33^rd International Congress on Prevention of Diabetes and Complications October 31-01, 2022 London, UK

Type 2 diabetes is a disorder characterized by abnormally high blood sugar levels. In this form of diabetes, the body stops using and making insulin properly. Insulin is a hormone produced in the pancreas that helps regulate blood sugar levels. Specifically, insulin controls how much glucose (a type of sugar) is passed from the blood into cells, where it is used as an energy source. When blood sugar levels are high (such as after a meal), the pancreas releases insulin to move the excess glucose into cells, which reduces the amount of glucose in the blood. Most people who develop type 2 diabetes first have insulin resistance, a condition in which the body's cells use insulin less efficiently than normal. As insulin resistance develops, more and more insulin is needed to keep blood sugar levels in the normal range. To keep up with the increasing need, insulin-producing cells in the pancreas (called beta cells) make larger amounts of insulin. Over time, the beta cells become less able to respond to blood sugar changes, leading to an insulin shortage that prevents the body from reducing blood sugar levels effectively. Most people have some insulin resistance as they age, but inadequate exercise and excessive weight gain make it worse, greatly increasing the likelihood of developing type 2 diabetes.

Three NIH-funded research groups are developing innovative technologies that may change the way health care professionals understand, diagnose, and treat type 1 and type 2 diabetes. Learn more about these tools and advances below.A tool to advance type 1 diabetes researchNIDDK-funded researchers are developing a new tool, called an islet chip, to study islets—groups of cells in the pancreas. Islets contain several types of cells, including beta cells that make insulin. In people with type 1 diabetes, the body’s immune system attacks and destroys the beta cells.Islet chips are bioengineered three-dimensional models that imitate the way the human body supports islets to allow human islets to survive and function in the lab. Islet chips will allow researchers to study how the immune cells interact with beta cells to mimic aspects of the autoimmune process involved in type 1 diabetes.“[Islet chips] will also serve as a platform for testing novel type 1 diabetes therapies, potentially saving time and money in terms of identifying the most promising therapies to test in people,” said NIDDK Director Dr. Griffin P. Rodgers, in 2019 testimony before the U.S. Senate’s Special Committee on Aging.

Correct diagnosis is essential. Thus emphasis should be placed on using appropriatediagnostic criteria. Treatment should not only consider lowering the blood glucose level but also shouldfocus on the correction of any associated CVD risk factors such as smoking,hyperlipidemias, and obesity as well as monitoring of blood pressure and ~treatment ofhypertension.Management of non-insulin-dependent diabetes mellitus (NIDDM) requires teamwork.The doctor should work closely with the nurse and other members of the diabeteshealth care team, whenever available, and with the person with diabetes.Self-care is an essential strategy. Education of the person with diabetes and his/herfamily is the cornerstone of management. Without appropriate education, the desiredtherapy targets are difficult, or even impossible to achieve. People with diabetes shouldbe encouraged and enabled to participate actively in managing and monitoring theircondition.Good control is important. Self-monitoring improves the quality and safety of therapy.The health care system should ensure that people with diabetes have access to the basicrequirements essential to practise self-care.Record-keeping is critically needed and should be considered a basic requirement forthe management and follow-up of all cases.Objectives and priorities of treatment must be tailored to individual needs; therapytargets should be individually determined for each case.

In August 2012, results of the Phase I trial showed that the pancreas of long-term diabetics was able to transiently make insulin after two doses of the Bacillus Camlette-Guerin (BCG) vaccine.  In 2018 a follow up report on a total of 232 participants both treated and untreated with BCG, published in the journal Vaccines, showed positive results in lowering blood sugars in subjects with type 1 diabetes to almost normal levels while also reducing the amount of insulin needed about one-third after 5 to 8 years from the initial treatment with the BCG vaccine without any reports of severe hypoglycemia. The 2015 FDA approved Phase II clinical trial, which is now fully enrolled with 150 participants with long-term type 1 diabetes, will determine the dose and frequency of doses required to reverse type 1 diabetes. It is still necessary to obtain funding to track these patients for an additional two years with the ultimate goal of bringing BCG to market as an approved treatment for type 1 diabetes. Five additional clinic trials with BCG/placebo to over 150 subjects are currently ongoing.

