Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 8th Euro Global Diabetes Summit and Medicare Expo Valencia, Spain.

Day 1 :

Keynote Forum

Emilio Herrera

Complutense University
Spain

Keynote: Role of maternal lipids on neonatal body weight under healthy and gestational diabetic conditions

Time : 09:00 to 09:30

Conference Series Euro Diabetes Expo 2015 International Conference Keynote Speaker Emilio Herrera photo
Biography:

Emilio Herrera is PhD from Complutense University (Madrid), Emeritus professor of Biochemistry and Molecular Biology at Faculties of Pharmacy and Medicine, University San Pablo-CEU in Madrid, Spain and Doctor Honoris causa in Medicine by Lund University (Sweden). He carried out his postdoctoral studies in Harvard University and Northwestern University Medical Schools. He has 282 peer-reviewed papers with IF (total IF by JCR-2009, 755.20) and 77 book chapters, having a h-index of 37 and has directed 49 PhD thesis.

Abstract:

During early pregnancy, the increase in maternal fat depots is facilitated by insulin, followed by increased adipose tissue breakdown and subsequent hypertriglyceridemia, mainly as a result of insulin resistance (IR) and estrogen effects. Most fatty acids (FAs) in maternal circulation are esterified and associated with lipoproteins which are taken up by the placenta and hydrolyzed by lipases and the released FAs enter fetal circulation. Under control conditions maternal glucose but not triacylglycerides (TAG) or nonesterified fatty acids (NEFA) correlate with neonatal weight, BMI or fat mass. However in gestational diabetic mellitus (GDM) the fetus does not seem to receive more FAs than in non-GDM pregnancies but whereas maternal glucose doesn’t correlate with fetal anthropometric parameters TAG and NEFA show significant correlations. In newborns of GDM mother’s serum glucose and consequent insulin levels are high and such hyperinsulinemia would facilitate TAG synthesis, contributing to their increased adipose tissue mass. Long-chain polyunsaturated FAs (PUFA) are essential for fetal development and are obtained from the mother. The proportion of arachidonic, docosahexaenoic and total n-6 and n-3 PUFA are lower in umbilical arterial plasma but not in venous plasma of neonates of GDM vs. controls indicating an altered metabolism of PUFA by the fetus of GDM mothers. In rats a moderate increase in dietary n-3 PUFA during early pregnancy reduces adiposity and the age-dependent insulin resistance in 12 months old male offspring. The increase in body fat in neonates of GDM women is a risk factor for obesity in early childhood and later life.

Conference Series Euro Diabetes Expo 2015 International Conference Keynote Speaker Etheresia Pretorius photo
Biography:

Etheresia Pretorius of the Department of Physiology, Faculty of Health Sciences, University of Pretoria is one of the Africa’s top women scientists, and she was the recipient of the African Union Kwame Nkrumah Scientific Awards Programme (Basic Science and Technology: African Women in Science), in 2011. Since 2000, she published/in press over 200 ISI rated research manuscripts. Her research has brought new insights into inflammation pathology and she has identified new methods that may be used in tracking disease progression. The majority of the afore-mentioned research has been published in high impact journals, including The Lancet (IF: 45.102) and FEMS (IF: 13.8).

Abstract:

Type II diabetes causes an ever-increasing burden on healthcare. The prevalence for all age-groups worldwide was estimated to be 2.8% in 2000 and predicted to increase to 4.4% in 2030. Among adults in the US, the prevalence of undiagnosed diabetes is currently 4.1% and pre-diabetes a staggering 35.6%. Type II diabetes is associated with three main glycemic disorders that are chronic hyperglycemia, glycemic variability, and iatrogenic hypoglycemia and also comorbidities including dyslipidemia and hypertension. All of the above comorbidities are associated with hypercoagulability. Because type II diabetes is such an extensive health issue, we suggest that the answer to adequate treatment is based on an individualized patient-centered approach, in combination with the latest NIH precision medicine approach. A combination of viscoelastic methodologies may be used in a personalized patient-centered regime, including thromboelastography (TEG) and the lesser, used scanning electron microscopy approach (SEM). TEG is a dynamic measure of clot formation, strength and lyses, while SEM provides a visual structural tool to study patient fibrin structure in great detail. We therefore consider the evidence for TEG and SEM as a unique means to monitor type II diabetes treatment efficacy. TEG and SEM has potential to be a useful tool combination, and could potentially alter clinical approach to type II diabetes treatment. As envisaged in the NIH precision medicine approach, it will involve a lot of role players and innovative new research ideas; with this ultimate goal in mind, we suggest that an individualized patient-orientated approach is now already within our ability.

  • Complications Associated with Diabetes
Speaker

Chair

Sebastian Oltean

University of Bristol

Speaker
Biography:

Emilio Herrera is PhD from Complutense University (Madrid), Emeritus professor of Biochemistry and Molecular Biology at Faculties of Pharmacy and Medicine, University San Pablo-CEU in Madrid, Spain and Doctor Honoris causa in Medicine by Lund University (Sweden). He carried out his postdoctoral studies in Harvard University and Northwestern University Medical Schools. He has 282 peer-reviewed papers with IF (total IF by JCR-2009, 755.20) and 77 book chapters, having a h-index of 37 and has directed 49 PhD thesis.

Abstract:

During early pregnancy, the increase in maternal fat depots is facilitated by insulin, followed by increased adipose tissue breakdown and subsequent hypertriglyceridemia, mainly as a result of insulin resistance (IR) and estrogen effects. Most fatty acids (FAs) in maternal circulation are esterified and associated with lipoproteins which are taken up by the placenta and hydrolyzed by lipases and the released FAs enter fetal circulation. Under control conditions maternal glucose but not triacylglycerides (TAG) or nonesterified fatty acids (NEFA) correlate with neonatal weight, BMI or fat mass. However in gestational diabetic mellitus (GDM) the fetus does not seem to receive more FAs than in non-GDM pregnancies but whereas maternal glucose doesn’t correlate with fetal anthropometric parameters TAG and NEFA show significant correlations. In newborns of GDM mother’s serum glucose and consequent insulin levels are high and such hyperinsulinemia would facilitate TAG synthesis, contributing to their increased adipose tissue mass. Long-chain polyunsaturated FAs (PUFA) are essential for fetal development and are obtained from the mother. The proportion of arachidonic, docosahexaenoic and total n-6 and n-3 PUFA are lower in umbilical arterial plasma but not in venous plasma of neonates of GDM vs. controls indicating an altered metabolism of PUFA by the fetus of GDM mothers. In rats a moderate increase in dietary n-3 PUFA during early pregnancy reduces adiposity and the age-dependent insulin resistance in 12 months old male offspring. The increase in body fat in neonates of GDM women is a risk factor for obesity in early childhood and later life.

Speaker
Biography:

Dr Sebastian Oltean studied clinical medicine at “Iuliu Hatieganu” Medical School in Cluj- Napoca, Romania followed by training in Nephrology and Dialysis. He then moved to USA where in 2004 obtained a PhD in Biochemistry from the University of Nebraska-Lincoln, followed by postdoctoral training at Duke University Medical Center, where he studied connections between alternative splicing regulation and disease. In 2008 he moved to University of Bristol (UK) where he is now a University research fellow and principal investigator. One of his main research themes is the understanding of therapeutic potential of targeting alternative splicing in diabetic nephropathy.

Abstract:

Diabetes is increasingly common in all regions of the world and diabetic complications represent an important burden on the health system. Though diabetic nephropathy (DN) is the main cause of end-stage renal failure in UK and worldwide, no specific treatment is yet available. Alternative splicing (AS) is one of the main determinant of proteomic diversity with more than 90% of genes being estimated to be alternative spliced in humans. In recent years a plethora of AS events have been described to be associated with specific diseases but their contribution to pathogenesis is very little understood. Several AS events have been described recently to be associated with diabetes and/or DN progression. We have focused so far on two splicing events connected with different pathogenic mechanisms in DN and related to VEGF (a promoter of increased permeability in the kidney and loss of protein in the urine) and FGFR2 (involved in epithelial-mesenchymal transitions, a major contributor to kidney fibrosis). Our data demonstrates that splicing isoforms may be manipulated in vivo to slow progression of DN and that splicing-sensitive fluorescent reporters designed to follow these particular AS events may be used as tools to investigate coordinated regulation of AS in DN. The ultimate goal of this work is to identify molecules (e.g splicing factors, kinases, signaling molecules) that are master regulators of this process and could represent attractive therapeutic targets.

Speaker
Biography:

Massimo Collinois Associate Professor of Pharmacology and Toxicology at the University of Turin (Italy) and head of the laboratory of “Cardiovascular and Metabolic Pharmacology” at the Department of Drug Science and Technology (University of Turin). He worked as Visiting Scientist at the William Harvey Research Institute, University of London (UK). His current research interests are the pathophysiology and the pharmacological therapy of diet-induced insulin resistance and the related cardiovascular risk factors, mainly organ-related ischemic events.He has published more than 50 papers in reputed international journals and has been serving as an editorial board member of several scientific journals.

Abstract:

The role of a low-grade, chronic inflammatory response in promoting cardiometabolic diseases (CMD) is well known. However, despite the recent publication of several documents and papers suggesting clinical and social interventions to prevent and benefit subjects afflicted with these co morbidities, the identification of common mechanisms of disease and related innovative pharmacological strategies are far from clear. Most recent evidences suggest a substantial role for the NLRP3 inflammasome, a large multimeric danger-sensing platform that promotes autocatalytic activation of the cysteine protease caspase-1 and mediates the cleavage of inactive pro-IL-1beta, among other proteins, into its active form. In the last few years, our research team has significantly contributed to elucidate the effects of pharmacological modulation of NLRP3 inflammasometo reverse the detrimental consequences of the cardiometabolic inflammation.We have recently demonstrated that a fructose-enriched diet evokesupregulation of renal NLRP3 expression, which significantly contributes to the development of the diet-related renal dysfunction. Similarly, we documented a key role of NLRP3 inflammasome activation in hepatic lipotoxicity evoked by microparticles produced following hepatic cell exposure tohigh concentration of saturated fatty acid. We also demonstrated that chronic mice feeding with an high-fat high-fructose diet induces an up-regulation of Nlrp3 inflammasome complex within the heart and its expression was exacerbated by an ischemic event. Our results will be discussed in keeping with most recent literature data for abetter understanding of the potential role of NLRP3 inflammasome as innovative pharmacological target for CMD.

Speaker
Biography:

Aline Meirhaeghe has completed her PhD at the age of 27 years from University of Lille (France) and postdoctoral studies from Cambridge University (UK). She is leading a group, in Inserm UMR1167 laboratory, investigating the molecular genetics of metabolic diseases at the Institut Pasteur de Lille (France). She has published more than 85 papers in reputed international journals

Abstract:

Genome-wide association studies (GWAS) represent a major tool in the understanding of the genetics of complex diseases including type 2 diabetes (T2D). More than 120 loci have been identified for T2D. Surprisingly, most of the known loci act through an effect on insulin secretion rather than insulin resistance. Details will be given. However, these variants explain only a small fraction of the estimated heritability of T2D. Possible explanations may be that : (i) the phenotypes of interest are not precise enough, (ii) several independent variants in a given gene or pathway, each of them having a small effect size, contribute synergistically to increase the susceptibility to the disease, (iii) the functional variants responsible for the GWAS signals, with stronger effect sizes, have not been deciphered, (iv) rare variants with stronger effect sizes exist and will need deep sequencing on large studies, (v) gene-gene and gene-environment interactions are not covered by classical GWAS as their studies need extremely large sample sizes, (vi) epigenetic changes in critical genes during intra-uterine life may play a major role in altering the risk of T2D, (vii) parent-of-origin effects should be dissected as the paternal and maternal alleles may have effects in opposite directions, leading to the impossibility to detect such an association in traditional case-control studies. Also, molecular post-GWAS data are necessary to elucidate the function of the proteins encoded by the disease-associated genes if one wants to obtain a complete picture of how genetic variation leads to T2D. Examples will be provided.

