6^th International Conference on Diabetes and Endocrinology December 05-07, 2016 Dallas, USA

Biography:

Weiqin Chen studied the role of dyslipidemia on Diabetic Retinopathy, a microvascular complication in diabetic patients with Dr. Julia Busik at Michigan State University and received her PhD degree in Molecular Genetics in 2005. Subsequently, she worked as a Post-doctoral associate for five years with Dr. Lawrence Chan at Baylor College of Medicine, where she was promoted as an Instructor in 2010. At BCM, she established two animal models based on genes that are associated with non-alcoholic fatty liver disease (NALFD) and human congenital generalized lipodystrophy (CGL) and characterized their functions in energy metabolism. In 2012, she was recruited as an Assistant Professor in the Department of Physiology at Georgia Regents University. The focus of her current research is to dissect the mechanisms underlying adipose tissue dysfunction and development of obesity and lipodystrophy using both in vivo and in vitro strategies.

Abstract:

Mutations in BSCL2 gene underlie human Congenital Generalized Lipodystrophy type 2 (CGL2) diseases. CGL2 is an autosomal recessive disorder characterized by a near total absence of body fat from birth or infancy associated with earlier diabetes onset and debilitating metabolic complications. We recently inactivated Bscl2 in mice to examine the mechanisms whereby absence of BSCL2 leads to adipose tissue loss and metabolic disorders. Bscl2^−/− mice recapitulate many of the major metabolic manifestations in CGL2 individuals, including lipodystrophy, organomegly, hepatic steatosis and insulin resistance. Lipodystrophy has been attributed to unbridle cyclic AMP-dependent protein kinase A-activated lipolysis which inhibits terminal adipocyte differentiation in Bscl2^-/- mice. However, the development of metabolic complications in CGL2 has been less characterized.  We found Bscl2^-/- mice exhibit a fasting-dependent insulin signaling in liver and muscle. They are hyperphagic, and rely exclusively on glucose as the main energy source. They display improved glucose homeostasis and insulin response under hyperinsulinemic-euglucemic clamp after overnight fast. The oxidative soleus muscle, but not gastrocnemius muscle, exhibits elevated glucose uptake rate in Bscl2^-/- mice. Unexpectedly, different from other lipodystrophic animals, Bscl2^-/- mice display reduced triglyceride contents in both soleus and gastrocnemius muscles; while significant elevation of glycogen levels was only observed in the oxidative soleus muscle but not in gastrocnemius muscle of Bscl2^-/- mice. More importantly, lipid pre-infusion in Bscl2^-/- mice mitigates glucose uptake in soleus muscle under hyperinsulinemic-euglucemic clamp, suggesting extreme lower NEFA after prolonged fasting could sensitize muscle insulin sensitivity in lipodystrophic Bscl2^-/- mice. Moreover, Bscl2^-/- mice also develop cardiac hypertrophy accompanied with cardiac dysfunction. These data provide a systemic view of metabolic disorders in lipodystrophic Bscl2^-/- mice, which have important clinical implications in treating patients with CGL2.

Biography:

Jose Mario F De Oliveira is an Associate Professor of Medicine in the Department of Medicine at the Universidade Federal Fluminense, in the State of Rio de Janeiro, Brazil. He is also one of the Deputy Editors for Diabetes of the British Medical Journal. He has published a number of papers and has served as a reviewer and has author for many prestigious medical journals like Hypertension, American Journal of Hypertension, Journal of the American Society of Nephrology, British Medical Journal and New England Journal of Medicine. His main interests are in the clinical research of Diabetes and Hypertension. He is a Certified Preventive Cardiologist, Nephrologist, and Adult Intensive Care Unit Physician. He was a Post-doctoral Clinical and Research Fellow at the Endocrinology-Hypertension-Diabetes division at Harvard Medical School, in Boston, USA.

Abstract:

Since this masterpiece of Bob Dylan created in 1964, when diabetic end-organ failures like visual blindness and neuropathy were much more common than today, the traditional therapeutic viewpoints have been the rule rather than the exception. The published results of the UKPDS the reduction of HbA1c levels has been the universal, and even more than that, ubiquitous paradigm in clinical guidelines, in older times for macrovascular diabetic complications and in the more recent times for microvascular diabetic complications. This overconfidence in the reliability of “safe” HbA1c levels, unfortunately, has increased over the last decades the frequency of severe hypoglycemic episodes, a high speed delivery into the market of unsafe new anti-diabetic drugs, forgetting about the endpoints that mostly matter to the diabetic patient survival and quality of life based on each day shorter and biased clinical trials. The purposes of this talk will be to explain for the audience; the concepts of a soft, a hard, and a surrogate outcome in the clinical spectrum of diabetes; and the relevance of highly intelligent strategies for diabetes therapeutics.

