Day 1 :
Keynote Forum
Douglas N Ishii
Colorado State University, USA
Keynote: Why clinical trials show that strict glucose regulation does not prevent diabetic complications in T2D: Evidence supporting an alternative hypothesis for pathogenesis
Time : 09:30-10:10
Biography:
Douglas N Ishii was born in US concentration camp at the onset of WWII, and grew up in a government housing project in San Francisco. He received a B.A. Biochemistry from Univ. Calif. Berkeley, a Ph.D. Pharmacology from Stanford Univ. Medical Sch., and conducted postdoctoral work in Neurobiology at Stanford. He became Assistant than Associate Prof. Pharmacology at Columbia Univ. NYC. He is a Professor of Biomedical Sciences at Colorado State Univ. He served on various scientific study sections for National Science Foundation, National Institutes of Health, and the Juvenile Diabetes nternational Foundation. Press coverage on his laboratory’s research on pathogenesis of diabetic neurological complications, and causation of brain atrophy in Alzheimer’s disease, includes articles in Der Spiegel, Hong Kong Standard, NY
Times, LA Times, Denver Post, Chicago Tribune, ABC News, Forbes News, USA Today, National Public Radio, and elsewhere. Nineteen patents were awarded based on this research.
Abstract:
Statement of Problem: A meta-analysis of clinical trials with 34,533 T2D patients shows that intensive lowering of glucose levels does not prevent neuropathy, retinopathy, nephropathy, cardiovascular death, nor excess mortality. Exposing patients to adverse effects from unbeneficial drugs is unjustified, yet remains standard therapy. An alternative hypothesis for pathogenesis of diabetic complications is greatly needed to develop meaningful rational therapies.
Methodology & Theoretical Orientation: Following discovery that insulin and insulin-like growth factors (IGFs) are neurotrophic factors, the inter-related hypotheses were developed that loss of insulin and IGF activities is the dominant cause of diabetic neuropathy, and that replacement of such activities should ameliorate diabetic complications irrespective of unabated hyperglycemia. These hypotheses were tested by infusing IGFs, insulin, or their combination into diabetic rats to determine whether neuropathy is alleviated under conditions in which hyperglycemia is not prevented.
Conclusion & Significance: IGF gene expression is reduced in peripheral nerves, brain and spinal cord in diabetes. Replacement IGF infusion prevented impaired sensory and motor nerve regeneration, hyperalgesia, abnormal ultrastructure in autonomic axons, loss of epidermal nerve fiber density, and poor gastric wound healing, but did not diminish hyperglycemia. To study mechanism, insulin and/or IGF was infused into diabetic rat brains under conditions that did not reduce hyperglycemia. A decrease in total mRNA, protein, and DNA levels was associated with brain atrophy and impaired learning/memory in diabetic rats. Insulin and IGF i.c.v. infusion prevented all of these disturbances despite unabated hyperglycemia. Insulin and IGFs are master switches controlling the levels of hundreds of proteins in tissues; loss of protein regulation, not hyperglycemia, is proposed as the most likely pathogenic cause for diabetic complications. Governments should manufacture clinical grade IGF (off-patent). Clinical trials are urgently needed to test insulin/IGF therapy.
Keynote Forum
Vithian Karunakaran
Colchester Hospital University NHS Foundation Trust, UK
Keynote: Integrating diabetes care to improve diabetes care across the community- experience from North East Essex
Time : 10:10-10:50
Biography:
Vithian Karunakaran has been a consultant in diabetes and endocrinology at Colchester Hospital University NHS Foundation Trust since 2013. He has been the Clinical Lead for the integrated diabetes service (NEEDS) and is a Local Clinical Champion for Diabetes UK.
Abstract:
The North East Essex Diabetes Service (NEEDS) was established in 2014 with a view of integrating specialist diabetes services with Primary Care across the North East Essex Clinical Commissioning Group area and improving diabetes outcomes. Quality of diabetes care across the region was patchy with delivery of the key 8 care processes of diabetes around 40% and extreme variation seen between different GP surgeries. Amputation outcomes were above national average and less than a third of high risk foot patients being referred to Podiatry.
Since its inception NEEDS has been working closely with the Primary Care workforce through a Practice Enhanced Service that remunerates Practices for delivering 8 care processes and for improving diabetes outcomes with focus on HbA1c, blood pressure and cholesterol. Practices can assess their progress via the Diabetes Dashboard and quarterly meetings enable Practices to benchmark themselves and share best practice. These measures have resulted in delivery of 8 care processes increasing from 40% in 2014 to 74.2% by 31/03/2017. 82.8% have reached target cholesterol levels (cf 76.3% in 2014), 76.6% with BP<140/80 and 75.9% with HbA1c <65 mmol/mol (cf. 69.6% in 2014). The numbers of high risk patients being referred to podiatry have also increased from 27.9% to 85.1% and there is now much less variation between the best performing and least performing practices within this locality.
In summary with proper clinical engagement vertical integration of diabetes services can transform diabetes care and improve patient experience and outcomes.
Keynote Forum
Arturo Solis Herrera
Human Photosynthesis Research Center, Mexico
Keynote: If glucose is not eukaryote cell power source, how understand diabetes mellitus?
