Day 1 :
Keynote Forum
Patrick G Sullivan
University of Kentucky, USA
Keynote: A nano-scale approach to mitochondrial uncoupling for the treatment of obesity
Time : 09:30-10:10
Biography:
Dr. Sullivan completed his Ph.D. at the University of Kentucky in Anatomy and Neurobiology in 2000 and immediately began a postdoctoral fellowship at the Reeve-Irvine Research Center at the University of California at Irvine under the direction of Dr. Oswald Steward. In August of 2002, he was recruited to the position of Assistant Professor in the Spinal Cord and Brain Injury Research Center and Anatomy & Neurobiology at the University of Kentucky. Currently he is a Professor of Anatomy & Neurobiology and an Endowed Chair in the Spinal Cord and Brain Injury Research Center. Dr. Sullivan has published over 80 peer-reviewed manuscripts and his work has been cited over 4200 times.
Abstract:
Obesity is recognized as a national and global epidemic, as approximately 65% of adults in the United States are classified as overweight or obese as defined by body mass index. While obesity is associated with increased risk for metabolic syndrome and cardiovascular disease, even a modest reduction in body weight has been shown to consistently reduce or reverse health risk factors. In the 1930s it was recognized that increasing the body’s basal metabolism using mitochondrial uncouplers, directly resulted in steady and rapid weight loss. During this period the mitochondrial uncoupler, 2,4-dinitrophenol, was sold over the counter as a weight-loss supplement. It is the only compound to date that has been shown to be 100% effective for weight-loss but was eventually pulled from the shelves by the Food and Drug Administration as people were routinely overdosing on the compound in an effort to increase their rate of weight loss. To overcome this challenge, we have developed non-carbon-based, “self-rectifying” nano-scale devices, in which we can specifically and step-wise set the uncoupling capacity that when reached shuts the device off to further proton conductance. By targeting mitochondrial bioenergetic uncoupling in a controlled manner using nano-scale devices, we hypothesize that this will significantly alter metabolism and result in significant weight loss in a model of diet-induced obesity. Data will be presented demonstrating that these devices can produce weight loss without decreasing food intake in multiple animal experiments.
Keynote Forum
Maria Faresjo
Jonkoping University, Sweden
Keynote: Psychological stress- Possible risk factor to induce and maintain autoimmunity in children
Time : 10:10-10:50
Biography:
Maria Faresjo was promoted as Professor in Biomedical laboratory sciences at Jonkoping University, Sweden at the age of 37. She is the Head of the Board of the Biomedical platform at Jonkoping University, an unique national arena for biomedical research and education. The main purpose of his research is to study the immunological mechanisms, especially the failure of immune regulatory cells that probably play an important role for the development of several immunological diseases e.g. type 1 diabetes. In collaboration with colleagues, she has recently shown that psychological stress in children may induce an autoimmune response (Journal of Immunology 2014).
Abstract:
Autoimmune diseases, such as type 1 diabetes are alarmingly common in children and teenagers. Psychological stress, recognized as a public-health issue in children and teenagers, may be one mechanism possible to induce autoimmunity and autoimmune diseases. Type 1 diabetes but also other autoimmune diseases such as celiac disease, systemic lupus erythematosus and juvenile idiopathic arthritis, frequently occurring in children may be induced by psychological stress. Psychological stress is defined as a state of threatened homeostasis or disharmony induced by various physical or psychological stressors such as disease, loss of a loved one, or marital conflict in the family. Confronted with a stressful condition, the body´s stress-regulation systems activate a multiple cascade of defense responses that involve several body systems for example the immune system. The role of the immune system in regulating brain and behavior is probably one of the fastest developing fields of modern science and the importance of T-cells in brain function has been clearly demonstrated in mouse model. A limited number of studies have this far evaluated the involvement of psychological stress in autoimmune response and disease in children. We have recently shown that small children exposed to high level of psychological stress show an imbalance in their immune system and an autoimmune response associated with type 1 diabetes. Consequently, psychological stress can possibly be an important risk factor to induce and maintain autoimmunity in children.
Keynote Forum
Khalid Alnemer
AL-Imam University, Saudi Arabia
Keynote: Opportunities and challenges in diabetic hearts 2015
Time : 11:10-11:50
Biography:
Khalid Alnemer did his MBBS, from King Saud University, Riyadh, and then internal medicine, interventional cardiology, nuclear and cardiac CT at McMasterrnUniversity School of Medicine, Hamilton Ontario. He is the vice dean of medicine college, advisor for Saudi FDA. He has published more than 20 papers in reputedrnjournals and serving as an Editorial Board Member at SHJ.
Abstract:
Cardiovascular disease (CVD) is a major cause of morbidity and mortality for individuals with diabetes, in addition it isrnconsidered the largest contributor to the direct and indirect costs of managing diabetes worldwide. We are going to shedrnsome lights on important concepts in managing cardiovascular disease in diabetes including issues related to hypertension,rnhyperlipidemia, myocardial ischemia, primary and secondary prevention policies in 2015, and updated management. Therncommon conditions coexisting with Type 2 Diabetes (hypertension and hyperlipidemia) are clear risk factors for myocardialrninfarctions, stroke, heart failure and cardiovascular death; in addition, diabetes itself confers independent risk for thoserncomplications. Numerous studies have shown established efficacy of controlling individual cardiovascular risk factors inrnpreventing or slowing CVD in people with diabetes but larger benefits are seen when multiple risk factors are addressedrnglobally. There is also evidence that using epidemiologically created risk calculators for measuring the 10-year coronary heartrndisease risk among adults with diabetes have improved significantly over the past decade and made a clear impact in preventingrndevastating cardiovascular events compared to previous decade’s data. The American College of Cardiology/American HeartrnAssociation new Pooled Cohort Equation, the “Risk Calculator,” may be a useful tool to estimate those 10-year atheroscleroticrnCVD. There is also an increased risk of incident diabetes with statin use which may indicate that these patients may benefitrnfrom diabetes screening when on statin therapy. Finally we will illustrate the important clinical messages for cardiology andrnendocrine practitioners should concentrate on during their practices and share it with their medical teams and patients.
- Diabetes Medications
Type 2 Diabetes- Therapies and Treatments
Alternative Treatment for Diabetes
Diabetic Diet and Prevention
Session Introduction
Fawad Javed
University of Rochester, USA
Title: Association between glycemic status and Oral Candida carriage in patients with prediabetes
Time : 11:50-12:15
Biography:
Dr. Fawad Javed (BDS, PhD) completed his doctoral and postdoctoral education from the Department of Dental Medicine, Karolinska Institute, Sweden in December 2008. Presently, Dr. Javed is a Research Associate at the Division of General Dentistry, Eastman Institute for Oral Health, University of Rochester, NY, USA. Dr. Javed has published over 85 studies in peer-reviewed indexed medical and dental journals. Dr. Javed’s research interests include oral immunology, oral mycology, oral oncology, oral radiology, implant dentistry and assessment of the influence of systemic diseases (particularly diabetes) on oral health. Dr. Javed is also serving on the Editorial board and Peer-review panels of several ISI-indexed medical and dental journals.
