Day 1 :
Keynote Forum
Lynn Ge-Zerbe
Boise Thyroid & Endocrinology PC
Keynote: What do we know about artificial sweetener and its relationship with obesity and diabetes epidemic?
Time : 09:30-10:15
Biography:
Lynn Ge-Zerbe is a recipient of the Leading Physician of the World and Pinnacle Professional of the Year 2017 award. She is board certified in Endocrinology and Internal Medicine, the Owner of Boise Thyroid & Endocrinology PC, a concierge endocrinology and weight loss practice, the Principle Investigator of Advanced Clinical Research, a Consultant Endocrinologist with RubiconMD and Video Medicine. She has earned her MD at PUMC, MPH of Epidemiology at University of Pittsburgh, Post-doctoral Fellowship in Molecular Medicine at NIH, Residency in Internal Medicine at Leigh Valley Hospital, Penn State University, Fellowship in Endocrinology at Vanderbilt University as well as Age Management Certification by AMMEF. She is passionate in combining east and west medicine to cure and prevent endocrinology disorders.
Abstract:
Obesity is among the most common and costly chronic disorders worldwide. The new epidemic is in Asia countries. Growing evidence suggests that obesity is a disorder of the energy homeostasis system. Weight control is important for reducing the risk of metabolic disease such as diabetes. Obesity and diabetes epidemic coincides with an increase in the widespread use of artificial sweetener in modern diet for weight control by retaining sweet taste without increase caloric intake. However, research studies suggest that artificial sweetener may contribute to weight gain instead of weight loss. Artificial sweetener caused weight gain may have multiple etiology. The new study shows that sweetness helps to determine how calories are metabolized and signaled to the brain. When sweetness and calories are matched, the calories are metabolized and this is registered by brain reward circuits. However, when a mismatch occurs, the calories fail to trigger the body’s metabolism and the reward circuits in the brain fail to register that calories have consumed. As a result, artificial sweetener triggers food seeking behavior and may contribute to obesity. Calories are only half of the equation; sweet taste perception is the other half. A sweet-tasting low calorie drink can trigger a greater metabolic response than drinks with higher calories, explaining the association between artificial sweeteners and diabetes discovered in earlier studies. Studies found artificial sweetener intake can induce excess activation of sweet taste receptor and evoke GLP-2 release, in turn, increase SGLT1 expression and mucosal growth. SGLT1 as a prime intestinal glucose transporter plays important role in intestinal glucose sensing and incretin secretion. So, artificial sweeteners encourage sugar craving and sugar dependence as well as alter glucose tolerance. Studies also showed that consumption of artificial sweetener drives the development of glucose intolerance through induction of compositional and functional alterations of the intestinal microbial. Numerous studies have indicated an important role of the gut microbiome in body weight control and glucose metabolism and regulation.
Keynote Forum
S Chhabra
Mahatma Gandhi Institute of Medical Sciences
Keynote: Hypertensive disorders during pregnancy: A disease of dilemmas and dangers
Time : 10:15-11:00
Biography:
S Chhabra is a Director Professor of Obstetrics and Gynecology in the College of Mahatma Gandhi Institute of Medical Sciences, India and CEO of Akanksha Shishu Kalyan Kendra and OSD in Dr. Sushila Nayar Hospital, Sewagram.
