if properly handled will go a long way to curb the menace of diabetes in his community.
Problem statement: Prevalence of type 2 diabetes (T2D) among the Ghanaian adult population is increasing. Interestingly, rural inhabitants tend to have lower prevalence and severity of T2D as compared to urban dwellers even though they (rural inhabitants) do not have access to proper medical services. The fall in prevalence and severity of T2D among the rural inhabitants is attributed to the use of unripe plantain peels (UPP) for T2D management. It is a routine practice by rural inhabitants to boil UPP, decant the boiled water and drink it when cooled. The purpose of this study is to investigate the chemical constituents of UPP and their medicinal effect on the management of T2D. Methodology: A qualitative case study was utilized on rural inhabitants who were known diabetes who volunteered to participate in the research. A digital glucometer was used for the estimation of glucose of participants before, during and after consumption of UPP decant and a standard scientific techniques were utilised to investigate the chemical constituents of UPP. Findings: The UPP decant upon investigation contained considerable amount of nutrients such as: Ca, K, Na, P and metals such as: Mg, Zn, Cu and Pb. Zinc found in higher concentration plays a vital role in the regulation of insulin production by the islets of Langerhans and glucose utilization by adipocytes and muscles. Magnesium another constituent found in higher concentration is a cofactor of hexokinase and pyruvate kinase and it also alters glucose transport across cell membranes. Conclusion: The research studies accentuate the medicinal potentials of UPP in the management of T2D. However, it is predictive that, prolong consumption of UPP decant may pose grave health problems in the long term since UPP contains considerable concentrations of lead (Pb) and cupper (Cu). Recommendation: More studies are encouraged to aid in the conversion of UPP into more useful and safe medicinal products.
Amity University Rajasthan, India
Dr. Komal Verma, Associate Professor, Amity Institute of Behavioral and Allied Sciences, Amity University Rajasthan
Diabetes mellitus is one of the most prevalent health problem which India is facing and self management is key component in dealing with it. Self management is considered to be individuals competency in handling situations but it is perceived to be more effective if influenced by social support. This study aims to assess the use and benefits of social media among patients with type 2 Diabetes in India as a well-being mechanism. Factorial design was used to address the study objectives. The current study reflects positive impact of usage of social media in managing type 2 diabetes, which also proves the theoretical base of social support and biopsychosocial model in managing long term illness. The results of the study adds to the current literature gap on perceived benefits of social media use in managing diabetes and it can also help health care providers to understand the role of social support which patients are considering to be important stakeholder in dealing with diabetes.
M.M. University, India
Randhir Singh holds M.Pharm., Ph.D. degrees in Pharmacology. Presently, he is working as Professor in Department of Pharmacology in M. M College of Pharmacy, M.M. University, Mullana, Ambala, India. He has an experience of more than 13 years in teaching and research. He has published more than 80 research and review articles in peer reviewed International Journals and his work is cited in highly reputed journals. He is an editorial board member of several journals. He has guided 09 Ph.D students (04 Awarded, 03 Submitted and 02 pursuing) and 08 M. Pharmacy students. He has received 02 projects worth 50 lacs from Goverment agencies of India. He has received Prof Saroj V.N Sharma award for best paper published in cardiovascular sciences in India in 2011 and Best Faculty Award, form Association of Pharmacy Professional in January 2018. He has authored 04 books (02 National and 02 International) with reputed publishers. His area of research is diabetes and diabetic complications, obesity and hypertension.
Etiology of diabetic nephropathy is multifactorial with many pathogenetic mechanisms. Many plant products are being used traditionally in the management of diabetes and its complications. Our study was aimed to evaluate the potential of hydro-alcohol extract (DHA) of Dillenia indica L. (Family: Dilleniaceae) in treatment of diabetic nephropathy by targeting renal markers and oxidative stress. DHA was evaluated for its inhibitory activity against formation of AGEs by using bovine serum albumin, sorbitol accumulation in human blood and aldose reductase in rat kidney. Diabetic nephropathy was assessed by determining serum glucose, insulin, renal parameters (urea, uric acid, creatinine level) and tissue histological examination. Tissue antioxidant enzymes (SOD, CAT and GSH) and LPO levels were measured along with the formation of AGEs in kidney to assess the effect of DHA in ameliorating oxidative stress. DHA showed significant inhibition against sorbitol accumulation and aldose reductase activity. DHA also produced significant attenuation in the glycemic status, renal parameter, lipid profile and level of antioxidant enzymes proving efficacy in diabetic nephropathy. Moreover, DHA has also produced significant reduction in the formation of AGEs in vitro as well as in kidneys. The results obtained from the study indicate the significant potential of D. indica as a possible therapeutic agent against diabetic nephropathy
Tehran University of Medical Sciences, Iran
Reza Daryabeygi-Khotbehsara, a master of nutrition graduate from Tehran University of Medical Sciences. He has been an international chemistry teacher for a year and medical advisor (pharmaceutical) for 7 months. He is working as an marketing advisor & education specialist (at a pharmaceutical company) guiding medical and sales representative team. Reza has been involved in intervention studies as well as systematic reviews and meta-analyses mainly among people with diabetes.
Introduction: Global prevalence of diabetes in alarmingly high. Moreover, global economic burden of diabetes is striking. With respect to these, more cost-effective approaches are required.
Nigella sativa (N. sativa), a popular herb in Asia, is reviewed as a miraculous top rank herbal medicine, and widely used in folk medicine. However, any study has assessed the pooled effect of N. sativa on glycemia and serum lipids in diabetes. The present meta-analysis investigates the effectiveness of N. sativa in type 2 diabetes (T2D).
Methods: Literature search was conducted covering PubMed/Medline, Scopus, and Cochrane Registry of Clinical Trials up to February 2017 to obtain the relevant published intervention studies. Two researchers (R.D and M.G) were involved in the identification of eligible studies. Heterogeneity was assessed using I-squared (I2) statistics test. Subgroup analysis was done to assess type of N.sativa supplement as source of heterogeneity. Effect sizes of eligible studies were pooled using STATA software version 12 (STATA corp, College Station, TX, USA).
Results: Seven trials were included in the meta-analysis of glycemic and serum lipid profile end points. Supplementation with N.sativa significantly improved fasting blood sugar (FBS), HbA1c, total-cholesterol (TC) and LDL-cholesterol (LDL-c). The overall effects for triglyceride (TG) and HDL-cholesterol (HDL-c) were insignificant. Subgroup analysis revealed significant reduction on TG with N.sativa seed oil, while TG was increased with seed powder. All measures, but HbA1c, showed no evidence of publication bias.
Discussion: To the best of our knowledge, this is the first meta-analysis investigating the effectiveness of N.sativa in T2D. Promising benefits of N.sativa on glycemia (FBS and HbA1c) and lipid parameters (TC and LDL-c) provides robust evidence for the incorporation of N.sativa as an adjunct therapy in diabetes.