Biography:

Manche Santoshi Kumari completed her Ph.D work from Osmania University and has submitted her thesis.  She is a research scholar of Institute of Genetics and Hospital for Genetic Diseases. She has participated and have given oral and poster presentations in National and International conferences. And she international papers to her credit.

Abstract:

Diabetes mellitus characterized by alterations in levels of glucose affects multiple organ system including auditory system. Hearing loss is one of the most common otological disorders in adults with diabetes. This study aims to identify the distribution pattern of hearing loss in adults suffering from diabetes affected with otological diseases. A total of 348 cases above 40 years of age with confirmed otological disorders presenting hearing loss visiting MAA ENT Hospitals, Hyderabad, India were considered for the study. Hearing loss was evaluated using pure tone audiometry and average for the frequencies at 0.5, 1and 2 KHz was recorded. Among the diabetic cases, 65.5% were males and 34.5% were females. 66.1% of the diabetic subjects suffering from hearing loss showed pathological changes in the middle ear followed by inner ear (31.6%) and outer ear (2.3%). It was also observed that 37.9% of the total diabetic subjects were in the age group of above 60 years followed by 40-50 years (35.1%) and 50-60 years (37.9%). With regard to pattern of hearing loss among diabetic subjects, 44.3% showed conductive form, 38.5% sensorineural and 17.2% showed mixed hearing loss. 33.2% and 13.8% of the diabetic subjects showed tinnitus and vertigo respectively. The present study revealed the significant contribution of co-morbid condition of diabetes mellitus to hearing loss in otological disorders.  

Biography:

Manche Santoshi Kumari completed her Ph.D work from Osmania University and has submitted her thesis.  She is a research scholar of Institute of Genetics and Hospital for Genetic Diseases. She has participated and have given oral and poster presentations in National and International conferences. And she international papers to her credit.

Abstract:

Diabetes mellitus characterized by alterations in levels of glucose affects multiple organ system including auditory system. Hearing loss is one of the most common otological disorders in adults with diabetes. This study aims to identify the distribution pattern of hearing loss in adults suffering from diabetes affected with otological diseases. A total of 348 cases above 40 years of age with confirmed otological disorders presenting hearing loss visiting MAA ENT Hospitals, Hyderabad, India were considered for the study. Hearing loss was evaluated using pure tone audiometry and average for the frequencies at 0.5, 1and 2 KHz was recorded. Among the diabetic cases, 65.5% were males and 34.5% were females. 66.1% of the diabetic subjects suffering from hearing loss showed pathological changes in the middle ear followed by inner ear (31.6%) and outer ear (2.3%). It was also observed that 37.9% of the total diabetic subjects were in the age group of above 60 years followed by 40-50 years (35.1%) and 50-60 years (37.9%). With regard to pattern of hearing loss among diabetic subjects, 44.3% showed conductive form, 38.5% sensorineural and 17.2% showed mixed hearing loss. 33.2% and 13.8% of the diabetic subjects showed tinnitus and vertigo respectively. The present study revealed the significant contribution of co-morbid condition of diabetes mellitus to hearing loss in otological disorders.  

Biography:

Abstract:

Background. Diabetes, a major CVD risk factor, is the leading cause of death in low and middle income countries (LMICs).

However, treatment and control rates are very low in many LMICs. one strategy to improve access is task shifting of Diabetes care to nurses, but it is unclear if such strategy is effective in LMICs. Here, I report the effect of a nurse based Diabetes management program in Kenya.

METHODS.

In 2011, AMPATH chronic Disease Management Program initiated nurse based diabetes management in rural western Kenya in level two facilities.

Diabetes patients who initiated care between January 1, 2015 and December 31, 2015, comprised the clinical cohort. The primary outcome measure was one year change in random blood sugars (RBS) evaluated by paired test. Results were determined overall, and stratified by key covariates, multivariable regression was also performed.

RESULTS

The cohort consisted of 563 adults patients (297 F, 266 M) with follow up data available for 399 (70.8% ) overall RBS decreased significantly from baseline to follow up ( 4.3 mmol/L), which was also observed across several participant subcategories.

CONCLUSION

These results suggest that nurses managed diabetes care can significantly improve blood sugar among diabetic patients. If reproduced in prospective trial settings, this could be an effective strategy for diabetes care in LMICs.