Time : 11:15-11:55
Biography:
Arturo Solís Herrera, Ophthalmologist, found the unsuspected capacity of human body to take energy from visible and invisible light, during an study about the three main causes of blindness. His hypothesis work was try to find morphological alterations of minute blood vessels of the optic nerve that eventually could be useful as indicators, but early in study, the ever-presence of melanin nearby optic nerve of 6000 studied patients, draw powerfully his attention, so melanin was included as variable under study. The cross-talk between melanin and blood vessels eventually end in the finding of the intrinsic property of melanin to dissociate the water molecule. Dr Solis-Herrera is director and founder of Human Photosynthesis Study Center since 2008 to date.
Abstract:
Biology and medicine currently, are based on the dogma that the glucose is the source of energy of the eukaryotic cell. It is to draw the attention of that, even though our body has handled the glucose from the beginning of time, seems that you forget. The concept of glucose as energy source seems to engage in the works of Priestley and Lavoisier, in the middle of the 18th century; and hence has evolved up to Peter Mitchell in 1951, who seems to solve the riddle of the transduction of the energy of the environment towards the cell. But the chemo-osmotic theory of Mitchell, is still theoretical to date. Mechanisms of transduction of energy from glucose or ATP to organelles and biochemical reactions are full of assumptions. 7000 intracellular reactions described to date, only 199 are described in the same way in the different existing information sources, the rest (6801) there is controversy; It is based on biology and medicine today. Therefore, it is not surprising that diabetes cannot understand it, prevent it, or let alone improve it. The discovery of the unsuspected inherent capacity of melanin to dissociate the water molecule, is a watershed at the mystery of the metabolic processes of the human body. When the water dissociates, transforms the visible and invisible light into chemical energy, and this is transported by molecular hydrogen. And it is what happens in plants, thanks to the chlorophyll. But in human beings was unthinkable. From now on forward can organize the biochemistry of otherwise, using glucose as a source of carbon chains and light / melanin / water as a source of energy of living beings. Evolutionarily speaking, the human body has handled the glucose from the beginning of life, billions of years. It is not consistent that suddenly not to carry it out. It is more coherent thinking that the human body, when it has altered the generation and distribution of power (of melanin); It cannot do what it does very well (to handle glucose) for millions of years, has done millions of times. The energy that emanates from the melanin is surprisingly accurate, as they are the body's biochemical processes. Therefore, the generation and distribution of energy that comes from the melanin, is altered by the contaminated water, polluted air, pesticides, herbicides, fertilizers, plastics, metals, industrial waste; numerous drugs, anesthetics agents, stress; injuries, aging; etc. ll it earlier is in an imbalance between the mass and the energy, because the levels of energy chemical that our body requires to operate well, as it has made millions of years, millions of times; they must be the same levels that our body has had throughout the evolution of creation. When they decrease, or are not adequate, our body cannot do what it does very well, and this can manifest itself in various ways, for example, diabetes mellitus. In any system, widespread failure is characteristic of energy, and our body is no exception. The metabolism of glucose is extraordinarily complex and dynamic, it is even known to all cells of the body have a thick layer of glucans, which is different in nature from cell to cell; Therefore, the power required by an accurate and complex system to work properly, starts with impeccable, accurate power distribution and generation, but from melanin; and not from glucose.
- Technologies for the Treatment of Diabetes | Diabetes Associated Disorders Diabetes and its Complications | Genesis of Diabetes | Screening of Diabetes
Location: Bleriot 2
Chair
Arturo Solis Herrera
Human Photosynthesis Research Center, Mexico
Co-Chair
Bandar Manawer Alharbi
Prince Sultan Military Medical City, Saudi Arabia
Session Introduction
Helene von Bibra
Klinikum Grobhadern, Germany
Title: Cardiometabolic syndrome and increased risk of heart failure
Time : 11:55-12:25
Biography:
Helene von Bibra studied medicine in Munich, Germany. She worked at Klinikum Großhadern, Munich, Kings College and Brompton Hospital, London, Municipal Hospital München-Schwabing and Klinikum rechts der Isar, Technical University Munich receiving the Internal medicine and the Cardiology board certifications in 1983 and 1993. In 1999, she became appl. Professor for Internal Medicine/Cardiology of the Technical University, Munich. She became appl. Professor for Internal Medicine/Cardiology of the Technical University, Munich in 1999 and continued her scientific work as visiting professor in 1997 Linköping, Sweden, from 1998 – 2002 at the Karolinska Hospital in Stockholm and then at the Municipal Hospital Bogenhausen, Munich. Member of cardiologic/diabetologic societies: ESC since 2000 as FESC, EASD, DGK, DDG.
Abstract:
Approximately 50 % of patients with heart failure have diastolic heart failure (HFPEF) with the major predisposing risk factors age, inactivity, obesity, insulin resistance (IR), type-2 diabetes, and hypertension. The prognosis of HFPEF is comparable to that of systolic heart failure, but without any specific or effective treatment. This review presents a biomathematically corrected diagnostic approach for quantification of diastolic dysfunction (DD) via the age dependency of diastolic function. Pathophysiological mechanisms for DD in the cardiometabolic syndrome (CMS) are mainly based on downstream effects of IR including insufficient myocardial energy supply. The second section discusses therapeutic strategies for the control and therapy of CMS, IR and the associated DD/HFPEF with a focus on dietary therapy that is independent of weight loss but improves all manifestations of the CMS and reduces cardiovascular risk.