Abstract:
Hypertensive disorders during pregnancy (HDsP) disease of dilemmas with dangers to mother/baby are difficult to predict with limitations to prevention. Some studies have revealed blood/urinary calcium inverse relationship to HDsP, so researchers believe calcium has a role, others refute. Problem seems to be at cellular level, needs to be investigated. Extra calcium as program needs more research. Concept of early onset (EO HDsP), late onset (LO HDsP), two entities with different etiologies, pathologies, effects on baby, mother, long term sequel is modern. LOHDsP are believed to be related to maternal constitution, EO HDsP probably have placental origin with interplay between maternal constitution, placental factors, inappropriate adaptive changes in pregnancy, predominantly involving cardiovascular, inflammatory system. EO is believed to be associated with increased arterial stiffness that extends beyond pregnancy with adverse vascular outcomes. Studies are being done about genetic variations, immune system association between HCG, a variety of thrombophilic disorders and EOHDP. In one of studies, HDsP contributed to 11.6% obstetric admissions. 17.8% births, 212 (5.6% of 3780 HDsP) were severely ill, case fatality was 0.5% of HDsP, 9% of severely ill (19 of 212), 43% (9 of 21) of severely ill with HELLP. Another study of 1046 cases HDsP represented 11.73% of 8920 births. Mean gestation at birth in HDsP of 20 to <28 weeks (A) was 30±1 weeks, between >28 to <34 weeks, (B) 32±6, between >34 to <37 weeks (C) 35±4 weeks, 37 weeks (D) 38±4 weeks. Mean birth weight in very early gestation cases was 1741.54 gms, in >28 to <34 weeks 1936.31 gms, >34 to 37 weeks 2633.38 gms and >37 weeks 2677.30 gms. Perinatal deaths in very early HDsP were 45%, >28 to <34 weeks 25.13%, >34 to <37 weeks 14.32%, >37 weeks 14.00%. Most of EO HDsP was primigravida of younger age with severe rapidly progressive disease with significantly higher multiorgan disorders, liver dysfunction, HELLP, renal failure. Placental abruption occurred in 25% in A, 14.66% B, 3.79% C, 2.67% D. Conservative management improved fetal outcome, but maternal mortality morbidity is concerned. LO HDsP also could become dangerous. Around 34 weeks survival was similar to term. Role of aspirin, calcium has been documented for prevention but continues to be surrounded by controversies. Studies are also being done about vitamin C and E for prevention of HDsP, some shown benefits, others not. Low-molecular-weight heparin has also been studied with no effect on outcome of EO HDsP.
Keynote Forum
Kriz-Ann R Hernandez
Jose R Reyes Memorial Medical Center, Philippines
Keynote: Prediction model of mortality among patients with diabetic ketoacidosis
Time : 11:20-12:05
Biography:
Abstract:
Background & Aim: Diabetes Mellitus (DM) is a major cause of premature mortality globally. One of its acute complications is Diabetic Ketoacidosis (DKA). DKA is a medical emergency wherein abrupt and correct management could prevent patient mortality. Prediction of mortality from DKA could be done using patient’s demographics, clinical profile and laboratory parameters. However, locally, there is no prediction model developed yet to predict mortality. This study aims to create an assessment tool that could accurately predict the risk of mortality among DKA patients within the first 24 hours of admission and correlate patient’s demographics, clinical profile and laboratory parameters with improvement of survival rate.
Methods: This is a retrospective, cohort study which included 129 admitted adult DKA patients. Statistical analysis used was logistic binary regression. Receiving operating characteristic (ROC) curve was done to validate prediction models.
Results: 6 variables identified to predict mortality are patient’s age ≥60 years, severe DKA, non- insulin dependent status, GCS<15, non-normal platelet count and non-normal estimated creatinine clearance. Prediction models developed included and omitted age profile. Cut-off scores of prediction models were validated with the ROC curve. Cut-off score with age was 5 with sensitivity of 73.91% and specificity of 74.70% and the area under the curve is 0.751 which is significant (p=0.0001). On the other hand, cut-off score of the prediction model without age is 4 with sensitivity of 65.22% and specificity of 67.47% and the area under the curve is 0.719 which is significant (p=0.0001).
Conclusion: This study was able to prove that mortality in DKA can be predicted within the first 24 hours of admission using patient’s demographics and significant clinical profile in the prediction models developed.
Keynote Forum
Juan C Calderon
University of Antioquia, Colombia
Keynote: The new endocrine role of skeletal muscle myokines
Time : 12:05-12:50
Biography:
There has been a recent change in the way scientists understand skeletal muscle functions. It is not only a tissue that generates force and movement, but a one that regulates its own functions and others by means of myokines secretion. Myokines are small peptides or proteins with autocrine, paracrine and endocrine functions. Some of them have long been known, such as cytokines and growth factors, but others are new such as musclin, myostatin, myonectic, apelin and irisin. They are regulated by exercise, muscle fiber type, caloric intake and several humoral stimuli. Their structure and receptors are now been sought. These molecules have regulatory effects on immune (inflammation), metabolic (insulin resistance/sensitivity and fat metabolism) and cardiovascular (blood pressure and angiogenesis) systems. They are important to understand the complex crosstalk between muscle-exercise-adaptations and muscle-sedentarism-chronic diseases. New myokines as well as their regulation and functions are likely to be discovered in the near future. Also, their therapeutic use is expected. Our research groups (PHYSIS and GRINMADE) have been exploring the relationships between muscle mass, fiber types and myokines in several populations in Colombia. We have found a protective effect of thigh muscle mass on metabolic disease, but not a direct relationship between musclin and insulin resistance in patients with metabolic syndrome. Preliminary results also show a regulation of musclin by a high intensity exercise bout in these patients. In conclusion, the skeletal muscle works too as an endocrine organ, whose study will help us understand the pathophysiology of some chronic diseases and also envision diagnostic and therapeutic tools to tackle them.
