18^th European Diabetes Congress July 17-18, 2017 Lisbon, Portugal

Biography:

Hidekatsu Yanai is a 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 was an Invited PhD Research Fellow at the National Institute of Health (NIH), USA. He is the Editor-in-Chief of Journal of Endocrinology and Metabolism and also an Editorial Board Member of ten medical journals. He has 168 published papers in reputed medical journals.

Abstract:

The new drug for type 2 diabetes, the sodium-glucose co-transporter 2 inhibitors (SGLT2i), leads to reduction of renal tubular glucose reabsorption and reduction of plasma glucose, in an insulin-independent manner. For the treatment of diabetes, in addition to glucose control, the management of coronary risk factors is crucial. First, the author searched for the published articles about the possible anti-atherosclerotic effects beyond glucose lowering of SGLT2i, by using PubMed, and found that SGLT2i are proved to be significantly associated with weight loss and reduction of blood pressure by a relatively large number of studies. Second, we retrospectively picked up patients who had been continuously prescribed SGLT2i by a chart-based analysis, and compared the data before the SGLT2i treatment with the data at 1, 2, 3 and 6 months after the SGLT2i treatment started, and found that SGLT2i significantly reduced HbA1c and body weight and improved liver function. Further, the author found a significant difference in hypoglycemic effect between canagliflozin with a low potency to inhibit SGLT1 and tofogliflozin which is a highly selective SGLT2 inhibitor. As the key to resolve this issue, a different distribution between SGLT1 (intestine) and SGLT2 (kidney) came to my mind. SGLT2i with potency to inhibit SGLT1 may be more effective to lower glucose as compared with highly selective SGLT2i, in patients with renal insufficiency. To understand an influence of the estimated glomerular filtration rate (eGFR) on improvement in metabolic parameters by SGLT2i, we sub-analyzed our study and discovered that body weight decreased by SGLT2i, independently of eGFR, however, the changes in HbA1c and liver function depended on eGFR. Recently, Sano reported that elevation of hematocrit by SGLT2i may be a surrogate marker for recovery from reversible tubulointerstitial injury; it was found that erythropoietin could be one of renoprotective effects of SGLT2i.

Biography:

Guido Lastra is specialist in Internal Medicine and Endocrinology. He is a research-oriented assistant professor at the University of Missouri in Columbia. His area of interest is the pathogenesis of chronic over-nutrition induced insulin resistance and cardiovascular disease. He is focused on studying the role of the mineralocorticoid receptor in the development of insulin resistance-mediated vascular dysfunction. In particular, he is actively exploring the interactions between inflammation and mineralocorticoid receptor activation that lead to vascular stiffness. Dr. Lastra has presented his research in several prestigious International conferences, including the International Aldosterone Conference, the Endocrine Society Meeting, and the American Heart association (High Blood Pressure Council) Meeting. Dr. Lastra has more than 50 publications in peer-reviewed journals, frequently as first author, in prestigious journals including, Diabetes, Endocrinology, Hypertension, and the American Journal of Physiology (AJP). He has served as reviewer for important journals, including Diabetes, Diabetes Care, and the Lancet. 

Abstract:

Obesity is a leading risk factor for the development of type 2 diabetes mellitus (DM2) and cardiovascular disease (CVD), however the underlying mechanisms still remain to be fully uncovered. It is now well accepted that dysfunctional adipose tissue in conditions of obesity is a critical source of inflammation that impacts the cardiovascular system and contributes to CVD. Although traditionally visceral adipose tissue has been linked to increased CVD risk, there is mounting interest in the role that fat accumulation around the vasculature plays in the pathogenesis of vascular dysfunction. Perivascular adipose tissue – PVAT- is in intimate contact with large, medium and small diameter arterial beds in several tissues, and has been shown to control vascular function as well as remodeling. PVAT does not merely mirror visceral adipose tissue changes seen in obesity, but has unique features that impact vascular biology. In lean individuals PVAT exerts vasodilatory and anti-inflammatory functions, however obesity results in PVAT inflammation, characterized by imbalance between pro and anti- inflammatory cells as wells as adipokines. PVAT inflammation promotes insulin resistance in the vasculature, thus resulting in impaired insulin-mediated vasodilatory responses and vascular remodeling. In this review we address current knowledge about the mechanisms that link PVAT inflammation to insulin resistance and vascular dysfunction. Indeed, PVAT emerges as a novel type of adipose tissue that participates in the pathogenesis of CVD, independently to a large extent to visceral adipose tissue.