Abstract:
OBJECTIVE: This study assessed the association between glycemic status and oral Candida carriage among patients with prediabetes. STUDY DESIGN: This was a comparative study of oral Candida carriage among individuals with prediabetes. Oral yeast samples were collected from 150 individuals: group A was 43 patients with prediabetes (fasting blood glucose levels and hemoglobin A1c, 100 to 125 mg/dL and ≥5%, respectively); group B was 37 individuals previously considered prediabetic but having fasting blood glucose levels <100 mg/dL and hemoglobin A1c <5%; and group C was 70 medically healthy individuals. Oral yeasts were identified using standard techniques. Unstimulated whole salivary flow rate and number of missing teeth were recorded. RESULTS: Oral Candida was isolated from 100% of patients with prediabetes and from 65.7% of control participants. Candida albicans carriage was higher among patients with prediabetes (48.7%) (P < .01) and patients in group A (51.2%) (P < .01) than among controls (25.7%). Candida carriage, unstimulated whole salivary flow rate, and number of missing teeth were similar in groups A and B. CONCLUSIONS: Oral Candida carriage was higher in patients with pre-diabetes than in controls and was independent of glycemic status in patients with pre-diabetes.
John Philip Tarburton
National University, USA
Title: Acquired Methemoglobinemia in Diabetics Blood Exposed to Organic Nitrites and Organic Nitrates
Time : 12:15-12:40
Biography:
John Philip Tarburton completed his Ph.D at the age of 25 years from the University of Nebraska and also did postdoctoral studies at the University of Nebraska. Dr. Tarburton is an Assistant Professor at National University, the second-largest private nonprofit institution of higher learning in California. Dr. Tarburton has published more than 30 papers and abstracts in reputed journals and a book chapter about his research findings.
Abstract:
Acquired methemoglobinemia in diabetics blood may be attributed to the intake of toxins and medications. Specifically organic nitrites such as butyl nitrite and amyl nitrite have been implicated in methemoglobin formation in diabetic patients given these drugs while organic nitrates such as nitroglycerin and isosorbide nitrates have been implicated in methemoglobin formation in diabetic coronary heart disease patients using these nitrates. While these organic nitrates and organic nitrites pose a risk to the general community of causing methemoglobin in both diabetic and nondiabetic alike, recent in vitro oxidation studies of diabetics blood samples by organic nitrites have clearly indicated their blood to be more susceptible to oxidation than non diabetics blood (n=20 and P< 0.05). The results for organic nitrates however did not show these findings. Specifically, diabetics blood treated with nitroglycerin was oxidized at a rate similar to that of nondiabetics (n=15 and P>0.05). Isosorbide mononitrate and isosorbide dinitrate treatment of diabetics blood samples and nondiabetics blood samples revealed no discernable oxidation of hemoglobin into methemoglobin for either group. These studies then reveal that the diabetic population is at greater relative risk of getting methemoglobinemia from organic nitrites than organic nitrates.
Mohamed El-Far
Mansoura University, Egypt
Title: Triggering central role of antioxidant defense in the management of Diabetes in potential therapy by stem cells, Silymarin and Silibinin in Diabetic rats: An overview
Time : 12:40-13:05
Biography:
Professor Mohamed El-Far, worked in biochemistry field for 40 years, published over 80 peer-reviewed papers. He received Fulbright and British council fellowships several times as well as German DAAD grant to establish PDT Program at Munchen.. He serving on the editorial boards and Hon. Editor to three international journals. He acts as UNESCO expert in science and technology. Dr. El-Far served as visiting professor to University of California as well as Utah laser center also Mayo clinic for several years. He also served as a visiting professor to Cardiff and Swansea Universities, UK. He is a member of International Photodynamic Association and Royal Society of Chemistry, UK. Selected recently as expert and consultant for biochemistry in the national committee of suprime council of Universities in Egypt, this is the highest nation honor.
Abstract:
In this presentation we will give insight for novel evidence(s) raised from our research groups studies in last five years about triggering central role of restoring as well as augmenting antioxidant defense by using adult bone marrow hematopoietic rich stem cells (HSCs), Silymarin (SM) and silibinin (SB) to produce remarkable antidiabetic activities in STZ-diabetic rats. Two strategies were adopted to activate pancreatic cell therapy via possible regeneration of pancreatic cells, stimulation of β-cells, and enhancement of insulin release. Protocol I: HSCs were transplanted into tests of STZ-diabetic rats to evaluate its effectiveness on blood glucose, insulin level, antioxidant capacity and oxidative stress biomarker (MDA), before and after transplantation. Also, all biochemical parameters were determined and monitored their levels following orchidectomy of the grafted tests. Protocol II: SM and SB oral treatments of diabetic rats (75mg/kg/2weeks) were performed. Blood and liver samples were collected from non-treated diabetic and treated-diabetic rats by both natural agents. Blood glucose, glycosylated haemoglobin, insulin, lipid profile were determined in all animals. Also, hepatic MDA, GSH and SOD were measured for all animals. Results and Conclusions: HSCs, SM and SB treatments have made statistically significant improvement of glucose, insulin, lipid profile, antioxidant status and lipid peroxidation biomarkers. Hypoglycemic action in all different treated groups were attributed to stem cells, SM and SB stimulating action(s) of β-cells for insulin secretion, and their ability to augment and restore antioxidant defense properties, in addition, diminished oxidative stress properties. We provided- first- comparative antidiabetic assessment between SM and SB as potential adjuvant for prevention and treatment of diabetes in rats. References: El-Far et al. Current Topics in Biochemical Research, 2012:14(2): 25-37. El-Far et al. World Journal of Pharmacy and Pharmaceutical Science.
Shagun Bindlish
St. Peter’s Health Partners, USA
Title: Pump therapy in Type 2 Diabetes: Novel approach to Glycemic control
Time : 13:45-14:10
Biography:
Shagun Bindlish MD has completed her residency training from Lutheran Medical Center NY and fellowship in Diabetes from Ohio University Heritage School of Osteopathic Medicine. During fellowship she was Associate Professor at Ohio University. She is currently practicing as a Diabetologist at Capital region Diabetes and Endocrine Care group at St. Peter’s Health, Albany NY, one of the premier organizations for Diabetes Care. She has recently published papers in reputed journals and has been serving as Specialty Peer Reviewer of AOFP (Journal of Osteopathic Family Physician)
Abstract:
Type 2 Diabetes is a progressive disorder characterized by insulin resistance and progressive beta cell failure. Many patients will require insulin therapy to bring glycosylated hemoglobin (HbA1C) levels to nationally standardized goals and thus minimize the risk of both microvascular and macrovascular complications. As the epidemic of type2 diabetes continues to increase (1 in 3 people in US by 2050), it is necessary to develop an accepted blueprint of how insulin should be delivered to this heterogeneous population. Although continuous subcutaneous pump therapy is widely accepted as the standard of care for patients with type 1 diabetes, studies are limited and inconclusive in type 2 diabetes population. Most recently OpT2mise has been completed, a large randomized multi-center trial showing the efficacy of insulin pump therapy in patients already receiving multiple daily injections of insulin. In this presentation, I will highlight this study and others to address the pros and cons of using continuous subcutaneous pump therapy in this challenging population. My goal is to increase awareness among health care providers about the benefit of pump initiation in patients with type 2 diabetes.
