27^th International Diabetes and Healthcare Conference July 18-19, 2019 Abu Dhabi, UAE

Eman I. Anwar is a lecturer in Clinical Pharmacology at Alexandria Faculty of Medicine, Egypt, completed her Master degree Medical Basic Science in Pharmacology general grade Excellent, 2011 and Doctor degree in Clinical Pharmacology with GPA score: 3.642, August 2016. She is Pharmacovigilance & drug counseling center advisor at university hospital clinics Since June 2015 and Egyptian Association of Medical Basic Sciences (EAMBS) member since 2009. Her research interest is on Experimental pharmacology in oncology, endocrinology, Pharmacovigilance, Medical education and E-learning.

Increasing evidences of cancer development in diabetic patients were reported. Many studies demonstrated a correlation between some anti-diabetic drugs and a higher risk of cancer incidence. The highest incidence was shown in liver cancer and pancreatic cancer then kidney, endometrial, colorectal, non-Hodgkin lymphoma, bladder, and breast cancers. Meta-analysis of cohort studies calculating the Relative Risk (RR) of all-site or site-specific cancers in diabetic patients were accomplished notifying a different RR according to sex. Mechanisms suggested by authors were related to diabetes itself whether being complicated or a nonadherence to anti-diabetic medications. Obesity-related hyperinsulinemia acts as a critical link to the increased cancer risk through mitogen pathway activation and the enhanced cellular growth and survival. On the otherhand, the influence of anti-diabetic medications itself on cancer has recently gained attention. Studies reported evidences that using metformin, as an insulin sensitizer, may decrease cancer development, progression, and mortality. However, treatment with insulin secretagouges, insulin analogues, thiazolidinediones, and some incretin based therapies are related to increased incidence of development and mortality related to cancer. Currently there is no sufficient evidence to force withholding of certain antidiabetic drugs use on the basis of cancer concern. So cancer risk assessment is a useful primary prevention tool in selecting a suitable antidiabetic drug(s). Identification of the individuals at increased genetic or environmental risks of cancer by diabetes physicians should be done. Web-based tools for collecting and predicting individual risks of certain cancers and familial syndromes are easily accessible. Individuals with a high likelihood of having an inherited syndrome should be seriously considered for referral to the cancer genetics professional for further workup. Special attention should also be paid to potentially modifiable cancer risk factors regarding a healthy lifestyle. Nevertheless, to reduce the cancer risk associated with anti-diabetic medications use, treatment with metformin is recommended throughout the course of the disease as long as it is medically acceptable. Also strong efforts to reduce excess of body weight should be taken. The selection of other anti-diabetic classes as an add-on treatment to metformin is based on cancer risk assessment and review of cohort studies and metanalyses reports on their associated cancer RR.

Sam Goo Lee is the CEO of 239bio Inc., which is located at Southern part of JeonBuk Province, South Korea. He has successfully accomplished the research related for “Regeneration of Pancreatic Beta-Cells Destroyed” using ‘D&D’ in T1DM. Dr. Lee showed this revolutionary efficacy on Diabetes from 14 groups of 180 T1DM rats induced by Streptozotocin. Those scientific revolutionary regeneration of beta cells destroyed was conducted by AAALAC at ChonBuk National University in Republic of Korea and proven scientifically every biomarkers such as C-peptide, Insulin secretion, Bax, Bcl-2, Cleaved caspase-3, HbA1c, no side effects in Liver and Kidney included, FBG, PP2, ITT and GTT etc. Lee’s researches are not limited to non-clinical trials, but made a much better achievements in human trials. Even T1DM patients showed remarkable recoveries from the worst cases of DM and became normalized of their C-Peptide and Insulin levels after 1 year of D&D trials.