Biography:

Irina Kurnikova is a Professor of Medicine, RUDN University (Peoples Friendship University of Russia), Russia. She has done her PhD in 2010. She has dealt with the problems of endocrinology for more than 20 years. She had led a course of Endocrinology at the Medical Academy (Izhevsk, Russia), Endocrinology department of Russian Scientific Center of Medical Rehabilitation and Health Resort, Russia. Currently, she teaches at Peoples' Friendship University of Russia, Curator of the Scientific Direction of Endocrinology. She has published more than 20 articles in well-known journals, and is the author of 25 books and manuals in Russian.

Abstract:

Statement of the Problem: Three systems provide the physiological functioning and interaction with the environment: Autonomic nervous regulation, endocrine-metabolic system and immune system. The most operational system of autonomic regulation, the level of functioning of which varies with age and systemic disorders inside the body. The purpose of this study is to assess the impact of diabetes mellitus on mechanisms of autonomic regulatory in different age groups.

Methodology & Theoretical Orientation: 101 people were divided in four age groups: 20-30 years, 31-40 years, 41-50 years and 51-60 years of age. All patients were evaluated based on autonomic regulation by the method of spectral analysis of daily variability of the heart rhythm power spectrum of oscillation in three frequency bands: 0.004-0.08 Hz (very low frequency – VLF), 0.09-0.16 Hz (low frequency – LF) and 0.17-0.5 Hz (high frequency – HF). The selection of three frequency ranges is due to differences in their formation. The low frequency range reflects the activity of the sympathetic system on the segmental level, the high-frequency range, the activity of parasympathetic nervous system at the segmental level.

Findings: Patients with diabetes at the age of 30-40 years we have seen a decrease in parasympathetic activity, which is more typical for patients the next decade of life. Since the age of 41, there was considerable centralization on mechanism of regulation (increase VLF), which usually starts 10-15 years later. The decrease in the total power spectrum on the background of inadequate compensator of diabetes showed decrease of reserve opportunities of the organism.

Conclusion & Significance: An important cause of early atherosclerosis in patients with diabetes is, in addition to endothelial dysfunction, syndrome of “early aging of regulatory system” (the reason - autonomic neuropathy). The status autonomic regulation in the current decade corresponds next age decade of the patient, which leads to increased comorbidities and increased cardiovascular risk.

Biography:

Bandar Manawer Al Harbi, Assistant Director of Pharmacy for Material Management, Prince Sultan Military Medical City, (PSMMC).

Abstract:

Prediabetes describes a condition whereby an individual’s level of blood glucose is above normal level, though not high enough to warrant them a T2D diagnosis. The condition is classified into two categories; impaired glucose tolerance (IGT) where blood glucose levels are above the normal 2 hours after glucose loading in the oral glucose tolerance test but not so high to warrant the classification as diabetes. The other is impaired fasting glucose (IFG) where blood glucose have risen to a fasting state but yet again, not so high to warrant the classification as diabetes. Physical exercise improves BG homeostasis but the extent to which exercise is effective strategy as primary prevention mechanism for people whom at risk to develop diabetes is not fully understood.

Purpose: To examine the effects of 6-weekes moderate-intensity combined aerobic and resistance exercise program in preventing or delaying the onset of diabetes for subjects at risk compared to sedentary non-diabetic individuals. Methods:  20 subjects of a sedentary lifestyle, diagnosed with either prediabetes or at risk to developed T2D (PRE-D) and 5 Subjects were sedentary healthy individuals (ND) met the inclusion criteria. Both PRE-D and ND have been asked to complete 6-weeks of moderate-intensity combined aerobic and resistance exercise for 60 minutes on two days/week. Each exercise session consists of a combined exercise protocol of 30 minutes of resistance exercise (3 sets of 10 repetitions) followed by 20 min cycling. The primary outcome is to concentrate on metabolic results, such as improved HbA1c, blood pressure, heart rate, 1-repition max, lipid profile (reduction in Total Cholesterol, Low Density Lipoproteins, Triglycerides or increase High Density Lipoproteins) and improvements in insulin sensitivity determined by responses to oral glucose tolerance tests on independent days.

Biography:

Mehdi Khalfallah has completed his Medical studies from Faculty of Medicine of Tunis, Tunisia. He is an Assistant Professor in Surgery at Charles Nicolle’s Hospital since 2012. He is an Editorial Board Member and Drafting Committee Member of “la Tunisie Médicale” (indexed in PubMed, impact factor=0.3). He has published more than 15 papers in reputed journals.