Biography:

Abstract:

Background. Diabetes, a major CVD risk factor, is the leading cause of death in low and middle income countries (LMICs).

However, treatment and control rates are very low in many LMICs. one strategy to improve access is task shifting of Diabetes care to nurses, but it is unclear if such strategy is effective in LMICs. Here, I report the effect of a nurse based Diabetes management program in Kenya.

METHODS.

In 2011, AMPATH chronic Disease Management Program initiated nurse based diabetes management in rural western Kenya in level two facilities.

Diabetes patients who initiated care between January 1, 2015 and December 31, 2015, comprised the clinical cohort. The primary outcome measure was one year change in random blood sugars (RBS) evaluated by paired test. Results were determined overall, and stratified by key covariates, multivariable regression was also performed.

RESULTS

The cohort consisted of 563 adults patients (297 F, 266 M) with follow up data available for 399 (70.8% ) overall RBS decreased significantly from baseline to follow up ( 4.3 mmol/L), which was also observed across several participant subcategories.

CONCLUSION

These results suggest that nurses managed diabetes care can significantly improve blood sugar among diabetic patients. If reproduced in prospective trial settings, this could be an effective strategy for diabetes care in LMICs.

Biography:

Dr. Priscilla Okunji is an Assistant Professor at Howard University, Division of Nursing. She obtained her Baccalaureate and a Master’s degree in Nursing and Informatics respectively from University of Maryland. In addition, she earned her Health Sciences doctoral degree with concentration in International Health Educator/Researcher. Dr. Okunji is a recipient of the 2015 NIH_UCLA mHIT scholar and 2014 NIH_NIMHD health disparities course Scholar and the Faculty Senate “Emerging Scholar” award in 2012. She has been board certified in ANCC Medical Surgical Nursing since 2010. Her scholarly paper at the University of Maryland inspired her into using the Agency for Health Research and Quality (AHRQ) large database to study the “Outcomes of Diabetic Myocardial Infarction Inpatients: Patient and Hospital Characteristics” as her Ph.D. dissertation. She spearheaded the development and implementation of the Howard University RN to BSN online program of which she presently coordinates. She is a recipient of several awards that include, “100 Extra Ordinary Nurses” from DC Black Nurses Association, ELITE “Faculty Fellowship Development” awarded by Pittsburgh University, HU CETLA “Teaching with technology and Reviewer, ” AHA “Early Investigator” and QCOR “Cardiovascular Nursing Council" Travel awards. Dr. Okunji has often been invited to deliver podium presentation at both National and International conferences and has published in peer reviewed journals. Dr. Okunji has been a Principal Investigator of intramural grants/projects.

Abstract:

In this study we assessed the differences in outcomes between a Minority Large Urban Teaching (MLUT) hospital and Healthcare Cost and Utilization Project, National Inpatient Stay (HCUP-NIS) datasets among diabetic patients discharged from non-federal hospital in 2012, in the United States. Sample of 1,437,975 and 2,185 subjects diagnosed with type 2 diabetes were extracted from national and MLUT datasets respectively using the International Classification Data, ICD 9 codes 25000 based on hospital location, size, teaching and ownership status. The result of the study showed that gender distribution was comparable according to the hospital categories with more females (7%) were admitted than their male counterparts. The MLUT data had 42.2% males and 57.8% females compared to the national (49.1% male and 50.9% females). For ethnicity, MLUT had 2.2% white, and 97.8% black compared to the national (55.6% white, 21.4 % black, 9.0% hispanic and 14.0% others). For age distribution, national hospitals had more age groups (40-59 years) and (80 years or older) admitted while MLUT hospitals admitted more diabetics of 40 – 59 years age group. A significant difference (~23%) in admission to national hospitals was noted for patients with income ($39,000 - 47,999) while patients with income range ($48,000 – $62,000) were admitted more (~26%) in MLUT. Patient outcomes were comparable, however, a difference (5%) was noted for hospital stay and hospital charges (13.3%) of patients with hospital charges of less than $20,000 than those admitted in national hospitals with same charges. The overall outcomes showed a significant difference between the hospital categories for length of stay and hospital charges but not for mortality rates. Hence the MLUT patients stayed more in the hospital with more charges but no significant difference was observed in mortality rates between the hospital categories. The authors call for the study to be replicated with more samples from minority large urban teaching hospitals and to incorporate higher statistical analytics to ascertain the impact of the variables on the outcomes for a more validated result.

