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.
- Complications associated with diabetes|Genetics of DiabetesAdvanced Technologies for Treatment of Diabetes|Diabetes Management
Location: Kiel 1-3
Sun Yat-sen University, China
Cong Yi Wang
Huazhong University of Science & Technology, China
Flinders University, Australia
Title: Development of a hypertension management program for community-dwelling older people with diabetes in Nanchang, China: A Delphi study
Time : 12:10-12:45
Qiang Tu is currently enrolled as a full-time PhD student at Flinders University, Australia. This paper reports part of his PhD project entitled: “A nurse-coordinated hypertension management program for community-dwelling older people with diabetes in Nanchang, China: A cluster randomized controlled trial”. He has been engaged in caring for patients with chronic conditions since his undergraduate medical study. He has published a number of research articles in Chinese Journal prior to his PhD study. His PhD study is supervised by Prof. Lily Xiao, Prof. Jeff Fuller, Dr Huiyun Du and Dr Shahid Ullah.
Background: Hypertension is poorly controlled in older people with diabetes. China has a large number of older populations living with diabetes and hypertension, and yet an underdeveloped primary care system to manage the conditions effectively. Research evidence on hypertension management for this population is limited.
Aims: To gain health professionals’ consensus on the applicability of an evidence-based hypertension management program.
Methods: A comprehensive literature review was undertaken to develop an evidence-based hypertension management program for community-dwelling older people with diabetes. The program were stated in a questionnaire and distributed to health professionals in Nanchang who were specialized in the area of practice via Email. This Delphi study set out 75% and over agreement as the consensus rate.
Results: Main interventions in the questionnaire include health education, lifestyle modification, medication adherence and intensification and follow-up visit. These interventions are built on the collaboration of health professionals between hospitals and community health services centers (CHSCs). Seventy participants completed the study. Participants were doctors, nurses, pharmacists and dieticians and from hospitals and CHSCs. Of the 28 intervention statements, 22 achieved consensus in round one and the other 6 were modified with consensus achieved in round two. Modification of the interventions was based on participants’ comments and addressed how to share the planned interventions by health professionals based on their availability, accessibility and roles in the healthcare system.
Conclusion: An evidence-based hypertension management program for community-dwelling older people with diabetes built on cross-sector and inter-professional collaboration was viewed as applicable in Nanchang, China.
Aligarh Muslim University, India
Title: Molecular and culture based assessment of bacterial pathogens in subjects with diabetic foot ulcer
Time : 12:45-13:20
Saba Noor is a PhD scholar, working under the supervision of Professor Jamal Ahmad at Rajiv Gandhi Centre for Diabetes and Endocrinology, Faculty of Medicine, J N Medical College. She has completed her Masters and graduation in Biochemistry from Department of Biochemistry, Faculty of Life Sciences from the same university. She has published one original article and one review in peer-reviewed reputed international journals and presently working to improvise the diagnostic tools implemented in exploring microbial spectrum and immunological studies among diabetic foot patients.
Diabetic foot ulcerations (DFUs), a dreadful micro-vascular complication is responsible for substantial increase in morbidity and mortality. DFU is a complicated amalgam of, neuropathy, peripheral arterial diseases, foot deformities and infection. Spanning the spectrum from superficial cellulitis, microbial flora leads to chronic ostemyelitis and gangrenous extremity requiring surgical interventions and lower limb amputations. Though expeditious and precise discerning of bacterial pathogens is a fundamental grail, of clinical diagnostic microbiology but when conventional methodologies are implemented in identifying bacteria, interpretation of test results requires substantial slanted judgment. Therefore, genotypic detection is budding as substitute to known phenotypic culture based processes. Typically, genotypic identification of bacteria involves the use of conserved sequences within phylogenetically informative genetic targets. Also time required in conventional diagnosis delays the selection of antibiotic regime making and adversely affects the outcome. Therefore, we report a comparative evaluation of biochemical and genomic based assays for exploring the common bacterial flora in infected DFU patients along with clinical variables of subjects enrolled. The pathogens selected (i) Kleibseilla pneumonia, ii) Pseudomonas aeruginosa, iii) Escherichia coli and iv) Staphylococcus aureus , stood for the most frequent isolates of diabetic foot infection (DFIs) in previous studies from Northern India. Of 50 specimens obtained from infected DFUs, 74% of cases were affirmative by bacteriological assays and 95% showed positivity via PCR methodologies. Among processed samples 44 isolates were detectable through phenotypic analysis and 73 bacteria by species specific PCR. 13 samples and 19 isolates could not be scrutinized by phenotypic identification systems. The most prevalent pathogens identifiable by both assays were Klebseilla pneumonia, followed by Staphylococcus aureus, Pseudomonas aeruoginosa and Escherichia coli. We have shown that PCR based diagnostic methods improved the identification of common aerobic pathogens compared to conventional phenotypic methods. The outcome of this study expresses that polymerase chain reaction provides rapid, unambiguous identification of clinical bacterial isolates. The results highlight the incorporation of PCR technique in bacterial identification due to shorten turnaround time and may translate into improve clinical outcomes by early use of appropriate antibiotic along with other principles followed in diabetic foot management.