Speaker
Biography:

2012-present: Professor, Faculty of Medicine, Johannes Wolfgang Goethe Unicersity, Frankfurt am Main, Germany. 2006-12: Consultant, Laboratorio di Biologia Vascolare e Medicina Rigenerativa, Istituto Cardiologico Monzino, via, Pareo 4, 20138, Milano, Italy. 1996-12: Senior Investigator, Laboratorio di Patologia Vascolare, Istituto Dermopatico dell\'Immacolata, via dei Monti di Creta 104, 00167, Roma 1999-00: Associate Professor, McMaster University, Hamilton (ON), Canada 1995-96: Visiting Scientist, National Cancer Institute, NIH, Bethesda (MD), USA 1992-95: Postdoctoral fellow, Istituto Regina Elena, Roma, Italy 1989-91: Postdoctoral fellow, National Cancer Institute, NIH, Bethesda (MD), USA. 1984-88: Intern, Dipartimento di Immunologia, Univ. La Sapienza, Roma, Italy 1981-83: Intern, Dipartimento di Virologia, Univ. La Sapienza, Roma, Italy

Abstract:

BACKGROUND: The hyperglycemic/metabolic memory is clinically evident in patients in which glycaemic control is not beneficial on the progression of complications including cardiovascular accidents. This condition has been recently associated with altered epigenetic mechanisms and the presence of dysmetabolic pathways. The molecular mechanism underlying this process is still uncharacterized.
METHODS & RESULTS: Total genomic DNA was extracted from non-diabetic-cardiac fibroblast (ND-CF) and diabetic-CF (D-CF) and analysed for the global content of modified cytosines including 5 methyl-cytosine (5mC), 5 hydroxy-methyl-cytosine (5hmC), 5 formyl-cytosine (5fC) and 5 carboxy-cytosine (5caC) by colorimetric ELISAs. Remarkably, D-CFs, cultured between passage 4 and 8 since isolation, were accumulated all types of modified cytosines compare to cells obtaind from normoglycemic controls. Similar findings were observed in DNA samples obtained from the heart of streptozotocin-induced diabetic mice as well as in the Ins2 Akita mouse model of genetic insulin defect. RNA-seq experiments showed that human D-CFs have a reduced content of transcripts encoding for proteins involved in proliferation, DNA synthesis and packaging, chromosome organization and metabolic processes. Moreover, D-CFs showed a significant reduction in the number of mitochondria, in Isocitrate Deidrogenase 1-2 (IDH1, 2) activity and in α-Ketoglutarate (αKG) levels. The latter is an important cofactor for the regulation for ten-eleven-translocation (TET) demethylases. Treatment with exogenous αKG or a TET activator, such as vitamin C, rescued proliferation in D-CFs as consequence of an active demethylation process.
CONCLUSION: DNA demethylation machinery may be important during the onset of the hyperglycemic/metabolic memory. TET activators may represent a novel tool to treat diabetic complications and reduce cardiovascular risk.

  • Diabetes Management

Session Introduction

Peter Decock

HAS University of Applied Science
Belgium

Title: Dietary-induced health benefits beyond sugar replacement in people with type-2 diabetes
Speaker
Biography:

Peter graduated as Food Technologist in 1979 at the HAS University of Applied Sciences. He started as R&D Project Leader at General Mills and in 1985 became R&D Manager at OZF responsible for confectionary, fine bakery, chocolate and ice cream. In 1989 he moved to Gist-brocades (now DSM) as European Technology Manager to lead the development of new pastry and bread ingredients and monitor corporate R&D projects. Peter joined Cargill in 1992 as Deputy Manager of the European Food Application Centre. From 1995 he directed more than 10 years a multidisciplinary team to successfully launch erythritol on the global market. Since 2006 Peter leads Global Nutrition and Regulatory Affairs. The research he currently directs targets dietary and personal care solutions for improved oral and cardiovascular health

Abstract:

Excessive intake of added sugars has been associated with health issues including diabetes. This has encouraged food scientists to reduce sugar in foods without compromising taste using calorie-reduced bulk sweeteners such as polyols. The newest polyol is erythritol (ERT), a white, crystalline powder with similar crystal appearance, density, and sweetness quality as sugar (sucrose). It is non-caloric, non-glycemic, non-insulinemic and non-cariogenic. Emerging evidence shows that ERT has health potential that goes beyond the mere replacement of sugar, especially in people with type-2 diabetes. Diabetes is characterized by hyperglycemia and development of vascular pathology. Endothelial cell (EC) dysfunction (ECD) is a starting point for pathogenesis of vascular complications in diabetes. We previously showed ERT to be a hydroxyl radical scavenger preventing ECD onset in diabetic rats. To better understand how ERT mediates this protective effect, ERT was studied in EC (HUVECs) exposed to diabetic stressors. Decreased viability of EC and increased oxidative damage resulting from such exposure were attenuated in the presence of ERT. Protective effects of ERT during hyperglycemia were confirmed and mechanistically expanded upon, with transcriptomics.A human pilot study in 24 subjects with type-2 diabetes consuming 36g ERT daily as a lemon-flavored beverage for 28 days showed that acute consumption significantly improved microvascular endothelial function and chronic consumption reduced central pulse pressure and carotid-femoral pulse-wave velocity, both indicating favorable effects on aortic compliance. Chronic ERT consumption also reduced systolic blood pressure in 12 subjects with a blood pressure above the recommended goal of 130mm Hg while no change was observed in normotensive subjects.

Speaker
Biography:

Marco Parente has completed his university degree at the age of 25 at the Department of “Scienza e TecnologiadelFarmaco” of the University of Turin. He is collaborating with the Department on different projects. He won the award “Young Pharmacist of the year 2015” for the project “Quaderni del Master Chiara Colombo”. He is correlator of thesis of different topics with particular interest about diabetes food supplements and diabetes disease. He presided as lecturer in different conferences.

Abstract:

The counselling of the community pharmacist may significantly contribute to improve patient’s compliance to the drug therapy, thus leading to an improvement in local healthcare and decrease costs. However, so far, this specific skill doesn’t provide an immediate economic fee. Very recently, pharmacists of the Piedmont region have been involved in the Inter-Athenaeum Project in Community Pharmacy, which aims to improve prevention and compliance for diabetes and other most common chronic diseases, including heart failure, dyslipidemia, and COPD. The Project is based on the administration of questionnaires to pharmacy’s customers to evaluate prevention and patient compliance. The first step of the Project is based on the attendance of specific training by pharmacists of the Piedmont Region. Focusing on the section of the Project dealing with diabetes, we tried to answer to the following question: a management based on the training provided by the Project and the new patient-centric approach can increase the earnings and inputs in pharmacy? The analysis has been performed comparing the 15 most effective pharmacies that have submitted more than 40 questionnaries/3 months, 46 that have submitted more than 15/3 months with the rest of the Piedmont. Our partial results show that most effective pharmacies had an increase in the number of inputs (22860 for the pharmacy that submitted more than 40 vs 19124 to the medium of the Piedmont pharmacies) in the period between January and April 2015, but it is unclear whether there is also an increase in sales related to adherence to the project.

Speaker
Biography:

Santilli has completed her MD at the age of 24 years from Chieti University, where she took her Board Certification in Internal Medicine and PhD in Aging Science. She is now Assistant Professor of Internal Medicine. She has co-authored62 papers in International peer-reviewed Journals. She has recently received research grants from the Ministry of Health and Ministry of University and research and is PI for a number of National and International projects in the field of diabetes and cardiovascular complications.

Abstract:

Obesity, insulin resistance and beta cell deterioration are key issues in the development and progression of type 2 diabetes (T2DM). Given the concurrent effects acknowledged for GLP-1 agonists on body weight, fat mass, insulin resistance and beta cell preservation, we hypothesized that this class of drugs may exert additional actions on top of those anticipated for lifestyle intervention-mediated weight loss. Twenty-nine metformin-treated obese subjects with impaired glucose tolerance (IGT), impaired fasting glucose (IFG) or newly diagnosed T2DM, were randomized to liraglutide treatment (1.8 mg/d) or lifestyle counseling to assess whether changes in subcutaneous (SAT) and visceral (VAT) adipose tissue distribution and in degree of non-alcoholic fatty liver disease (NAFLD) (all assessed by MRI) after a modest and comparable weight loss (7% of initial body weight), might affect insulin sensitivity (Matsuda Index) and -cell performance (by Insulin Secretion-Sensitivity Index-2 (ISSI-2)) during multiple sampling oral glucose tolerance test. SAT and NAFLD grade were significantly and comparably reduced in both treatment groups, whereas insulin sensitivity was not significantly affected by any intervention. In contrast, the liraglutide group showed a significantly greater reduction in median VAT (p=0.001), as compared to the lifestyle group (-15.3% vs. -7.3% median decrease) and a greater improvement in beta cell function (ISSI-2) (96.3% vs. 29.8%, p=0.006), which translated into a significantly more pronounced reduction in both fasting, 1-hour and 2-hour postprandial plasma glucose, despite comparably reduced HbA1c in both groups (by 7.0%). In the liraglutide arm, but not in the lifestyle arm, VAT values were significantly related to ISSI-2 (Rho=-0.60, p=0.023) and adiponectin levels (Rho=-0-589, p=0.021) throughout the intervention period. This pilot study may help establishing a cause-and-effect relationship between VAT inflammation, beta cell performance and development or progression of T2DM, unravelling as well potential mechanisms by which liraglutide may favorably impact T2DM pathogenesis.

Speaker
Biography:

Emmanuel Navarro has completed his PhD at the age of 31 years from Málaga University. He is lecturer at University Miguel Hernández and University Alfonso X el sabio at the podiatry degree. Also sometimes is invited at Malaga University where he was teaching podiatry in the past.. He has published several papers in reputed journals in diabetic foot and has been working as podiatry specialist in biomechanics and diabetic foot in repute hospitals in Spain such as university clinica of podiatry at Complutense University and Valencian Institut of foot many time ago. Nowdaysmainly him activity is academic at university making research in differents podiatry fields.

Abstract:

This question naireassessed the reliability and construct validity of a tool to evaluate the foot self-care of diabetic patients. The education of diabetic patients about their foot care is a major issue to avoid complications like amputations and ulcers. Specific tools aimed to assess patient’s knowledge in this area are needed. The study had two phases: in Phase 1, item-generation was carried out through a literature review, expert review by a Delphi technique and cognitive interviews with diabetic patients for testing readability and comprehension. In Phase 2, diabetic patients participated in a cross-sectional study for a psychometric evaluation (reliability and construct validity) was carried out on a sample of type I and II diabetic patients. The study was conducted at the University of Malaga (Spain), podiatric clinics and a Diabetic Foot Unit between October 2012 and March 2013. After psychometric-test analyseson a sample of 209 diabetic patients, the questionnaire resulted in 16 questions. Cronbach’salphawas 0.89 after removing 4 items because of their low reliability. Inter-item correlations gave a mean value.of 0.34 (range: 0.06e0.74). The rotated solution showed a 3-factor structure (selfcare, footcare, and footwear and socks) that jointly accounted for 60.88% of thev ariance observed. The correlation between the questionnaire scores and HbA1c was significant and inverse, (r ¼ _0.15; p < 0.01). The findings show that the questionnaireis a valid and reliable tool for evaluating footself-care behavior in diabetic patients.

  • Diabetes research in Clinical Practice
Speaker
Biography:

Edyta Gendaszewska-Darmach is an Asissstant Professor at Faculty of Biotechnology and Food Sciences, Lodz University of Technology. She completed her PhD degree in Bioorganic Chemistry from Polish Academy of Sciences. Research involves anti-diabetic and wound healing properties of natural and modified biophosphates (nucleotides and lysophospholipids) as well as biomaterials for regenerative medicine.

Abstract:

Based on the results of research conducted recently, lysophosphatidylcholine (LPC) has been observed to be not only a structural component of cellular membranes but also a biologically active molecule influencing regulation of metabolic diseases, such as obesity and diabetes. Much attention has been paid to the fact that LPC causes an increase in glucose-stimulated insulin secretion from β pancreatic cells. To address the need of further characterization of various LPC species with regard to diversity of their structures as well as longer biological half-lives we have recently described the chemical synthesis of new sulfur analogues of LPC with well-defined fatty acid residues [1]. In order to prevent possible 1→2 acyl migration in LPC analogues, the oxygen atom in position 2 of glycerol was protected by methylation. A series of phosphorothioate and phosphorodithioate derivatives of 2-OMe-LPC bearing five different fatty acid residues both saturated (12:0, 14:0, 16:0, 18:0) and unsaturated (18:1) were prepared. Preliminary studies towards pancreatic βTC-3 cells proved that even a slight difference in chemical structure of a stimulus may result in significant changes in the exerted biological effects

Speaker
Biography:

MałgorzataZakłos-Szyda has completedher PhD studiesat Lodz University of Technology in the field of technical sciences (molecular biotechnology). She is the assistant professor in Faculty of Biotechnology and Food Sciences.