Shirley Mcilvenny
The Food Coach Institute, Australia
Title: Diet as a therapeutic intervention
Time : 14:10-14:35
Biography:
Dr Shirley was born in Ireland and trained as a doctor in the UK. After becoming a Family Doctor she traveled all over the world, studying how chronic illness could be solved by healthy nutrition. Now settled in Australia, Dr Shirley was Professor of Education at the Faculty of Health Sciences and Medicine at Bond University, Queensland. Dr Shirley has developed her practice to include nutrition as a healing therapy and also trains food coaches through the Food Coach Institute. Her MD thesis was on Fatigue and she has published over 20 papers on various Family Medicine topics. She received a research grant of $328,000 from His Majesty’s Research Fund to study Type 2 Diabetes in Oman.
Abstract:
The first line treatment with any newly diagnosed Type 2 Diabetic is always dietary intervention first. However this strategy rarely works as patients are given advice which is not in line with up-to-date scientific evidence, is not contextualised for their situation and does not take into account their motivation to use diet as a therapy. Far too many patients believe they can carry on eating as usual and the pills will do the rest. However, dietary intervention is taking on much greater importance now, as the prevalence of Type 2 Diabetes skyrockets in developed and developing countries, increasing the cost of both therapy and diabetic complications. Many countries across the world are struggling with the high cost of modern health care, provoking governments into considering such extremes as linking health indicators such as reducing obesity with social welfare payments. Recent research shows we can make an impact on the prevalence of type 2 diabetes, making its management much more cost-effective with 1) employing the right dietary advice based on scientific evidence, 2) using motivational skills to move the patient into taking action, 3) using epigenetics and nutrigenomics to guide us in our targeted therapy. This presentation explores the most recent evidence in dietary advice, epigenetics and nutrigenomics to argue a new dietary intervention plan is the way forward for management of Type 2 Diabetes which is effective, will reduce health care costs greatly and will reduce the prevalence of secondary complications. This will reduce the number of patients who need to access medication and insulin therapy thus relieving the burden on health care costs world-wide.
Gannu Praveen Kumar
Sahasra Institute of Pharmaceutical Sciences, India
Title: Current Status of Diabetes and a Need for Novel Formulations of Thiazolidinediones
Time : 14:35-15:00
Biography:
Gannu Praveen Kumar, Professor and Principal in Sahasra Institute of Pharmaceutical Sciences since April 2014, graduated from H.K.E’s society college of Pharmacy, Gulbarga University in 1997, post graduation from BITS, Pilani in 1999 and Ph.D from UCPSC, kakatiya university in 2009. He worked as assistant professor for Vaagdevi college of Pharmacy, from 1999 - 2005, as Associate professor for SR college of Pharmacy from 2008-2010, as Professor and HOD for Talla Padmavathi college of Pharmacy from 2010-2011 and as Professor & HOD for St. Peter’s Institute of Pharmaceutical Sciences from 2011 to 2014. Since 2009, he was appointed as an external examiner for post-graduation and has guided 30 M. Pharm students. He has published in both National and International journals and compiled few chapters for text books. He received Gem of India award in the year 1999. He was selected as a best academician of Vaagdevi college of Pharmacy in 2002 and of Talla Padmavathi college of Pharmacy in 2011. He is an advisor for few pharmaceutical companies. He visited foreign countries like London, Dubai, Singapore, Malaysia and Spain as invited speaker.
Abstract:
Worldwide it is estimated that 220 million people suffer from diabetes mellitus and among all the diabetic patients, almost 90% suffer of type 2 diabetes. Twenty one million people in the United States, accounting for 7 % of the population, have diabetes mellitus (DM) according to the American Diabetes Association (ADA). One third of these people are not aware that they are diabetic as another 41 million people are preâ€diabetic. The total economic cost annually of diabetes is approximately 132 billion dollars. Diabetes is more frequent among African Americans, Hispanic Americans, American Indians and Asian/ Pacific Islanders. In people age 20 and older, 9.6% have diabetes and in patients of 60 years or older 20.9 % have diabetes. Diabetes is the sixth leading cause of death in the U.S, according to the center for disease control and prevention (CDC). The widespread occurrence of obesity supports the projection that cases of diabetes will continue to grow. Diabetes causes a significant economic burden both in terms of direct and indirect costs to society. It is also responsible for increased morbidity and mortality. Three metabolic defects are responsible for the progression to type 2 diabetes mellitus: peripheral insulin resistance, impaired -cell function, and increased hepatic glucose production. In modern age medicine1, treatments are available for diabetes mellitus like Sulfonylureas, GLP-1 agonists, DPP4 inhibitors, PPAR-γ agonists, GPR119 agonists and SGLT2 inhibitors. The thiazolidinediones are a new class of agents that have been developed to treat type 2 diabetic patients. They act as peroxisome proliferator-activated receptor gamma (PPAR-γ) agonists. Following their binding to the receptor, the heterodimer molecule that contains the binding site is activated thereby decrease insulin resistance. Pioglitazone hydrochloride acts as an agonist at peroxisome proliferator-activated receptors (PPARs) in target2 tissues for insulin action, such as adipose tissue, skeletal muscle, and liver. Activation of the PPAR-g regulates the transcription of insulin-responsive genes involved in the control of glucose production, transport, and utilization. In this manner, it enhances tissue sensitivity to insulin. Since there is a decrease in solubility with increase in pH and the half life being 3-5 hrs, so is incomplete absorption and eliminated quickly from the conventional tablets. Pioglitazone hydrochloride being a non-polar drug and cannot effectively break down the lattice structure of water and hence its aqueous solubility is low. Different techniques are used to enhance the aqueous solubility of drugs including salt formation, cocrystal formation, addition of cosolvents3, hydrotropes, surface active agents and SEDDS and ionic liquids. Pioglitazone hydrochloride is used in oral formulations, however the aqueous solubility is still low and reports of a number of investigations deal with solubilization. The objective of the present research work was to perform solubility studies in various oils and surfactants along with the cosolvents and to develop an optimum SEDDS for Pioglitazone HCl. SEDDS were characterized for size and zeta potential and in-vivo studies were performed to assess the bioavailability. Pioglitazone, a widely prescribed anti diabetic drug belongs to class IΙ under BCS and exhibit low and variable oral bioavailability due to its poor aqueous solubility. Its oral absorption is dissolution rate limited and it requires enhancement in the solubility and dissolution rate for increasing its oral bioavailability. The highest solubility was observed in labrafac, Tween 80 and propylene glycol. Then the feasibility of formulating pioglitazone SEDDS was evaluated and to analyse the effect of dilution on the dissolution rate and dissolution efficiency of pioglitazone. A comparative evaluation of pioglitazone from SEDDS was made in SGF and 1 % SLS. Pioglitazone dissolution was rapid from SEDDS and was higher when compared to pure drug. The rate and extent of release of pioglitazone Hcl from stable SEDDS (F1) was high in 1% SLS when compared to SGF. The FTIR spectra proved that there was on chemical interaction between excipients and drug. SEM studies confirmed that the size was small and spherical.
Marluce Da Cunha Mantovani
University of Sao Paulo, Brazil
Title: Decellularized pancreas bioscaffold generation aiming at Type 1 Diabetes therapeutics
Time : 15:00-15:25
Biography:
Marluce Cunha Mantovani has a Master´s degree in Biological Sciences (Biochemistry) from the Chemistry Institute of the University of São Paulo (2007) and an MBA in Health Management and Infection Control from the National Institute of Higher Education and Research (2011). Currently, she is a Laboratory Specialist at the University of São Paulo Medical School - Department of Internal Medicine, working as a Senior Lab Manager and a pre-doctoral student at the Cell and Molecular Therapy Center (NUCEL - www.usp.br/nucel). She has experience in Biochemistry with emphasis in Cell and Molecular Biology, Biotechnology and Cell Therapy.