Type 1 diabetes results from the body's failure to produce insulin, the hormone that "unlocks" the cells of the body, allowing glucose to enter and fuel them. It is an autoimmune disease in which the body views the beta cells (insulin producing cells found in the islets of the pancreas) as a foreign substance, so the patient's immune system attacks the islets and kills them. It is estimated that 5-10% of Americans who are diagnosed with diabetes have type 1 diabetes. Most people with type 1 diabetes do not have a family history of the disease and there  is no way currently to prevent the onset of type1 diabetes. Insulin therapy, given by injection or insulin pump, is life-saving. However, it's not perfect. Most people with type 1 diabetes still have blood glucose levels that are above normal. This puts them at risk for the long-term complications of diabetes.Some people have what doctors call labile, or brittle, diabetes. Blood glucose levels swing from high to low despite the best insulin plans. Because of this, long-term type 1 diabetic survivors often develop vascular complications, such as diabetic retinopathy, an eye disease that can cause poor vision and blindness, and diabetic nephropathy, a kidney disease that can lead to kidney failure.

Diabetes Research and Clinical Practice is an international journal for health-care providers and clinically oriented researchers that publishes high-quality original research articles and expert reviews in diabetes and related areas. The role of the journal is to provide a venue for dissemination of knowledge and discussion of topics related to diabetes clinical research and patient care. Topics of focus include translational science, genetics, immunology, nutrition, psychosocial research, epidemiology, prevention, socio-economic research, complications, new treatments, technologies and therapy. The International Diabetes Federation (IDF) is an umbrella organization of 221 member associations in more than 160 countries, representing over 285 million people with diabetes, their families, and their healthcare providers. The mission of IDF is to promote diabetes care, prevention and a cure worldwide. Its main activities include education for people with diabetes and healthcare professionals, public awareness campaigns and the promotion and exchange of information. IDF is a non-governmental organization in official relations with WHO

Diabetes Systems Biology provides senior undergraduate students and junior scientists, interested in diabetes systems biology, with a tool to learn more about the mathematical models and methods used to understand macroscopically and microscopically beta-cell behaviour in health and disease. The book introduces readers to the quantitative methods used to examine beta-cell dynamics, islet biology and architecture, as well as diabetes etiology and implications. The goal is to allow junior researchers in the fields of mathematical biology and biophysics to obtain a broad understanding of these quantitative methods, and guide them into taking the first steps into the field of diabetes systems biology. At the end of each chapter, several problem-solving exercises (that require both analytical and computational skills) are provided for the readers to help them become more proficient in this field.

Factors that increase your risk differ depending on the type of diabetes you ultimately develop.Risk factors for Type 1 diabetes include:Having a family history (parent or sibling) of Type 1 diabetes.Injury to the pancreas (such as by infection, tumor, surgery or accident).Presence of autoantibodies (antibodies that mistakenly attack your own body’s tissues or organs).Physical stress (such as surgery or illness).Exposure to illnesses caused by viruses.Risk factors for prediabetes and Type 2 diabetes include:Family history (parent or sibling) of prediabetes or Type 2 diabetes.Being African-American, Hispanic, Native American, Asian-American race or Pacific Islander.Being overweight.Having high blood pressure.Having low HDL cholesterol (the “good” cholesterol) and high triglyceride level.Being physically inactive.Being age 45 or older.Having gestational diabetes or giving birth to a baby weighing more than 9 pounds.Having polycystic ovary syndrome.Having a history of heart disease or stroke.Being a smoker.Risk factors for gestational diabetes include:Family history (parent or sibling) of prediabetes or Type 2 diabetes.Being African-American, Hispanic, Native American or Asian-American.Being overweight before your pregnancy.Being over 25 years of age

Your endocrine system includes eight major glands throughout your body, such as the thyroid gland, pituitary gland, adrenal gland, and pancreas. This system affects growth and development, metabolism, sexual function, and mood.If your hormone levels are too high or too low, you may have an endocrine disease or disorder. Endocrine diseases and disorders also occur if your body does not respond to hormones the way it is supposed to.