Biography:

Jenesh Shrestha  has completed his MBBS from B P Koirala Institute of Health Sciences, Dharan, Nepal. His articles are based on different types of cancers, endocrinological diseases, gastrointestinal diseases, economy associated with health problems, etc., has been reviewed by the few renowned journals of South Asia and the United States. He is currently a Member of Nepal Medical Association, American Medical Association and Nepal Medical Council. He is also an active member of Physician for Social Responsibility Nepal. He is an ECFMG Certified Doctor in US.

Abstract:

 

Background: Type 2 diabetes is typically a chronic disease associated with a ten-year-shorter life expectancy because of the number of complications with which it is associated.

Objective: To find the association between treatment compliance (adherence in regular follow up, routine investigations and complication screening) and other related variables.

Method & Materials: One hundred and twenty consecutive out-patients of internal medicine BPKIHS for follow up of diabetes who are diagnosed as diabetic for at least 1 year. Face to face interview was taken to fill the semi-structured questionnaire which included patients detail and information regarding regular follow up, routine investigations and complication screening.

Results: Out of 120 respondents, most were of age group more than 60 years with female preponderance 76 (63.3%).60 (50%) respondents were compliant for follow up and reasons of missing the appointment were 21 (35%) reported due to poor accessibility, 19 (31.6%) reported lack of time, 15 (25%) reported being unable to come by oneself (geriatric patients), 4 (6.7%) reported financial problem and 1 (1.7%) reported ignorance about follow-up.71 (64.5%) had some complications which are 47 (42.7%) had hyperlipidemia, 11 (10%) had diabetic retinopathy, 9 (8.1%) had nephropathy, 4 (3.6%) had neuropathy, 6 (5.4%) had cataract and 3 (2.7%) had glaucoma.

Conclusion: We found that the compliance in the routine investigation (i.e.90.0%) and screening of the complication (i.e. 91.8%) was much better than that in follow-up (i.e. 50.0%).

Biography:

Rajiv Kumar Jaiswal has completed his Post-graduation in Internal Medicine from St. Petersburg State Medical Academy and then to pursue Pain Management, he had completed his Post Graduation Diploma in Anesthesiology. He is working as a HOD for pain clinic in Esani Diabetes and Multispecialty Research Centre in India. He has published more than 11 papers in reputed journals.

Abstract:

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia due to defects in secretion of insulin, action of insulin, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the heart, kidneys, eyes, nerves, and blood vessels. In India, there is rampant increase in the incidence and prevalence of type 2 diabetes mellitus. Kutty BM, Raju TR et.al. (2010) have shown that nearly 30 million people are suffering from diabetes and this figure is expected to increase to 60 million by 2017. In 2011, at united nation general assembly there was discussion on control and prevention of non-communicable disease, because it has been shown that the incidence of death due to non-communicable disease (like cancer, cardiovascular disease, diabetes) is far greater than communicable disease. Yoga-based programs should be low-cost intervention strategy to improve physical and psychological well-being. Yoga provides slow rhythmic movements; by easy extensions and bending without over-stimulate muscles which can results in stimulation of the organs and glands. Yoga could be also useful in patient suffering from insulin resistance syndrome. The insulin resistance syndrome or metabolic syndrome is a characterized by hyperglycemia, obesity (central), hypertension and dyslipidemia.  Patient with metabolic syndrome have insulin resistance due to i) cardiovascular reactivity enhancement ii) decreased parasympathetic tone and iii) Increased sympathetic activity. Major recent advanced researches have shown that chronic stress (psychological) and negative affective states are the contributing factors towards the pathogenesis and progression of insulin resistance, intolerance of glucose, hypertension, and other IRS-related conditions. Diabetes poses a biggest challenge to health system for coming up with newer modalities of treatment. Hence, it is necessary to look at adjuncts to effective management of diabetes; adjuncts which are not resource intensive and are nearer to the community that people live in. Yoga holds promise as a therapeutic intervention and health promotion measure. This brief communication explores the studies done to date on the beneficial effects of Yoga on Diabetes.