Abstract:
Type 1 diabetes mellitus (T1DM) is a condition resulting from the autoimmune destruction of pancreatic β cells, leading patients to require lifelong insulin therapy, however, often, this therapy does not avoid the most common complications of this disease. Transplantation of isolated pancreatic islets from heart-beating organ donors is a promising alternative treatment for T1DM, however, this approach is severely limited by the pancreas shortage. Recently, pancreatic bioengineering in Regenerative Medicine has been proposed as a potential alternative therapy. Human pancreas may be decellularized and the remaining bioscaffold, a skeleton of extracellular matrix (ECM), can provide the optimal microstructure and microenvironment for in vitro islets formation, maintenance and transplantation. Our group designed a new protocol for pancreas decellularization which may be used for both rat and human pancreas. The pancreatic tissue is submitted to a series of water and detergent-enzymatic solutions wash cycles. Complete decelullarization of the rat pancreas was obtained after only one cycle of this treatment (approximately 31h), as compared to another protocols in literature. Apparently, complete decelullarization of human pancreas was obtained only after approximately seven days under this protocol. Our next steps consist in evaluating and characterizing the extracellular matrix integrity. Therefore, instead of discarding, cadaveric pancreas may be decellularized to generate a very useful and powerful bioscaffold, which may be reconstituted to generate a partially or fully functional organ. This study intends to improve the islet transplantation outcome and to develop alternative treatments for T1DM.
Kasturi Sen Ray
Tata Institute of Social Sciences, India
Title: Assesment of quality of dietary carbohydrates for normal and Diabetic subjects
Time : 15:45-16:10
Biography:
Kasturi Sen Ray, PhD had done postdoctoral research in School of Medicine, South Carolina and Turft University, Boston, USA. She is recipient of National Merit Scholarship, represented India in ‘Global Nutrition’, Sweden. She was Rotary International Ambassadorial scholar at University of Sebalus Maret, Indonesia. Invited by SIDA for Global Nutrition IT Fair Bangladesh, Dr. Ray was Guest lecturer for Nelson Mandela School of Medicine and resource person at 18th International Congress of Nutrition, Durban, South Africa, She has 38 International and national publication in peer reviewed Journal, Lead article writer in ‘The Nutritionist: Digest Seriese of Clinical Nutrition, BioQuest. Authored 3 books, member of editorial board of J of Vitamines and Minerals. Organized and presented her research work in large no. of National and International Conferences, travelled all over the globe for academic assignments.
Abstract:
Dietary management of diabetes focuses on maintaining the postprandial blood sugar levels close to normal. In patients with diabetes mellitus the metabolism of carbohydrates is completely deranged. Effective management of blood sugars in such patients requires careful selection of the quality and quantity of CHO. The glycemic and insulin response to food may vary widely in normal and diabetic subjects. There are many food restrictions and taboos that govern food intake in these subjects. However, some of these are misleading, propagated by incomplete data regarding specific impact of foods on postprandial metabolism. Since 1981, Glycemic Index (GI) was used to assess glycemic quality of foods on equi-carbohydrate basis. But, we do not consume carbohydrate in isolation but rather food as a whole, along with the co-nutrients as proteins, fats, fiber, which influence the glycemic and insulinemic responses of food. The quantity of food consumed varies from person to person and GI value does not reflect the change in the impact. Therefore, the concept of glycemic index food (GIfood) based on equi-quantity comparison of whole food was used to compare glycemic response to some common CHO rich food. GIfood and IIfood may help in control and management of postprandial metabolism in individuals with type 2 diabetes. GIfood value, being expressed in gm units, can be included in the Food Exchange table to predict response to common serving sizes of food consumed.
Manal Mahmoud
Cairo University, Egypt
Title: Effect of caloric restriction on Sirtuin-1 disorders associated with diabetes in male rats
Time : 16:10-16:35
Biography:
Manal Mahmoud has completed her phD at 2012 from faculty of medicine Cairo university and she is preparing for postdoctoral studies . She has Diploma of clinical nutrition from European society for clinical nutrition. She is lecturer of physiology Cairo university.
Abstract:
Effect of caloric restriction on Sirtuin-1 disorders associated with diabetes in male rats ABSTRACT Background: Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance, hyperinsulinaemia and hyperglycaemia. Increased glucose production through abnormally elevated hepatic gluconeogenesis is central to the manifestation of hyperglycaemia in T2DM. Also,obesity is associated with hyperinsulinemia and insulin resistance (IR).So, the effects of caloric restriction (CR) on diabetes have been documented extensively . Even, in short term studies, CR exhibited improvement of hyperglycemia and insulin level before changes in body composition and fat distribution(Westman et al., 2007). Sirtuin 1 (SIRT1) has been identified as regulator of gluconeogenic gene expression. The present study aimed to evaluate the effect of caloric restriction on SIRT1 level and activity in liver and pancreas of diabetic rats. Further, the possible role of SIRT1 on metabolic disorders associated with diabetes mellitus, including serum levels of glucose, insulin, triglyceride (TG) and high density lipoprotiens (HDL), will be explored. Methods: Thirty two male albino rats were divided into control group (GpI), diabetic (DM) group (GpII), (CR+DM) group (GpIII) subjected to 30% caloric restriction program for 1 month before induction of diabetes, (DM+CR) group (GpIV) subjected to 30% caloric restriction program for 1 month after induction of diabetes. At the end of the study, BMI%, serum levels of glucose, insulin, TG and HDL, HOMA, SIRT1 level and activity in liver and pancreas and pancreatic DNA ladder were assessed. Results: Our results showed caloric restriction either before or after induction of diabetes was associated with significant improvement of (serum glucose, insulin, TG and HDL levels, HOMA-IR, SIRT1 level and activity in liver and pancreas, and pancreatic tissue). Although BMI% was significantly decreased in GpIV yet it did not show any significant change in GpIII when compared to GpII. Remarkably, we did not detect any significant difference between the effects of CR either pre or post diabetes. Conclusion: lowered SIRT1 in diabetes was improved by 30% caloric restriction. Consequently, the pathophysiological disorders associated with T2DM were improved.
Salihu Ibrahim Ismail
Federal University Dutse, Nigeria
Title: Carbonic anhydrase: A new therapeutic target for managing Diabetes
Time : 16:35-17:00
Biography:
Salihu Ibrahim is a Lecturer at the College of Medicine and Allied Health professions, Federal University Dutse. He received his BSc and MSc in Biochemistry from Bayero University Kano, and is completing a PhD in Biochemistry at Ahmadu Bello University, Zaria . His field of study includes metabolic profiling and metabolic diseases with special interest in diabetic complications. His research interest has focused primarily on identification of a prognostic biomarker for diabetic complications that could be used as therapeutic drug target.