Abstract:
Juan C Calderon is a Medical Doctor, completed his PhD in Physiology, devoted to understand different functions of skeletal muscle. His work has been related to excitation-contraction coupling, calcium signaling and muscle fatigue.
Keynote Forum
Juan C Calderon
University of Antioquia, Colombia
Keynote: The new endocrine role of skeletal muscle myokines
Time : 12:05-12:50
Biography:
Abstract:
- Endocrinology Research and Development | Diabetes and its Treatment | Obesity and Metabolism | Cardiovascular Complications | Clinical Studies & Case Reports | Management & Prevention | In Children‘s, Teens & Adolescents
Location: Seletar Room 2, Level 3
Chair
Emmanuel Mukwevho
North West University, South Africa
Session Introduction
Li Li
Li Li, University of Alabama, USA
Title: Childhood maltreatment is an independent risk factor for type-2 diabetes mellitus
Time : 13:50-14:20
Biography:
Li Li is an Assistant Professor at the University of Alabama, School of Medicine in the USA. Her research focuses on insulin resistance, pre-diabetes and obesity in individuals with major depressive disorder and child abuse and more generally, individuals with comorbid mental illness and metabolic syndrome. She currently holds a K23 career development award from the National Institute Health to support her research. Her other ongoing projects include investigating the relationship between inflammation and child abuse in individuals with depression and using exercise as an interventional approach to manage depression and metabolic syndrome. In addition to her practice and research, she also directs the evidence-based medicine and mechanisms in psychiatry curriculum and administers the research programs for residents.
Abstract:
Aims: Childhood maltreatment (CM) is shown to be associated with obesity and depression. However, the relationship of CM to type-2 diabetes mellitus is much less studied. We tested the hypothesis that CM increases the risk for type-2 diabetes mellitus due to glucose intolerance, reduced insulin sensitivity and beta cell function.
Methods: Oral glucose tolerance test (OGTT)-derived metabolic parameters of glucose tolerance, insulin sensitivity and beta cell function were evaluated in 121 participants aged 19-60 years. CM exposure was measured using the Childhood Trauma Questionnaire. Blood samples were collected to measure the inflammatory factors.
Results: After controlling for age, race, gender, education and depression, about 15% higher glucose area under the OGTT curve was observed in the CM group. CM individuals also exhibited impaired insulin sensitivity manifested by the Matsuda index and homeostasis model assessment of insulin resistance, which were correlated with CM severity after adjusting for depression. CM group showed approximately 50% lower disposition index. C-reactive protein and tumor necrosis factor-α levels were greater in the CM group vs. the non-CM group and both were correlated with CM severity (r=0.21, 0.23, respectively, both p<0.05). Multiple regression analyses revealed that CM contributed to reduced insulin sensitivity and lower disposition index independent of depression and obesity.
Conclusions: These data suggest an important relationship between CM and increased risk for type-2 diabetes mellitus due to glucose intolerance, impaired insulin sensitivity and beta cell function. Our findings indicate that CM appears to be an independent risk factor for developing type-2 diabetes mellitus.
Emmanuel Mukwevho
North West University, South Africa
Title: Adiponectin regulation of AMPK on oleanolic acid treated Sprague Dawley rats
Time : 14:20-14:50
Biography:
Emmanuel Mukwevho is a Professor of Biochemistry at the School of Chemical and Physical Sciences at the NWU, South Africa. He has completed his PhD from University of Cape Town, South Africa. He has also obtained certificates in Project Management and in Financial Management from UCT. Presently, he has registered for MBA with NWU Graduate Business School.