Bandar Manawer Alharbi
Prince Sultan Military Medical City, Saudi Arabia
Title: The effect of 6 weeks exercise program in prediabetic and metabolic syndrome individuals
Biography:
Bandar Manawer is a member of American Society of Health System Pharmacist (ASHP) - since 2001 and Saudi Commission for Health Care Specialties. He has
presented his research in several prestigious International conferences. He served as Director of Pharmacy, Director of Medical Supplies and Purchasing (PSMMC)
and Director of Central Sterile Supplies Department (PSMMC). He is currently working as an Assistant Director of Pharmacy for Material Management, Prince
Sultan Military Medical City (PSMMC).
Abstract:
Introduction: 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.
Results: There were significant reduction (p=0.00) on the HbA1c after applying of 6 weeks’ combination exercise intervention in both groups comparing to baseline. OGTT indicated significant differences between Pre Exercise & Post 12th exercise session in both groups with p=0.01. BG concentrations were reduced post each exercise session and was significant Post-EX S12 comparing PRE-EX to P= 0.00 and P= 0.09 in PRE-D and ND respectively. A significant reduction in TC (P= 0.04) and LDL (P= 0.02) in PRE-D only. SBP drops from 127.3±13.1 to 119.6±8.4 mmHg with P= 0.04 in PRE-D while in ND was not significant. HR was significantly reduced (P=0.01) and goes from 73.5±10.3 to 70.3±12.1 in PRE-D and was significantly
reduced (P= 0.03). A significant reduction in RPE have been achieved with P=0.00 in PRE-D and P=0.03 in ND group.1RM improved significant in back (P=0.04) and triceps (P=0.04) in PRE-D, while in ND group the significant improvement was in squat (P=0.02) and back (P=0.02).
Conclusion: A combination exercise programs, which involves both RE, and AE performed at moderate intensity (50 – 60% of 1RM) over 6-weeks period can be feasible and economical prevention strategies to minimize the risk factors for T2D in prediabetes subjects
Marisa Freitas
University of Porto, Portugal
Title: Prediction of anti-diabetic activity of flavonoids targeting α-glucosidase
Biography:
Marisa Freitas currently is Research Assistant at the Department of Chemical Sciences of Faculty of Pharmacy, University of Porto, and member of the Free Radical and Antioxidants Unit of this Department. She has built her scientific career on the evaluation of the antioxidant an anti-inflammatory activities of various natural and synthetic compounds, namely flavonoids. Her expertise on the anti-inflammatory effects of flavonoids have evolved to new horizons related the evaluation of flavonoids as interesting new anti-diabetic agents
Abstract:
The limitations of currently available oral antidiabetic agents in what concerns the efficacy/safety, together with the global development of the diabetes, have stimulated the scientific community to find alternative therapies. The inhibition of α-glucosidase, the most important enzyme in the gut for the breakdown of carbohydrates before monosaccharides absorption, has been recognized as the most effective measure in reducing post-prandial hyperglycemia (PPHG) from all available antidiabetic drugs. Some flavonoids, have been shown to exhibit inhibitory effects against α-glucosidase enzymes. Nevertheless, the information found in the literature is disperse and variable, thus hindering comparisons and consequently conclusions about their efficacy against α-glucosidase activity. Thus, our aim was to establish a structure - activity relationship of a panel
of flavonoids against α-glucosidase activity, covering a solid set of different structures. The evaluation of α-glucosidase activity was performed in vitro by monitoring the α-glucosidase-mediated transformation of the substrate p-nitrophenyl-α-Dglucopyranoside (pNPG) into into p-nitrophenol. The inhibitory kinetic analysis was made by using nonlinear regression Michaelis-Menten enzyme kinetics and the corresponding Lineweaver-Burk plot. We concluded that the flavonoid structure, and the position and number of OH groups are determinant factors for the intended effect. The most active compound was quercetin, showing a competitive inhibition, which indicates that hydroxylation at 3, 5, 7 positions of the A-ring and at 3’ and 4’ positions of the B-ring, as well as the 2,3 double bond in the C-ring, are important for the inhibitory activity of flavonoids.
Parijat De
Sandwell & West Birmingham NHS Trust, UK
Title: HbA1c screening for new onset diabetes following acute coronary syndrome: Is it a worthwhile test in clinical practice?
Biography:
Parijat De is a Consultant Physician in Diabetes, Endocrinology, and Lipid Metabolism at City Hospital (Sandwell & West Birmingham NHS Trust), Birmingham. He started as a Consultant Physician in January 2003 having trained as a Specialist Registrar in Wales. He has done his MD Medicine from India. He has a wide interest and expertise in all aspects of Diabetes, especially in the field of Metabolic Medicine and Diabetes Renal disease. His special interest in Diabetes is Metabolic Syndrome as well as the growing problem of obesity including new oral and injectable therapies for weight loss. He has published widely in his field and Perseus an active research interest. He has published numerous papers in peer reviewed journals. He is involved in both undergraduate and postgraduate MRCP teaching and is an MRCP examiner and host. He has previously been the trust Clinical Governance Lead, College Tutor and is currently the Clinical Lead. He has set up local protocols and guidelines in most aspects of metabolic medicine including emergencies in diabetes as well as endocrinology.