Abstract:
Background: Carbonic Anhydrase (CA) is a zinc metallo-enzyme that is critical to acid-base homeostasis. Carbonic anhydrase (CA) plays a fundamental role in the regulation of systemic acid-base homeostasis by facilitating urinary acidification. Inhibition of carbonic anhydrase results in acidification of the blood, leading to the manifestation of acidosis which is known to occur in diabetic subjects. The consequence is a decrease in pH that leads to loss of function of many enzymes and proteins. Results: Here we report that 21 days after intraperitoneal injection of streptozotocin (STZ) 60 mg/kg body weight, there is a significant increase in carbonic anhydrase activity compared to control rats that received only vehicle. Correlation studies showed that carbonic anhydrase is negatively correlated with lactate level in the STZ induced diabetic rat model. In a second experiment a standard carbonic anhydrase inhibitor (acetazolamide) was given to (STZ 60 mg/kg body weight induced) diabetic rat model for a period of 28 days. The results showed a decrease in carbonic anhydrase activity with a marked rise in lactate level. A negative correlation was also seen between carbonic anhydrase activity and lactate level. Conclusions: Here we have identified carbonic anhydrase activity to be altered in different stages of Diabetes Mellitus and its association with lactic acid as a response to high glucose level in the blood. Here we report that mild extracellular acidosis; a physiological consequence of lactic acid accumulation was due to high activity of carbonic anhydrase to preserve optimal pH of the blood by efficient secretion of H+. Our findings suggest that inhibition of carbonic anhydrase in Diabetes results in lactic acid accumulation which ultimately leads to decrease in pH and results in cellular dysfunction.
Shagun Bindlish
St. Peter’s Health Partners, USA
Title: Update on Gestational Diabetes- Diagnosis to delivery and beyond
Time : 17:00-17:25
Biography:
Shagun Bindlish MD has completed her residency training from Lutheran Medical Center NY and fellowship in Diabetes from Ohio University Heritage School of Osteopathic Medicine. During fellowship she was Associate Professor at Ohio University. She is currently practicing as a Diabetologist at Capital region Diabetes and Endocrine Care group at St. Peter’s Health, Albany NY, one of the premier organizations for Diabetes Care. She has recently published papers in reputed journals and has been serving as Specialty Peer Reviewer of AOFP (Journal of Osteopathic Family Physician).
Abstract:
Pregnancy is a state of insulin resistance and hyperinsulinemia that may predispose some women to develop diabetes. Gestational diabetes mellitus (GDM) occurs when a woman’s pancreatic function is not able to overcome the diabetogenic environment of pregnancy. GDM is defined as a glucose intolerance that occurs during second or third trimester of pregnancy and is not clearly overt diabetes. The effectiveness and time period of screening and diagnosis of GDM has been controversial. There are conflicting recommendations from experts of multiple organizations suggesting to follow one step or two step approaches for the diagnosis. This talk will focus on discussing the latest diagnostic screening options, the treatment strategies for women with gestational diabetes and potential impact of diabetes on the mother during postpartum period. The discussion will include the focus group study to evaluate the effectiveness of postpartum screening time period. Our practice is using a novel approach incorporating data for diabetes prevention to find the effectiveness of postpartum screening that could best prevent or delay the onset of Type 2 diabetes in high risk population. Most updated literature will be collected using different resources including PubMed, American Diabetes Association, American College of Obstetrics and Gynecology and American society of Endocrinology.
Habiba AlSafar
Khalifa University, UAE
Title: The Prevalence of Type 2 Diabetes Mellitus in the United Arab Emirates: Justification for the Establishment of the Emirates Family Registry
Time : 17:25-17:50
Biography:
Dr. Alsafar is currently a Director of Khalifa University Biotechnology center and an Assistant Professor in the Biomedical Engineering Department at Abu Dhabi’s Khalifa University of Science, Technology & Research, Habiba is an Emirati research scholar who has a wealth of professional and educational experience. She gained a summer fellowship from the Massachusetts General Hospital in 2013. Her research interest is constructing the genomic structures of individuals of Arab descent to identify genomic segments that carry gene(s) that predispose to disease. Specifically, addressing diseases that are increasing in prevalence amongst the local communities of the UAE. Dr. alsafar has identified a gene strongly associated with the prevalence of Type 2 diabetes among the Emirati population. This is the first Genome Wide Association Study of the UAE Bedouin population and first of its kind in the Middle East.
Abstract:
This project was conceived with the aim of studying the prevalence of Type 2 Diabetes (T2D) in a population of United Arab Emirates (UAE) residents through the creation of the “Emirates Family Registry” (EFR). Major hospitals and diabetes centres in the UAE were contacted to establish a bio-banking facility referred to as the EFR. Data of T2D patients were collected also clinical specimens were collected for biochemical profiling. In the first 24 months of the operation the EFR recruited 23,064 adult volunteers from three major hospitals and nine primary care centres throughout the UAE. Within this cohort, 88% were patients classified as T2D patients from the medical records. The cohort was divided into age categories with 59% of T2D patients aged between 40 and 59 years old. UAE nationals comprised 30% of the database of which 21% were diagnosed with T2D. However the percentage of adults with T2D was higher in other ethnic groups effecting almost 33% of the Indians who live in the UAE. A total of 741 UAE Nationals consented to donate blood; in phase I of the study; for biochemical testing, of which 23% were diagnosed with T2D, 30% with pre T2D and 47% were healthy following the completion of testing. This study is consistent with the previously reported high prevalence of T2D in the UAE. Furthermore, analyses of the factors that predispose to the disease have revealed that obesity, a large waist circumference, consanguineous marriage, family history, lack of physical activity, unhealthy dietary practices, high total cholesterol, and high triglycerides levels were more prevalent in T2D patients. The classification of these features will contribute to defining more effective and specific plans to screen for and manage diabetes and its complication in the UAE and other developing countries throughout the Middle East region as well as other developing countries.
Patrick G. Sullivan
University of Kentucky College of Medicine, USA
Title: A nano-scale approach to mitochondrial uncoupling for the treatment of obesity
Biography:
Dr. Sullivan completed his Ph.D. at the University of Kentucky in Anatomy and Neurobiology in 2000 and immediately began a postdoctoral fellowship at the Reeve-Irvine Research Center at the University of California at Irvine under the direction of Dr. Oswald Steward. In August of 2002, he was recruited to the position of Assistant Professor in the Spinal Cord and Brain Injury Research Center and Anatomy & Neurobiology at the University of Kentucky. Currently he is a Professor of Anatomy & Neurobiology and an Endowed Chair in the Spinal Cord and Brain Injury Research Center. Dr. Sullivan has published over 80 peer-reviewed manuscripts and his work has been cited over 4200 times.
Abstract:
Obesity is recognized as a national and global epidemic, as approximately 65% of adults in the United States are classified as overweight or obese as defined by body mass index. While obesity is associated with increased risk for metabolic syndrome and cardiovascular disease, even a modest reduction in body weight has been shown to consistently reduce or reverse health risk factors. In the 1930s it was recognized that increasing the body’s basal metabolism using mitochondrial uncouplers, directly resulted in steady and rapid weight loss. During this period the mitochondrial uncoupler, 2,4-dinitrophenol, was sold over the counter as a weight-loss supplement. It is the only compound to date that has been shown to be 100% effective for weight-loss but was eventually pulled from the shelves by the Food and Drug Administration as people were routinely overdosing on the compound in an effort to increase their rate of weight loss. To overcome this challenge, we have developed non-carbon-based, “self-rectifying” nano-scale devices, in which we can specifically and step-wise set the uncoupling capacity that when reached shuts the device off to further proton conductance. By targeting mitochondrial bioenergetic uncoupling in a controlled manner using nano-scale devices, we hypothesize that this will significantly alter metabolism and result in significant weight loss in a model of diet-induced obesity. Data will be presented demonstrating that these devices can produce weight loss without decreasing food intake in multiple animal experiments.