Type 1 diabetes (T1D), formerly known as juvenile diabetes, is an autoimmune disease that originates when very little or no insulin is produced by the islets of Langerhans (containing beta cells) in the pancreas. Insulin is a hormone required for the cells to use blood sugar for energy and it helps regulate normal glucose levels in the bloodstream.Before treatment this results in high blood sugar levels in the body. The common symptoms of this elevated blood sugar are frequent urination, increased thirst, increased hunger, weight loss, and other serious complications.Additional symptoms may include blurry vision, tiredness, and slow wound healing. Symptoms typically develop over a short period of time, often a matter of weeks.The cause of type 1 diabetes is unknown,but it is believed to involve a combination of genetic and environmental factors.The underlying mechanism involves an autoimmune destruction of the insulin-producing beta cells in the pancreas. Recent studies suggest this autoimmune islet destruction may be triggered by persistent enteroviral infections. Diabetes is diagnosed by testing the level of sugar or glycated hemoglobin (HbA1C) in the blood. Type 1 diabetes can be distinguished from type 2 by testing for the presence of autoantibodies.

Type 2 diabetes mellitus (T2DM) accounts for around 90% of all cases of diabetes. In T2DM, the response to insulin is diminished, and this is defined as insulin resistance. During this state, insulin is ineffective and is initially countered by an increase in insulin production to maintain glucose homeostasis, but over time, insulin production decreases, resulting in T2DM. T2DM is most commonly seen in persons older than 45 years. Still, it is increasingly seen in children, adolescents, and younger adults due to rising levels of obesity, physical inactivity, and energy-dense diets.Gestational Diabetes MellitusHyperglycaemia, which is first detected during pregnancy, is classified as gestational diabetes mellitus (GDM), also known as hyperglycemia in pregnancy. Although it can occur anytime during pregnancy, GDM generally affects pregnant women during the second and third trimesters. According to the American Diabetes Association (ADA), GDM complicates 7% of all pregnancies. Women with GDM and their offspring have an increased risk of developing type 2 diabetes mellitus in the future.GDM can be complicated by hypertension, preeclampsia, and hydramnios and may also lead to increased operative interventions. The fetus can have increased weight and size (macrosomia) or congenital anomalies. Even after birth, such infants may have respiratory distress syndrome and subsequent childhood and adolescent obesity. Older age, obesity, excessive gestational weight gain, history of congenital anomalies in previous children, or stillbirth, or a family history of diabetes are risk factors for GDM.Monogenic Diabetes .A single genetic mutation in an autosomal dominant gene causes this type of diabetes. Examples of monogenic diabetes include conditions like neonatal diabetes mellitus and maturity-onset diabetes of the young (MODY). Around 1 to 5% of all diabetes cases are due to monogenic diabetes. MODY is a familial disorder and usually presents under the age of 25 years. Secondary diabetes is caused due to the complication of other diseases affecting the pancreas (for example, pancreatitis), hormone disturbances (for example, Cushing disease), or drugs (for example, corticosteroids).

Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. Over time, having too much glucose in your blood can cause health problems, such as heart disease, nerve damage, eye problems, and kidney disease. You can take steps to prevent diabetes or manage it.An estimated 30.3 million people in the United States, or 9.4 percent of the population, have diabetes. About one in four people with diabetes don’t know they have the disease. An estimated 84.1 million Americans aged 18 years or older have prediabetes.

Diabetes mellitus (DM) is a global epidemic and affects populations in both developing and developed countries, with differing health care and resource levels. Diabetic retinopathy (DR) is a major complication of DM and a leading cause of vision loss in working middle-aged adults. Vision loss from DR can be prevented with broad-level public health strategies, but these need to be tailored to a country’s and population’s resource setting. Designing DR screening programs, with appropriate and timely referral to facilities with trained eye care professionals, and using cost-effective treatment for vision-threatening levels of DR can prevent vision loss. The International Council of Ophthalmology Guidelines for Diabetic Eye Care 2017 summarize and offer a comprehensive guide for DR screening, referral and follow-up schedules for DR, and appropriate management of vision-threatening DR, including diabetic macular edema (DME) and proliferative DR, for countries with high- and low- or intermediate-resource settings. The guidelines include updated evidence on screening and referral criteria, the minimum requirements for a screening vision and retinal examination, follow-up care, and management of DR and DME, including laser photocoagulation and appropriate use of intravitreal anti–vascular endothelial growth factor inhibitors and, in specific situations, intravitreal corticosteroids. Recommendations for management of DR in patients during pregnancy and with concomitant cataract also are included. The guidelines offer suggestions for monitoring outcomes and indicators of success at a population level.