Biography:

Marwa Sayed Abdel Latief Eassa graduated from Cairo University in 2005 with an excellent degree. She finished her BCS degree in Internal Medicine in Cairo University in 2010, and her thesis was insulin resistance as predictor for response to interferone based therapy in HCV infected patients. Currently, she is a MD candidate, and finished her MD thesis. She is working as Teaching Assistant in Internal Medicine Department, and in Endocrine Out Patient Clinic and Department in Kasralainy Hospital, Cairo University. She is a member of primary aldosteronism  group undersupervision of Pro. Dr. Mona Mansour.

Abstract:

Background: Thyroid nodule is common, malignancies found in ≈ 9-15% of the nodules evaluated with FNAB (1). High resolution US and FNAB are the most important steps in diagnostic workup of thyroid nodule. 20–40% of FNABs yield undetermined cytology (2). Surgery is required in indeterminate FNAB, but only quarter of them prove to be malignant after surgery (3), so 77% underwent unneeded surgery. So, finding a mean to diagnose malignant nodule preoperative is important. Advances in molecular genetics can be applied to develop a new diagnostic markers for FNA samples.

Objective: Evaluating the diagnostic value of high resolution U/S, FNAC, and BRAFV600 in diagnosing malignant thyroid nodules.

Patients & Methodology:  50 patients from Kasr alainy endocrine outpatient clinic with solitary or multiple thyroid nodules. All subjected to full history and examination, thyroid profile, high resolution neck U/S, U/S guided FNAC and BRAFV600E analysis on FNAB using DNA sequencing then HRMA for confirmation.

Results: The incidence of BRAFV600E mutation among PTC patients was 55.6%, P value < 0.001. The sensitivity of BRAFV600E mutation was 42.9%, specificity was 100%. Ultrasound sensitivity in detecting malignancy was 88.2%, specificity 72.7%. Addition of ultrasonography to BRAFV600E analysis increased ultrasound sensitivity  in detecting PTC preoperative to 92%. There was a positive correlation between most suspicious ultrasonography  findings and presence of BRAFV600E mutation (increased AP/T diameter, Increase intra-nodular  blood flow, cervical lymphadenopathy, absent or incomplete halo (all p value < 0.001), irregular border p value 0.004, micro calcifications p value 0.007.

Conclusion: 1. High resolution US and FNAB are the most important steps in diagnosis of thyroid nodule. 2-BRAFV600E mutation detected mainly in PTC. 3. Adding BRAFV600E analysis to U/S and FNA will increase the sensitivity of preoperative diagnosis of PTC especially in indefinite nodules. 4. BRAFV600E positivity was associated with most known suspicious U/S finding and significantly present in cases with cervical lymphadenopathy that may give it a prognostic value. 5. HRMA is simple, accurate, and a low cost tool for BRAFV600E analysis.

Biography:

Ruchika Mittal is the student in Panjab University.

Abstract:

Diabetes mellitus is a serious global health problem and its prevalence is estimated to be 366 million worldwide by the year of 2025. Streptozotocin (STZ, 55 mg/kg), Commiphora mukul (50 and 100 mg/kg, i.p.) and Ramipril (0.2 and 2.3 mg/kg, p.o.) were tested in this study on experimental animals. Animals with a blood glucose level more than 250g/dl are considered diabetic and are used for further studies. All the behavioural parameters were performed on day 0, 2^nd, 4^th, 6^th and 8^th week. On the last day (of 8^th week), blood was collected retro-orbitally and mean nerve conduction velocity (MNCV) was assessed. The animals were then sacrificed sciatic nerves were isolated for further biochemical estimations. Commiphora mukul (50 and 100 mg/kg) for 8 weeks significantly protected all the behavioral alterations, oxidative damage and change in MNCV induced by STZ. Further, the combination of Commiphora mukul (50 and 100 mg/kg) with Ramipril (0.2 mg/kg) significantly reversed all the behavioural, biochemical and changes in MNCV as compared to their effect per se in STZ-induced diabetic neuropathy. The present study suggests the protective effect of Commiphora mukul against STZ-induces diabetic neuropathy. Study further provides evidence that Commiphora mukul produces better effect in combination with Ramipril against STZ-induces diabetic neuropathy.

Biography:

Zahra Banazadeh is currently working as Internist at University of Medical Sciences, Iran. She specially works in internal Medicine. She served for about 14 months in school health clinic in the Olympic Village of Tehran.  She is having certification in ICDL.

Abstract:

Background: The aim of this study was to measure the body composition in adults with newly diagnosed type 2 diabetes mellitus and to explore the effect of metformin therapy on the various components of body composition, insulin sensitivity and glucose homeostasis.