Abstract:
Background: Disturbances of glucose metabolism and diabetes are widely prevalent in acute coronary syndrome (ACS) and relate to adverse outcome, irrespective of presence or absence of previously diagnosed diabetes. The aim was to use HbA1c to screen for degrees of glucose intolerance amongst non-diabetic patients admitted to our cardiology ward with ACS.
Method: We developed a protocol incorporating a random HbA1c diagnostic blood test on day 2 or 3 post admission for every patient admitted with ACS without known diabetes. All HbA1c results were sent directly through to Diabetes Department via Think Glucose (TG) electronic system on iCM. As per protocol, patients were subsequently invited for a repeat HbA1c at 2
weeks, and if indeterminate result, for an oral glucose tolerance test (OGTT) at 3 months. Baseline characteristics and severity of ACS was recorded.
Results: We screened 399 patients over a 1-year period (June 2014 – June 2015). The mean age was 65±14 years, 268 (67%) were male, 290 (73%) were Caucasian, 95 (24%) were South-Asian and 14 (4%) were Afro-Caribbean ethnicity. Of all patients, 57 (14.3%) were found to be pre-diabetic, 43 (10.8%) diabetic, 6 (1.5%) died and 22 (5.5%) did not attend follow-up. Of all baseline contributory factors, there were significantly more patients who were South Asian in the new diabetes group compared to the normal group (42% Vs 20%; p=0.003). However, there was no difference in new glycaemia detection rates in
patients with more severe ACS, or those requiring coronary intervention or urgent cardiac surgery.
Summary: This screening method has managed to accurately estimate new onset abnormal glycaemia in high-risk post ACS patients. Patients of South Asian ethnicity presenting with ACS are at highest risk of developing diabetes. All new diabetes patients receive counselling about their diagnosis and future cardiovascular risks, management plan for their GP and are enrolled into our structured diabetes education programme.
Juntao Kan
Nutrilite Health Institute, China
Title: A novel botanical formula prevents diabetes by improving insulin resistance
Biography:
Juntao Kan got his PhD from Fudan University with a major of cardiovascular and molecular pharmacology. After graduation, he worked in pharmaceutical
companies for 2 years, and be responsible for high throughput screening assays and animal models on diabetes and metabolic disease. Then he joined Nutrilite
as a senior scientist and did research and development for functional food.
Abstract:
Statement of the Problem: The prevalence of type 2 diabetes mellitus (T2DM) has increased significantly in recent decades to epidemic proportions in China. Individually, fenugreek (Trigonella foenum graecum) seed, mulberry (Morus alba L.) leaf and American ginseng (Panax quinquefolius) root can improve glycemia in various animal models and humans with impaired
glucose metabolism and T2DM. The aim of this study was to design an optimized botanical formula containing these herbal extracts as a nutritional strategy for the prevention of insulin resistance and T2DM.
Methodology & Theoretical Orientation: Cell-free α-amylase and α-glucosidase enzyme assays were used to determine inhibitory potential of extracts. Glucose uptake was examined in differentiated human adipocytes using radiolabeled 2-deoxyglucose. Male Sprague Dawley rats were divided and glycemia balanced into 5 groups: two controls (naïve and model) and three doses of the botanical test formula. Insulin resistance and T2DM was induced by feeding animals a high fat diet and with an alloxan injection. Glucose tolerance was examined by measuring serum glucose levels following an oral glucose load.
Findings: Fenugreek seed and mulberry leaf dose dependently inhibited α-amylase (IC50 = 73.2 μg/mL) and α-glucosidase (IC50 = 111.8 ng/mL), respectively. All three botanical extracts improved insulin sensitivity and glucose uptake in human adipocytes, which lead to the design of an optimized botanical test formula. In a rat model of insulin resistance and T2DM,
the optimized botanical test formula improved fasting serum glucose levels, fasting insulin resistance and the development of impaired glucose tolerance. The reduction in epididymal adipose tissue GLUT4 and PDK1 expression induced by high fat diet and alloxan was blunted by the botanical test formula.
Conclusion & Significance: A novel botanical formula containing standardized extracts of mulberry leaf, fenugreek seed and American ginseng prevented the development of insulin resistance, impaired glucose tolerance and T2DM. Given the rising need for effective non-drug targeting of insulin resistance and progression to T2DM, complementary and alternative nutritional strategies without intolerable side effects could have meaningful impact on metabolic health and diabetes risks.
Owusu Akyiaw Bempah
fv supplement ltd, UK
Title: Polyuria is the cause of long term diabetes complications
Biography:
Owusu Akyiaw Bempah is a graduate in MSc (Radiochemistry) from Lomonosov Moscow State Univ; the author took a Teaching Assistantship at McMaster Univ. in Hamilton, Ontario Canada and obtained Ph.D in Analytical chemistry. He taught Inorganic and Analytical chemistry in Cape Coast Univ. Ghana; and did Consultancy for local industries. He developed interest in research into diabetes when, as type 2 diabetes mellitus patient, he suffered chronic complications. He soon realised there was little anyone could do for him. So he hit the Internet for information. Fortunately medical information was also available. Using the knowledge gained, he formulated a tablet and had it made. He ingested the tablet, one a day, for a year and all his symptoms disappeared. He organised an open trial to validate his cure. The results are published.https://diabetesmeeting.conferenceseries.com/
Abstract:
Statement of the problem: The blood plasma glucose-protein interactions model (the glycation theory) for the study of chronic diabetes complications has failed to find cure for, or prevent long-term (chronic) diabetes complications. Available data showing that polyuria reduced blood plasma concentrations of thiamine (a vasodilator) in diabetes mellitus patients to 25% of concentration level needed to sustain vasodilatation in the microcirculation of normal persons have been used to propose a new theory.