Biography:

Manche Santoshi Kumari completed her Ph.D work from Osmania University and has submitted her thesis.  She is a research scholar of Institute of Genetics and Hospital for Genetic Diseases. She has participated and have given oral and poster presentations in National and International conferences. And she international papers to her credit

Abstract:

Diabetes mellitus characterized by alterations in levels of glucose affects multiple organ system including auditory system. Hearing loss is one of the most common otological disorders in adults with diabetes. This study aims to identify the distribution pattern of hearing loss in adults suffering from diabetes affected with otological diseases. A total of 348 cases above 40 years of age with confirmed otological disorders presenting hearing loss visiting MAA ENT Hospitals, Hyderabad, India were considered for the study. Hearing loss was evaluated using pure tone audiometry and average for the frequencies at 0.5, 1and 2 KHz was recorded. Among the diabetic cases, 65.5% were males and 34.5% were females. 66.1% of the diabetic subjects suffering from hearing loss showed pathological changes in the middle ear followed by inner ear (31.6%) and outer ear (2.3%). It was also observed that 37.9% of the total diabetic subjects were in the age group of above 60 years followed by 40-50 years (35.1%) and 50-60 years (37.9%). With regard to pattern of hearing loss among diabetic subjects, 44.3% showed conductive form, 38.5% sensorineural and 17.2% showed mixed hearing loss. 33.2% and 13.8% of the diabetic subjects showed tinnitus and vertigo respectively. The present study revealed the significant contribution of co-morbid condition of diabetes mellitus to hearing loss in otological disorders.

Biography:

Marzieh Nojomi has completed her specialist in Community Medicine at the age of 33 years from Medical School from Iran University of Medical Sciences, Tehran, Iran. She has also complited a course in Clinical Epidemiology from University of Washington, Seattle, U.S.  She is the chief of the department of Community Medicine.  She has published more than 170 papers in reputed journals and has been serving as an editorial board member of three medical journasls.         
 

Abstract:

Diabetic retinopathy (DR) is one of the leading cause of blindness among adults worldwide. There is considerable variation in the consistency, pattern, and strength of risk factors of DR in different studies. Therefore we decided to determine the prevalence of DR and its risk factors in diabetic patients in Ahvaz. Four hundred diabetic patients from 2013 to 2015 from Imama-Khomaini hospital were enrolled in current study. They were all examined by an ophthalmologist and categorized as DR and non DR groups. The characteristics of patients included age, gender, blood pressure, body mass index, lipid profile, HbA₁c, duration of diabetes and smoking were measured. Mean age was 49.7 (±8) years old. About 56% were males and 44% females. One hundred and seventy two patients (43%) had DR. Mean duration of affected by diabetes was 9 (±3) years. The mean of systolic blood pressure was 176 (±10) and 136 (±5) mmHg in patients with DR and without DR respectively. The duration of affected by diabetes was 11.4 (±4.9) years in patients with DR compared to 7.5 (±1.2) years in patients without DR. The prevalence of DR was more in patients who were older, having higher systolic blood pressure, affected more years with diabetes, and had higher HbA1c significantly. Diastolic blood pressure, total cholesterol, triglycerides, BMI and smoking were not associated with DR.   

Biography:

Marzieh Nojomi has completed her specialist in Community Medicine at the age of 33 years from Medical School from Iran University of Medical Sciences, Tehran, Iran. She has also complited a course in Clinical Epidemiology from University of Washington, Seattle, U.S.  She is the chief of the department of Community Medicine.  She has published more than 170 papers in reputed journals and has been serving as an editorial board member of three medical journasls.         
 