 

Methods: This was an observational study consisted of 51 newly diagnosed people with type 2 diabetes on 1000 mg metformin twice daily for 6 months. The body composition of each subject was measured by dual energy X-ray absorptiometry at enrollment and 24 weeks after metformin mono-therapy. Sarcopenia was defined and compared based on the ratio of appendicular skeletal muscle and height squared, skeletal muscle index and residual methods. Homeostasis model assessment-insulin resistance and Quantitative Insulin Sensitivity Check Index were used for estimating insulin sensitivity. The level of physical activity was assessed using self-administered International physical Activity questionnaire.

 

Results: Forty one subjects (80.4%) completed the study. The mean age of the participants was 52.67±10.43 years. Metformin treatment was associated with a significant decrease in total fat mass (-1.6 kg, P=0.000). By week 24, the lean to fat ratio increased (P=0.04) with men showing greater significant changes. Twenty percent of the female participants were detected to have sarcopenia. In addition, there was a significant improvement of glucose homeostasis and insulin sensitivity.

Conclusions: Metformin therapy results in significant improvement in body composition and insulin sensitivity of adults with newly diagnosed type 2 diabetes. Furthermore, sarcopenia begins in women with diabetes much earlier than expected as an age related phenomenon.

Biography:

Adel Ahmed Mohmed Ahmed Elnaggar is a Medical Endocrinologist with an extended expertise in adult diabetes and obesity; as regard prevention and early detection/diagnosis and management and risk reduction of their outcomes. He also share diabetes & obesity clinical trials link and research work concerning both. He is also working on community planning against chronic diseases/disabilities affecting community productivity; prevention & management. He is experienced in thyroid diseases and female endocrine health problems. He is a graduate and earned undergraduate and internship and completed Postgraduate residency in Internal Medicine & Endocrinology from Ain Shams University, School of Medicine, Cairo, Egypt. He is a member of Endocrine & Diabetes Society in Saudi Arabia. He is an active member of Diabetes Club & Endocrine Club, Saudi Arabia. He is also a member of Diabetes Investigators of Ministry of Health, Saudi Arabia sponsored by Sanofi Pharmaceutical company. He is member of European Society of Endocrinology and International Diabetes. He gives lectures on diabetes & obesity management to local Endocrinologists & Internists & GPs and takes part in diabetes health educational programs for the patients & health care professionals.

Abstract:

Diabetes Mellitus (DM); defined as a group of diseases (cardio-metabolic disorders/complex metabolic disorders) characterized by hyperglycemia due to an absolute or relative lack of insulin or to a cellular resistance to insulin. Diabetes had multiple health hazards & high incidence of cardio metabolic comorbidities due to the nature of disease progress, leading to diabetic complications & disabilities, which impair individual productivity towards the community. Prevalence of adult diabetes worldwide is growing forcibly to affect the adolescence especially in gulf areas & America due to unhealthy life styles & physical inactivity. The most common cause of adult diabetes is the obesity. Diabetes & obesity are the highest prevalence of the gulf area; Saudi Arabia is considered the highest real country worldwide in diabetes & obesity prevalence. This patient’s case of adult type 2 DM with obesity is commonly seen worldwide; especially in gulf (Middle East) & America. Such cases are missed by routine management of blood sugar level apart from the focus on the main cause of their diabetes, which is the obesity in adults. Control of diabetes not only means blood sugar control, but also should be causality control. Role of weight reduction is very important here towards causality control for patient’s diabetes, furthermore multiple cardio metabolic risks outcomes associated with both diabetes & obesity. Aim of lowering insulin resistance by encouraging weight loss is beneficial, although unhealthy life style in gulf area & patient’s socio-economic status, which is affecting drug choices ideally preferred in such cases like injectable Glucagon-like peptide-1 (GLP-1) Analogues; liraglutide (high cost) & Sodium-glucose co-transporter 2 (SGLT2) inhibitors, which are not yet launched in Saudi Arabia. Due to these challenges; I chose first basal insulin detemir plus metformin_sitagliptin oral anti_diabetic combination as regard to weight concern/cost/glucotoxicity control/preserve pancreatic beta cell function; then maintenance on metformin_sitagliptin combination plus weight reduction motivation by good doctor-patient relationship & play on good psychological support. Specify the target aim for patient’s control of this diabetes by weight loss regimen, which by regular follow-up leads to achieving our target for both, controlling patient’s diabetes & obesity.