American University of Beirut, Lebanon
Title: Unfolding the novel role of SLC35b4 in glucose production and diabetes: Localization, expression, protien profiling and pathway analysis in HepG2 cells
Time : 14:30-15:05
Soha N Yazbek is an Assistant Professor of Genetics at the Medical Laboratory Sciences Program, AUB. She is trained in Basic Genetics and focuses on researching the genetic basis of complex multifactorial diseases (diabetes and non-communicable diseases). She also works to identify the research gap in non-communicable diseases in selected countries of the region. Recently, her research has focused on the genetic disease status and the genetic service response in Lebanon. She holds a PhD in Genetics from Case Western Reserve University, and MS in Molecular Biology from the Lebanese American University and a BS in Medical Laboratory Sciences at AUB.
Type II diabetes is one of the most common endocrine disorders. The cumulative action of genetic variants account for 10% of heritability. SLC35b4, a solute receptor associated with obesity, insulin resistance and gluconeogenesis, transports UDP-N-acetylglucosamine and UDP-Xylose. The correlation between expression and functionality and the mechanism of action have not been elucidated. This study aimed to investigate the regulation of protein expression and localization of SLC35b4. We also aimed at comparing differentially expressed proteins between a knockdown of SLC35b4 and controls in HepG2 cells in order to decode its implication in macromolecules glycosylation and sugar production. Responsiveness was assayed using western blot analysis and immunostaining. To identify the cytoplasmic compartment harboring SLC35b4, double immunofluorescence (SLC35b4-Golgi apparatus and endoplasmic reticulum) studies were performed. The subcellular localization was confirmed using a PLA technique (duo-link). 2D gel elctrophoresis and MALDI_TOF were used to identify differentialy expressed protiens. Pathway analysis was performed to understand the downstream effect of the gene knock-out. Results revealed SLC35b4 is increased up to 60% upon glucose stimulation. SLC35b4 localized with Golgi apparatus and to a lesser extent with the endoplasmic reticulum. The presence of SLC35b4 in the Golgi apparatus confirms its involvement in the biosynthesis of glycoconjugates proteins. Four proteins were under-expressed when SLC35b4 gene was knocked out (HSPD, HSPA8, TUBA1A, and ENO1), all of which are involved in pathways affecting glucose and insulin homeostasis.We suggest that SLC35b4 activation alters the glycosylation pattern inside the cells causing an improvement of the insulin ability to inhibit endogenous glucose production.
Tel Aviv University, Israel
Title: Diabetes is not a homogenous risk: The role of coronary calcium score in the reclassification of cardiovascular risk in diabetic patients
Time : 15:05-15:40
Joseph Shemesh is a full clinical Professor of cardiology at the Sackler School of medicine, Tel-Aviv University, Israel. He is a recognized investigator in the field of non-invasive detection of sub-clinical coronary atherosclerosis. As one of the pioneers in this field, he used in 1995 the Twin dual slice CT device which was the prototype of all the multi-slice CT devices and led the first publication that demonstrated the validity of coronary artery calcifications (CAC) measuring by mechanical CT. During the last 20 years he published over 50 original articles that contribute to the understanding of the clinical significance of CAC and its application to the daily clinical practice. In his recent publications he demonstrated the incremental prognostic value of CAC measuring in high risk populations including smokers, diabetics and hypertensive patients.