This study was carried out by Non-Clinical Evaluation Centre of Biomedical Research Institute, Chonbuk National University Hospital, South Korea to investigate the preventive efficacy of Gryllus Bimaculatus extracts"D&D" in Streptozotocin-induced T1DM rats. Among nine weeks male STZ-induced (65mg/kg) diabetic Sprague-Dawley rats, STZ-induced diabetic rats were randomly divided equally into six groups: Control, highdose D&D and untreated diabetic rats, D&D (1.63, 3.25 and 6.5g/kg) and treated through oral gavage for 4 weeks. Diabetic related biomarkers were investigated using biochemical and immune histo chemical analysis. Treatment with D&D markedly improved the blood glucose level which was analyzed by Intraperitoneal Glucose Tolerance Test (IP GTT) and Insulin Tolerance Test (ITT). At the end of the experimental period, expression levels of phospho-mammalian target of rapamycin(mTOR), B-cell lymphoma 2(Bcl-2), Bcl-2 associated X protein(Bax) and phospho-serine and threonine kinase(p-Akt Ser473) were measured in pancreas by immune blotting. The D&D treatment led to significant increase in p-Akt(Ser473), p-mTOR and Bcl-2 expression; decrease in Bax expression; and enhanced the production of intracellular insulin in pancreas. In addition, D&D treated diabetic rats were compensated for body weight loss and alleviated hyperglycemia. These results suggest that the supplementation of D&D improves diabetes by inhibiting oxidative stress and ameliorating STZ-induced pancreatic damage through AKT/mTOR mechanism. Accordingly, the results strongly support that the D&D is beneficial in the treatment of T1DM by regenerating beta-cells against pancreatic dysfunction.

M. Shaikh Yousef have been graduated from Abu Dhabi International Private School in June 2016.Currently, she finished her third year of study in Medical School at NUI Galway. She has a special interest in Endocrinology. She look forward to being more involved in this field and perhaps be involved in research in that area.

Ketosis prone diabetes, a condition that emerged in the mid 1990’s, is a heterogeneous syndrome and a form of diabetes that doesn’t fit the criteria that was defined by the American Diabetes Association. This condition is also described as “Flatbush Diabetes’’ or “Ketosis prone type II diabetes’’ . Its prevelance has been increasing particularly among urban multiethnic populations. It involves patients that present with Diabetic Ketoacidosis but lack the typical phenotype of type I diabetes, and instead have the characteristics of type II diabetes which include: Acanthosis nigricans and elevated BMI. Those patients usually present with DKA as the initial manifestation then develop insulin independence including hypoglycemic episodes, and will require oral hypoglycemic agents. They are often investigated 3 weeks post the DKA episode to identify their beta cell function reserve and autoantibody status. Consequently, a new classification system, the Aß system, emerged and that categorizes patients based on the presence or absence of antibodies or the presence or absence of beta cell function reserve. In this presentation, an 18 year old boy with features of metabolic syndrome presented with DKA as the initial presentation, and was treated and managed as type I diabetes until the investigations identified him as A-ß+ . A potential treatment option of bariatric surgery was offered after adjusting his medication accordingly.

Sanjay Banjare, completed his PhD at the age of 30 years from SGT university Gurgaon. He is the Assistant Professor in Department of Pharmacology CIMS Bilaspur Chhattisgarh. He has published more than 5 papers in reputed journals and has been serving as an editorial board member of repute. Published paper as a coresponding author more than 10 papers in international journal.

Background: Metabolic syndrome is a combination of multiple risk factors that increases an individual chance of developing cardiovascular or type II diabetes mellitus and most of people with metabolic syndrome have Insulin resistance, which elevates the risk of developing Type II diabetes mellitus. While the pathogenesis of the metabolic syndrome and each of its components is complex and not well understood, central obesity and insulin resistance are acknowledged as important causative factors. Most scrutinized literature was collected from different sources including PubMed.

 

Aim: To compare the incidence of progression of metabolic syndrome into type II diabetes mellitus in patient who were put on one of the following treatments along with lifestyle modification :-Metformin , Chromium Piconilate ,Vitamin –D3 and Niacin (Vitamin. -B3).

