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.