26th International Diabetes and Healthcare Conference November 26-27, 2018 Helsinki, Finland

Rajesh Jain is a chairman at Jain Hospital & Project Manager, Gestational Diabetes Prevention Control Project, UP, NHM, India in Collaboration with World Diabetes Foundation, Denmark. He is the faculty in RSSDI, DIPSI, Diabetes India, SAIDIP at National & International Conference, Technical Advisor in Diabetes & NCD to Uttar Pradesh Ministry of Health and Family Welfare, NRHM (National rural Health mission), MOHFW, and Gov. of India. Ex. Medical officer with World Health Organization (WHO), Author of Book "AVATAR"

Background: Gestational Diabetes Mellitus (GDM) is a glucose intolerance that occurs or is identified for the first time all through pregnancy. Perinatal & neonatal morbidity mortality is significant in pregnant women in GDM with extra hazard of growing diabetes later in life. Uttar Pradesh is a largest state of India with one of the highest rate of the infant as well as maternal mortality which might be at least partially due to GDM. Thus, careful evaluation, administration & training of HCPs for GDM can improve the outcomes in National Health Mission supported Govt funded Program.

Aims and Objectives: Primary objective of this find out about used to be to determine the incidence of GDM and evaluate the maternal and fetal result in Uttar Pradesh. Thus, this study was once undertaken to recognize the extent of the burden on Healthcare, earlier than the scope of intervention ought to be defined.

Materials and Methods: A potential find out about (September 2012-October 2017) was executed at 806 CHCs & PHCs Healthcare facilities. 223446 pregnant women have been screened at 16-20 weeks & 24th-28 weeks of pregnancy as per guidelines of National Health Mission, GOI & Federation of Obstetric and Gynecological Societies of India (FOGSI).

Results: >76% of pregnant women did now not recognize about GDM. Prevalence of GDM used to be 11.12%. Stillbirth, perinatal & neonatal mortality have been respectively 2.6, 2.2 & 2.7 instances greater in GDM. Most of the GDM used to be identified in primigravida (52%). Congenital malformation was once nine instances higher, low birth weight (LBW) was 32% in GDM (14% in non-GDM). GDM find instances had 22.7% wonderful household history of diabetes (compared to 6.5% in non-GDM). Relative dangers for PBU admission, LGA (large for gestational age), Low birth weight (LBW), pre-eclampsia and jaundice were also higher.

Conclusion: All the pregnant women want screening in public facilities & implementation of National Health Mission, GOI guidelines for GDM has to be followed to improve outcome for mother and newborn. As the lack of information about GDM amongst pregnant women is high, to decrease the risk, Awareness & Implementation of Guidelines is key thrust area.

Anne Sophie Mathiesen is a Registered Nurse since 2004. She has completed her Masters in Public Health from the University of Copenhagen in 2012 and is due to defend her dessertation in September 2019 from the Faculty of Health and Medical Sciences at the University of Copenhagen. Anne Sophie is employed at the Department of Endocrinology since 2008 as a Clinical Nurse Specialist. Anne Sophie has published five papers in international journals, two as the first author.