Abstract:

Epidemiological data indicate that diabetes is one of the main health problems of the world. Type 2 diabetes (T2D), which is usually a result of wrong dietary habits and reduced physical activity, represents 85-95% of all diabetes cases and among other diet-related diseases is the major cause of deaths. The disease is mainly associated with irregularities in the insulin secretion, attenuated insulin sensitivity and pancreatic beta cells dysfunction caused by multiple stimuli including glucotoxicity, lipotoxicity, proinflammatory cytokines, endoplasmatic reticulum stress and oxidative stress. Those factors lead to increased level of blood glucose concentration after food intake. Since polyphenols possess multiple biological activities and constitute an important part in human diet, they have recently emerged as critical phytochemicals in type 2 diabetes prevention and treatment. This study investigates polyphenolic extracts obtained from selected edible plants, which were screened in terms of protective activity against oxidative stress induced by tert-butylhydroperoxide (t-BOOH) in βTC3 pancreatic and HepG2 hepatic cells.These cell linesare commonly used as model targets for antidiabetic drugs.

Speaker
Biography:

Mercedes de Mirecki Garrido (Madrid, 1983). Degree in Marine Sciences(ULPGC), Masters in Animal Health and Food Safety (ULPGC), Ph.D.Clinical and Therapeutic research (ULPGC), European PhD from the University of Las Palmas de Gran Canaria (2014) with a thesis entitled Studies on estradiol,Growth hormone and Suppressor of Cytokine signaling-2, influences in hepatic metabolism. Currently she is working with the Department of Clinical Sciences at the University of Las Palmas de Gran Canaria and participateactively in the development of various research projects. During the last years she has publisheds everal research papers at national and international conferences and in specialized journals.

Abstract:

Currently there has been a rapid increase in the prevalence of diabetes and associated metabolic disorders. Identifying the molecular mechanisms responsible isessential to develop effective strategies. An insufficient number of insulin-producing β cells is a hallmark of both type 1 and type 2 diabetes. SOCS proteins are powerful inhibitors of pathways involved in survival and function of pancreatic β cells [1] also are potent regulators of pro-insulin processing and insulin secretion in β-cells. Moreover, constitutive production of SOCS2 in β-cells leads to hyperglycaemia and glucose intolerance [2]. It is the rationale to investigate, how SOCS2 ablation may influence the development of diabetes in a mice model of autoimmune diabetes and β-cell destruction (multiple low-dose of streptozotocin (MLD-STZ). To analyze SOCS2 glucose homeostatsis and metabolism, all diabetes development parameters were monitored, and both MLD-STZ-treated SOCS2-/- and WT mice developed severe diabetes after day 9 from injecting first dose of STZ. However, SOCS2−/− mice were more resistant to develop diabetes. Also our results suggest higher degree of insulin sensitivity with SOCS2 ablation. Moreover, we further observed higher fasting plasma insulin and the higher HOMA-IR in MLD-STZ- treated SOCS2-/- mice. Taken together, the results suggest that SOCS2 ablation seems to compensate β-cell destruction induced by MLD-STZ. The insulin immunostaining assays showed that SOCS2-/- pancreas have higher β-cell mass and bigger islets size than the control WT pancreas [3].These results seems to explain the augmented serum insulin levels observed in SOCS2-/-, also when treated with the STZ a destruction in the β-cell of the WT was observed, but some conserved structures could be find in the SOCS2-/-. In summary, this study identified SOCS2 as an important regulator of insulin homeostasis in vivo and suggests that inhibition of SOCS2 may be used as therapeutic target to ameliorate diabetes development.

Speaker
Biography:

Maria Grechnikova graduated from Lomonosov Moscow state university, Faculty of biology in 2013 and got a diploma with honour. Since then works for her PhD thesis in Laboratory of free radical oxidation biochemistry in Russian cardiology research and production complex studying the fundamental prosesses of atherosclerosis development ant its connection to other deseases. At the same time she learned bioinformatics and statistics in Moscow bioinformatic school. During this period she got some interesting results that are already published or going to be published after some additional work in near future.

Abstract:

Diabetes mellitus is a risk factor for the development of vascular diseases. Modification of low-density lipoproteins (LDL) plays an important role in atherosclerosis. Natural dicarbonyls formed in oxidative glucose metabolism in diabetes mellitus patients (predominantly glyoxal and methylglyoxal) or by oxidative stress in patients with atherosclerosis (malondialdehyde [MDA]), can probably modify LDL particles. Oxidative modification of LDL enhances their accumulation in vascular walls. Oxidized LDL level in blood plasma is higher in diabetes patients with decompensated carbohydrate metabolism in comparison with atherosclerosis patients, moreover, glucose stimulates free radical oxidation of LDL in vitro. Normalization of blood glucose level decreases oxidized LDL level. Aldehydes can travel across cell membrane and modify not only LDL, but also blood proteins, including erythrocytic enzymes. There is a decrease in superoxide dismutase (SOD) and glutathione peroxidase (GPx) activity in diabetes patients compared to the control group (age-matched patients without lipid or carbohydrate metabolic disturbances). Glucose-lowering therapy with sulfonylurea derivatives or metformin significantly increased erythrocyte Cu,Zn-SOD activity in diabetes patients. Metformin-treated patients had significantly higher levels of enzyme activity likely due to its enhanced utilization of methylglyoxal. All three dicarbonyl compounds rapidly changed the kinetic properties of GPx at physiological temperature and pH. The marked inhibition of antioxidant enzyme activity observed after incubation with dicarbonyls can result from modification of their amino and SH groups during interaction with the aldehyde groups. Based on these reactions, we hypothesized that there is a common mechanism underlying vascular wall damage in patients with atherosclerosis and type 2 diabetes mellitus.

Speaker
Biography:

Diana Isaacs, Pharm.D., BCPS, BC-ADM, CDE is a Clinical Associate Professor at Chicago State University College of Pharmacy (CSU-COP) and a clinical pharmacy specialist at the Edward Hines, Jr. VA Hospital. Dr. Isaacs earned her Bachelor’s degree in Chemistry from the University of Illinois at Chicago and her Doctor of Pharmacy degree from Southern Illinois University Edwardsville. Dr. Isaacs is a member of several pharmacy organizations and was honored with the Illinois Council of Health-System Pharmacists (ICHP) New Practitioner Leadership Award in 2014. She was also selected as the CSU-COP Teacher of the Year from 2012-2015 and Preceptor of the Year in 2014.

Abstract:

The prevalence of type 2 diabetes is increasing at an astounding rate. Many of the agents used to treat type 2 diabetes have undesirable adverse effects of hypoglycemia and weight gain. Glucagon-like peptide-1 (GLP-1) receptor agonists represent a unique approach to the treatment of diabetes, with benefits extending outside glucose control, including positive effects on weight, blood pressure, cholesterol levels, and beta-cell function. They mimic the effects of the incretin hormone GLP-1, which is released from the intestine in response to food intake. Their effects include increasing insulin secretion, decreasing glucagon release, increasing satiety, and slowing gastric emptying. There are currently four approved GLP-1 receptor agonists in the United States: exenatide, liraglutide, albiglutide, and dulaglutide. A fifth agent, lixisenatide, is available in Europe. There are important pharmacodynamic, pharmacokinetic, and clinical differences of each agent. The most common adverse effects seen with GLP-1 therapy include nausea, vomiting, and injection-site reactions. Other warnings and precautions include pancreatitis and thyroid cell carcinomas. GLP-1 receptor agonists are an innovative and effective option to improve blood glucose control, with other potential benefits of preserving beta-cell function, weight loss, and increasing insulin sensitivity. Once-weekly formulations may also improve patient adherence. Overall, these are effective agents for patients with type 2 diabetes, who are either uncontrolled on metformin or intolerant to metformin.

  • Advanced Technologies for Treatment of Diabetes
Speaker

Chair

Massimo Collino

University of Turin

Speaker
Biography:

David Grayson Marrero, PhD, is Director of the Diabetes Translational Research Center in Indianapolis, Indiana. He is the JO Ritchey Endowed Professor of Medicine at Indiana University School of Medicine. An expert in community-based diabetes prevention, he has published more than 300 papers in reputed journals. He is currently the President of Health Care and Education for the American Diabetes Association. In 2008, the American Diabetes Association named him Outstanding Educator in Diabetes and presented him with the Josiah K. Lilly Distinguished Service Award. In 2013, he also received the Outstanding Leadership in Population Health Award from the Care Continuum Alliance.

Abstract:

Objectives. In spite of solid evidence that risk for developing type 2 diabetes can be prevented by lifestyle interventions, it has been difficult to scale prevention research to address the growing public health demand. This study investigated if an already-scaled weight management program (Weight Watchers- WW) could achieve weight loss levels in persons with prediabetes that are Methods. An individual, randomized intervention trial evaluated the effects of the WW program in 225 persons with prediabetes on weight and metabolic regulation compared with a program developed by the National Diabetes Education Program at baseline, 6 and 12 months.
Results. Intervention participants lost significantly more weight than controls at 6 (5.6 % vs. 0.8%) and 12 months (5.6% vs. 0.1%); both p values < .0001). The intervention group also had significantly greater improvements in A1c and HDL than did controls.
Conclusion. These data suggest a scalable weight management program is effective for achieving lifestyle changes associated with diabetes prevention. Such scalable programs could significantly increase the availability of diabetes prevention programs worldwide making an immediate and significant public health impact.

Speaker
Biography:

Etheresia (Resia) Pretorius of the Department of Physiology, Faculty of Health Sciences, University of Pretoria is one of the Africa’s top women scientists, and she was the recipient of the African Union Kwame Nkrumah Scientific Awards Programme (Basic Science and Technology: African Women in Science), in 2011. Since 2000 she published/in press over 200 ISI rated research manuscripts. Her research has brought new insights into inflammation pathology and she has identified new methods that may be used in tracking disease progression. The majority of the afore-mentioned research has been published in high impact journals, including The Lancet (IF: 45.102) and FEMS

Abstract:

Type II diabetes causes an ever-increasing burden on healthcare. The prevalence for all age-groups worldwide was estimated to be 2.8% in 2000 and predicted to increase to 4.4% in 2030. Among adults in the US, the prevalence of undiagnosed diabetes is currently 4.1% and pre-diabetes a staggering 35.6%. Type II diabetes is associated with three main glycemic disorders that are chronic hyperglycemia; glycemic variability; and iatrogenic hypoglycemia and also comorbidities including dyslipidemia and hypertension. All of the above comorbidities are associated with hypercoagulability. Because type II diabetes is such an extensive health issue, we suggest that the answer to adequate treatment is based on an individualized patient-centered approach, in combination with the latest NIH precision medicine approach.A combination of viscoelastic methodologies may be used in a personalized patient-centered regime, including thromboelastography (TEG) and the lesser, used scanning electron microscopy approach (SEM). TEGis a dynamic measure of clot formation, strength and lyses, while SEM provides a visual structural tool to study patient fibrin structure in great detail. We therefore consider the evidence for TEG and SEM as a unique means to monitor type II diabetes treatment efficacy. TEG and SEM has potential to be a useful tool combination, and could potentially alter clinical approach to type II diabetes treatment. As envisaged in the NIH precision medicine approach, it will involve a lot of role players and innovative new research ideas; with this ultimate goal in mind, we suggest that an individualized patient-orientated approach is now already within our ability.

Speaker
Biography:

Abstract:

Background
Diabetes is a chronic metabolic disease with impaired glucose tolerance. Diabetic neuropathy affects sensory, autonomic, and motor neurons of the peripheral nervous system so that nearly every type of nerve fiber in the body is vulnerable.
Objectives
Evaluation of variation in motor functions and postural sway in patients with type 2 diabetes mellitus (DM) and comparing the results with those obtained from control group. This will help in rehabilitation programs for diabetic patients to avoid postural instability and risk of falling.
Methodology
Forty patients with the diagnosis of type 2 DM (group 1) participated in this study and twenty subjects who had no diagnosis of type 2 DM were evaluated as a control group (group 2). Blood glucose level of patients was measured then they referred to audio vestibular assessment. Computerized dynamic posturography (CDP)was done in form of motor control test and functional limitation assessment; Tandem walk
Results
Findings showed statistically significant difference between study group and control group as regards response latency, speed of the forward progression and endpoint sway velocity. A statistically significant correlation was found between response latency and speed of the forward progression with FBS level in study group.

Biography:

Paola Brusa Is Associate Professor in Pharmaceutical Technology, Socio-economics and Legislation at Pharmacy Dept., University of Turin . Since 2005 she is Vice President in A.P.P.A.®non profit association concerning the realization of Galenic labs in medical structures sited in Developing Countries. She is Director of Master in Community Pharmacy "Chiara Colombo" since 2010. She is Coordinator of the InterAthenaeum Project in Community Pharmacy since 2012. She has published more than 50 papers in reputed journals. She has presided as lecturer in many conferences.