Abstract:

Diabetic retinopathy (DR) is one of the leading cause of blindness among adults worldwide. There is considerable variation in the consistency, pattern, and strength of risk factors of DR in different studies. Therefore we decided to determine the prevalence of DR and its risk factors in diabetic patients in Ahvaz. Four hundred diabetic patients from 2013 to 2015 from Imama-Khomaini hospital were enrolled in current study. They were all examined by an ophthalmologist and categorized as DR and non DR groups. The characteristics of patients included age, gender, blood pressure, body mass index, lipid profile, HbA₁c, duration of diabetes and smoking were measured. Mean age was 49.7 (±8) years old. About 56% were males and 44% females. One hundred and seventy two patients (43%) had DR. Mean duration of affected by diabetes was 9 (±3) years. The mean of systolic blood pressure was 176 (±10) and 136 (±5) mmHg in patients with DR and without DR respectively. The duration of affected by diabetes was 11.4 (±4.9) years in patients with DR compared to 7.5 (±1.2) years in patients without DR. The prevalence of DR was more in patients who were older, having higher systolic blood pressure, affected more years with diabetes, and had higher HbA1c significantly. Diastolic blood pressure, total cholesterol, triglycerides, BMI and smoking were not associated with DR.   

Biography:

Abstract:

Back ground

The prevalence of diabetes is alarmingly rising around the globe. According to the International Diabetes Federation (IDF). IDF estimates that up to 70% of type 2 diabetes cases can be prevented or delayed. There are several factors which may lead towards type 2 diabetes but many factors are still uncontrollable and untreatable.

Points to discuss

1. Most common ten prevention messages
2. The main focus of current prevention messages
3. The accuracy of the existing prevention messages
4. The controllable vs uncontrollable factors of diabetes prevention
5. Intervention strategies and measures of success
6. Existing interventions that do not always work well
7. Examples of productive and motivating prevention messages

Description

Type 2 diabetes can be prevented or delayed and the best way to prevent it is to create awareness and deliver proper self- management education. We just don’t need to educate people on what not to do but rather what can be done to make their living environment healthier. Help people to be in control of their existing situation, no matter where and whatever the societal limitations are. Find out the realistic solutions and how to do self-behavior modifications as a society, not just as an individual. Most of the prevention messages target the prominent problems such as obesity but never targets the real solutions such as healthy food is expensive and junk food are cheaper and have become a big business globally. Governments, policy makers and stake holders should be involved. Media is also playing great role especially inspiring children by wrong messages causing drastic increase in childhood obesity which eventually leads to Diabesity. Prevention messages promoting physical activity are not always successful as not applicable within the general environment. There are lots of prevention messages and campaigns to target obesity but little to stop fizzy drinks and high sugar snacks, which are simply full of calories. There are several places where due to poverty, people only eat junk foods as they are cheap.

On the other hand there are many factors and medical conditions which are uncontrollable and untreatable that usually cause type 2 diabetes, such as age, PCOS, Cushing’s syndrome etc. Some issues of further discussion include: is it wise to classify every type 2 diabetics in the same category; do we have any messages for such cases; do we address those issues publicly; how can we make their lives healthier?

Biography:

Abstract:

Pakistan, a developing country with limited resources, is having huge burden of diabetes and its complications. The local health care providers face limitations due to the related cost while emphasizing on self-monitoring of blood glucose. The lack of health care infrastructure, non-affordability of the patients and non-existence of national guidelines are the most significant obstacles. Having realized these issues we decided to initiate a project of self-monitoring of blood glucose, “BRIGHT (Better Recommendations, Implementation and Guideline development for Health care providers and their Training).

After extensive literature search, the project team, approached and communicated with “Advisory Board for the Care of Diabetes (ABCD) of Pakistan” for their expert opinion and suggestions. The board members belong to the faculty of main teaching hospitals of the four provinces (states) of Pakistan thus ensuring national representation. The endorsement of these guidelines has paved the way for their uniform implementation all over the country.

Development of these Guidelines is the first part of BRIGHT project. In the next phase, we have started training of health care providers. Five mega programs have been conducted in this regard in the major cities. So far a patient’s log book has also been designed and distributed. Like all other guidelines, this is a living document which will be revised and updated from time to time in the light of new information which becomes available.

Following recommendations are proposed to guide people with diabetes and their healthcare providers in the use of Self-Monitoring of Blood Glucose (SMBG).