Abstract:
AMPK is known to control glucose and lipid metabolism, two main candidates critical in the development of type-2 diabetes (T2D). Studies have shown that AMPK can be activated by adiponectin. Patients suffering from T2D are known to have low adiponectin concentration in their blood plasma. In this study we have assessed one anti-diabetic compounds; Oleanolic Acid (OA), if it could produce desirable effect in up-regulating adiponectin concentration and the subsequent regulation of AMPK. Sprague Dawley rats were fed with high fructose diet (HFD) to induce T2D and the rats that developed insulin resistance were considered as diseased, they were then treated with OA. Analysis of adiponectin concentration in blood plasma was done, AMPK gene expression and subsequent genes that play vital role in glucose and lipid metabolism (GLUT-4 and CPT-1) in skeletal muscle tissue was also performed. The results showed 1.19 folds increase in blood plasma adiponectin concentration after OA administration. Furthermore AMPK gene expression showed 3.98 folds increase and GLUT-4 gene expression was increased with 1.5 fold whereas CTP-1 gene expression was increased with 1.59 folds. These results clearly indicate that OA produced good effects in ameliorating insulin resistance since it was able to up-regulate all the genes and adiponectin concentration which are well known to be abnormally suppressed in a situation of T2D. In conclusion, this study further confirms that OA can be used as an effective therapeutic agent to ameliorate T2D and this study also suggest that OA’s mechanism of action could be through AMPK pathway.
Christoph Sperker
Krankenanstalt Rudolfstiftung, Austria
Title: Interactions between calcium metabolism and anti-reflux medication after sleeve gastrectomy
Biography:
Christoph Sperker has specialized in Laproscopic Surgery and Bariatric Surgery. He is a Visiting Professor to the Medical University of Vienna and is passionate in teaching and passing on his skills. His main focus in the field of bariatric surgery is nutrition and deficiencies after bariatric surgery depending on PPI medication.
Abstract:
Introduction: Malabsorption and micronutrient deficiencies are known problems after bariatric surgery. Therefore, supplementation and regular controls are inevitable. Calcium (Ca2+) levels, which may be disrupted after malabsorptive bariatric procedures are known to depend on gastric pH levels.
Objectives: To determine the effect of proton pump inhibitors (PPI) on Ca2+, parathyroid gland hormone (PTH) and vitamin D levels after sleeve gastrectomy (SG).
Methods: All patients who underwent SG between 2008 and 2013 were enrolled in our follow-up program. The patients were examined preoperatively and then four times during the first year. Ca2+ metabolism and weight parameters were monitored. All the patients received 3000 mg of Ca2+ carbonate (equivalent to 1200 mg of Ca2+), 800 IE of vitamin D, as well as one multivitamin tablet daily. All the parameters were then analyzed for associations with PPI intake.
Results: Data of 385 out of 400 (96.2%) patients were analyzed after 1 year of follow-up (3.8% lost to follow-up). Thirty nine (10.1%) patients took PPI for at least three months during the first year. The Ca2+ levels were significantly lower (p<0.0001) in the PPI group in comparison to the non-PPI group, although neither of the groups showed hypocalcaemia. The PTH levels showed an opposite behavior (p<0.0001).
Conclusions: Our data show that higher gastric pH levels caused by PPI intake negatively influence Ca2+ absorption. Therefore, Ca2+ and PTH levels should be monitored, especially in patients receiving PPI therapy after SG.
Asma Ahmed
Aga Khan University Hospital, Pakistan
Title: Diabetes prevention in Pakistan: Reality, challenges and outcome
Time : 15:20-15:50
Biography:
Abstract:
Statement of the Problem: Pakistan has an estimated 7.9 million people affected with DM according to IDF and this number is expected to increase to 15.1 million by the year 2040. Landmark trials on DM prevention like DPP, Finnish Diabetes Prevention Study and Da Qing IGT study proves that type 2 DM can be prevented substantially with the help of life style modification. To implement such a trial in Pakistan is need of an hour since due to non-availability of national health system in the country there is tremendous pressure on individuals, families and community to deal with the long term complications of DM. The life style intervention trial conducted for the prevention of type-2 DM is funded by IDF.
Methodology & Theoretical Orientation: Before the intervention, baseline data was collected from the two main sub towns of Karachi, the largest city of Pakistan and also among the world’s largest and densest cities with a population exceeding 23 million. The population of Karachi is cosmopolitan consisting of diverse ethnic and cultural groups residing in areas with different city plans. The analysis reported here is a part of the baseline data collected for screening of individuals for the presence of risk factors for development of type 2 DM. The survey was conducted on 15,215 people between 30-64 years of age in urban households.
Findings: The prevalence of overweight and obesity was found to be quite high in Pakistani population (35.2 and 33.1, respectively). The prevalence of pre and unrecognized DM was also found to be high 31% and 12%, respectively. 34.4% of the participants in an intervention arm showed reversal of pre diabetes in comparison to 22.2% in control group after one year of life style intervention.
Conclusion: The trial shows increased burden of obesity and overall glucose intolerance in Pakistani population.