Abstract:

The Inter-Athenaeum Project in Community Pharmacy aims to improve prevention and compliance for diabetes and other most common chronic diseases: heart failure, dyslipidemia, and chronic obstructive pulmonary disease (COPD). The project is coordinated by University of Turin, the RegionalAssociation of Pharmacy owners(Federfarma) the Orders of Pharmacists of Piedmont in cooperation with the Regional Epidemiology Unit. The first step of the Project is the pharmacist attendance of training courses, performed by specialists of each specific chronic disease. The second step of the Project is the development of specific programmes of prevention and compliance within the pharmacy setting. The prevention programmeis addressed to the healthy population with specific risk factors is aimed to the early identification of unknown risk factors or undiagnosed diseases. The compliance programmeis addressed to acclaimed patients and designed to evaluate adherence to therapy. The last step of the project is the pharmacoeconomic evaluation of both the programmes for each chronic disease, which will be discussed and evaluated in keeping with public health decision-makers. Preliminary results on the prevention and compliance programmes for diabetes performed by pharmacists show risk factor of getting the disease between 25-30% for citizens considered not sick and almost 30% of patients not adherent to the drug therapy. Overall, contact tools/survey/counseling may significantly contribute to increase diabetes and other chronic disease prevention by improving lifestyle and diet, mainly among elderly. They also may help to promote better patient adherence to therapy.

Biography:

Abstract:

Diabetes is a prevalent disease in the Middle East (ME) and constitutes a true healthcare problem. Within the ME, Lebanon comes in the 5th place, with a prevalence for Type 2 Diabetes (T2D) reaching 18.9%. According to “HAS”, Patient Therapeutic Education (PTE) is a complimentary and inseparable element which prevents further complications. ADA recommends introducing new technics for communication to improve patient knowledge and self-management. Based on these recommendations, this project aims to create new tools and methods for the PTE. These tools enhance the interactivity and provide clear and precise information. With this in mind, we created 14 tools corresponding to the “HAS” recommendations that our educator uses to complete the educative objectives of our patients. These tools have been validated by our expert panel of multidisciplinary team and 70 patients. The results were satisfactory for the patients and the team, with significant drop in HbA1C.

  • Emerging Focus in Diabetes Research
Speaker

Chair

Massimo Collino

University of Turin

Speaker
Biography:

Given Hapunda is a Lecturer and Researcher at the University of Zambia in the Department of Psychology. Given is a recipient of the International Society for the Study of Behavioral Development – Jacobs Foundation (ISSBD-JF) mentored fellowship. He is also currently the research and participatory monitoring and evaluation coordinator at the University of Zambia. His Research interests and publications cover topics such child and adolescent health, application of attachment theory, and applied cross-cultural psychology. He is also a member of numerous professional bodies including, the International Society for Pediatric and Adolescent Diabetes (ISPAD) and the International Diabetes Federation.

Abstract:

There is an increase in the incidence of diabetes in Sub-Saharan Africa and evidence of increased risk of several psychosocial problems including depression, anxiety, and distress among individuals with diabetes. However, few Sub-Saharan empirical studies have documented psychosocial issues affecting individuals living with diabetes. This presentation reviews results from 4 empirical studies from Zambia investigating psychosocial functioning and factors including stress, stress coping strategies, stigma, depression, diabetes specific emotional distress, diabetes self-care, quality of care and life in Zambianindividuals with diabetes mellitus. Key findings indicated that comorbid depression, emotional stress are common in patients with diabetes. These psychological issues seem to be compounded by poor stress coping strategies, poor quality of life and care in the patients. In order to improve the lives of patients, health care provision and self-care among patients must first be improved. Clinicians must identify, register and treat psychosocial issues affecting patients. Awareness and education on diabetes must be accelerated and medical care awareness amid tradition medicine in Sub-Saharan African countries must be improved. Policy makers, clinicians and others stakeholders must work together to improve health care and quality of life of patients.

Biography:

Abstract:

MATERIAL & METHODS. A cross-sectional study was performed in 310 patients with T2DM from the Diabetes Clinics of the Health Services of Hidalgo that belong to the Mutual Help Group (GAM, for its initials in Spanish). The patients were given the Diabetes Knowledge Questionnaire (DKQ 24); later a fasting blood glucose sample was taken and an interview (analysis of content) performed in order to identify their stage of grief. For data analysis descriptive statistics, the chi square test, and odds ratio were used.
RESULTS. Of the total,74.2% were women, 37.4% were illiterate and 27.1% had an elementary level education; mean age was 59 ± 11.3 years; 71.6% were housewives; the mean time of evolution of T2DM was 10.4 ± 6.8 years. The mean glycemic level was162.4 ± 74.5 mg/dl. The score of the DKQ 24 was basic knowledge 5.4 ± 1.9, glycemic control 5.4 ± 2.4, complications 7.1 ± .5 and global 5.9 ± 1.5. It was observed that 80.6% did not identify symptoms of hypoglycemia and 50.3% of hyperglycemia; 90.3% of patients did not know vasculopathy prevention measures. Those who were in acceptance managed to control their glycemic levels better than those who were in depression or denial (P<0.05). CONCLUSION. The level of knowledge of diabetic patients regarding their disease was low. These results suggest the importance of evaluating the subject content of the GAM, provide thanatologicalskills, therapeutics and clinics that allow patients to elaborate their grief and identify warning signs.

Speaker
Biography:

Samah DJEDDI received her high study degree in plant physiology from Annaba University (Algeria) in 1997, her Ph.D. degree in 2008 and her Algerian accreditation to supervise researche in 2010 from the same University. She got two postdoctoral scholarships (University of Athens, Greece and University of Granada, Spain), she is chairman of research project “Evaluation of the antimicrobial antidiabetic and cytotoxic activities of plant extracts Collected from Edough mountain (Eastern Algeria), code number: F01120130128". She is author of more than 21 articles, also she published five books. Actually she is an Associate Professor at the Biology department, Annaba University (Algeria).

Abstract:

Medicinal plants have been a source of a wide variety of biologically active compounds for many centuries. These plants have been used extensively, as crude material or after the extraction of their key active compounds, for treating various disease conditions. The present investigation was carried out to evaluate the antidiabetic effect of the Greek medicinal plant Pyracantha coccinea in alloxan induced diabetic rats. Blood glucose levels and body weights of control and diabetic rats were monitored. In the present study activities of liver enzymes (glucokinase, glucose -6- phosphatase and fructose -1- 6-diphosphatase) were also determined. Glucophage an antidiabetic oral drug was used as reference. Oral administration of methanolic extract (200 mg/kg body weight) for 30 days resulted in a significant decline in blood glucose from 340.20 to 145.0 mg/dl and significant recovery in body weight of diabetic rats. There was also a significant reduction in the activities of glucose-6-phosphatase and fructose-1-6-disphosphatase in liver. The study clearly shows that the methanolic extract of Pyracantha coccinea possesses potent antidiabetic activity.

Biography:

Abstract:

There is a debate on the function of mitochondrial uncoupling protein-2 in beta cells and its involvement in palmitate-induced impairment of glucose-stimulated insulin secretion. Some investigators suggested that uncoupling protein-2 is involved in this impairment while others denied its involvement. Based on the results of their studies, this controversy can be solved by hypothesizing that palmitate-induced impairment of glucose-stimulated insulin secretion occurs in two stages, early stage and late stage, depending on the integrity of electron supply and transport system through electron transport chain after palmitate treatment. Prolonged exposure of beta cells to palmitate can impair this system. Early stage impairment occurs due to uncoupling by uncoupling portein-2 when this system is still intact. When this system becomes impaired, late stage impairment occurs due to reduced ATP production independent of uncoupling by uncoupling protein-2. The change in glucose-stimulated oxygen uptake after palmitate treatment reflects the integrity of this system and can be used to differentiate between the two stages. Some beta-cell lines appear to be more resistant to palmitate-induced impairment of electron supply and transport system than others and therefore, early stage is prominent in the more resistant cell lines and less prominent in the less resistant cell lines.

  • Alternative Treatment for Diabetes
Speaker

Chair

Massimo Collino

University of Turin

Session Introduction

Fadia Doumani

Diabetes Education Consultant
Lebonan

Title: What Makes Diabetes Education Tools Effective on Treatment Outcome
Speaker
Biography:

Fadia Doumani holds a French BS Nursing, an MBA from Dauphine University, Certificates of Training the Trainers in Diabetes Therapeutic Education from DESG and Expert Trainer in Diabetes Conversation Map. She is one of the pioneers in Diabetes Education in the MENA region where she offered, since 1993, related services for the private & government sector. She developed & implemented National Diabetes Education programs, Train the Trainers manual, booklets & tools and conducted lectures & trained > 2500 professionals. She founded & managed: the Education Section at the only specialized center for T1 Diabetes in Lebanon; the WHO/National NCD Program -Diabetes Section (Lebanon); two Medical Education Departments at Roche Diabetes Care (MEA) and Lilly (NE & Gulf). Received Awards for having participated in the development and launch of "Managing Diabetes during Ramadan Conversation Map” IDF tool. Currently, Ms. Doumani acts as a consultant, she supports countries and healthcare settings in establishing, developing and implementing National Standards for Diabetes Education.

Abstract:

Nowadays, innovative therapies are constantly improving towards offering better diabetes treatment. Yet, with such a silent & multifactorial disease, diabetes management remains complex and the adherence to treatment, control & care very challenging. Education programs & tools encompass a combination of different Education models including individual and group sessions knowing that no preferred method was reported in the literature. As an example of a tool developed by IDF, the Diabetes Conversations Map® that includes a comprehensive curriculum through visuals, cards and guides; it supports an innovative patient-centered approach that enhance a real-world active dialogue, exchange and learning between participants and facilitators. Surveys conducted on participants in many countries showed improvement in their health behavior and HbA1c. Another example of a simple paper-based tool, the 36 00 View TM, used for blood glucose monitoring. Observational studies in Europe and the Middle East showed better understanding of the blood glucose numbers, better adaptation of the prescribed therapy and improvement in HbA1c. Cutting-edge education programs and tools are essential to educate people with diabetes and their surroundings; they offer a dynamic and interactive discovery-learning experience, motivating participants to improve their treatment outcome and ultimately quality of life. However, the effectiveness of these programs and tools relies heavily on the education structure, process and outcome, and on the pivotal role that Diabetes Self-Management Education Service & Support play in diabetes care.

Speaker
Biography:

Adejumo Olamide is a fresh graduate of Medicine and Surgery from the Olabisi Onabanjo University Teaching Hospital. He is Africa’s leading voice on prevention and care of diabetes and other related Non-Communicable Diseases on Social Media. A highly competent and determined individual. An emerging leader in the healthcare industry with a good negotiation and inter-personal skills, armed with a desire for effective change in healthcare of the People. He is the co-founder of the Nigeria Diabetes Online Community a Non Governmental Organization that aims at providing social peer support for people living with diabetes through adequate awareness, empowerment and care.

Abstract:

It is a unique study as it aims to relate the psychosocial effects of religion & culture with the awareness, knowledge and attitude of Nigerians regarding diabetes prevention and care in an urban setting in south-west Nigeria Our study population included a higher proportion of female respondents (65%), with the majority between 19 and 29 years old (56%). The majority were unemployed (67%) or in the teaching profession (24%). Over half (58%) of our respondents were Christian (C); while 41% were Muslim (M), and 1% were Traditional worshippers (TW). At least 25% of Nigerians believed that diabetes was due to witchcraft or a punishment from God. Specifically, 28% of respondents believed that diabetes was caused by an infection; this belief was more prevalent among Muslims compared to other religions (C vs. M vs. T: 33% vs. 66% vs. 1%). Also, 16% and 10% of respondents believed diabetes could be caused by witchcraft or by God, respectively; these beliefs were more prevalent among Christians compared to others (C vs. M vs. T: 84% vs. 14% vs. 2% and 63% vs. 34% vs. 3%, respectively). (P<0.0001) Nearly all (90%) of respondents believed that diabetes can kill; this belief was more prevalent among Christians compared to others (C vs. M vs. T: 60% vs. 39% vs. 1%) (P<0.0001). From our study we conclude that many respondent have inadequate knowledge about the causes of diabetes & its complications Future studies should attempt to improve knowledge about diabetes.

Speaker
Biography:

Adejumo Olamide is a fresh graduate of Medicine and Surgery from the Olabisi Onabanjo University Teaching Hospital. He is Africa’s leading voice on prevention and care of diabetes and other related Non-Communicable Diseases on Social Media. A highly competent and determined individual. An emerging leader in the healthcare industry with a good negotiation and inter-personal skills, armed with a desire for effective change in healthcare of the People. He is the co-founder of the Nigeria Diabetes Online Community a Non Governmental Organization that aims at providing social peer support for people living with diabetes through adequate awareness, empowerment and care.