Coronary artery calcification (CAC) is the best surrogate marker of the total burden of coronary atherosclerosis. Its presence in asymptomatic subjects indicates sub-clinical disease and its quantity reflects the extent and the chronicity of the disease. CAC can be easily measured and reported by radiologists while reading chest CT. The presence or absence of CAC contributes to the reclassification of diabetic patients, pre-diabetics and those with metabolic syndrome as well. Prospective studies demonstrated that approximately one third of asymptomatic, middle aged, diabetic patients have no CAC detected indicating an excellent prognosis. In a meta-analysis of 8 studies that includes 6521 diabetics with a follow-up of 5.8 years, the presence of CAC is associates with a relative risk of 5.47 for all cause mortality or CV events and 9.22 for fatal and non fatal CV events. The recently published MESA CHD risk score is the first available algorithm incorporating CAC with traditional risk factors for 10-year risk prediction. For example in a 60 years old diabetic Caucasian male without CAC, the estimated 10-year MESA score risk of CHD event including the CAC score=0 is reduced to 3.5% compared to 9.3% if one did not factor in his CAC score. In summary, CAC reflects the atherosclerosis sequelae of the individual long-life global exposure to all the risk and protecting factors. It contributes to reclassify risk in diabetic patients and may improve individualized treatment.
Mersin University, Turkey
Time : 15:40-16:15
Mualla Yilmaz completed her PhD in Psychiatric Nursing at Marmara University Institute of Health Sciences in 2007. She started working as an Assistant Professor at Mersin University School of Health in 2009 and became an Associate Professor in 2014. She holds the post of head of the department of Psychiatric Nursing and deputy director of Mersin University School of Health and she has published many articles in international and national journals. Her main area of research is Consultation-Liaison Psychiatry Nursing. She is currently conducting studies on psychosocial problems of chronic diseases (e.g. diabetes, kidney failure, heart failure).
Background: Diabetes mellitus (DM) is a complex and chronic disease with multiple complications leading to increased mortality and poor quality of life. How the disease is perceived by the individual, the meaning of the disease, illness and treatment compliance, and psychosocial difficulties are some of the issues that need to be addressed. Mental, emotional, social and psychosexual problems and conflicts arise because this is a lifelong disease and requires a continuous controlled lifestyle.
Aim: The aim of this study was to determine what it means for patients to live with diabetes, to reveal patients’ feelings, thoughts and wishes, and to examine their perspectives and coping strategies regarding the disease.
Method: The study population consisted of all the patients treated for Type II DM at the Department of Endocrinology at a University Hospital (N=350). The sample consisted of 37 patients meeting the inclusion criteria in the study. Data were collected by asking the participants a total of three questions in the individual in-depth interview form. After transcribing the recorded interviews, the transcripts were combined with observation notes and then raw data were transferred to computer. Finally, a content analysis was performed.
Results: Out of the patients in the study, 50% were female, 80% were married and the mean age was 57 years. Three main themes with 10 subthemes emerged from the content analysis: “Experiences during the Diagnosis Stage”, Experiences after Diabetes Diagnose”, and “Management of and Coping with Diabetes”. The results showed that diabetes adversely affected the participants’ lives; they experienced mental, physical and social problems related to the illness; and they exhibited a fatalistic approach feeling convinced that everything comes from God and feeling thankful in coping with these problems. Also, after being diagnosed with diabetes, more than half of the participants rearranged their lives by doing exercise, going for a walk, paying particular attention to nutrition and diet, visiting their doctors, and regularly checking their blood sugar.
Conclusion: In the management of diabetes, patients can adapt to the disease by expressing their emotions and thoughts and by realizing the meaning of life with the disease. Nurses have extremely important responsibilities in this process.
Kyung Yul Hur, is Professor and chief of General Surgery at Soonchunhyang University hospital, Seoul, Korea. He graduate Soonchunhyang University, school of medicine at 1984.
And then god degree of master, doctor at the same university. Now he is hepatobiliary and pancreatic surgeon among the various surgical field. He has lot of experiences with the liver and pancreas surgery such as major hepatectomy and pancreatico-duodenectomies and invented many innovative expedient technique for procedure.
He also has great interest in developing new technology and procedure. During his staying in the United States of America from 1999 to 2000, he focused and spent all of the time to the laparoscopic surgery. He stamped to the pioneer of laparoscopic surgical field in Korea. He adopted laparoscopic TEP hernia repair in Korea, and 1st surgeon who performed gastric bypass to deal with metabolic issues.