 

Results: 250 Participants was enrolled during 3 years of the study. 145 (58%) male and 105 (48%) Female has been found metabolic syndrome. A total (8%) of patient has been found incidence of progression of metabolic syndrome into Type II Diabetes Mellitus. In different group as Metformin group (0%), Niacin

group (6%), Vit-D3 group (0%), Chromium Piconilate group (16%) and (18%) in the life style modification group.

Rabab Alkutbe is a researcher working with Dr Gail Rees at the University of Plymouth. Rabab received her bachelor degree in Nutrition food sciences in Saudi Arabia and then matriculated at Flinders University in Australia where she conducted her Masters study in public health in 2010. Rabab's graduate work focused on nutrition stream, food policy and determinants of health and wellbeing. She was awarded her PhD in 2017 from University of Plymouth, her thesis investigated obesity and its causes in children. Currently, she examines the effect of nutrientextraction on postprandial glucose when consume different fruits in obese adults.

Increasing fruit consumption may reduce the risk of several chronic diseases. The nutrient extraction blender is a new method to consume fruit; however, health risks remain unclear. Nutrient-extraction blenders are designed to

homogenize the whole fruit without removing the fibre; conversely, old-style juicers squeeze the juice and remove the pulp. This study aimed to understand the effect of nutrient-extraction of raspberries on the glycaemic response

in healthy weight adults and overweight/obese, who are at risk of glucose intolerance. A total of 9 HW and 5 OW/OB adults were recruited to participate. Participants fasted for 12h overnight and then consumed raspberries with mango as whole fruit (WF), nutrient-extracted (NE) or a glucose control (C) (all 25g total sugar/ serving). Blood glucose levels were obtained via finger prick blood samples with a minimum 3-day washout period between

test days. Glycaemic index was calculated from the incremental area under the 2-h glucose response curve for each meal. Multiple comparisons post-hoc (Turkey HSD) was conducted to determine the difference between meals. GI was significantly different between all conditions with mean ±SD (C, 100 ±37.07), (WF, 72.07 ± 28.54), (NE, 43.31 ±23.57), (p<0.001), but there were no differences between healthy weight and overweight / obese. The postprandial glucose response from NE raspberries was significantly lower than both WF and C. Whereas, other published findings demonstrated that the consumption of nutrient-extracted mango alone was not significantly different from the whole mango. These results show that homogenized raspberries could be a potential approach for glycaemic control.

Mohammed Reza Shoghli holds master degree in the filed of Biochemitsry and has been working in the Tehran Heart Center Hospital for the last 17 years, and has been conducting research about links between diabetes type 2 and cardiovascular complications especially post coronary surgery.