Abstract:

Background & Aim: Identifying the infecting bacterial flora is one of the main rules to be followed to ensure the success of antibiotherapy in the treatment of the infected diabetic foot. The aim of the work was to define the bacteriological profile of the bacteria causing the infection of the diabetic foot at the Surgery Unit B of Charles Nicolle’s Hospital in Tunis and determine the prognostic factors of this condition.

Methods: It was an open prospective study. It concerned 100 diabetic patients operated on for diabetic foot infection. All patients had bacteriological samples taken through deep scraping and swabbing carried out in the operating room.

Results: The average age of patients was 59.5±11 years, with a sex ratio of 2:4. The foot infection was represented in 82% of cases by a wet gangrene. The enterobacteria were the most frequently isolated bacteria (73%), followed by Streptococcus (10%), Staphylococcus aureus (9%). The rate of multidrug-resistant bacteria was of 9.5%. The empiric antibiotic therapy used (fusidic acid+amoxicillin/clavulanic acid) was inactive on 44.1% of the isolated bacteria. When we compared the group of patients with unfavorable development (who have been re-operated) and the group of patients with favorable development, we have found two poor prognosis factors: arteritis (p=0.018; OR=23.7) and presence of multidrug-resistant bacteria (p=0.027; OR=5.8).

Conclusion: The enterobacteria were the main bacteria causing the infection of diabetic foot. The prognostic factors found, arteritis and isolation of multidrug-resistant bacteria; outpoint the importance of multidisciplinary care.

Biography:

Mehdi Khalfallah has completed his Medical studies from Faculty of Medicine of Tunis, Tunisia. He is an Assistant Professor in Surgery at Charles Nicolle’s Hospital since 2012. He is an Editorial Board Member and Drafting Committee Member of “la Tunisie Médicale” (indexed in PubMed, impact factor=0.3). He has published more than 15 papers in reputed journals.

Abstract:

Background & Aim: Major amputation of the lower limb is defined by a leg or thigh amputation. The aim of our work was identifying predictive factors for lower limb major amputation in patients with diabetes admitted on for foot lesions through using an administrative data base.

Methods: It was a retrospective study ranging from June 1^st, 2008 to December 31^st, 2011, which included all the patients admitted on for an infected diabetic foot to the Surgery Unit B of Charles Nicolle Hospital in Tunis. The main judgment criterion was the major amputation of the lower limb. We have done a descriptive and a comparative study, with univariate and multivariate analysis.

Results: We have enrolled 319 men and 111 women. The average age was 60.5±12 years. Ninety five patients had a major amputation that is 24% of cases. Former inpatient, patient readmitted within one month post-operatively, stay in intensive care, admission in intensive care within 48 hours after admission, age ≥65 years, presence of kidney problem, preoperative stay and length of intervention were identified as predictive factors of major amputation in the univariate analysis. Age is the only independent variable predictive for major amputation which appeared from the multivariate analysis (p=0,004). The age cut-off ≥65 years have a specificity of 69% and a sensitivity of 47% (p=0.004, OR=1.971, IC 95%: 1.239-3.132).

Conclusions: Age is the only independent predictive factor for major amputation of the lower limb in the diabetic foot with a threshold value higher or equal to 65 years. Patients aged more than 65 had 1.9 times more risk to undergo major amputation of the lower limb.

Biography:

David Karásek is an associate professor of Internal Medicine at Faculty of Medicine and Dentistry of Palacky University in Olomouc, Czech Republic. He works as Deputy Head of Third Department of Internal Medicine – Nephrology, Rheumatology and Endocrinology of University Hospital Olomouc. He manages the Center for diabetes of University Hospital Olomouc and as specialist doctor is involved in the activities of the Clinic for endocrine diseases and the Center for lipid metabolism disorders. His research is focused on the issue of dyslipidemia, metabolic syndrome, insulin resistance, visceral obesity and their relationship to early cardiovascular involvement. He is the author or co-author of several chapters in monographs or textbooks and of about one hundred scientific papers. He is the editorial board member for the two scientific journals. For his research, he received a number of medical awards (Prizes of the Czech Society for Internal Medicine, Czech Society for Atherosclerosis, Czech Diabetes Society) and the Minister of Health of the Czech Republic Prize for research and development.

Abstract:

Introduction: Adiponectin, adipocyte fatty acid-binding protein (A-FABP), fibroblast growth factor 21 (FGF-21), C1q/TNF-related protein 9 (CTRP9) and allograft inflammatory factor-1 (AIF-1) differently contribute to oxidative stress, chronic inflammation, insulin resistance and vascular damage. The aim was to compare their levels in patients with type 2 diabetes and in healthy controls and to determine their relationship to markers of endothelial dysfunction and arterial stiffness.