Abstract:

It is a unique study as it aims to relate the psychosocial effects of religion & culture with the awareness, knowledge and attitude of Nigerians regarding diabetes prevention and care in an urban setting in south-west Nigeria Our study population included a higher proportion of female respondents (65%), with the majority between 19 and 29 years old (56%). The majority were unemployed (67%) or in the teaching profession (24%). Over half (58%) of our respondents were Christian (C); while 41% were Muslim (M), and 1% were Traditional worshippers (TW). At least 25% of Nigerians believed that diabetes was due to witchcraft or a punishment from God. Specifically, 28% of respondents believed that diabetes was caused by an infection; this belief was more prevalent among Muslims compared to other religions (C vs. M vs. T: 33% vs. 66% vs. 1%). Also, 16% and 10% of respondents believed diabetes could be caused by witchcraft or by God, respectively; these beliefs were more prevalent among Christians compared to others (C vs. M vs. T: 84% vs. 14% vs. 2% and 63% vs. 34% vs. 3%, respectively). (P<0.0001) Nearly all (90%) of respondents believed that diabetes can kill; this belief was more prevalent among Christians compared to others (C vs. M vs. T: 60% vs. 39% vs. 1%) (P<0.0001). From our study we conclude that many respondent have inadequate knowledge about the causes of diabetes & its complications Future studies should attempt to improve knowledge about diabetes.

  • Risk Factors and Related Diseases of Diabetes
Speaker

Chair

Emilio Herrera

Biography:

Abstract:

Background:
Several factors can predict the development of atrial fibrillation following cardiac surgery in diabetic patients. Nonetheless, the role of hemoglobin A1c is yet to be investigated. Methods:
We prospectively studied 708 type-2 diabetes patients (433 men [61.2%]), who were candidate for isolated coronary artery bypass grafting and met the study criteria. Biochemistry profile, including serum hemoglobin A1c was measured on the day of operation. All patients were telemonitored for 72 hours following operation for the occurrence of atrial fibrillation. The patients were then dichotomized at the hemoglobin A1c level of 8% and the frequency of atrial fibrillation, as well as demographic and clinical parameters were compared between the two groups. Results:
The mean age of the study population was 60.83±8.70 years. A total of 109 (15.3%) patients developed atrial fibrillation and in 274 (38.7%) patients hemoglobin A1c was below 8%. There was no significant difference between the two study groups regarding the frequency of atrial fibrillation (P=0.47). There was no statistically significant association between the level of hemoglobin A1c and the occurrence of postoperative atrial fibrillation controlling for age, hypertension, duration of diabetes, serum creatinine, and left atrial size (P=0.50). In the multivariable logistic regression model, age, hypertension, chronic obstructive pulmonary disease, serum creatinine, left atrial size, and full perfusion time were important predictors of atrial fibrillation. Conclusion:
In this study, the association between postoperative atrial fibrillation and the level of hemoglobin A1c was not statistically significant.

Biography:

Bodo Haas has completed his PhD at the age of 32 years from Department of Pharmacology at Ludwig-Maximilians-University Munich, Germany and postdoctoral studies from the Institute of Pharmacology and Toxicology at Rheinische Friedrich-Wilhelms-University Bonn, Germany. He is European Certified Toxicologist (ERT), non-clincial assessor and resereach group leader diabetes at the Federal Institute for Drugs and Medical Devices in Bonn, Germany. He has published more than 25 papers in reputed German and international journals, contributed to text books and has been serving as reviewer for scientific journals.

Abstract:

The anti-diabetic effects of glitazones, which are ligands at the transcription factor PPAR, appear in part to be mediated by inhibition of cyclin-dependent kinase 5 (CDK5)-mediated phosphorylation of PPARγ at Ser273 in adipocytes resulting in a positive anti-diabetic expression profile. Cytokines (adipokines) such as tumor necrosis factor  (TNF) have been shown to induce PPARγ Ser273 phosphorylation, thereby increasing the expression of pro-diabetic adipokines like monocyte chemotactic protein-1 (MCP-1). Here, we investigated whether the widely used sulfonylureas (SUs) glibenclamide and glimepiride alter phosphorylation of PPARγ at Ser273 in an in vitro phosphorylation assay, in human primary adipocytes in vitro and in adipose tissue in mice. In addition, the effects of SUs on adipocyte differentiation and changes in the anti-diabetic expression profile were examined by Real-time PCR. TNF induced PPARγ Ser273 phosphorylation in a time- and concentration-dependent manner in primary human adipocytes and in adipose tissue of TNF injected mice. Treatment of cells and mice with SUs, Rosiglitazone or the PPAR partial agonist SR1664 prior to TNF challenge resulted in a reduction of PPARγ Ser273 phosphorylation in vitro and in vivo. Furthermore, SU were able to block CDK5-mediated PPARγ phosphorylation in an in vitro phosphorylation assay. The alteration of the PPARγ phosphorylation state upon SU treatment was correlated with the reduced expression of pro-diabetic adipokines (e.g. MCP-1). Taken together, our data indicate that SU have anti-diabetic glitazone-like actions on human adipocytes in vitro and in vivo in mice by reducing PPARγ Ser273 phosphorylation resulting in a positive anti-diabetic expression profile.

Speaker
Biography:

Abstract:

Objective:
The purpose of this study was to assess the effect of increased calcium consumption on obesity prevention and control. Methods:
Thirty three women, low-calcium consumers (<800mg/day), aged 18-42 years, BMI 27.72 +1.14 kg/m² and body fat 42.61+1.03% participated in this 45 consecutive days (6 weeks), parallel design study. Subjects were randomly allocated in one of the experimental groups: low calcium (control (LC)) or high calcium (calcium citrate (CIT) or skim milk (SM)). Breakfast (LC:0mg of calcium/day, CIT and SM:~700mg/day) was consumed in the laboratory. Hypocaloric diets (-500kcal/day; 800mg of calcium/day (C) or 1500 mg of calcium/day (CIT and SM)) were prescribed. Fasting blood samples, body fat, anthropometric and biochemical parameters were assessed on days 1 and 45. Food intake was assessed in the first, third, and last weeks. Results:
There was a significant reduction in serum uric acid concentration in SM, and in ionized calcium in SM and CIT compared to C. Body fat (total, trunk, and android) and waist circumference significantly reduced in the SM group. Weight loss was 119% and 100% higher in the SM group compared to LD and CIT groups, respectively. Energy, macronutrients, and fiber intakes did not differ between-group.

Speaker
Biography:

Reza Yousefi is associated professor of Biochemistry in Biology Department of Shiraz University. He received his PhD by the end of 2004 in Biochemistry from the institute of Biochemistry and Biophysics (IBB) of the University of Tehran. In 2004 he has joined Department of Chemistry and Biochemistry of Bern University as a visiting scholar. During 2005-2008, he has participated in two post doctorate research programmers in Tehran University and in the National Institute for Agricultural Research (INRA) of Nantes, France. In 2009 he joined Shiraz University as assistant professor and established Protein Chemistry Laboratory (PCL) in the Biology Department. In 2014, he was appointed as the chair of scientific committee of the national conference on protein and peptide sciences in Iran. His research interest focuses on structure and function of proteins and peptides, as well as biological activity of organometallic complexes and nanomaterials.

Abstract:

The eye lens is composed of highly stable and long-lived proteins (α, β and γ-crystallins) which perform both structural and refractive functions. Due to their limited turnover during the life span, these proteins accumulate various modifications in their structures which finally attenuate their ability in the maintenance of lens transparency. In the current study, lens crystallins were chemically modified with peroxynitrite, different types of reducing sugar and ascorbic acid, as all of these chemical agents have been already indicated to contribute in the pathogenesis of cataract development. The different spectroscopic techniques and gel mobility shift assay were applied to investigate the structural feature, stability, aggregation/oligomerization and chaperone-like activity of lens proteins after these modifications. The concentration of peroxynitrite in the lenticular tissue can be significantly elevated during inflammation and in diabetic patients. Also, chronic hyperglycemia in eye lens results in formation of advanced glycation end products (AGEs) on lens crystallins and oxidative stress. Additionally, the cupper-catalyzed oxidation of ascorbic acid to dehydroascorbate which is known as a strong modifier of lens crystallins, plays a central role in pathology of cataract diseases during aging and in patients with diabetes mellitus. In the current work, as the structural and functional impacts of these modifications were evaluated on the lens crystallins, their pathomechanisms as the causative players in development of cataract diseases during ageing, inflammation and hyperglycemia are discussed.

Biography:

Alaa shaheen has graduated from mansoura university , worked at Kafr el-sharakwa medical centre

Abstract:

There is a debate on the function of mitochondrial uncoupling protein-2 in beta cells and its involvement in palmitate-induced impairment of glucose-stimulated insulin secretion. Some investigators suggested that uncoupling protein-2 is involved in this impairment while others denied its involvement. Based on the results of their studies, this controversy can be solved by hypothesizing that palmitate-induced impairment of glucose-stimulated insulin secretion occurs in two stages, early stage and late stage, depending on the integrity of electron supply and transport system through electron transport chain after palmitate treatment. Prolonged exposure of beta cells to palmitate can impair this system. Early stage impairment occurs due to uncoupling by uncoupling portein-2 when this system is still intact. When this system becomes impaired, late stage impairment occurs due to reduced ATP production independent of uncoupling by uncoupling protein-2. The change in glucose-stimulated oxygen uptake after palmitate treatment reflects the integrity of this system and can be used to differentiate between the two stages. Some beta-cell lines appear to be more resistant to palmitate-induced impairment of electron supply and transport system than others and therefore, early stage is prominent in the more resistant cell lines and less prominent in the less resistant cell lines.

Ijaola

Science Laboratory Technology Department
Nigeria

Title: Antidiabetic Effect of Ipomoea batatas in Normal and Alloxan-Induced diabetic rats
Biography:

Ijaola Taiwo O. is a PhD student of the Federal University of Agriculture Abeokuta, Nigeria. He is the Coordinator of Chemistry Unit, Department of Science Laboratory Technology, Moshood Abiola Polytechnic Abeokuta. He has published more than 6 papers in reputed journals and he is a Lecturer in the above-named school.

Abstract:

The hypoglycemic effects of graded quantities (200mg/kg, 300 mg/kg and 400mg/kg/day) of Ipomoea batatas leaf extracts at a dose of once daily for fourteen days on the blood glucose level of 20 rats whose glucose level exceeded 200mg/dl after alloxan induction were studied. Qualitative and quantitative analysis of phytochemical ingredients of Ipomoea batatas leaf were also carried out. Data obtained were subjected to Analysis of variance (ANOVA) with probability set at p<0.05. The results showed that oral treatment with 2ml of 200 mg/kg/day of Ipomoea batatas aqueous extract did not produce significant (p>0.05) alterations in the blood glucose concentration level when compared with basal value. Also, there was no significant difference (p>0.05) in the sugar level of rats treated with 300mg/kg/day and 400mg/kg/day of the extracts but the hypoglycemic effect significantly differ (p<0.05) from non-diabetic and rats treated with oral administration of 200mg/kg/day of Ipomoea batatas extracts. The highest percentage blood sugar reductions of 69.67% was recorded in rats treated with 300 mg/kg/day, followed by 59.24%( 400mg/kg/day extract) while the least percentage sugar reduction of 52.18% was observed in 200mg/kg/day extract. The non-diabetic induced rats exhibited steady increase (8.03%) in their normal glucose level. It was revealed that alloxan induced rats treated with 200mg/kg/day, 300mg/kg/day and 400mg/kg/day sustained percentage weight loss of 48.91, 28.66 and 31.11 percent respectively compared with non-diabetic induced rats. The qualitative phytochemical screening investigation of Ipomoea batatas indicated the presence of alkaloids, flavonoids, tannins, saponins, steroids, phenol, anthraquinone, Phlobatannin, Glycosides and terpenoids. Also, quantitative phytochemical study revealed that saponin (6.21) was the highest phytochemical content followed by tannin (4.15) while Glycoside was the least (0.40). In conclusion, 300mg/kg/day of the extract produced the best hypoglycemic effect (69.67%) in diabetic induced rats.