The number of people who die from kidney disease every year has risen over the past decade and is now estimated at 5 million to 10 million worldwide. The increase in rates of obesity along with associated rates of type 2 diabetes, hypertension, and cardiovascular disease has principally driven the elevated mortality. More than 660,000 Americans have reached the point of requiring intervention for end-stage kidney disease, with 468,000 receiving dialysis and more than 193,000 undergoing kidney transplantation, leading to a major public health and economic burden. Hence, the development of new treatments that may prevent or delay the progression of chronic kidney disease, as well as treat type 2 diabetes, is an important goal. Tight control of glucose levels and blood pressure slows but does not prevent the onset of diabetic nephropathy. The standard approach for retarding the onset of diabetic nephropathy and stabilizing renal function has been blockade of the renin–angiotensin–aldosterone system, particularly with inhibitors of angiotensin-converting enzyme. This approach was first used in the early 1990s in patients with type 1 diabetes; randomized trials subsequently established that such drugs were also effective in type 2 diabetes. Newer classes of agents have also been tried but have not been successful. Inhibitors of sodium–glucose cotransporter-2 (SGLT2) were initially approved as a new class of hypoglycemic agents that lowered blood glucose levels in patients with type 2 diabetes by enhancing urinary glucose excretion through the inhibition of SGLT2 in the proximal convoluted tubule,where glucose is reabsorbed. SGLT2 inhibitors reduce the renal threshold of glucose from 180 mg per deciliter (10 mmol per liter) to 40 to 120 mg per deciliter (2 to 7 mmol per liter), thereby effectively lowering blood glucose levels. In 2015, EMPA-REG OUTCOME (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients) changed the landscape in diabetes management by showing a lower risk of cardiovascular death among the 4687 patients who eceived empagliflozin than among the 2333 controls (172 patients [3.7%] vs. 137 patients [5.9%]) (hazard ratio, 0.62; 95% confidence interval [CI], 0.49 to 0.77). Patients in the empagliflozin group also had a lower risk of death from any cause (269 patients [5.7%] vs. 194 patients [8.3%]) (hazard ratio, 0.68; 95% CI, 0.57 to 0.82) and a lower risk of hospitalization for heart failure (126 patients [2.7%] vs. 95 patients [4.1%]) (hazard ratio, 0.65; 95% CI, 0.50 to 0.85). Recently, the CANVAS Program (Canagliflozin Cardiovascular Assessment Study) showed imilar cardiovascular benefits, indicating a class effect of SGLT2 inhibitors. Further support for that finding was noted in the CVD-REAL (Comparative Effectiveness of Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors) and the Health Improvement Network (THIN) trials. As a result, SGLT2 inhibitors are now widely used in patients with type 2 diabetes both to improve glycated hemoglobin levels and to reduce cardiovascular risk. Recent studies have hinted that medications designed to treat diabetes could also confer renoprotection through a mechanism that differs from those affecting glucose

homeostasis. Among these drugs, the SGLT2 inhibitors appeared to be the most promising.

Mohammed Reza Shoghli holds master degree in the filed of Biochemitsry and has been working in the Tehran Heart Center Hospital for the last 17

years, and has been conducting research about links between diabetes type 2 and cardiovascular complications especially post coronary surgery.

The number of people who die from kidney disease every year has risen over the past decade and is now estimated

at 5 million to 10 million worldwide. The increase in rates of obesity along with associated rates of type 2

diabetes, hypertension, and cardiovascular disease has principally driven the elevated mortality. More than 660,000

Americans have reached the point of requiring intervention for end-stage kidney disease, with 468,000 receiving

dialysis and more than 193,000 undergoing kidney transplantation, leading to a major public health and economic

burden. Hence, the development of new treatments that may prevent or delay the progression of chronic kidney

disease, as well as treat type 2 diabetes, is an important goal. Tight control of glucose levels and blood pressure slows

but does not prevent the onset of diabetic nephropathy. The standard approach for retarding the onset of diabetic

nephropathy and stabilizing renal function has been blockade of the renin–angiotensin–aldosterone system,

particularly with inhibitors of angiotensin-converting enzyme. This approach was first used in the early 1990s in

patients with type 1 diabetes; randomized trials subsequently established that such drugs were also effective in type

2 diabetes. Newer classes of agents have also been tried but have not been successful. Inhibitors of sodium–glucose

cotransporter-2 (SGLT2) were initially approved as a new class of hypoglycemic agents that lowered blood glucose

levels in patients with type 2 diabetes by enhancing urinary glucose excretion through the inhibition of SGLT2

in the proximal convoluted tubule,where glucose is reabsorbed. SGLT2 inhibitors reduce the renal threshold

of glucose from 180 mg per deciliter (10 mmol per liter) to 40 to 120 mg per deciliter (2 to 7 mmol per liter),

thereby effectively lowering blood glucose levels. In 2015, EMPA-REG OUTCOME (Empagliflozin Cardiovascular

Outcome Event Trial in Type 2 Diabetes Mellitus Patients) changed the landscape in diabetes management by

showing a lower risk of cardiovascular death among the 4687 patients who eceived empagliflozin than among the

2333 controls (172 patients [3.7%] vs. 137 patients [5.9%]) (hazard ratio, 0.62; 95% confidence interval [CI], 0.49 to