The most potent therapeutic modality for type 2 diabetes is rerouting of food passage or restriction of food intake by surgery. But, the Achilles heel of surgery is surgical risk itself. So far, aggressiveness and morbidity were excusable in surgical treatment because it was final modality for most cases. But, in metabolic & bariatric surgery, it’s just the beginning of treatment. We need to carefully weigh the pros and cons before surgical intervention. Recently, we have found acceptable operative procedure for cure of diabetes. Before discussing about the mechanism of surgery, it would be better to open our published data for better understanding. The numbers of patients who have been followed up for more than 5 years were 60. Among them, 37 patients were analyzed. Outcomes of preoperative, post-operative 1st year and 4th year follow-up were included. The HbA1C, HOMA-IR, Matsuda index and acute insulin response were analyzed to evaluate blood glucose control, insulin resistance, insulin sensitivity and pancreatic beta cell function. Perioperative incretin changes were evaluated in 12 non-obese subjects to compare at before the surgery and 1 month after by ELISA. Preoperatively, mean age was 48, BMI was 24.5 and HbA1C level was 9.1%. 30 patients (81%) have shown decreased HbA1C lower than 6.9% during the follow up. HbA1C decreased continuously after the surgery. HOMA-IR decreased at first year after the surgery and then increased within the acceptable range. Interestingly, insulin sensitivity, which is represented by Matsuda index, sharply increased at first year and then recovered. The major cause of type 2 diabetes in East Asia has been thought to be impaired insulin secretion rather than increased insulin resistance. Modulation of gastric emptying in response to signal from small intestine prevents dumping syndrome, marginal ulcer, diarrhea, bile reflux to stomach and so forth. But, care should be taken to pyloric preservation. Meticulous analysis of published data for duodeno-jejunal bypass, anti-diabetic effect of surgery is extremely inconstant between paper to paper. Subtle difference between two groups was whether preservation or exclusion of pyloric ring. In other word, completeness of duodenal mucosal exclusion is possible determinant. Incomplete exculsion of duodenal tissue is directly connected with recurrence of hyperglycemia. Unique pattern of mucosal regeneration is key element of recurrence. Intestinal mucosa is replaced with its progeny adjourn to another villi within 5 days. Anastomosed jejunal epithelium becoming duodenal epithelium will be a reasonable thesis. Best design of rerouting is preservation of pyloric digestive function simulaneously complete exclusion of duodenal mucosa. he pyloro-enteric anastomosis technique guarantees both anti-diabetic effect and functional preservation. Incretin secreting entero-endocrine cells never found in pyloric ring covered with gastric mucosa. Guarantee of anastomosis safety by 5cm epigasrtic incision with extracorporeal hand-sewing is another benefit. Result is more than better for 7 patients underwent single anastomosis pyloro-enterostomy. Long-term follow up for effectiveness and safety is mandatory.
The University of Hull, UK
Title: Exploring perception of type 2 diabetes and self-management among black Africans: A systematic literature review
Time : 17:15-17:50
Love Onuorah is currently a PhD student at University of Hull, UK. She is researching on type-2 diabetes and ethnic minority groups. Upon completing her first degree in nursing, she worked with end stage renal patients as a dialysis nurse for some years where her interest in diabetes grow, before going to Anglia Ruskin University for her MSN.
Diabetes and its complications disproportionately affect ethnic minority groups. It is estimated to be the fifth leading cause of death in the U.K., with about 10% of the NHS annual budget used for its treatment. Despite the various educational programs to enhance self-management, the outcome remains poor. Adequate plans and policies informed by findings from assessing the views of the population at high risk is needed for desirable outcome. There is a gap in literature on the views and knowledge of diabetes for the high risk black Africans. Studies indicate that perceptions or knowledge about health and illnesses influence behaviors and attitudes towards health conditions like diabetes. Hence, programs for diabetes prevention and self-management should be based on findings from exploring individual or groups’ perceptions. This systematic review explores the views and knowledge about this disease and its impact on self-management among black Africans. Key data bases were systematically searched and the papers that met the strict inclusion criteria were selected. Primary empirical studies, written in English language, assessing perception (and its synonyms) and self-management in blacks, black Africans, African-Caribbean and African-Americans were included. Selected studies were assessed for Methodological quality using the McMaster framework, and the studies were extracted under relevant headings. Data were analyzed using thematic analysis to identify the different emergent themes. Findings on how black Africans perceive or understand type-2 diabetes and how that influences its management will be presented.