Diabetes Distress (DD) disproportionately affects vulnerable people with Type 2 Diabetes Mellitus (T2DM) and interventions targeting this population are therefore relevant. Diabetes distress is a condition potentially hindering adequate diabetes management and associated to poor adherence and glycaemic control. A systematic review and meta-analysis was performed to assess the evidence for an effect of psychosocial interventions for reducing DD and, secondly HbA1c, depression and Health Related Quality Of Life (HRQOL) in vulnerable people with T2DM. Vulnerability encompasses poor glycemic control (HbA1c>7.5%) and at least one additional risk factor for poor diabetes outcomes such as low educational level, comorbidity and risky lifestyle behavior. The interventions should be theoretically founded and include cognition- or emotion-focused elements. We systematically searched four databases for articles published between January 1995 and March 2018. Eighteen studies testing a variety of psychosocial interventions in 4066 patients were included. We adhered to the Cochrane methodology and PRISMA guidelines. Review Manager 5.3 was used for data extraction and risk of bias assessment, and Grades of Recommendation, Assessment, Development and Evaluation (GRADE) for assessing the quality of the evidence. Data were pooled using the fixed or random effects method as appropriate. We investigated effects of individual versus group, intensive versus brief interventions and interventions with and without motivational interviewing in sub-group analyses. To assess the robustness of effect estimates, sensitivity analyses excluding studies with high risk of bias attrition >20% were conducted. We found low to moderate quality evidence for a significant small effect of psychosocial interventions on DD and very low to moderate quality evidence for no effect on HbA1c, both outcomes assessed at 3, 6, 12 and 24-month follow-up. The effect on depression was small, while there was no effect on HRQOL. Exploratory subgroup analyses suggested that interventions using motivational interviewing and individual interventions were associated with incremental effects on DD. Likewise, intensive interventions were associated with significant reductions in both DD and HbA1c.

Anastasia P Papachristou has completed her studies in the Kapodistian University of Athens in the field of Robotic Surgery and in the Management & Administration of Health Units. Her field of expertise is International Medicine and Health Crisis management. She has participated in numerous missions with international organizations globally and she has been granted several awards both for her academic and humanitarian action.

One of the late complications of diabetes is diabetic foot syndrome (DFS), characterized by reduction in blood supply to the feet that leads to neuropathy and angiopathy. DFS patients are at risk of developing foot ulcers and wounds as a result of neuropathy. The care of individuals with diabetic foot ulcers is often expensive and requires multiple Hospital visits most of the times. Inadequate care leads to serious complications and a high risk of lower extremity amputation. The role of telemedical monitoring in diabetic foot ulcer care remains still uncertain. The objective of this systematic review of the literature was to assess the effect of telemedicine in the prevention and treatment of diabetic foot ulcers. This systematic review included research studies published in the 2008-2018 period from search databases Medline, Scopus, CINAHL and PubMed with index words diabetic foot, diabetic foot ulcers, telemedicine. Eighteen studies were reviewed and evaluated. Most of them showed that the telemedical intervention can effectively support the treatment of diabetic foot ulcers and monitor every change of the ulcer as the agreement for remote vs in-person assessment of the ulcers were in most studies quite high. Moreover, in many of the included studies, both Healthcare professionals and patients that used the telemedical devices reported their satisfaction of the intervention and that they were quite easy to use. The feasibility studies that were reviewed, showed that the telemedical intervention is cost effective in comparison with the cost for foot ulcer or amputation treatment in the national Health system which is estimated between 5,000$ and 40,000$. Telemedicine care is promising for the management of diabetic foot patients as the results of the included studies were comparable with usual care. In conclusion, there is a need for large multicenter studies so that safe conclusions can be drawn about the usefulness and effectiveness of the telemedicine in this specific group of patients.

Anouk Prop is a Psychologist and Registered Yoga Alliance (E-RYT 500) Yoga Teacher and Trauma Therapist, originally from the Netherlands. She combines psychology, trauma healing and yoga through their very compatible aspects and stresses on the non-medical methods in healing and offers a holistic approach as such. Anouk has a broad range of experience in the field, in clinical and rehabilitation settings in several countries, varying from working with children and adults with a history of abuse, addiction, anxiety disorders, depression, but also car-accidents and other traumatic events like war or natural disasters. She encounters people with deeply rooted tension, trauma or blockages on a level which goes beyond cognition and shows that addictive behavior can be replaced by more Healthy habits to overcome obstacles in life. Her mindful approach is focused on empowerment and guiding people towards their own unique essence by gently inviting them to look in the beautiful, though sometimes confronting mirror life provides, taken by her hand of compassion, positivity and enthusiasm.