Biography:
Dr. Lorraine Platka-Bird received her doctorate from Michigan State University in 1980 with a major in human nutrition and a minor in psychology. She became a registered dietitian in 1982. As a dedicated professor in the Nutrition and Dietetics Department at the State University of New York for 19 years, Dr. Platka-Bird taught a wide variety of courses including Weight Management, Medical Nutrition Therapy, Nutritional Biochemistry, Sports Nutrition, Human Physiology, Nutrition Across the Life Span, and numerous related courses. During this period of time Dr. Platka-Bird was granted some of the most prestigious teaching awards offered in the State University system. Dr. Platka-Bird has been counseling individuals with eating disorders for over 25 years. She takes a holistic approach to treatment, considering all aspects of physical, mental, social, emotional, and spiritual well-being. In addition to helping clients develop a healthy relationship with food, Dr. Platka-Bird helps individuals minimize eating disorder thoughts and behaviors, improve self-image and self-esteem, and develop healthy coping skills and life skills to improve overall quality of life.
Abstract:
People with the combination of diabetes and an eating disorder have a drastically increased risk of developing both the acute and the chronic complications of diabetes more rapidly, especially when the eating disorder presents as insulin restriction for the purpose of weight management. It is not uncommon for people with diabetes and an eating disorder to have an A1c in the range of, or often above, 15 to 16 because of the knowledge that restricting insulin usually results in weight loss. The problem is not an absence of knowledge about how to properly manage diabetes, but rather unwillingness to properly dose because of a fear of weight gain or an absence of weight loss. Because diabetics who restrict insulin are frequently not honest with their endocrinologists about their behaviors, insulin doses may be increased with potential risks if the diabetic begins taking the prescribed dosage. Severe complications in diabetics with an eating disorder are not uncommon in people in their early to late twenties. Traditional treatment for a diabetic in DKA due to insulin restriction typically involves hospitalization with the goal of normalizing blood glucose levels, re-education about diabetes management, and discharge to the environment in which the eating disorder originally developed. The common result of this approach is return to the eating disorder and extremely poor diabetes management. Dietary recommendations which may be helpful for the diabetic without an eating disorder can be dangerous for the individual with one, as they often trigger the eating disorder thoughts and behaviors. The mindful eating approach often used to treat people with eating disorders can be extremely effective in treating people with type 1 or type 2 diabetes. This approach leads to decreased pre-prandial, post-prandial, and random blood glucose levels, significantly decreased A1c levels, and normalization of food behaviors with minimal or no weight gain, and sometimes actual weight loss. It is critical that endocrinologists and diabetes educators become more effective in diagnosing eating disorders in their diabetic patients and that they develop an approach to treatment which considers the impact of an eating disorder on diabetes management.
Maria Faresjo
Jonkoping University, Sweden
Title: Psychological stress- Possible risk factor to induce and maintain autoimmunity in children
Biography:
Maria Faresjo was promoted as Professor in Biomedical laboratory sciences at Jonkoping University, Sweden at the age of 37. She is the Head of the Board of the Biomedical platform at Jonkoping University, an unique national arena for biomedical research and education. The main purpose of his research is to study the immunological mechanisms, especially the failure of immune regulatory cells that probably play an important role for the development of several immunological diseases e.g. type 1 diabetes. In collaboration with colleagues, she has recently shown that psychological stress in children may induce an autoimmune response (Journal of Immunology 2014).
Abstract:
Autoimmune diseases, such as type 1 diabetes are alarmingly common in children and teenagers. Psychological stress, recognized as a public-health issue in children and teenagers, may be one mechanism possible to induce autoimmunity and autoimmune diseases. Type 1 diabetes but also other autoimmune diseases such as celiac disease, systemic lupus erythematosus and juvenile idiopathic arthritis, frequently occurring in children may be induced by psychological stress. Psychological stress is defined as a state of threatened homeostasis or disharmony induced by various physical or psychological stressors such as disease, loss of a loved one, or marital conflict in the family. Confronted with a stressful condition, the body´s stress-regulation systems activate a multiple cascade of defense responses that involve several body systems for example the immune system. The role of the immune system in regulating brain and behavior is probably one of the fastest developing fields of modern science and the importance of T-cells in brain function has been clearly demonstrated in mouse model. A limited number of studies have this far evaluated the involvement of psychological stress in autoimmune response and disease in children. We have recently shown that small children exposed to high level of psychological stress show an imbalance in their immune system and an autoimmune response associated with type 1 diabetes. Consequently, psychological stress can possibly be an important risk factor to induce and maintain autoimmunity in children.
Sonia Valeria Pinheiro
Jundiaà Medical School, Brazil
Title: Diabetes Mellitus risk screening of parents of private school students in the city of JundiaÃ, Sao Paulo, Brazil
Biography:
Sonia Valeria is currently working as Full professor (Head of the Biology and Physiology Department, Faculty of Medicine (FMJ), Jundiai, SP, Brazil. Her reaerch expertise entails Biochemistry and Clinical Biochemistry, focusing in Drug-membrane interaction and Metabolic Diseases. She has over 28 articles in indexed international and national journals; 48 Congress participation.
Abstract:
Objective: To screen the risk of developing Diabetes Mellitus type 2 (DM2) in adult individuals. Methods: Several risk factors for DM2 (sedentary lifestyle, previous coronary artery disease, hyperglycemia-inducing medications, body mass index [BMI], blood pressure, serum triglyceride, and HDL-cholesterol levels) were assessed in 314 adults as a function of gender and age group. Results: 73.2% of the population had two or more concurrent risk factors and 26.8% had less than two factors. The occurrence of risk factors for DM2 development was observed even in young adults, and the risk factors are likely associated with aging. Differences in risk factors and incidence were observed between men and women in the same age group. Conclusion: Regardless the age studied, the most prevalent risk factors associated with DM2 were: BMI, sedentary lifestyle, and reduced serum HDL-cholesterol, which are modifiable, thus increasing the importance of preventive measures. Discrepancies found in prevalent risk factors in men and women also suggest that sociocultural differences influence the risk of developing DM.
Zheng-Wang Chen
Huazhong University of Science and Technology, China
Title: Aglycin and Vglycin, A New Generation peptide drug for treatment of T2D
Biography:
Zheng-Wang Chen is currently working at Huazhong University of Science and Technology, China. He with his team is working efficiently to cure diabetes t a faster pace in addition to the current drugs available to manage diabetes
Abstract:
We have previously reported that the bioactive peptide aglycin regulates glucose homeostasis in type 2 diabetic (T2D) mice by the process of activating Insulin Receptor/Insulin Receptor Substrate1 Pathway (IR/IRS1 P). Furthermore, we have reported that the bioactive peptide vglycin, a homologous peptide of aglycin, normalizes fasting glucose and restores impaired pancreatic function in T2D Wistar rats. Both peptides aglycin and vglycin, consisted of 37 amino acid residues respectively and share 35 residues identically. In particular, the 6 cystines are located at the same sites and constitute the structure domain “cystine knot” which can resist hydrolysis from proteases in the digestive tract. Recently, we have successfully conducted the toxicity tests with the peptides, aglycin and vglycin, in rats and mice respectively. We have also determined their effectiveness in 107 volunteers with diabetes and prediabetes. Our findings reveal that the peptides aglycin or vglycin take a crucial role in the prevention and treatment of diabetes. We will report these results in the Diabetic Medications-2015 conference of USA.