0.77). Patients in the empagliflozin group also had a lower risk of death from any cause (269 patients [5.7%] vs. 194

patients [8.3%]) (hazard ratio, 0.68; 95% CI, 0.57 to 0.82) and a lower risk of hospitalization for heart failure (126

patients [2.7%] vs. 95 patients [4.1%]) (hazard ratio, 0.65; 95% CI, 0.50 to 0.85). Recently, the CANVAS Program

(Canagliflozin Cardiovascular Assessment Study) showed imilar cardiovascular benefits, indicating a class effect

of SGLT2 inhibitors. Further support for that finding was noted in the CVD-REAL (Comparative Effectiveness

of Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors) and the Health Improvement Network (THIN)

trials. As a result, SGLT2 inhibitors are now widely used in patients with type 2 diabetes both to improve glycated

hemoglobin levels and to reduce cardiovascular risk. Recent studies have hinted that medications designed to

treat diabetes could also confer renoprotection through a mechanism that differs from those affecting glucose

homeostasis. Among these drugs, the SGLT2 inhibitors appeared to be the most promising.

Eman I. Anwar is a Lecturer  in Clinical Pharmacology at Alexandria Faculty of  Medicine, Egypt, college female section. completed her Master degree Medical Basic Science in Pharmacology general grade Excellent, 2011 and Doctor degree in Clinical Pharmacology with GPA score: 3.642, August 2016. She is Pharmacovigilance & drug counseling center advisor at university hospital clinics Since June 2015 and Egyptian Association of Medical Basic Sciences (EAMBS) member since 2009. Her research interest is on Experimental pharmacology in oncology, endocrinology, Pharmacovigilance, Medical education and E-learning.

The concept of restricting dietary fat intake for body weight reduction is changed since 1920. When multidrug resistant epileptic patients used ketogenic diet as a non-pharmacological therapeutic option for epilepsy control and a concomitant weight reduction was statistically proved. Ketogenic Diet (KD) entails high fat, low carbohydrates and controlled protein consumption. This ketotic state can be also pharmacologically induced with the consumption of ketone salts/esters and consequently provide a source of ketone bodies without fasting or adherence to ketogenic diet. The reviewed randomized controlled trials and meta-analytic studies in literature demonstrated an expanding role of KD in various other adult neurological disorders including Parkinsonism, Alzheimer’s disease, sleep and cognitive disorders. The pleotropic anti-seizure,

antioxidant, anti-inflammatory and neurotropic actions of ketone bodies were suggested by authors besides their metabolic advantages. Thus, in one hand KD is considered as a dietary therapeutic option while on the other hand various adverse effects were reported. The long-term adverse effects of KD consumption were hepatic steatosis, renal stones and hypoproteinemia and vitamin deficiencies. These necessitate adequate patient selection, monitoring until reaching the ideal body weight and gradual shift to normal dietary caloric

consumption when needed.

Ashish is trained in Diabetologist from All India institute of Diabetes S.L. Raheja Hospital Mumbai. He has done his Preceptor- Ship 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.

Statement of the Problem: 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 carers. 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

Royida Al Marastani is a Senior Pharmacist with more than thirty years of experience in the UAE in Abu Dhabi in Primary Health Centers (PHC), Urgent Care Center (UCC) and Ambulatory Health Services (AHS) and MSc in Clinical Pharmacy UK. She is a lecturer from 2003 in Ministry of Health (MOH), in CPE/CME pharmacist’s program from 2011 in SEHA/ Ambulatory Healthcare Services (AHS). Her roles include conducting research, conference abstracts, invited presentations in the national & international conferences, focusing on pharmaceutical care based on safety and efficacy of the medications.

Aim: To clarify the role of the pharmacist intervention by practicing MTM as pharmaceutical care in uncontrolled adult’s diabetic patients based on the improvement of HBA1c and other patients/outcomes.

 

Introduction: Diabetes is a chronic progressive disease requiring continuous medical care. HbA1c measures blood glucose control in is well accepted as a measuring performance allows the organization to assess how well care is currently provided and address the points of improvement.