 Methods: 54 patients with type 2 diabetes (32 men, 22 women) and 21 healthy controls (8 men, 13 women) were included in the study. Adipokines, lipids, anthropological parameters, indicators of insulin resistance and also soluble markers of endothelial dysfunction - von Willebrand factor (vWF), plasminogen activator inhibitor-1 (PAI-1) and tissue plasminogen activator (t-PA) were measured. Augmentation index (AI) and pulse wave velocity PVW measured by SphygmoCor served as markers of arterial stiffness.

 Results: Type 2 diabetics had significantly higher levels of A-FABP [50.0 (38.1-68.6) versus 28.6 (23.6-32.9) mg/l, p<0.001], vWF [133.1 (110.7-163.2) versus 98.5 (84.4-125.0)%, p<0.01] and PAI [78.1 (41.2-106.5) versus 36.9 (27.5-41.9) ng/ml, p<0.001] and lower levels of adiponectin [5.9 (4.3-9.0) versus 11.3 (8.7-14.8) mg/l, p<0.001] compared to healthy controls. Differences in other adipokines were not statistically significant. Adiponectin correlated negatively with vWF levels (r=-0.29, p<0.05) and PAI-1 (r=-0.35, p<0.01), A-FABP positively with vWF (r=0.45, p<0.01) PAI-1 (r=0.46, p<0.01) and augmentation index (r=0.39, p<0.01). The levels of FGF-21 correlated only with PAI-1 (r=0.27, p<0.05).

Conclusion: Patients with type 2 diabetes have significantly higher levels of A-FABP and lower levels of adiponectin. These adipokines correlate with markers of vascular damage and may interfere with the cardiovascular risk of these individuals.

Biography:

Kurnikova Irina is a Professor of Medicine, RUDN University (Peoples Friendship University of Russia), Russia. She has done her PhD in 2010. She has dealt with the problems of endocrinology for more than 20 years. She had led a course of Endocrinology at the Medical Academy (Izhevsk, Russia), Endocrinology department of Russian Scientific Center of Medical Rehabilitation and Health Resort, Russia. Currently, she teaches at Peoples' Friendship University of Russia, Curator of the Scientific Direction of Endocrinology. She has published more than 20 articles in well-known journals, and is the author of 25 books and manuals in Russian.

Abstract:

Statement of Problem: One of the most important tasks at the initial stage of treatment of patients with primary insulin resistance is a weight loss, which means a decrease in the amount of food consumed. Patients rarely manage to cope with this task independently, and drug therapy does not always provide sufficient effect.

Purpose of Study: To evaluate the effect of acupuncture on the production of serotonin and especially eating disorders patients with primary insulin resistance.

Methods & Theoretical Orientation: Patients (42 people) aged 38.4±2.0 years, body mass index (BMI) 32.3±4.2 kg/m² were selected for this study. Two groups of observation were formed: group 1 (20 people) received reflex therapy using special corporal and auricular points and a low caloric diet. Patients of the 2^nd group (22 people) were prescribed only a diet. The comparison group consisted of 12 practically healthy persons. We studied: BMI, ratio of OT/OB (waist circumference/hip circumference), HOMA-IR index, insulin and C-peptide. Serotonin in serum was determined by ELISA. Reflex therapy procedures included daily corporal and auricular acupuncture, surface acupuncture according to a certain scheme (11 II, 36III, 7V, 41XI, 60VII, 34, 25, 22, 18 and 55).

Results: A lower serotonin level in the serum of patients in the observation groups was noted -173.3±60.8 ng/ml (in the comparison group -223.9±90.4 ng/ml). The relationship between BMI and serotonin concentration in serum r=-0.23 (p=0.04) was revealed. In group 1 there was an increase in serotonin level by 69.5% (p=0.0057), body weight decreased by 9.8%. In group 2 serotonin level increased by 34.4% (p=0.031), and body weight decreased by 7.4% (p=0.051). Patients of group 1 after the course of treatment noted a decrease in appetite, which allows observing the diet and reducing the amount of food.

Conclusion: The use of reflex therapy with the use of special corporal and auricular points promotes serotonin increase in serum and leads to rapid satiety during eating. This allows patients to follow a low caloric diet at the initial stage of treatment.

Biography:

Abeuova Gulnara. Entered Almaty State Medical Institute in 1976, graduated in 1982. Since 1982 work as a doctor and teach at Medical University as well as at medical college. Specialist - family doctor, doctor of the highest category. I wrote educational materials for students. Personal growth - I took international courses of personal growth with USAID (United States). Specialties: gynecology, oncology, family medicine - in the Almaty Institute of Advanced Medical. Since 2005 I opened up my own medical center “ACAP”. -Director 2005-current.