Biography:

Abstract:

Background:
Diabetic mellitus (DM) is a chronic disease characterized by high glucose levels, Lipoprotein abnormalities and Altered intermediary metabolism of major food substrates. In this study , we have investigated effects of green tea extract (GTE) on some blood profiles like: Serum glucose, hemoglobin A1C (HbA1C), Triglyceride (TG), low density cholesterol (LDL-c), high density cholesterol (HDL-C) and Total Cholesterol (TC) in Type 1 Diabetic Rats. Methods:
Diabetes was induced by injection of alloxan (45mg/kg) to male Wistar rats (180-220 g). Animals showing glucosuria more than 2% or blood glucose level (>140 mg/dl) 48 h after alloxan injection were selected for experiment. Sixty Animals divided into three groups (n=30) : diabetic group without green tea extract (GTE) and diabetic group with 100 mg/kg body weight GTE for eight weeks. The some blood profiles like: Serum glucose, HbA1C, TG, LDL-c, HDL-C and TC were measured before the experiment and by the end of period (8 weeks) in all groups. Results:
We did not find significant effects of consumption of green tea extract in decrease the levels of Serum glucose, hemoglobin A1C. TG, LDL-c and TC and increase HDL-C in compared with those of diabetic rats without GTE. Conclusion:
The results of this study did not Show beneficial effects of this dose of green tea extract on some blood factors of diabetes rats. There might be beneficial effects in use higher doses of GTE on some blood factors.

Speaker
Biography:

Samah DJEDDI received her high study degree in plant physiology from Annaba University (Algeria) in 1997, her Ph.D. degree in 2008 and her Algerian accreditation to supervise researche in 2010 from the same University. She got two postdoctoral scholarships (University of Athens, Greece and University of Granada, Spain), she is chairman of research project “Evaluation of the antimicrobial antidiabetic and cytotoxic activities of plant extracts Collected from Edough mountain (Eastern Algeria), code number: F01120130128". She is author of more than 21 articles, also she published five books. Actually she is an Associate Professor at the Biology department, Annaba University (Algeria).

Abstract:

Medicinal plants have been a source of a wide variety of biologically active compounds for many centuries. These plants have been used extensively, as crude material or after the extraction of their key active compounds, for treating various disease conditions. The present investigation was carried out to evaluate the antidiabetic effect of the Greek medicinal plant Pyracantha coccinea in alloxan induced diabetic rats. Blood glucose levels and body weights of control and diabetic rats were monitored. In the present study activities of liver enzymes (glucokinase, glucose -6- phosphatase and fructose -1- 6-diphosphatase) were also determined. Glucophage an antidiabetic oral drug was used as reference. Oral administration of methanolic extract (200 mg/kg body weight) for 30 days resulted in a significant decline in blood glucose from 340.20 to 145.0 mg/dl and significant recovery in body weight of diabetic rats. There was also a significant reduction in the activities of glucose-6-phosphatase and fructose-1-6-disphosphatase in liver. The study clearly shows that the methanolic extract of Pyracantha coccinea possesses potent antidiabetic activity.

Apeksha Niraula

Department of Biochemistry
Nepal

Title: Adenosine Deaminase Activity in Diabetes Mellitus
Biography:

Abstract:

Diabetes mellitus is a group of metabolic disorders of carbohydrate metabolism in which glucose is underused, producing hyperglycemia. It is a major worldwide health problem leading to increased mortality and serious morbidity.Adenosine Deaminase (ADA) is a polymorphic enzyme that catalyses the irreversible deamination of adenosine to inosine. ADA is considered as a good marker of the cell mediated immunity and it has been a established screening test for Tuberculosis.Literature suggests that the Serum ADA activity is significantly raised in patients with Type 2 DM .Diabetic patients are prone to opportunistic infection, thus serum ADA levels in these patients is very important as a screening test for Tuberculosis and autoimmune diseases. Objective:
To correlate the serum ADA level with HbA1c, Fasting and Postprandial Blood Glucose level in Patients with Diabetes Mellitus. Material and Methods:
This is a Hospital based cross-sectional study done in B.P.Koirala Institute of Health Sciences.150 diagnosed patients (72 males and 78 females) with DM was enrolled in the study from April 2014 to August 2014. Fasting,Postprandial and HbA1c blood sample was analysed in cobas c311.Serum ADA was done by Giusti method. Data were analysed using SPSS version 20, p value <0.05 was considered significant Results:
Mean age group in the study was 56 ± 11.95. Mean value of HbA1c,fasting and postprandial blood glucose and serum ADA level was 6.54 ± 2.49; 153.45 ±94.40, 239.56 ± 139.38 and 41.30 ± 19.99 respectively. Serum ADA level was significantly correlated with HbA1c levels (r= 0.426, p=0.0001), fasting blood glucose(r=0.297, p=0.0001) and Postprandial Blood Glucose(r=0.278, p value= 0.001). Conclusion:
There is a significant increase in Serum ADA activity in DM with increase in HbA1c levels which may play an important role in predicting the glycemic status in these patients.

  • 2, 3, 5 and 8
Location: Melia Meeting 8
Speaker

Chair

Sebastian Oltean

University of Bristol
UK

Speaker

Co-Chair

Massimo Collino

University of Turin
Italy

  • Track2: Genetics of Diabetes
    Track 3: Alternative Treatments for Diabetes
    Track 5: Diabetes Management
    Track 8: Diabetes Research in Clinical Practise
Location: Melia Meeting 8
Speaker

Chair

Sebastian Oltean

University of Bristol
UK

Speaker

Co-Chair

Massimo Collino

University of Turin
Italy

Speaker
Biography:

Edyta Gendaszewska-Darmach is an Asissstant Professor at Faculty of Biotechnology and Food Sciences, Lodz University of Technology. She completed her PhD degree in Bioorganic Chemistry from Polish Academy of Sciences. Her research involves anti-diabetic and wound healing properties of natural and modified biophosphates (nucleotides and lysophospholipids) as well as biomaterials for regenerative medicine.

Abstract:

Based on the results of research conducted recently, lysophosphatidylcholine (LPC) has been observed to be not only a structural component of cellular membranes but also a biologically active molecule influencing regulation of metabolic diseases, such as obesity and diabetes. Much attention has been paid to the fact that LPC causes an increase in glucose-stimulated insulin secretion from β pancreatic cells. To address the need of further characterization of various LPC species with regard to diversity of their structures as well as longer biological half-lives, we have recently described the chemical synthesis of new sulfur analogues of LPC with well-defined fatty acid residues. In order to prevent possible 1→2 acyl migration in LPC analogues, the oxygen atom in position 2 of glycerol was protected by methylation. A series of phosphorothioate and phosphorodithioate derivatives of 2-OMe-LPC bearing five different fatty acid residues both saturated (12:0, 14:0, 16:0, 18:0) and unsaturated (18:1) were prepared. Preliminary studies towards pancreatic βTC-3 cells proved that even a slight difference in chemical structure of a stimulus may result in significant changes in the exerted biological effects

Speaker
Biography:

Massimo Collino is Associate Professor of Pharmacology and Toxicology at the University of Turin (Italy) and Head of the Laboratory of Cardiovascular and Metabolic Pharmacology at the Department of Drug Science and Technology (University of Turin). He worked as Visiting Scientist at the William Harvey Research Institute, University of London (UK). His current research interests are the pathophysiology and the pharmacological therapy of diet-induced insulin resistance and the related cardiovascular risk factors mainly organ-related ischemic events. He has published more than 50 papers in reputed international journals and has been serving as an Editorial Board Member of several scientific journals.

Abstract:

The role of a low-grade, chronic inflammatory response in promoting cardiometabolic diseases (CMD) is well known. However, despite the recent publication of several documents and papers suggesting clinical and social interventions to prevent and benefit subjects afflicted with these co-morbidities, the identification of common mechanisms of disease and related innovative pharmacological strategies are far from clear. Most recent evidences suggest a substantial role for the NLRP3 inflammasome, a large multimeric danger-sensing platform that promotes autocatalytic activation of the cysteine protease caspase-1 and mediates the cleavage of inactive pro-IL-1beta, among other proteins, into its active form. In the last few years, our research team has significantly contributed to elucidate the effects of pharmacological modulation of NLRP3 inflammasome to reverse the detrimental consequences of the cardiometabolic inflammation. We have recently demonstrated that a fructose-enriched diet evokes upregulation of renal NLRP3 expression, which significantly contributes to the development of the diet-related renal dysfunction. Similarly, we documented a key role of NLRP3 inflammasome activation in hepatic lipotoxicity evoked by microparticles produced following hepatic cell exposure to high concentration of saturated fatty acid. We also demonstrated that chronic mice feeding with a high-fat high-fructose diet induces an up-regulation of Nlrp3 inflammasome complex within the heart and its expression was exacerbated by an ischemic event. Our results will be discussed in keeping with most recent literature data for a better understanding of the potential role of NLRP3 inflammasome as innovative pharmacological target for CMD.

Sebastian Oltean

University of Bristol
UK

Title: Therapeutic manipulation of splicing in diabetic nephropathy

Time : 12:45-13:10

Speaker
Biography:

Sebastian Oltean studied clinical medicine at “IuliuHatieganu” Medical School in Cluj- Napoca, Romania followed by training in Nephrology and Dialysis. He then moved to USA, where in 2004 obtained a PhD in Biochemistry from the University of Nebraska-Lincoln, followed by postdoctoral training at Duke University Medical Center, where he studied connections between alternative splicing regulation and disease. In 2008, he moved to University of Bristol (UK), where he is now a University research fellow and principal investigator. One of his main research themes is the understanding of therapeutic potential of targeting alternative splicing in diabetic nephropathy.

Abstract:

Diabetes is increasingly common in all regions of the world and diabetic complications represent an important burden on the health system. Though diabetic nephropathy (DN) is the main cause of end-stage renal failure in UK and worldwide, no specific treatment is yet available. Alternative splicing (AS) is one of the main determinant of proteomic diversity with more than 90% of genes being estimated to be alternative spliced in humans. In recent years a plethora of AS events have been described to be associated with specific diseases but their contribution to pathogenesis is very little understood. Several AS events have been described recently to be associated with diabetes and/or DN progression. We have focused so far on two splicing events connected with different pathogenic mechanisms in DN and related to VEGF (a promoter of increased permeability in the kidney and loss of protein in the urine) and FGFR2 (involved in epithelial-mesenchymal transitions, a major contributor to kidney fibrosis). Our data demonstrates that splicing isoforms may be manipulated in vivo to slow progression of DN and that splicing-sensitive fluorescent reporters designed to follow these particular AS events may be used as tools to investigate coordinated regulation of AS in DN. The ultimate goal of this work is to identify molecules (e.g splicing factors, kinases, signaling molecules) that are master regulators of this process and could represent attractive therapeutic targets.

Speaker
Biography:

Małgorzata Zakłos-Szyda has completed her PhD studies at Lodz University of Technology in Technical Sciences (Molecular Biotechnology). She is an Assistant Professor in Faculty of Biotechnology and Food Sciences.

Abstract:

Epidemiological data indicate that diabetes is one of the main health problems of the world. Type 2 diabetes (T2D) which is usually a result of wrong dietary habits and reduced physical activity, represents 85-95% of all diabetes cases and among other diet-related diseases is the major cause of deaths. The disease is mainly associated with irregularities in the insulin secretion, attenuated insulin sensitivity and pancreatic beta cells dysfunction caused by multiple stimuli including glucotoxicity, lipotoxicity, proinflammatory cytokines, endoplasmatic reticulum stress and oxidative stress. Those factors lead to increased level of blood glucose concentration after food intake. Since polyphenols possess multiple biological activities and constitute an important part in human diet, they have recently emerged as critical phytochemicals in type 2 diabetes prevention and treatment. This study investigates polyphenolic extracts obtained from selected edible plants, which were screened in terms of protective activity against oxidative stress induced by tert-butylhydroperoxide (t-BOOH) in βTC3 pancreatic and HepG2 hepatic cells. These cell lines are commonly used as model targets for antidiabetic drugs.