Theory: Polyuria-induced vitamin deficiency in blood plasma causes vasoconstriction in the microcirculation; impairing the exchange of nutrients, gases and particles between blood and tissue causing tissue damage in organs with microcirculation everyday. Over time, the accumulated damage manifests as organ failure described as “diabetes complications”.
Hypothesis: Supplementation with vasodilators to ensure 24-hour vasodilatation in the microcirculation will halt tissue damage to allow natural healing.
Methodology & findings: A tablet containing niacin, thiamine and calcium-d-pentothenate was prepared and given to type 2 diabetes patients in open trial to ingest, one-a-day, over seven years. Cures reported included early-stage symptoms of chronic complications such as; ulcers, nephropathy, retinopathy and peripheral neuropathy. Continued use after the initial cure has prevented developments of new symptoms.
Conclusion and significance: The multiple cures of chronic complications affecting all organs by the vitamin supplementation demonstrate the validity of the polyuria theory. This is a breakthrough in diabetes research. That the tablet contains, well characterised substances with no known side effects, is additional bonus. Patients will not require hospital treatment or need supervision by trained medical personnel; thus reducing treatment costs. The therapy itself is not expensive to buy. People with diabetes will not anymore live with the threat of blindness, amputation, kidney failure, stroke and heart problems.
Mahmoud Balbaa
University of Alexandria, Egypt
Title: Role of Nigella sativa oil and antidiabetic drugs in modifying the brain insulin signaling in Streptozotocin-induced diabetic rats
Biography:
Mahmoud Balbaa has received his PhD in Hokkaido University, Japan during the period of 1984-1988. Currently, he is working as a professor of biochemistry in Alexandria University, Egypt. He was appointed as head of the Biochemistry Department, Alexandria University, Egypt from 2007 to 2009. His research has included the study of enzyme characterization and inhibition, cell signaling and the biochemical parameters in diseases. Based on this research and fellowship training, he has received several awards and honors, such as post-doctoral fellowship from the Medical Research Council, Canada, post-doctoral fellowship from AIEJ, Japan. He is serving as an editorial member of several reputed journals. He has authorized more than 50 research articles.
Abstract:
The black seeds of Nigella sativa have different biological activities and the anti-diabetic effect is among these activities. Streptozotocin (STZ) - induced diabetic rats were treated daily with NS oil (NSO) in order to study its anti-oxidative, antibrain insulin resistance, acetylcholinestrase (AChE) inhibition and anti-amyloidogenic activities. A significant decrease in the antioxidant status with peripheral and central production of pro-inflammatory mediators were observed. The brain insulin resistance and the reduced insulin signaling pathway (p-IRS/ p-AKT/p-GSK-3β) were accompanied by an increment of the
GSK-3β level, which in turn may contribute in the extensive alterations of Tau phosphorylation along with changes in PP2A level. In addition, the brain AChE was activated and associated with diminished brain glucose level and cholinergic function Furthermore, neuronal loss and elevation in Aβ-42 plaque formation were observed due to a low IDE formation and an increased expression of p53, BACE1 and APP with diminished ADAM10, SIRT1 and BDNF levels. The treatment of diabetes induced rats with NSO and the anti-diabetic drugs alone and/or in combination have the potential to suppress the oxidative stress, the pro-inflammatory mediators and amyloidogenic pathway. Moreover, it lowers the inhibitory effect of IOMe-AG538 for the insulin receptor and modifies the insulin-signaling pathway. Therefore, it prevents the neurotoxicity, amyloid plaque formation and Tau hyper-phosphorylation. These data suggest that NSO or its combined treatments with anti-diabetic drugs
have a possible protective and modifying effect of the insulin resistance in the brain through enhancing brain insulin signaling pathway.
Artur Bossowski
University of Bialystok, Poland
Title: Analysis of chosen polymorphisms rs2476601 A/G - PTPN22, rs20541 A/G – IL13 rs29941 A/G – KCTD15 in pathogenesis of type 1 diabetes in children
Biography:
Abstract:
Background: Type 1 Diabetes is multifactorial disease with a genetic susceptibility and environmental factors. The Tyrosine phosphatase non-receptor type 22 (PTPN22) gene polymorphism is known to be associated with T1DM, but it has not been established in a Caucasian children population yet. The interleukin 13 (IL13) and the potassium chanel tetramerization domain
containing 15 (KCTD15) gene polymorphisms impact on the development of Type 1 DM in children has not been reported yet.
Objective & Hypothesis: To estimate the association of polymorphisms of PTPN22, IL13 genes and KCTD15 polymorphisms with the predisposition to T1DM in children.
Method: The study was performed in 94 patients with T1DM. The three single nucleotide polymorphisms (SNPs): rs2476601 - PTPN22, rs20541- IL13 , rs29941 -KCTD15 were genotyped by TaqMan SNP genotyping assay using the real-time PCR.