 

Mythology: During the 6 months, starting from (1/3/2018 till 31/8/2018) we establish MTM for Diabetic Mellitus patients, by follow-up the patients for minimum 2 clinical visits:

• We identify uncontrolled patients HbA1c > 7 (found 39 patients)

• We reassess the treatment plan and provide the proper required intervention in timely manner

• We assess patient’s compliance to their medication and provide the counseling

• We assess patient’s Self-Monitoring Blood Glucose and we provide the education

 

The results: The types of pharmacist’s intervention in 39 totals are:

• Improve medication adherence 21 cases (54%)

• Initiate new drug therapy 14 cases (36%)

• Institute a monitoring plan 4 (10%)

Considering the target of HbA1c for controlled diabetic patients is (7%):

• The patients achieved the target are 16 patients (41%)

• The patients not achieved the target (HbA1c > 7%) are 21 patients (54%)

• No data for 2 patients (5%)

Improving HbA1c towards the target:

• The patients improved 24 patients (62%)

• The patients not improved 2 patients (5%)

• No data (only one reading for HbA1c) 13 patients (33%)

Alafraa Ahmed, 23 years old, fifth year medical student from university of Khartoum, faculty of medicine, Sudan. working as organizer committee in many event in university, working in medical campaign, member of local team of standing committee of medical education(SCOME) and public health (SCOPH) which related to MEDSINSUDAN under umbrella of international federation of medical students association(IFMSA)

Foot care received little attention from medical doctors who are concentrating on therapeutic and diagnostic measures more than education of patients and preventive aspects. The aim of this study was to assess knowledge, attitude and practice regarding foot care among diabetic patients. In this multicentral

cross-sectional study, 270 diabetic patients interviewed using a questionnaire containing qualitative and quantitative aspects after taking verbal consent. Data has been analyzed using SPSS statistic version20. Overall, 176(65.2%) women and 94(34.8%) men were included. The average of age was 57 years(SD=11.6). A total of 219(81.1%) have educational level below the level of university those who have knowledge about foot care constitute 151(55.9%) with different response to knowledge measures. The source of information was

medical staff in 95(63%) of patients. Regarding atitude, 257 patients (95.2%) aware about foot care, and they considered as a preventable method from foot complication. On the other hand, 158 patients (58.5%) have poor practice. There are highly significant association between educational level and knowledge (<0.001),educational level and practice (0.012) and between knowledge and practice (0.001). These results supported the view that education and trained health care providers have a role in increasing the awareness of diabetic patients about foot care.

Introduction: The T2DM in adulthood is strongly related to weight gain and excessive accumulation of pancreatic and hepatic fat. It is very uncommon to have remission without bariatric surgery. Acute negative energy balance can reverse the twin defects of beta cell failure and insulin resistance alone with diet restriction to around 700 kcal; that result in decreased pancreatic and liver triacylglycerol stores. Weight loss of at least 10–15 kg has been shown to achieve euglycemia in people with short-duration T2DM for at least 12 months.

 

Case Presentation: AJ is a 48 year old diabetic male presented to Faiha Specialized Diabetes, Endocrine,and Metabolism Center two years ago with very poorly controlled T2DM that was diagnosed more than 3 years ago, along with severe hypertension and marked dyslipidemia. AJ underwent complete remission of his diabetes after losing 18 kg of his original weight (58 kg), with a very good euglycemia measures, on no treatment at all for the last 2 years. The effect that extends to make AJ had normal blood pressure and normal

lipid profile, with decreased cardiovascular risk from 26% to be less than 1%.

A medical doctor by background (Bachelor of Ayurvedic Medicine & Surgery) and a gold medalist from SP Jain University with specialization in Operations & Marketing Management, Dr Rekha has proven expertise and experience of more than 10 years in the areas of Healthcare Marketing, Ayurvedic Medicine, Holistic Nutrition & Digital Transformation and has proven expertise in the healthcare management.