• SMBG recommendations would ensure that people with diabetes (and/or their care-givers) and their healthcare providers have the knowledge, skills and willingness to incorporate SMBG monitoring and therapy adjustment into their diabetes care plan, in order to attain agreed treatment goals.
• SMBG should be considered at the time of diagnosis to enhance the understanding of diabetes as part of individual’s education and to facilitate timely treatment initiation and titration optimization.
• SMBG should also be considered as part of ongoing diabetes self-management education to assist people with diabetes to better understand their disease and provide means to actively and effectively participate in its control and treatment, modifying behavioral and pharmacological interventions as needed, in consultation with their healthcare providers.
• SMBG protocols (intensity and frequency of SMBG) should be individualized to address each individual’s specific educational, behavioral or clinical requirements in order to identify, prevent and manage acute hyper- and hypoglycemia. The requirements of the care provider for collection of data on glycemic patterns and for monitoring the impact of therapeutic decision making should also be addressed.
• The purpose(s) of performing SMBG and using SMBG data should be agreed between the person with diabetes and the healthcare provider. These agreed-upon goals and actual review of SMBG data should be documented.
• SMBG requires an easy procedure for patients to regularly monitor the performance and accuracy of their glucose meter.
• Ketone test should be performed when needed, in type 1 individuals.
• In accordance with the sick day rule, the frequency of SMBG should be increased in special situations like fever, vomiting and persistent polyuria with uncontrolled blood glucose, especially if abdominal pain or rapid breathing is present

Biography:

Dr. T. Kanda is a professor of General Medicine and director of Community Medicine at Kanazawa Medical University, Japan.  He is a council member of Japan Obesity Association and Japan Society of Internal Medicine. He is a member of Japan Heart Association, Japan Diabetes Association, and Japan Primary Care Association. His current interest is to understand the mechanism of exercise effects on cardiovascular disease and metabolic syndrome and the role of hippocampus in obese patients. His research fields are Pathology, Cardiology, Laboratory Medicine, and General Medicine. Dr. T. Kanda has completed his MD at the age of 24 years from Kanazawa Medical University and postdoctoral studies from Gunma University Graduate School of Medicine, Japan. He is a generalist working at Kanazawa Medical University Himi Municipal Hospital. He has published more than 200 papers in scientific journals including Circulation Research, JACC, and Lancet. 

Abstract:

Obesity has been associated with cognitive deficits and even dementia, accordingly the metabolic abnormalities such as diabetes. We hypothesized anti-diabetic agent, alogliptin, DPP4 inhibitor, could affect to cognition deficits and metabolic abnormality. Three months oral administration of alogliptin (30mg/kg/day) were performed in ApoE-/- mice with high-fat diet (HFA, n=15). The non-treated mice with high-fat diet (HFD, n=15) became obese. Mice were fed from the age of 8 weeks until 20 weeks. As a control, non-exercised mice without high-fat diet (NOR, n=15) were prepared. Morris water maze test as spatial learning and novel object recognition test as recognition memory were performed. Forced swimming test as depressive state was also performed.Mice in HFD showed cognition deficits, depressive condition and metabolic abnormality. The alogliptin treatment did not reduce the body weight compared with non-exercised mice with high-fat diet (HFA; 46.5　+　5.9 g vs. HFD; 49.7　+　2.7g vs. NOR; 30.4 + 1.6g, P<0.05). The liver weight/ body weight ratio was significantly reduced in HFA compared with HFD (HFA; 59 + 17 x10-3 vs. HFD; 76 + 18 x10-3 vs. NOR; 48　+ 9 x10-3, P<0.05). The circulating levels of liver enzyme and triglyceride were significantly lower in HFA compared with HFD. Both of Morris water maze test and novel object recognition test were significantly recovered in HFA compared with HFD. The forced swimming test was also recovered in HFA compared with HFD.

Biography:

Abstract:

Providing care for elderly patients with diabetes would be difficult due to the difficulties of this disease, such as underlying medical conditions or general disability. Suitable care for elderly diabetic patients could significantly affect their physical and mental health. Psychological and social support for these patients could help them manage and control stressful situations and affairs of daily life. This study aimed to determine the relationship between social support and quality of life in elderly patients with diabetes. This descriptive co relational study was conducted on all the elderly residents of the nursing homes in Borazjan and Booshehr cities (73 female patients), Iran. All the subjects met the inclusion criteria and were selected by census sampling. Data collection was performed using demographic questionnaires, SF-36 questionnaire and Diabetes Social Support Questionnaire Family-Version (DSSQFamily). Data analysis was performed using SPSS V.13.Linear regression between social support and quality of life in general health was ((P=0.008) and in Mental (P<0.001) showed a significant association. However, no significant correlation was observed between social support and physical or social health of the patients (P=0.49).