Results: Rs2476601 A alleles were more frequent in patients with T1DM in comparison to healthy subjects (p=0.004 with OR=2). Rs20541 A alleles were more frequent in T1DM patients in comparison to healthy subjects (p=0.002 with OR=2). Rs29941 A alleles were more frequent in T1DM patients in comparison to healthy subjects (p=0.001, OR=7).
Conclusion: Rs2476601 A/G - PTPN22, rs20541 A/G - IL13 , rs29941 A/G - KCTD15 polymorphisms could contribute to development of T1DM in children. The main risk factor for rs2476601, rs20541 and rs29941 is allele A.
Don S Schalch
University of Wisconsin, USA
Title: Impact of nutritional access on obesity and diabetes: “Food Swamps†and “Food Desertsâ€
Biography:
Don Schalch completed his M.D. at the Univ. of Cincinnati, OH, in 1960 and medicine residency and fellowship in endocrinology at the Univ. of Rochester (U of R), NY, and Washington Univ. in St. Louis, MO in 1964, then joining the U of R faculty. He was a visiting scientist at Erasmus Univ. in Rotterdam and at Kantonspital in Zürich in 1972-73, and joined the Univ. of Colorado Medical School facutly in Denver, CO in 1974. In 1982, he became chief of endocrinology at the Univ. of Wisconsin School of Medicine and Public Health. He has published 101 papers, was reviewer for 3 journals, and became emeritus professor in 1999.
Abstract:
Availability of various foods is important determinant of what people buy and eat, thus impacting on their health. This is illustrated in our studies of two cities: one larger; i.e., Cleveland, Ohio, replete in "food swamps," and one smaller; i.e., Madison, Wisconsin, site of many "food deserts." Food swamp = readily-accessible convenience stores and fast food restaurants; food desert = difficult-to-buy fresh fruits and vegetables. Food swamps and deserts often co-exist. Availability of nutritious food is one determinant of people’s diet; others are cost, cultural, racial, ethnic, habits, and inadequate transportation in poverty
areas. "Fast foods" in restaurants and "junk foods" in convenience stores, rich in carbohydrates, fats and sugar, are associated with increased risk of being overweight/obese and increased prevalence of type 2 diabetes, hypertension, heart disease, and cancer. Recent WHO European Region report indicated, "poor diet, overweight and obesity contribute to a large proportion of cardiovascular diseases and cancer, the two main killers in the Region." Using food provider interviews in Cleveland, and Public Health Service and UW Applied Pop. Lab. data in Madison, employing GIS (Geographic Information System), food swamps in the former and food deserts in the latter have been mapped, found corresponding to areas of poverty, mainly inhabited by people of color. To emphasize complexity of poor diet choices, a refrigerated 40-foot trailer offering fresh fruits and vegetables in 8 food deserts in Madison was unsustainable after 2 years because consumer interest declined.
- Computerised Applications in Diabetes | Diabetes Education and its Risk Factors | Emerging Focus in the Treatment of Diabetes | Gestational Diabetes
Location: Bleriot 2
Chair
Vithian Karunakaran
Colchester Hospital University NHS Foundation Trust|, UK
Co-Chair
Bandar Manawer Alharbi
Prince Sultan Military Medical City, Saudi Arabia
Session Introduction
Jana Votapkova
Charles University, Czech Republic
Title: Type 2 diabetes mellitus in the Czech Republic: Prediction of prevalence and costs
Biography:
Jana Votapkova specializes in healthcare economics and economic modelling. She cooperates with the Observatory for Health systems and policies and other
international institutions on economic expertise. Her research concentrates on technical and economic efficiency in the healthcare sector, economic analyses of
healthcare reforms or analyses of determinants affecting long-term sustainability of healthcare finances.
Abstract:
Statement of the Problem: Costs associated with the treatment of type 2 diabetes mellitus represent a large share of healthcare costs of developed societies. Being diagnosed with type 2 diabetes mellitus is associated with increased healthcare costs compared to the population not suffering from diabetes. As opposed to published research which analyzes small samples or
survey data, we use population-based individual data to predict the number of Czechs that will suffer from diabetes and their healthcare costs.
Methodology & Theoretical Orientation: Individual-level data on healthcare costs and drug consumption for the whole Czech population over 30 years of age for the period 2010- 2015 are used to identify patients with diabetes. Observations are divided into age and sex groups to identify how costs of different age cohorts of diabetics change over time using a GLM model. The share of diabetics in age cohorts and sex groups is predicted using linear regression. Absolute numbers of diabetics are calculated based on the official demographic prediction of the Czech Republic. Future healthcare costs of diabetes reflect different percentiles of distribution and inflation expectations.
Findings: The strongest association between increased healthcare costs and the presence of diabetes was found for 55-69 year olds Czechs. The highest share of diabetics is among 75-year-olds reaching 21.4 % (22.3 % males; 20.8 % females] in 2015. In the observed period, costs of a 75-old-diabetic increase by 2.7 % on average (3 % males; 2.4 % females] annually. Future costs of diabetes are expected to rise and so is the share of diabetics.
Conclusion & Significance: Given escalating costs and increasing prevalence boosted by population ageing, ceteris paribus, diabetes will represent a significant burden for the Czech healthcare system. The methodology is applicable to other chronic diseases too.