Jiankang Liu
Xi’an Jiaotong University, China
Title: Targeting mitochondria for preventing and treating diabetes with natural compounds from food and nutrition
Biography:
Jiankang Liu received his BS from Xi’an Jiaotong Unviersity in and PhD of Medical Science from Okayama University School of Medicine, Japan. He completed Post-doc training in Dr. Bruce Ames laboratory at University of California, Berkeley and worked as a faculty at University of California at Berkeley, Children Hospital Oakland Research Institute, University of California at Irvine, University of Kentucky College of Medicine, and Shanghai Institute for Nutritional Science, Chinese Academy of Sciences. Currently, he is a Professor and the Dean of Xi’an Jiaotong University School of Life Science and Technology and an Adjunct Professor of the School of Pharmacy, University of Southern California. His research interests include molecular and cellular mechanisms of aging, stress, and age-/stress-associated degenerative diseases with a focus on nutritional regulation of mitochondrial metabolism.
Abstract:
Insulin resistance is an important feature of type 2 diabetes and obesity. The underlying mechanisms of insulin resistance are still unclear. Mitochondrial dysfunction, including mitochondrial loss and over-production of oxidants, has been suggested to be involved in insulin resistance. Increasing evidence suggests that targeting mitochondria to protect mitochondria function could prevent and ameliorate various diseases associated with mitochondrial dysfunction to form a unique medicine, i.e., mitochondrial medicine. In this presentation, the author has summarized his recent studies with nutrients to target mitochondria by stimulating mitochondrial homeostasis to improve mitochondrial function and regulate redox balance for preventing and ameliorating diabetes. Emphasis was put on natural compounds from food and nutrition including olive, bitter gourd and pomegranate to regulate mitochondrial biogenesis and degradation in cellular systems and in animal models. The in vitro and in vivo studies on the effects and mechanisms of mitochondrial targeting nutrients or their combinations may help us to understand the importance and mechanisms of mitochondrial metabolism, and to develop mitochondria-targeting agents for preventing and treating diabetes.
Sultan Al Mubarak
King Faisal Specialist Hospital & Research Center, Saudi Arabia
Title: The prevalence of Oral Candida infections in periodontitis patients with Type 2 Diabetes Mellitus
Biography:
Professor Sultan Al Mubarak holds a PhD in Dentistry as a Periodontist. He is currently active as a Periodontist at the Dentistry Department and as Senior Clinical Scientist at the Research Centre at King Faisal Specialist Hospital & Research Centre (KFSH&RC) in Riyadh, K.S.A. He is a long established researcher, educator, and instructor having undertaken several major local and international, private and government grant research programs and awards in Saudi Arabia and United States. Prof. Al Mubarak is corresponding author to: a range of publications, peer reviewed by many scientific high impact factor international journals; a book in innovations in health products.
Abstract:
Objectives: The aim of this study was to determine the prevalence of Candida spp. in periodontitis patients with type 2 diabetes mellitus. Methods: This cross-sectional study included 42 diabetic patients with periodontitis (aged 21—70 years; 18 males and 24 females). Clinical measurements included probing pocket depth (PPD), clinical attachment level (CAL) and hemoglobin A1c (HbA1c) levels. Sub-gingival samples were collected from the mesio-buccal aspect of 3 teeth for fungal analysis. Candida species, including Candida albicans, Candida dubliniensis, Candida tropicalis and Candida glabrata, were identified using Gram staining, the germ tube test, CHROMagar, Staib agar and API 20C AUX. Results: The overall prevalence of Candida in diabetic patients with periodontitis observed in our study was 52%. The most common spp. of Candida identified were C. albicans (38%), followed by C. dubliniensis (9.5%), C. tropicalis (4.7%) and C. glabrata (4.7%). Compared to females, male patients were characterized by increased levels of Candida infections. Our results also indicate that individuals over the age of 40 had increased levels of Candida infections compared to patients younger than 40. Candida infections were higher among subjects with elevated blood sugar levels (HbA1c > 9) compared to individuals with well-controlled blood sugar levels (HbA1c < 6). Patients with PPDs ≥5 had an increased risk of Candida infection compared to patients with PPDs between 3 and 4. Conclusion: This study indicates that the frequency of C. albicans is higher than the frequencies of C. dubliniensis, C. tropicalis and C. glabrata in diabetic patients with periodontitis. Candida infections were observed at increased frequencies among subjects with high blood sugar levels and PPDs ≥5.
Ibtissem Ghedira
Monastir University, Tunisia
Title: Type 1 Diabetes and Celiac disease: Pathogenesis overlap
Biography:
Ibtissem Ghedira completed her PhD in Paris since 1996. She is a Professor of Immunology since 2003. She teaches in the Faculty of Pharmacy in Monastir Tunisia. She is a head of Immunology Laboratory of Farhat Hached University Hospital in Sousse Tunisia. She is a Director of a research-unit on autoimmune diseases. She had directed a French-Tunisian research project about Celiac disease. She published 50 articles on autoimmune diseases in reputed journals; among them 19 on T1D and/or CD. She is an editorial board member of World Journal of Gastroenterology. She actively participated to many international congress on autoimmune diseases.
Abstract:
Patients with type 1 diabetes (T1D) are at high risk of developping other autoimmune diseases (AID). Celiac disease (CD) is one of the most common disorders occuring in T1D. The mean prevalence of CD in patients with T1D is about 8%. Screening for CD in T1D is currently advocated. Similarly, patients with CD have a two-to three-fold increased risk of developping T1D. The overall incidence of these two AID is increasing. Both T1D and CD result from a complex interplay between genetic, immune and environmental factors. T1D is characterized by immune-mediated damage to insulin-secreting cells from the pancreatic islets of Langerhans. CD is characterized by immune-mediated damage to the small intestinal mucosa. Both T1D and CD are associated with not only the major histocompatibility complex class II antigen DQ2 encoded by the alleles, DQA1*501 and DQB1*201 but also DQ8 and non-HLA loci. Gluten is one the environmental factors which trigger both CD and T1D. High consumption of gluten results in high zonulin secretion and altered gut permeability in both diseases. Significant differences in the composition of the gut microbiota between patients with T1D or active CD and healthy controls are demonstrated. Vitamine D deficiency is both a consequence of malabsorption secondary to CD and a risk factor for T1D. Both in T1D and in CD there is increased oxidative stress. The accumulation of inflammatory cytokines is found in both T1D and active CD. Patients with both CD and T1D have more severe complications than patients presenting T1D or CD only.
Lakshmi Kant Shankhdhar
L.K. Diabetes Center, India
Title: Offloading a Diabetic Foot Wound in developing world
Biography:
Triply post graduate in Medicine (MD), Nutrition (PGDND) and Radiology (DMRE), 63 years old Dr. Lakshmi K Shankhdhar, holds the credit of establishing North India’s still only exclusive Diabetes Clinic in Lucknow, India and is the fourth Indian to receive Wockhardt-Harvard Medical Excellence Award and Visiting Fellowship of Harvard Medical International, the International Arm of Harvard Medical School (Boston). He has presented several abstracts and Faculty orations in many International conferences on Diabetes, besides chairing some International conferences. Currently he is Principal of a medical College of Diabetology, besides working as Medical Director and Endocrinologist in his own Clinic, the LK Diabetes Centre.
