Day 1 :
National Center for Global Health and Medicine Kohnodai Hospital, Japan
Keynote: Clinical characteristics of Japanese patients with autoimmune polyglandular syndrome type 3a
Time : 10:30-11:10
Hidekatsu Yanai, MD, PhD, Fellow of American College of Physicians (FACP), is the Director of the Department of Internal Medicine and Clinical Research and Trial Center, National Center for Global Health and Medicine Kohnodai Hospital, Japan. He obtained his MD and PhD degrees in National Defense Medical College and Hokkaido University School of Medicine, respectively. He studied as Invited PhD Research Fellow in the National Institutes of Health (NIH), USA (2002-2004). He is the Editor-in-Chief of Journal of Endocrinology and Metabolism and also an Editorial Board Member of ten medical journals. He has 153 published papers in refereed medical journals.
Autoimmune polyglandular syndrome (APS) is an autoimmune disease that involves multiple organ failure. In APS type 3 (APS3), autoimmune thyroid disease occurs with other autoimmune diseases, but not with Addison disease. APS3a is defined as APS3 including autoimmune diabetes. The information about clinical backgrounds of APS3a is very limited. We retrospectively picked up and studied patients with type 1 diabetes and autoimmune diabetes, who showed the positivity for anti-glutamic acid decarboxylase antibody (anti-GAD ab) or anti-islet antigen 2 antibody (anti-IA2 ab) or anti-thyroglobulin antibody (anti-TG ab) or anti-thyroid peroxidase antibody (anti-TPO ab) or anti-thyroid stimulating hormone receptor antibody (anti-TR ab) between January 2010 and January 2016. Present study revealed a remarkable female predominance in APS3a. Among patients with autoimmune diabetes, slowly progressive insulin-dependent diabetes mellitus (SPIDDM) was the most common type of diabetes, and almost 80% of patients with APS3a showed the positivity for anti-GAD ab. Among patients with autoimmune thyroid diseases, almost 80% of patients had possible Hashimoto thyroiditis. Almost 70% of patients with APS3a showed the positivity for anti-TPO ab. Almost 20% of APS3a patients had possible Grave’s disease and 83% of patients with possible Grave’s disease showed overt Grave’s disease. In patients with possible Grave’s disease, the positive rate of anti-TR ab was 100%. In conclusion, we revealed clinical, endocrinological and immunological characteristics of patients with APS3a in Japan.
Lekhraj Diabetes Hospital & Medical College, India
Time : 11:30-12:10
L K Shankhdhar holds the credit of establishing North India’s first exclusive Diabetes Clinic in Lucknow, India, while heading a Medical College devoted to Diabetes education as Principal, Triply Post-graduate in Medicine (MD), Nutrition (PGDND) and Radiology (DMRE). He is the fourth Indian to receive Wockhardt-Harvard Medical Excellence Award and Visiting Fellowship of Harvard Medical International, the International Arm of Harvard Medical School (Boston). He has presented several abstracts and Faculty orations in many international conferences on Diabetes and Podiatry, besides chairing some international conferences. Currently, he is also reviewer of the journals of American Diabetes Association, namely Diabetes Care and Diabetes.
Type 2 Diabetes is generally regarded a chronic, progressive and incurable condition. This view is based upon UK Prospective Diabetes Study which displayed progressive deterioration of glycemic control with time, attributed to deterioration of beta cell function. Massive correction in glycemic control and even reversal to normal glycemia, just after bariatric surgery even before any substantial weight was lost, led to the conclusion that it was due to massive caloric curtailment, as is done before and after the surgery. The interesting work by Roy Taylor of Newcastle University, UK revealed that type 2 Diabetes is a potentially reversible metabolic state, precipitated by chronic excess intra organ fat accumulation in pancreatic beta cells, muscle cells and fat cells and hypocaloric diet is capable of reducing this fat accumulation with reversal of the process. His approach to offer very low caloric diet (VLCD) through special dietary package comprising of shakes and high fibre snacks appears impractical in routine practice so we decided to change our goals and attitude. We decided to aim at partial reversal of Diabetes, hence we offered moderately low caloric diet of 1000-1200 calories. To make the things still simpler, we guided the patients to half the dietary contents and add some functional foods to be consumed in between meals when they feel hungry. All our patients were OHA failed patients and were candidates for initiating Insulin therapy, which they were reluctant. We undertook measurements at baseline and at the end of the study i.e. three weeks, which included glycemic parameters, Weight, Blood Pressure, body fat% (BFP), lipid profile and HOMA-IR. Results were spectacular- All patients revealed betterment in glycmia, reduction in wt and BFP and HOMA- IR and betterment in BP and lipids. Need for Insulin ceased in 90% pts. Thus HALF DIET concept is an easy and prac tical approach to manage uncontrolled T2D patients.