Biography:

Syeda Sadia Fatima is a Senior Instructor at the Aga Khan University Hospital. She holds a MBBS degree and is currently pursuing her PhD in Molecular Physiology. Her research focuses on Genetic and Adipocytokine Factors, unique to Pakistani population with respect to Metabolic Syndrome. She has offered courses, workshops and public awareness sessions on these non-communicable diseases and has more than 30 publications in reputed journals and has also contributed a book chapter in this thematic area. In addition, she has been serving as an Editorial Board Member and Reviewer for many reputed journals.

Abstract:

Chemerin is a multi-functional peptide involved in lipid and glucose metabolism. Elevated levels of this peptide have been associated with insulin resistance and systemic inflammation. We aimed to explore whether chemerin can discriminate subjects at risk of developing diabetes in non-pregnant population (n=286) as well as in pregnant females (n=483). All study participants were classified according to the American Diabetic Association Criteria as normoglycemic controls or diabetic cases. ELISA assays were performed for chemerin, leptin, interleukin-18, tumor necrosis factor and insulin; while body mass index and insulin resistance were calculated. Ultrasound scans were conducted on pregnant females to record the fetal growth parameters. Levels of chemerin, interluekin-18 and leptin were 7, 4 and 5 folds higher in newly diagnosed diabetic non-pregnant cases as well as those who developed gestational diabetes (p<0.01). Chemerin showed strong positive correlation with fasting blood glucose, insulin resistance, fetal weight and TNF (p<0.01) even after adjusting for age and BMI. Based on these findings we proposed that the cutoff of 13.7 ng/ml of chemerin can discriminate 73% of subjects with impaired glucose level with 91% sensitivity and 96% specificity respectively. Furthermore, a cutoff of 15.49 ng/ml can identify 96% GDM cases with 96% sensitivity and 72% specificity. Chemerin along with other inflammatory biomarkers suggest an ongoing inflammatory process in high risk individuals suggesting a role in development of insulin resistance and subsequent diabetes in the long run. Therefore, it can be used as a potential screening biomarker to identify individuals at risk of developing diabetes.

Biography:

Stanley I. R. Okoduwa is a doctoral scholar from Ahmadu Bello University, Zaria Nigeria and a Research officer at the Nigerian Institute of Leather and Science Technology, Zaria Nigeria. He is the co-founder of Info-health Awareness Group, a non for profit organization under the SIRONigeria Global Limited, Abuja-Nigeria, whose mission is geared towards eradication of preventable diseases in Nigeria. His passion is on innovative research that would improve the quality of human life. He has published and co-authored several articles in reputable journals and has been serving as a peer reviewer to high profile journals.  

Abstract:

Pathophysiological investigation of disease in a suitable animal model is a classical approach towards development of credible therapeutic strategy. This study examined appropriate insulin level in selecting animal model for type 2 diabetes (T2D) studies. Albino wistar rats (150-200g) were divided into two groups fed with commercially available normal-diet-feed (NDF) and water or fortified diet feed (FDF) (10g NDF per gram of margarine) with 20% fructose-solution as drinking-water. After 6 weeks of dietary regimen both groups were divided into 5 sub-groups and injected intraperitoneally with graded dose of streptozotocin (STZ) (0, 25, 35, 45 & 55-mg/kg b.w.). The result showed that the FDF-fed rats increased significantly in body weight, basal serum insulin, total cholesterol, triglycerides and blood glucose levels as compared to NDF-fed rats. Ten days post STZ induction, the groups treated with STZ (45 & 55 mg/kg) developed frank hyperglycemia with < 46.8% serum-insulin, a severe deficiency typical of diabetes type-1. The NDF₂₅ and NDF₃₅ groups with 75.7 and 64.4% serum insulin respectively presented relatively normoglycemia, whereas the FDF₃₅ (85.8% serum insulin) were notably hyperglycemia ( >300 mg/dL) throughout the 6-weeks post diabetes confirmation. This FDF₃₅ rats were sensitive to glibenclamide, metformin and pioglitazone in lowering hyperglycemia, hypertriglyceridemia and hypercholesterolemia, thus proved to be a suitable non-genetic stable model for T2D studies. The study suggests that circulating serum-insulin > 85.8% with overt hyperglycemia may be utilized as the benchmark in selecting animal-model for T2D studies.