Abstract:

                           Metabolic syndrome                            is primarily a condition of middle aged populations but becoming more prevalent in younger populations. Its criteria are overweight, sedentary lifestyle, and “modern diets” of unhealthy foods. Diet and physical activity are the most modifiable behaviors. The metabolic syndrome is an entity, made up of a cluster of cardiovascular risk factors, which increases risk of future coronary type II diabetes, heart disease, and stroke. The prevalence runs about 20% in most westernized cultures. “Normal” blood sugar, as measured by HbA1-C, has a range of high-, medium- and low-normal ranges to indicate rising blood sugar. When the HbA1-C marker shows values in the high-normal range it indicates the subject is beginning to show abnormal blood sugar and/or insulin resistance. This early detection provides an interim whereby the individual may reverse the pattern. A clinical trial was conducted by the primary physician selecting ten subjects with high normal HbA1-C levels who were not taking medications to manage blood sugar. Subjects were informed about the dietary supplement Laminine (LifePharm Inc., Lake Forest, CA) which contains proprietary fertilized chicken egg extract, shark cartilage and pea protein powders. Subjects signed informed voluntary consent. Subjects were asked to refrain from taking other supplements and maintain routine dietary and exercise patterns. Subjects were instructed to consume two supplements in the morning and two in the evening daily for 12 weeks. A t-test for related samples was performed comparing baseline and 12 week final HbA1-C values showing a statistically significant decrease with a p value of 0.013. Results indicated four Laminine supplements consumed daily for 12 weeks supported lowering high-normal blood sugar values in this study. No untoward side effects were observed. Support for reducing high normal blood sugar with a safe, active dietary supplement warrants further investigations.

Biography:

Joyce Espinosa is working a Staff Nurse, Al Sheehaniya Health Center, Doha, Qatar

Abstract:

This descriptive-relational study was conducted to determine the psychological and social aspects of living with diabetes mellitus. The findings would be the basis for an enhancement of the diabetic program in primary health care. Using the one-shot survey design, 280 patients with diabetes mellitus were included as respondents of the study. The statistical tools employed were means and frequency distribution for descriptive analysis, while Gamma and Cramer’s V were used for inferential analysis. This research has shown that the respondents were fairly psychologically and socially well. They were satisfied with self and living in a purposeful manner, however, they were anxious about the complications of the disease. Family members were concerned about their condition wherein they could talk freely about diabetes mellitus. Educational attainment and living arrangement were significantly correlated with psychological well-being. Presence of illnesses not related to diabetes was significantly correlated with both psychological and social well-being. In conclusion, patients with diabetes mellitus still have the ability to feel good about themselves, having healthy relationships, and maintain psychological health and social well-being.

Biography:

Nurten Terkes completed her Master’s degree in 2012 and doing her PhD at Akdeniz University Institute of Health Sciences. She has many articles published in national and international journals about diabetes mellitus. She participated in many national and international congresses about diabetes mellitus. She is a Research Assistant at Akdeniz University Faculty of Nursing.

Abstract:

Aim: To evaluate the psychometric properties of the Diabetes Distress Scale, as measures of diabetes-related psychosocial symptoms, in patients with type 2 diabetes in Turkey.

Methods: This research was carried out on 170 patients diagnosed with type 2 diabetes in the Department of Endocrinology and Metabolic Diseases of a university hospital in Turkey from 15^th September 2016 till 15^th January 2017. Personal information forms developed by the researchers and the Diabetes Distress Scale were used as the data tools. The informed consent was obtained from the patients. Descriptive statistics, parametric and nonparametric tests and exploratory factor analysis were used in data analysis.

Results: According to the results of the research, the patients had a mean±standard deviation age 55.9±7.54 years (range, 20–65) and included most patients who were female (64.1%), married (87.1%), housewives (50.3%), and had completed primary education (47.4%). Cronbach’s alpha found reliability for the total scale to be 0.91 and subscale alpha coefficients ranged 0.76–0.85. Exploratory factor analysis resulted in a three factor structure: (1) emotional and regimen distress (9 items), (2) health professional-related distress (4 items), and (3) diabetes-related interpersonal distress (3 items).

Conclusion: The Turkish version of the Diabetes Distress Scale was found to be a reliable and valid means to measure diabetes-related psychosocial symptoms in patients with type 2 diabetes.