Speaker
Biography:

2012-present: Professor, Faculty of Medicine, Johannes Wolfgang Goethe Unicersity, Frankfurt am Main, Germany. 2006-12: Consultant, Laboratorio di Biologia Vascolare e Medicina Rigenerativa, Istituto Cardiologico Monzino, via, Pareo 4, 20138, Milano, Italy. 1996-12: Senior Investigator, Laboratorio di Patologia Vascolare, Istituto Dermopatico dell\'Immacolata, via dei Monti di Creta 104, 00167, Roma 1999-00: Associate Professor, McMaster University, Hamilton (ON), Canada 1995-96: Visiting Scientist, National Cancer Institute, NIH, Bethesda (MD), USA 1992-95: Postdoctoral fellow, Istituto Regina Elena, Roma, Italy 1989-91: Postdoctoral fellow, National Cancer Institute, NIH, Bethesda (MD), USA. 1984-88: Intern, Dipartimento di Immunologia, Univ. La Sapienza, Roma, Italy 1981-83: Intern, Dipartimento di Virologia, Univ. La Sapienza, Roma, Italy

Abstract:

Background:
The hyperglycemic/metabolic memory is clinically evident in patients in which glycaemic control is not beneficial on the progression of complications including cardiovascular accidents. This condition has been recently associated with altered epigenetic mechanisms and the presence of dysmetabolic pathways. The molecular mechanism underlying this process is still uncharacterized. Methods & Results:
Total genomic DNA was extracted from non-diabetic-cardiac fibroblast (ND-CF) and diabetic-CF (D-CF) and analysed for the global content of modified cytosines including 5 methyl-cytosine (5mC), 5 hydroxy-methyl-cytosine (5hmC), 5 formyl-cytosine (5fC) and 5 carboxy-cytosine (5caC) by colorimetric ELISAs. Remarkably, D-CFs, cultured between passage 4 and 8 since isolation, accumulated all types of modified cytosines compared to cells obtained from normoglycemic controls. Similar findings were observed in DNA samples obtained from the heart of streptozotocin-induced diabetic mice as well as in the Ins2 Akita mouse model of genetic insulin defect. RNA-seq experiments showed that human D-CFs have a reduced content of transcripts encoding for proteins involved in proliferation, DNA synthesis and packaging, chromosome organization and metabolic processes. Moreover, D-CFs showed a significant reduction in the number of mitochondria, in Isocitrate Deidrogenase 1-2 (IDH1, 2) activity and in α-Ketoglutarate (αKG) levels. The latter is an important cofactor for the regulation for ten-eleven-translocation (TET) demethylases. Treatment with exogenous αKG or a TET activator, such as vitamin C, rescued proliferation in D-CFs as consequence of an active demethylation process. Conclusion:
DNA demethylation machinery may be important during the onset of the hyperglycemic/metabolic memory. TET activators may represent a novel tool to treat diabetic complications and reduce cardiovascular risk.

Peter Decock

Cargill Research & Development Center
Belgium

Title: Dietary-induced health benefits beyond sugar replacement in people with type-2 diabetes

Time : 15:35-16:00

Speaker
Biography:

Peter Decock graduated as Food Technologist in 1979 at HAS University of Applied Sciences. He started as R&D Project Leader at General Mills and in 1985 became R&D Manager at OZF responsible for confectionary, fine bakery, chocolate and ice cream. In 1989, he moved to Gist-brocades (now DSM) as European Technology Manager to lead the development of new pastry and bread ingredients and monitor corporate R&D projects. He joined Cargill in 1992 as Deputy Manager of the European Food Application Centre. From 1995, he directed more than 10 years a multidisciplinary team to successfully launch erythritol on the global market. Since 2006, he leads Global Nutrition and Regulatory Affairs. The research he currently directs targets dietary and personal care solutions for improved oral and cardiovascular health.

Abstract:

Excessive intake of added sugars has been associated with health issues including diabetes. This has encouraged food scientists to reduce sugar in foods without compromising taste using calorie-reduced bulk sweeteners such as polyols. The newest polyol is erythritol (ERT), a white, crystalline powder with similar crystal appearance, density, and sweetness quality as sugar (sucrose). It is non-caloric, non-glycemic, non-insulinemic and non-cariogenic. Emerging evidence shows that ERT has health potential that goes beyond the mere replacement of sugar, especially in people with type-2 diabetes. Diabetes is characterized by hyperglycemia and development of vascular pathology. Endothelial cell (EC) dysfunction (ECD) is a starting point for pathogenesis of vascular complications in diabetes. We previously showed ERT to be a hydroxyl radical scavenger preventing ECD onset in diabetic rats. To better understand how ERT mediates this protective effect, ERT was studied in EC (HUVECs) exposed to diabetic stressors. Decreased viability of EC and increased oxidative damage resulting from such exposure were attenuated in the presence of ERT. Protective effects of ERT during hyperglycemia were confirmed and mechanistically expanded upon, with transcriptomics. A human pilot study in 24 subjects with type-2 diabetes consuming 36 g ERT daily as a lemon-flavored beverage for 28 days showed that acute consumption significantly improved microvascular endothelial function and chronic consumption reduced central pulse pressure and carotid-femoral pulse-wave velocity, both indicating favorable effects on aortic compliance. Chronic ERT consumption also reduced systolic blood pressure in 12 subjects with a blood pressure above the recommended goal of 130 mm Hg while no change was observed in normotensive subjects.

  • Track 1: Complications associated with diabetes
    Track 4: Advanced Technologies for Treatment of Diabetes
    Track 5: Diabetes Management
    Track 6: Emerging Focus in Diabetes Research
    Track 10: Risk Factors Related to Diabetes
Location: Melia Meeting 8
Speaker

Chair

Emilio Herrera

University San Pablo-CEU
Spain

Speaker

Co-Chair

Massimo Collino

University of Turin
Italy

Speaker
Biography:

Raffaella Mastrocola has completed her PhD in the 2005 from the University of Torino, Italy. She experienced 10 years of research activity on diabetic complications holding different positions in several departments of the University of Torino. She has published 33 full-length research articles in peer reviewed international journals and has attended as presenter at several international conferences. She is serving as reviewer for reputed journals and as editorial board member of Journal of Diabetes Research.

Abstract:

The worldwide epidemic rise in metabolic disorders is tightly linked to excessive dietary intake of saturated fat and sugars. Although Advanced Glycation End-Products (AGEs) are toxic compounds well-known for their roles in type 1 diabetes complications, recent studies indicate their diet-induced accumulation in several dysmetabolic conditions, as obesity, insulin resistance, and type 2 diabetes. Consistently, we have recently reported in different animal models of diet-induced metabolic disorders the associative link between AGEs and the dysregulated activation of the lipogenic transcription factor SREBP1c. In particular, we have evidenced a double mechanism by which carboxy methyllysine (CML), the most studied AGE, interferes on SREBP1c activation by the direct glycation of its activating protein SCAP and by the reduction of the SREBP1c inhibitor SIRT-1. As consequence of SREBP1c overactivation, a marked lipid deposition was found in liver and skeletal muscle of mice fed high-fat and high-sugar diets. In addition, recent studies highlighted new transcriptional roles for SREBP1c in the development of cell damage and metabolic impairment. Specifically, we analyzed in different target tissues of dysmetabolism, as liver, skeletal muscle and brain, the effect of SREBP1c overactivation on selective pathways involved in the regulation of antioxidant and inflammatory response and structural and metabolic adaptation. Finally, our most recent findings evidenced that the inhibition of CML production by the administration of the anti-glycative compound pyridoxamine to mice fed a high-fructose diet was able to prevent both SREBP1c activation and SREBP1c-depending signaling impairment.

Speaker
Biography:

Debora Nigro has completed her Bsc in 2012 at the University of Torino, Italy. She is now attending a PhD in Experimental Medicine and Therapy at the Department of Clinical and Biological Sciences. She works on the pathogenic mechanisms underlying diet-induce metabolic diseases and she is coauthor of 9 papers published in peer reviewed international journal.

Abstract:

Several studies indicate the involvement of advanced glycation end-products (AGEs) in neurodegenerative diseases. Moreover, the rising consumption of fructose in industrialized countries has been related to cognitive impairment, but the impact of fructose-derived AGEs on hippocampus has never been investigated. The present study aimed to evaluate in the hippocampus of C57Bl/6 mice fed a standard (SD) or a 60% fructose (HFRT) diet for 12 weeks the production of the most studied AGEs, carboxy methyllysine (CML), focusing on the role of the glutathione-dependent enzyme glyoxalase (Glo-1), the main AGEs-detoxifying system, and early signs of neuronal impairment. HFRT diet evoked CML accumulation in the cell body of pyramidal neurons, followed by RAGE/NFkB signaling activation. A widespread reactive gliosis and altered mitochondrial respiratory complexes activity have been evidenced in HFRT hippocampi, paralleled by oxidative stress increase due to impaired activity of Nrf2 signaling. In addition, a translocation of Glo-1 from axons toward cell body of pyramidal neurons has been observed in HFRT mice, in relation to CML accumulation. Despite increased expression of dimeric Glo-1, its enzymatic activity was not upregulated in HFRT hippocampi, due to reduced glutathione availability, thus failing to prevent CML accumulation. The prevention of CML production by administration of the specific inhibitor pyridoxamine was able to prevent all the fructose-induced hippocampal alterations. In conclusion, a high-fructose consumption, through CML accumulation, induces in the hippocampus the same molecular and metabolic alterations observed in early phases of neurodegenerative diseases, and can thus represent a risk factor for their onset.

Speaker
Biography:

Marco Parente has completed his University degree at the Department of “Scienza e Tecnologia del Farmaco” of the University of Turin. He is collaborating with the department on different projects. He won the award, “Young Pharmacist of the Year 2015” for the project “Quaderni del Master Chiara Colombo”. He is correlator of thesis of different topics with particular interest about diabetes food supplements and diabetes disease. He presided as Lecturer in different conferences.

Abstract:

The counselling of the community pharmacist may significantly contribute to improve patient’s compliance to the drug therapy, thus leading to an improvement in local healthcare and decrease costs. However, so far, this specific skill doesn’t provide an immediate economic fee. Very recently, pharmacists of the Piedmont region have been involved in the Inter-Athenaeum Project in Community Pharmacy, which aims to improve prevention and compliance for diabetes and other most common chronic diseases, including heart failure, dyslipidemia, and COPD. The project is based on the administration of questionnaires to pharmacy’s customers to evaluate prevention and patient compliance. The first step of the project is based on the attendance of specific training by pharmacists of the Piedmont Region. Focusing on the section of the project dealing with diabetes, we tried to answer to the following question: A management based on the training provided by the project and the new patient-centric approach can increase the earnings and inputs in pharmacy? The analysis has been performed comparing the 15 most effective pharmacies that have submitted more than 40 questionnaries/3 months, 46 that have submitted more than 15/3 months with the rest of the Piedmont. Our partial results show that most effective pharmacies had an increase in the number of inputs (22860 for the pharmacy that submitted more than 40 vs. 19124 to the medium of the Piedmont pharmacies) in the period between January and April 2015, but it is unclear whether there is also an increase in sales related to adherence to the project.

Biography:

Bodo Haas has completed his PhD from Department of Pharmacology at Ludwig-Maximilians-University Munich, Germany and Post-doctoral studies from the Institute of Pharmacology and Toxicology at Rheinische Friedrich-Wilhelms-University Bonn, Germany. He is European Certified Toxicologist (ERT), non-Clincial Assessor and research group Leader of Diabetes at the Federal Institute for Drugs and Medical Devices in Bonn, Germany. He has published more than 25 papers in reputed German and international journals, contributed to text books and has been serving as reviewer for scientific journals.

Abstract:

The anti-diabetic effects of glitazones, which are ligands at the transcription factor PPAR, appear in part to be mediated by inhibition of cyclin-dependent kinase 5 (CDK5)-mediated phosphorylation of PPARγ at Ser273 in adipocytes resulting in a positive anti-diabetic expression profile. Cytokines (adipokines) such as tumor necrosis factor  (TNF) have been shown to induce PPARγ Ser273 phosphorylation, thereby increasing the expression of pro-diabetic adipokines like monocyte chemotactic protein-1 (MCP-1). Here, we investigated whether the widely used sulfonylureas (SUs) glibenclamide and glimepiride alter phosphorylation of PPARγ at Ser273 in an in vitro phosphorylation assay, in human primary adipocytes in vitro and in adipose tissue in mice. In addition, the effects of SUs on adipocyte differentiation and changes in the anti-diabetic expression profile were examined by real-time PCR. TNF induced PPARγ Ser273 phosphorylation in a time- and concentration-dependent manner in primary human adipocytes and in adipose tissue of TNF injected mice. Treatment of cells and mice with SUs, Rosiglitazone or the PPARpartial agonist SR1664 prior to TNF challenge resulted in a reduction of PPARγ Ser273 phosphorylation in vitro and in vivo. Furthermore, SU were able to block CDK5-mediated PPARγ phosphorylation in an in vitro phosphorylation assay. The alteration of the PPARγ phosphorylation state upon SU treatment was correlated with the reduced expression of pro-diabetic adipokines (e.g. MCP-1). Taken together, our data indicate that SU have anti-diabetic glitazone-like actions on human adipocytes in vitro and in vivo in mice by reducing PPARγ Ser273 phosphorylation resulting in a positive anti-diabetic expression profile.

Speaker
Biography:

Maria Grechnikova graduated from Lomonosov Moscow State University, Faculty of Biology in 2013 and got a Diploma with Honour. She is working for her PhD thesis in Laboratory of Free Radical Oxidation, Biochemistry in Russian Cardiology Research and Production Complex studying the fundamental prosesses of atherosclerosis development ant its connection to other deseases. She learned Bioinformatics and Statistics in Moscow Bioinformatics School. During this period, she got some interesting results that are already published or going to be published after some additional work in near future.