Nowadays many treatments are available in Health care to address the chronic condition of diabetes. An increasing number is focusing on a more holistic approach, encompassing a variety of methods and tools to help achieve, maintain and enhance a Healthy way of living, diet and exercise. Yoga and mindfulness as complementary Health practices are increasingly being used to help battling the physical and emotional challenges that come with living with diabetes and provide a Healthy outlet to cope with its daily life stressors. It is considered to be a promising, cost-effective option in the treatment and prevention of diabetes. Yoga has been used for thousands of years as a means of promoting physical, mental and spiritual Health and is seen as very beneficial in holistic Health care to help reduce levels of stress, enhance mobility, lower blood pressure and improve overall wellbeing. The benefits support improving posture, circulation, strength, flexibility and dealing with pains and discomfort. Breathing exercises, gentle motions and mindfulness enhance the function and efficiency of respiratory, neurological and endocrine organs, enhance energy levels and reduce stress. The improved circulation lowers blood pressure and increases oxygen flow to the brain that has a mood-altering effect on accompanying feelings of depression, anxiety or psychological distress. Self-awareness and self-discipline are enhanced through the practice of yoga and its full-on exposure therapy nature. An increasing number of diabetics are turning yoga and mindfulness in an effort to keep their condition under control and improve their quality of life. In addition, yoga and mindfulness practices focus on acceptance and compassion that are main principles in stress management that is one of the keys in diabetes treatment. In this workshop, best practices of yoga postures, controlled breathing techniques and mindfulness meditations as a tool to prevent and treat diabetes are demonstrated in combination with an overview of its theoretical background and benefits and implications for practice.

Ashish S Dengra is trained in Diabetologist from All India institute of Diabetes, S.L. Raheja Hospital Mumbai. He has done his Preceptorship course in Diabetology (Italy), Diploma in Diabetes, Cardiff University (UK), PG Course in Diabetes, Boston University, Advanced Certificate Course in Diabetes, Cleveland Clinic and Certificate Course in Diabetes Foot. He has published various papers in peer reviewed journals including original articles. His current area of interest in research includes GDM, Young DM. He has received diabetes awareness award at RSSDI 2014.

Diabetes is a long-term condition that can have a major impact on the life of a child or young person, as well as their family or careers. In addition to insulin therapy, diabetes management should include education, support and access to

psychological services. Young patient can have different diagnosis of diabetes and their management must be individualized. Five young patients with five different types of diabetes: Nine-year-old boy, FPG: 208, PPPG: 342, HbA1c: 10.1% -> Type 1 DM Twelve-year-old girl, FPG: 196, PPPG: 320, HbA1c: 9.8% -> Type 2 DM Fifteen-year-old girl, FPG: 205, PPPG: 321, HbA1c: 9.9% -> MODY Twenty year old man, FPG: 234, PPPG: 398, HbA1c: 10.2 % -> FCPD, Twenty two year man, FPG: 202, PPPG: 320, HbA1c: 9.9% -> LADA. A case based discussion on Juvenile and young diabetes and their management.

Background: We aimed to determine the association between the level of HbA1c and in-Hospital mortality in patients who underwent valvular heart surgery in our center in a retrospective cohort.

Methods: In this retrospective cohort study, patients with type 2 diabetes mellitus who were referred to our center for elective valvular surgery were enrolled and followed up. The endpoint of this study was in-Hospital mortality. Based on the level of HbA1c, patients were dichotomized around a level of 7% into two groups: Exposed patients with HbA1c≥7% and unexposed patients with HbA1c<7%. Then, the study variables were compared between the two groups.

Results: 224 diabetic patients who were candidate for valvular surgery were enrolled. 106 patients (47.3%) had HbA1c<7% and 118 patients (52.6%) had HbA1c≥7%. There was no significant difference between the groups in demographic and clinical characteristics. 13 (5.8%) cases died during Hospital admission which 9 cases were in the high HbA1c group. Both the unadjusted and adjusted logistic regression models showed that HbA1c was not a predictor for in-Hospital mortality

Conclusion: This study showed no association between preoperative HbA1c levels and in-Hospital mortality in the candidates for valvular heart surgery.