Gauri Billa
Abbott Healthcare Pvt. Ltd, India
Title: A retrospective study to determine the prevalence of hyperuricemia in Indian subjects attending hyperuricemia screening camps
Biography:
Gauri Billa is an experienced senior medical advisor with a demonstrated history of working in the hospital & health care industry. She is skilled in clinical research, pharmacology, clinical trials, healthcare, and clinical pharmacology. She has a strong healthcare services professional with a Doctor of Medicine (M.D.) focused in Pharmacology from King Edward Memorial Hsopital.
Abstract:
Statement of the Problem: The prevalence of type-2 diabetes mellitus (T2DM) and hypertension (HTN) has been rapidly rising in India, over the past few decades. Elevated levels of serum uric acid (SUA) have been shown to be associated with both T2DM and HTN. About two-thirds of hyperuricemics remain asymptomatic, without any signs and symptoms of urate crystal deposition/gout. Hence screening for hyperuricemia may play a significant role in early detection, prevention, and management of complications associated with T2DM and HTN. However, limited information is available regarding the
burden of hyperuricemia in Indian population. The objective of this study was to determine the prevalence of hyperuricemia in subjects with HTN and T2DM, in Indian setting.
Methodology & Theoretical Orientation: A retrospective analysis of patients undergoing screening for hyperuricemia in health clinics across India between April to May 2017 was carried out. Data regarding demographics, history of T2DM and HTN and uric acid levels (easy touch uric acid monitoring system) were recorded during the camps.
Findings: Data from 3044 screening camps was analyzed. The mean age of the study population was 47.92 years; about two-thirds of the subjects were men. Of the 29,391 subjects screened, 25.79% were found to have hyperuricemia (uric acid >7mg/dl). The percentage of diabetics, hypertensives and Diabetic hypertensives who had hyperuricemia was 33.62%, 35.11%, and 34.39% respectively. A trend towards increased prevalence of hyperuricemia was seen with increasing age and increased duration of diseases like HTN and diabetes.
Conclusion and Significance: High prevalence of hyperuricemia was observed in T2DM and HTN and in patients with both co-morbidities. Age-wise analysis revealed an increasing trend of hyperuricemia with age. Further, the prevalence of hyperuricemia also increased with increasing duration of T2DM and HTN.
Eleni Andreou
University of Nicosia, Cyprus
Title: Type 2 diabetes and obesity and its correlates in a first nationwide study among Cypriot adults
Biography:
Eleni Andreou is currently working as Assistant Professor, at the University of Nicosia , Cyprus. She received her Doctoral degree on Clinical Dietetics, Health Education and Behavioral Studies from the University of Middlesex, UK. Dr Andreou completed her Masters/CPD Nutrition and Clinical Dietetics from the University of Youngstown, USA. She then worked in Cyprus as clinical dietitian, elected as president of the Cyprus Dietetic and Nutrition Association, served as Assistant Professor at the University of Nicosia in Cyprus. Dr Andreou has authored several publications in various journals and books. Her publications reflect her research interests in diabetes, obesity, weight management, eating disorders, nutrition behavioral modification. She is also an Associate Editor of the Journal PANR. Dr. Andreou is serving as the president of the Cyprus Dietetic and Nutrition Association, vise president of the Cyprus Registration Board for Food Scientists and Dietitians and a member in American Academy of Nutrition and Dietetics. She is currently in charge of ongoing scholarly project of epidemiological study of obesity and nutritional habits of Cypriots in Cyprus. She is awarded by the American Dietetic Association (ADA)/AODA.
Abstract:
Obesity rates in Cyprus are very high and epidemiological information on type 2 Diabetes mellitus is limited. The correlates of type 2 diabetes among adults remain unknown in the Cypriot population. Thus, the purpose of this study is to provide the first national estimate of the prevalence of type 2 diabetes and investigate its correlates. A randomly stratified nationally sample of 1001 adults aged 18-80 participated in the study. Only 950 subjects completed the study. All subjects were free of any diseases (known diabetes, kidney, liver), medication and supplementation. The overall prevalence of diabetes and pre-diabetes based on WHO criteria was 9.2% and 16.3%, respectively. After adjusting for age, energy intake, smoking and physical activity participants with obesity (BMI) (OR=2.00, P<0.001), waist circumference (WC) OR=2.08, P<0.001), hypertension (HT) (OR=1.99, P<0.001) and hypercholesterolemia (HC) (OR=2.07, P<0.007) were most likely to develop T2DM compared with the normal ones. The odds of having Diabetes was also found significant between subjects with high levels of Triglycerides (TG) (OR=1.49, P<0.007), compared with the normal ones and between subjects with low levels of HDL (OR=1.44, P<0.008) compared with the ones with high levels of HDL. The prevalence of type 2 diabetes in Cyprus is relatively medium- high. However, the pre-diabetes rates are very high showing a promising increase towards total rates of type 2 Diabetes. Obesity, HT, WC, TG, HC and low HDL are all strong correlates of type 2 Diabetes. Healthy education programs should be initiated for young and Elderly people and those with described abnormal risk factors.
Armin Ezzati
University of Leeds, UK
Title: Does the olive-derived polyphenol oleuropein affect postprandial glycaemic response following a short term high fat intake: Randomised, double-blinded, placebocontrolled, crossover trial
Time : 14:40-15:10
Biography:
Armin Ezzati is a MSc student in Nutrition at University of Leeds, conducting human research on the health effects of functional foods under supervision of Prof. Gary Williamson, professor of functional food.