Abstract:

Diabetes mellitus is a risk factor for the development of vascular diseases. Modification of low-density lipoproteins (LDL) plays an important role in atherosclerosis. Natural dicarbonyls formed in oxidative glucose metabolism in diabetes mellitus patients (predominantly glyoxal and methylglyoxal) or by oxidative stress in patients with atherosclerosis (malondialdehyde [MDA]), can probably modify LDL particles. Oxidative modification of LDL enhances their accumulation in vascular walls. Oxidized LDL level in blood plasma is higher in diabetes patients with decompensated carbohydrate metabolism in comparison with atherosclerosis patients, moreover, glucose stimulates free radical oxidation of LDL in vitro. Normalization of blood glucose level decreases oxidized LDL level. Aldehydes can travel across cell membrane and modify not only LDL, but also blood proteins, including erythrocytic enzymes. There is a decrease in superoxide dismutase (SOD) and glutathione peroxidase (GPx) activity in diabetes patients compared to the control group (age-matched patients without lipid or carbohydrate metabolic disturbances). Glucose-lowering therapy with sulfonylurea derivatives or metformin significantly increased erythrocyte Cu,Zn-SOD activity in diabetes patients. Metformin-treated patients had significantly higher levels of enzyme activity likely due to its enhanced utilization of methylglyoxal. All three dicarbonyl compounds rapidly changed the kinetic properties of GPx at physiological temperature and pH. The marked inhibition of antioxidant enzyme activity observed after incubation with dicarbonyls can result from modification of their amino and SH groups during interaction with the aldehyde groups. Based on these reactions, we hypothesized that there is a common mechanism underlying vascular wall damage in patients with atherosclerosis and type 2 diabetes mellitus.

Speaker
Biography:

Petteri Väisänen completed a BSc and is pursuing Biomedical Engineering as his major for MSc in Tampere University of Technology, Finland. He is the Data and Algorithm Specialist at Quattro Folia, a high-tech proactive self-care service provider to those who have chronic illnesses such as diabetes.

Abstract:

Background:
The measurement of HbA1c is one of the most well established means to monitor glycemic control in persons with diabetes. Typically HbA1c measurements are done 2-4 times per year, even though HbA1c levels can change substantially in 3-4 weeks. This ultimately leads unmonitored gaps. Therefore, we sought to define continuous HbA1c estimate (eA1c) to guide in day-to-day diabetes management. We present an adaptive method to calculate eA1c level using SMBG data and previous HbA1c measurements. Materials & Methods:
An estimation algorithm was constructed based on correlations between blood glucose distribution parameters and laboratory HbA1c measurements. The best linear combination of those parameters was applied to the model and individually updated scaling factors were introduced. The derived mathematical model was tested with 30 diabetic subjects. Retrospective analyze with leave-one-out cross-validation was used for model performance evaluation. Mean absolute relative deviation (MARD) of eA1c from reference HbA1c and eA1c-HbA1c correlation were calculated. Also, an error grid analysis was made. Results:
MARD was 6.17% and correlation between eA1c and reference HbA1c was strong (r=0.83). Error grid analysis showed that 82.55% of eA1c values were within 10% from reference HbA1c and 98.61% within 20% from reference. Conclusions:
Adaptive mathematical model was developed to calculate a continuous eA1c to each diabetic using their laboratory HbA1c and SMBG measurements. Results in this study show that algorithm is able to calculate eA1c reliably for diabetics with regular SMBG measurements, and algorithm works even with biased and irregular measurement patterns.

  • Track 7: Transplantation of Diabetes
    Track 9: Computational Biology of Diabetes
Location: Melia Meeting 8
Speaker

Chair

Massimo Collino

University of Turin

Biography:

Cesar Ruano I. Nieto is Senior Professor in the School of Medical Sciences of the Central University of Ecuador. He obtained the title of MD in the same Faculty and the degree of specialist in Internal Medicine at the Faculty of Medicine of the University of Guayaquil. He studied at the Faculty of Pharmacy of the University of Valencia and the Carlos III Institute. Active member of the Ecuadorian Society of Endocrinology. He has published more than 30 articles in Ecuadorian and foreign Journals. Editor of various scientific journals in Ecuador.

Abstract:

Introduction: There is evidence that obesity increases cardiovascular risk and metabolic syndrome (MS) in children, adolescents and adults. Inflammation plays an important role in the development of these diseases. Today, obesity in children and adolescents is a serious public health problem and appears to be the most important cause of insulin resistance, which makes them a risk group for developing metabolic syndrome.
Objective:
To determine the prevalence of metabolic syndrome and associated predisposition factors among students of the first three semesters from the school of Medicine, Faculty of Medical Sciences of the “Universidad Central Del Ecuador”.
Methods:
We included medical students from the first three semesters of the “Universidad Central Del Ecuador”. The students’ weight, height, blood pressure, waist circumference were measure and BMI were calculated. Furthermore, total cholesterol levels in serum, HDL cholesterol, LDL cholesterol, triglycerides, glucose, insulin, hsCRP, IL-6 were determined and the HOMA-IR was calculated. Results:
883 medical students were studied, with a mean age of 19.3±1.4 where 67% were female. The prevalence of MS was 8.2% (n= 73), 68% were women and 32% men. 29.3% of men presented pre obesity or obesity compared with 23.3% of women (p> 0.05). It was found that waist circumference was preferentially altered in women compared to men (52.3% vs 26.2%) (p <0.05). 39.7% of women had HDL levels below the normal values versus 18.2% in males (p <0.05). The values of total cholesterol, LDL cholesterol and glucose were within normal parameters. The blood pressure levels were above the normal range in men more than in women (24.4% vs 9.8%) (p <0.05). 19.4% of the total population presented hsCRP values between 1-3 mg / l and 7.4% between 3-9 mg / l. The 7.48% had altered levels of IL-6 (> 3.1 pg / ml) and was found a slight increase in students with overweight, obesity and MS. Insulin resistance was found in both groups, the one with normal BMI as well as in the overweight and obesity group, 15.3% and 14.4% respectively.
Conclusion:
The prevalence of metabolic syndrome was 8.2% and only 34% of the population presented no risk factors for MS. 1 out of 4 students presented some degree of overweight or obesity. A directly proportional relationship between the presence of risk factors and increased blood pressure was evident. Given the large number of individuals who have at least one risk factor, it is crucial to promote a healthy lifestyle that includes non-pharmacological interventions such as diet and exercise.Inflammation

Biography:

Akbar Shafiee is currently working in Tehran University of Medical Sciences, Iran.

Abstract:

Background:
Several factors can predict the development of atrial fibrillation following cardiac surgery in diabetic patients. Nonetheless, the role of hemoglobin A1c is yet to be investigated. Methods:
We prospectively studied 708 type-2 diabetes patients (433 men [61.2%]), who were candidate for isolated coronary artery bypass grafting and met the study criteria. Biochemistry profile, including serum hemoglobin A1c was measured on the day of operation. All patients were tele-monitored for 72 hours following operation for the occurrence of atrial fibrillation. The patients were then dichotomized at the hemoglobin A1c level of 8% and the frequency of atrial fibrillation, as well as demographic and clinical parameters were compared between the two groups. Results:
The mean age of the study population was 60.83±8.70 years. A total of 109 (15.3%) patients developed atrial fibrillation and in 274 (38.7%) patients hemoglobin A1c was below 8%. There was no significant difference between the two study groups regarding the frequency of atrial fibrillation (P=0.47). There was no statistically significant association between the level of hemoglobin A1c and the occurrence of postoperative atrial fibrillation controlling for age, hypertension, duration of diabetes, serum creatinine, and left atrial size (P=0.50). In the multivariable logistic regression model, age, hypertension, chronic obstructive pulmonary disease, serum creatinine, left atrial size, and full perfusion time were important predictors of atrial fibrillation. Conclusion:
In this study, the association between postoperative atrial fibrillation and the level of hemoglobin A1c was not statistically significant.

Biography:

Saleem Ali Banihani has completed his PhD in Clinical Bioanalytical Chemistry from Cleveland Clinic-Cleveland State University joint program. He is currently the Vice Dean of the Faculty of Applied Medical Sciences at Jordan University of Science and Technology, one of the top Universities in the middle east. He has published more than 17 articles in reputed journals in the fields of clinical nutrition and andrology.

Abstract:

Various reports have linked pomegranate (Punica granatum Linn) with diabetes prevention and treatment. However, before pomegranate or any of its fractions can be medically recommended for the management of diabetes, extensive clinical studies are still desired. This study measured the direct effect of fresh pomegranate juice on the level of fasting serum glucose, insulin, and melatonin in subjects with impaired fasting glucose (IFG). Blood samples from 28 participants with impaired fasting glucose were collected after at least 10 hrs fasting, then after 1 and 3 hours from the pomegranate juice administration at 1.5 mL per kg of the body weight. Serum glucose was measured by standard methods using the BS-200 Chemistry Analyzer, while a commercially available immunoassay kits were used to measure human insulin and melatonin. The results from this study observed lower fasting serum glucose levels as well as lower insulin resistance (P<0.05) among the IFG participants after 3 hours of pomegranate juice administration. This hypoglycemic response to pomegranate juice was not affected by the patient's gender and was found to decrease with age. On the other hand, pomegranate juice, after 1 hour of its consumption, was found to decrease the level of serum melatonin, while it increased the level of serum insulin among the tested population. These results offer some encouragement regarding the consumption of pomegranate juice by subjects with IFG.

Biography:

Soha Mohamed Hamada is working in Audiology department, Hearing and speech Institute in Egypt

Abstract:

Background: Diabetes is a chronic metabolic disease with impaired glucose tolerance. Diabetic neuropathy affects sensory, autonomic, and motor neurons of the peripheral nervous system so that nearly every type of nerve fiber in the body is vulnerable. Objectives: Evaluation of variation in motor functions and postural sway in patients with type 2 diabetes mellitus (DM) and comparing the results with those obtained from control group. This will help in rehabilitation programs for diabetic patients to avoid postural instability and risk of falling. Methodology: forty patients with the diagnosis of type 2 DM (group 1) participated in this study and twenty subjects who had no diagnosis of type 2 DM were evaluated as a control group (group 2). Blood glucose level of patients was measured then they referred to audiovestibular assessment. Computerized dynamic posturography (CDP)was done in form of motor control test and functional limitation assessment; Tandem walk Results: Findings showed statistically significant difference between study group and control group as regards response latency, speed of the forward progression and endpoint sway velocity. A statistically significant correlation was found between response latency and speed of the forward progression with FBS level in study group. Conclusions: Speed of the forward progression was less , however response latency and endpoint sway velocity were more in diabetic patients in comparing with normal subjects. Response latency and speed of the forward progression showed a statistically significant correlation with FBS level in diabetic patients.

Biography:

Lourdes Cristina Carrillo Alarcon is perusing her studies in Board of Health Hidalgo and Autonomous University oh Hidalgo Plis, Mexico

Abstract:

OBJECTIVE. To identify the level of knowledge of Type 2 Diabetes Mellitus (T2DM) in patients assigned to the of Diabetes clinics of the Health Services of the state of Hidalgo, Mexico and its relationship with the glycemic level and stage of grief according to Kübler-Ross. MATERIAL & METHODS. A cross-sectional study was performed in 310 patients with T2DM from the Diabetes Clinics of the Health Services of Hidalgo that belong to the Mutual Help Group (GAM, for its initials in Spanish). The patients were given the Diabetes Knowledge Questionnaire (DKQ 24); later a fasting blood glucose sample was taken and an interview (analysis of content) performed in order to identify their stage of grief. For data analysis descriptive statistics, the chi square test, and odds ratio were used. RESULTS. Of the total, 74.2% were women, 37.4% were illiterate and 27.1% had an elementary level education; mean age was 59 ± 11.3 years; 71.6% were housewives; the mean time of evolution of T2DM was 10.4 ± 6.8 years. The mean glycemic level was162.4 ± 74.5 mg/dl. The score of the DKQ 24 was basic knowledge 5.4 ± 1.9, glycemic control 5.4 ± 2.4, complications 7.1 ± .5 and global 5.9 ± 1.5. It was observed that 80.6% did not identify symptoms of hypoglycemia and 50.3% of hyperglycemia; 90.3% of patients did not know vasculopathy prevention measures. Those who were in acceptance managed to control their glycemic levels better than those who were in depression or denial (P <0.05). CONCLUSION. The level of knowledge of diabetic patients regarding their disease was low. These results suggest the importance of evaluating the subject content of the GAM, provide thanatological skills, therapeutics and clinics that allow patients to elaborate their grief and identify warning signs.