Day 1 :
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
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.
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.
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
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.
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.
Human Photosynthesis Research Center, Mexico
Time : 11:15-11:55
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.
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.