Abstract:
Polyphenol-rich foods have the potential to improve post-prandial glycaemic response by decreasing glucose absorption thus lowering the risk of Type 2 Diabetes. A randomised, double-blinded, placebo-controlled, cross-over study was conducted on 10 healthy volunteers (5women, 5 men) to investigate whether supplementation with oleuropein extracted from olive leaves extract (Oleaeuropea L.) could attenuate post-prandial blood glucose levels following a 3-day high/normal fat diet. The participants randomised to receive a 3-day high fat diet(~43%fat from daily energy intake) or normal fat diet (~23%fat from daily energy intake) and were given oleuropein(100mg) or placebo capsules for three days before each visits. The participants were fasted and attended four sessions: two control visits and two test visits(after 3-day high fat with or without oleuropein). Blood samples were collected following eating a 109g of white bread at 0(fasted), 15, 30, 45, 60, 90, 120, 150, 180 min. High fat diet with oleuropein, high fat diet with placebo, normal diet with and without oleuropein trials were compared together. There were no significant differences between the tests and controls. Change in mean incremental areas under the glucose curves (IAUC) was calculated and no significant difference were observed. Further studies with a larger sample size with more fat percentage from energy is essential to obtain more accurate results.
Carina Proença
University of Porto, Portugal
Title: Structure-related inhibition of Protein Tyrosine Phosphatase 1B (PTP1B) by flavonoids
Time : 15:30-16:00
Biography:
Carina Proença is a PhD student of Pharmaceutical Sciences at UCIBIO, REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy of University of Porto. Her actual domain of study involves the in vitro and in silico evaluation of the inhibitory effect of flavonoids against several enzymes intrinsically related with the type 2 diabetes mellitus.
Abstract:
Type 2 diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycemia resulting from inadequate insulin secretion and/or resistance to insulin action. Protein tyrosine phosphatase 1B (PTP1B) is considered a major
negative regulator in the insulin signaling pathway, contributing to insulin resistance. Thus, the discovery and development of selective and effective PTP1B inhibitors is a potential therapeutic target for the management of type 2 DM. Some flavonoids have already been shown to inhibit this enzyme, but the literature still lacks in depth structure-activity relationship studies. The main aim of the present work was to test a diversified panel of known and new flavonoids, with different types of substituents (-OH, -OMe and/or -OBn) in different positions, against the PTP1B inhibitory activity. The evaluation of PTP1B activity was performed in vitro by monitoring PTP1B-catalyzed hydrolysis of the substrate p-nitrophenyl phosphate (pNPP) into the product p-nitrophenolate at 405 nm in a microplate reader. The study of the inhibition type of the most active flavonoid was made using the nonlinear regression Michaelis-Menten enzymatic kinetics and the corresponding Lineweaver-Burk plot. Our results suggest that that the presence of -OMe groups at positions 7 and 8 in A ring, together with the presence of -OBn groups at 3’ and 4’ positions in B ring and a OH group at 3 position in C ring, increases the flavonoids’ ability to inhibit PTP1B. The most active flavonoid was 3’,4’-dimethoxy-7,8-dibenzoxyflavonol, presenting a mixed type inhibition. In conclusion, some of the tested flavonoids seem to be promising PTP1B inhibitors and potential effective drugs in the management of type 2 DM, increasing insulin sensitivity.
Ugochukwu Offor
University of KwaZulu-Natal, South Africa
Title: Possible attenuating influence of M. Charantia in diabetic nephropathy following triplavar: Any glimmer of hope?
Time : 16:00-16:30
Biography:
Ugochukwu Offor is a PhD researcher in the department of clinical anatomy, University of KwaZulu-Natal Durban, South Africa. He is a member of Morphology and Andrology Group (MAG) UKZN which philosophical ethos is geared towards addressing core health issues, particularly complications arising from diabetes using sophisticated techniques for medical investigations while promoting indigenous knowledge system (IKS) that is of cutting edge significance in the Republic of South Africa. He is also a Member of Golden Key International Honours Society, an organization that recognizes specifically top 15% academic achievers globally. He was recently nominated for the International Scholars Laureate Program in Australia and China.
Abstract:
Diabetic nephropathy (DN) has become a primary cause of end-stage kidney disease. Several complex dynamics converge together to accelerate the advancement of DN. The study was carried out to explore the mechanism of reno-protective nature of Momordica Charantia (MC) in streptozotocin (STZ) - induced diabetes rats following treatment with triplavar in adult male Sprague-Dawley rats. 78 male Sprague-Dawley rats (n=78) weighing 200±250 were used for the study. The study comprised of two groups i.e. a non-diabetic (A-F) comprising of six animals per group and a diabetic group (G-L) comprising
of seven animals per group. Diabetes was induced in the overnight fasted rats by intraperitoneal injection of STZ (45 mg/kg body weight). The animals were euthanized on the tenth week and the kidneys were removed and prepared for examination. M. charantia illustrates significant improvement in blood glucose levels. Urinary parametric indices displayed positive outputs and enhanced protection of M. charantia. Consequently, histological observations restored kidney tissues from hyperglycemia mediated oxidative damage and efficient protection from apoptotic index.