Abstract:
Ninety percent amputations are preceded by an ulcer and most are preventable. Increased plantar foot pressure is the leading cause of plantar ulceration in the diabetic population. While one is standing, both feet bear 50% of body weight but during walking, there are times when one foot bears even 1.5 times of body weight which is further increased if deformity were present. Small muscle atrophy, with consequent muscle weakness and deformity, occurs in the diabetic foot before clinical peripheral neuropathy is detected. This muscle atrophy may lead to increased plantar foot pressure even in the “low-risk,” sensate diabetic feet. Many factors such as deformity, partial amputation, limited Joint mobility (LJM), calluses, corns, wrong footwear and a foreign body in the foot wear may be responsible for raised plantar pressure and plantar ulceration. Healing of these ulcers requires proper dressing of the ulcer(s), observing universal principles of hygiene, restoration of adequate vascularity, control of infection, good metabolic control including glycemia and lipids, cessation of smoking, weight reduction and offloading of the ulcerated area but offloading remains the most important of all. Many methods of offloading are available currently but Total Contact Casting (TCC) is known to be the gold standard of offloading but is used only in 1.7% clinics in US owing to its cost, needing specially trained personnel to apply and remove and consuming too much of time in its application and removal. Removable Cast Walkers (RCWs) are the measure of choice since they cost lesser than TCC, can be applied and removed by anyone and offer comparable offloading and hence ulcer healing. Other options such as Custom Foot wear, half shoes, ankle arthroses and Internal Offloading measures such as metatarsal head resection are sparingly used even in developed countries. In developing countries most of the offloading methods are either unaffordable or unavailable, with the result that offloading is neglected by most physicians. The team of physicians at LK Diabetes Centre, Lucknow, India, have researched and developed an altogether new offloading device, called the “Samadhan System of Offloading,” which is very affordable, costing lesser than 1 USD, simple, needing no special training for its application and removal, least time consuming, having both removable (SS-R) and irremovable versions (SS-IR) and efficacious too. The Samadhan System comprises of a rubberized foam cylinder, the “Samadhan Unit,” to be placed on plantar surface to offload body weight, a piece of an elastocreppe bandage, the “retainer” to retain the Samadhan Unit in position and a fastening device, the “fasteners” to retain the edge of the retainer. In one of the oral abstracts, presented in American Diabetes Association, 2005 (OR 199), the Removable version of Samadhan System (SS-R) revealed much better healing rates of Wagner grade 1 diabetic foot wounds, compared to common footwear 73.3% vs 13.3% with much lesser healing time (42 vs 60 days).
Biography:
Dr. Kshitij Shankhdhar is a Diabetologist from Lucknow, India. He has specialized in diabetic foot care and diabetes education. He did his medical graduation in India followed by post graduate training and fellowships in European countries. He established the first diabetic foot clinic of North India and invented methods and techniques for rendering diabetic foot care in low resource areas for amputation prevention. Recently, he successfully established a first of its kind, UPMA's Medical College of Diabetology, for a structured education program for people with diabetes. He strongly believes in the words of Dr. Elliott Joslin, “The person with diabetes who knows the most lives the longest.”
Abstract:
A lower limb is lost to diabetes somewhere in the world every 20 seconds. If a person with diabetes has a lesion on the sole of a foot, offloading bodyweight is of vital importance; all therapeutic efforts are bound to fail if he or she continues to walk on an ulcer. In 2000, the authors of this report designed a system of offloading that was developed specifically for people living in developing countries. The Samadhan System is based on the principles of simplicity and ease of application. Requiring no special training, it is affordable and effective. The word Samadhan means 'solution' in Hindi language. In the words of Dr. Elliott Joslin, “The person with diabetes who knows the most lives the longest.” Different people with diabetes need different education. Conventional methods (lectures/literature) are often ineffective. The author discovered The Samadhan System of Diabetes Education. In this method, diabetes education is rendered through Mobi-films - films made using mobile phones. Then they are classified based on type, duration and complication of diabetes - for single viewing or group education. This needs basic mobile phone (take pictures/videos/audio) with use of computer software Windows Movie Maker (available free) to edit the film. Such films are displayed in diabetes centre / diabetes camps / distributed amongst doctors / patient / educators / via internet / MMS. Patients are involved in script writing / acting. Patients make mobi-films - record their activities (self insulin administration at home/ diet intake etc) - show to doctor/educator - mistakes are pointed and corrected. Recently, the author successfully established a first of its kind, UPMA's Medical College of Diabetology, for a structured education program for people with diabetes.
Naglaa Mesbah
Dasman Diabetes Institute, Kuwait
Title: Dasman Diabetes Motivational Interview Program (DDMI)
Biography:
Naglaa Mesbah is currently working at Dasman Diabetes Institute, Kuwait. She has many research articles related to diabetes focusing on managing diabetes. These researches are published in the reputed peer reviewed journals of diabetes.
Abstract:
Kuwait is among the top 10 countries with the highest prevalence of diabetes worldwide. 1 Diabetes is associated with high morbidity and mortality rates. 2 Given the growing prevalence of diabetes worldwide; controlling modifiable risk factors for diabetes is necessary to prevent complications and disease progression. 2 Diabetes management programs recommend constant life-style changes. 3 Promoting lifestyle changes necessitate a shift in patient management from straight forward recommendation to counseling-based approach. 4-5 Aim: Study aims to address the impact of applying MI during the educational sessions on people with diabetes to change their behaviors in order to enhance their diabetes self management, achieve better glycaemic control, prevent diabetes complication and improve their quality of life. Objectives: (i)To determine whether adding motivational interviewing to diabetes self-management education (DSME) program improves positive behavior changes, improve glycemic control, increase diabetes self-care and increase self efficacy for people with diabetes. (ii)To develop additional skills for helping patients to explore and resolve their ambivalence about health behavior change. Methods: Ten female patients with poorly controlled type 2 diabetes selected to participate into three sessions of motivational interview (MI) and telecare-support in between the MI sessions, the intervention was based on motivational interviewing using of different interviewing strategies and techniques, based on each person's readiness stage to change. Intervention planned according to information gathered from validated ‘Diabetes Self-Management Questionnaire’ and ‘Pre-Self Care Inventory survey to address the main patients’ concerns. The patients were assessed for any improvement regarding the diabetes self management by using ‘Follow-up Assessment Form’ every follow-up visit. At the end of MI sessions, post assessment was done by using ‘Diabetes Self-Care Confidence Scale’ and ‘Post-Self Care Inventory survey’. Questionnaires used were valid and reliable, adopted and edited with the permission of Joslin Diabetes Center. Results: A statistically significant improvement in glycemic control was demonstrated (p= 0.002) as assessed from glucose-meters downloads. Behavioural changes outcomes were also statistically significant (p= 0.0003) as assessed by questionnaire. Conclusion: Based on our initials findings, the effect of MI on improving the positive behavior changes and glycemic control of females with type 2 diabetes seem to be promising.