Priyanga Suriyamoorthy
Karpagam University, India
Title: Macrotyloma uniflorum induced expression of adiponectin exerts antidiabetic action in STZ treated rats
Time : 16:40-17:10
Biography:
Priyanga Suriyamoorthy is currently working as Assistant Professor at the Department of Biochemistry, Karpagam University, India. She holds a PhD degree in Biochemistry. She has special interest in the area of natural product research and diabetes.
Abstract:
Despite extensive progress in the treatment of diabetes by oral hypoglycemic agents, search for newer drugs continues because the existing synthetic drugs have several limitations. Previous studies carried out at our laboratory and others have reported the hypoglycemic effects of M. uniflorum in STZ induced diabetic rats. The present study is aimed to evaluate the effect of ethanolic extract of M. uniflorum leaves and isolated compounds in the regulation of adiponectin in vivo and in vitro, in order to delineate the effect of this plant on adiponectin expression in diabetes. The plasma adiponectin levels were decreased in the diabetic rats. This is associated with reduced adiponectin mRNA expression in adipose tissue of STZ induced rats. Treatment with the ethanolic extracts of M. uniflorum up-regulated the expression of adiponectin. To identify and delineate the individual compounds responsible for enhancing adiponectin levels, the extract was subjected to fractionation and nine compounds were isolated and screened using molecular docking analysis. From these results, four compounds were selected for in vitro analysis. The crude extract and four compounds were used to assess cytotoxicity through MTT assay in 3T3-L1 cells. Based on the results obtained from cell proliferation assay the crude extract, CPD 7 and CPD 8 exhibited significant proliferative effect when compared with control cells. Two compounds and crude extract were further chosen to study the expression of adiponectin gene pattern using 3T3-L1 cells. The adipocytes treated with ethanolic leaf extract of M. uniflorum (1 µg/ml and 10 µg/ml), CPD 6 (50 µM and 100 µM), CPD 7 (50 µM and 100 µM) and Glibenclamide (50 µM and 100 µM) for 48 hours exhibited up-regulation of adiponectin mRNA expression as compared with control cells. These results demonstrate that the hypoglycemic effect of M. uniflorum may be mediated through enhanced adiponectin levels.
Nathania Sutandi
Newcastle University, UK
Title: Comparison of robotic versus open and laparoscopic distal pancreatectomy in pancreatic neuroendocrine tumor
Time : 17:10-17:40
Biography:
Nathania Sutandi is a Medical student from University of Indonesia. She intercalated in Master of Research (MRes) in Cancer at Newcastle University, UK between her 3rd and 4th year of study. She had worked at Hepato-biliary and Pancreatic (HPB) Surgery and Transplant Department in Freeman Hospital, Newcastle, UK for 6 months. She has particular interest in pancreatic neuroendocrine tumor (pNET).
Abstract:
Statement of the Problem: The incidence of pancreatic neuroendocrine tumors (pNETs) has gradually increased over the last three decades. As most pNETs are relatively small and solitary, they may be considered well suited for surgical removal by minimally invasive approach. Over the past few decades, robotic distal pancreatectomy is being used increasingly in specialized pancreatic surgery centers. Until now, no studies have reported the safety and feasibility of robotic distal pancreatectomy (RDP) in the management of pNET. The aim of our study was to perform the first study, which compares the outcomes of robotic versus open (ODP) and laparoscopic (LDP) distal pancreatectomy in pNET treatment.
Methodology & Theoretical Orientation: Patients’ baseline characteristics, intra-operative data and post-operative data for LDP and RDP were collected prospectively whereas ODP was collected retrospectively. All procedures performed during a 9-year period (2007-2017) were compared with RDP introduced as our standard approach in 2014.
Findings: In total, 33 patients (age range 17-76 years) underwent distal pancreatectomy with the indication of pNET. Conversion rates for LDP and RDP were 2/14 and 0/10 respectively. Docking and robotic set-up took an additional 47 minutes (range 20-75). Complications were graded according to the Clavien-Dindo classification and pancreatic fistulas were graded according to ISGPF classification. There were no mortalities in this study. Results are expressed as mean values or percentages.
Conclusion & Significance: Robotic distal pancreatectomy has unique advantages over laparoscopic and open approach in the management of pNET and should be considered where appropriate surgical expertise exists. Its safety and feasibility are comparable with the other two techniques as shown by the lower trend in blood loss, similar R0 resection rate, lower post-operative diabetes mellitus, lower high-grade complication and lower high-grade fistula. The major disadvantages are the increased cost and operative time.