16^th Global Diabetes Conference and Medicare Expo March 22-23, 2017 Rome, Italy

Sharifa Ali Abdulrahman Hashem is a Senior Medical Technician in the Health Education department, Ras Al-Khaimah Medical District, Ministry of Health (UAE). Currently, she is pursuing her PhD in the Public Health department, College of Medicine and Health Sciences, United Arab Emirates University (UAE). She is the member of the United Arab Emirates Nutrition Committee and has completed her MSc in Health Care Administration.

Background: Gestational diabetes (GDM) affects 8-25% of Emirati women and its prevalence is progressively increasing in this population. Concurrently, vitamin D deficiency is a common problem among pregnant Emirati women. Existing literature suggests that vitamin D deficiency increases the risk of GDM. Despite high burden of both vitamin D deficiency and GDM among women, few studies have examined the relationship between these two health issues in the UAE. Objectives: The primary objective is to investigate the association between vitamin D deficiency and the development of GDM. The secondary objective is to assess major risk factors for GDM such as diet and physical activity. Methods: A prospective cohort study was conducted on Emirati women (n=563) aged 18-45 years, who were free of GDM at baseline and underwent maternal serum screening in eight primary healthcare centers in Ras Al Khaimah, UAE. Data on demographics, physical activity (global physical activity questionnaire), diet intake (food frequency questionnaire), anthropometrics and blood pressure were collected at baseline. Also, blood samples were drawn at baseline to measure the fasting blood glucose and the 25 (OH) D levels. GDM was screened by using the fasting and the 75 g 2 hour postprandial oral glucose tolerance test (OGTT) at follow up between 24th and 28th weeks of gestation. The diagnosis of GDM was done according to the American Diabetes Association (ADA) where the participant is diagnosed with the GDM if the fasting blood glucose is ≥5.3 mmol/l or the 2-h postprandial blood glucose is ≥8.6 mmol. Vitamin D deficiency was diagnosed by using the radioimmunoassay kits from immunodiagnostic systems Cobas e-411 from Roche Company USA, in Obaidallah and Saqer Hospitals laboratories according to the NIH and NHS criteria (deficiency if 25 (OH) D<50 nmol/l=20 ng/ml). Results: Overall, 58% and 26% of pregnant women had vitamin D deficiency and insufficiency, respectively as per NIH and NHS criteria. The incidence of GDM was 15.2% as (81) women developed GDM according to ADA criteria. Among women who had vitamin D deficiency, 16% developed GDM as compared to 14% in those who had no vitamin D deficiency but this difference was not statistically significant (p=0.527). The adjusted odds ratio (aOR) for developing GDM was 1.27 (95% [CI]: 0.74-2.18, p: 0.37) in vitamin D deficient women versus non-deficient women. The adjusted odds ratio of GDM for sitting time (time the participant spent daily sitting without doing any work to examine the physical activity) was 1.04 (95% CI: 0.92-1.16, p: 0.50). The adjusted odds ratio of GDM was significant in those who ate red meat daily (OR: 6.54, 95% CI: 1.53-27.82, p=0.011). No significant difference in the odds ratio of GDM was observed with respect to other diets. Family history of diabetes and obesity were significant risk factors for the development of GDM (OR: 1.9, 95% CI: 1.04-3.51, p: 0.03) and (OR: 2.62, 95%CI: 1.36-5.06, p=0.004), respectively. Conclusion: In this cohort study, there was no statistically significant association between vitamin D deficiency in early pregnancy and the development of GDM. These findings are consistent with the majority of previous studies in the region and abroad.

Alhazmi A S has completed his PhD from King Abdulaziz University. He is an Associate Professor in the Faculty of Applied Medical Sciences, Taif University, Saudi Arabia. He has published 19 papers in different journals.

Introduction & Aim: Diabetic nephropathy is the common process that leads to end-stage kidney disease (ESRD). Several studies showed that TGF-β is a major anti-inflammatory cytokine involved in extracellular matrix deposition and thickening of basement membrane of glomeruli. This study is aimed to evaluate the association of TGF-β1 gene polymorphisms (869T/C) and (509C/T) with complicated and uncomplicated type 2 diabetes mellitus. Methods: In this study, 250 Saudi male patients were classified, 100 healthy men as control, 80 uncomplicated type 2 diabetes mellitus male patients and 70 type 2 diabetes mellitus male patients with nephropathy. Blood and urine samples were collected from all groups for measurement of plasma glucose, urea, cholesterol, triglyceride, HDL-C, urea, creatinine and TGF-β1. In addition, a genotyping of TGF-β1 was done. Results: Our results showed a statistical difference in TGF-β1 levels in all groups, also a positive correlation between hyperglycemia and HbA1c with TGF-β1 level was detected. According to genotypes, only 869T/C genotypes were involved in susceptibility to T2DM and diabetic nephropathy. Both TC and CC genotypes were higher in T2DM patients compared with control (P<0.05), while only CC was higher in diabetic nephropathic patients compared with uncomplicated T2DM (P<0.05). Conclusion: It can be concluded that increase TGF-β level could be involved in the process of T2DM development and its nephropathic complication. In addition, the TC and CC genotypes of TGF-β1 869T/C were more susceptible to T2DM, while only CC genotype to diabetic nephropathy.

Nikita Naicker has completed her Master’s degree in Medical Science from the University of KwaZulu-Natal in 2014. She is currently doing her PhD in Medical Biochemistry from the University of KwaZulu-Natal. She has three publications in reputed journals and manuscripts in review.

Presently, type 2 diabetes mellitus (T2DM) is related to both impaired insulin action at specific tissues and impaired insulin release. A deficiency at these levels is an early occurrence in the disorder and evidence proposes that mitochondria play an imperative role in both these processes. During the progression of T2DM, mitochondrial biogenesis is also impaired. As a result, there is a reduction in the number of mitochondria and reduced capacity for oxidative phosphorylation in a diabetic state. This study evaluated the effect of fenugreek seed extract (FSE), 4-hydroxyisoleucine (4-OH-lle), metformin (MF) and insulin on the SIRT3-NRF2 mediated antioxidant mechanism, under a normo- and hyperglycemic condition in human hepatoma cells at 72 hours. Markers for mitochondrial function and biogenesis, oxidative stress parameters and antioxidant response were evaluated by spectrophotometric assays and Western blotting. We found that FSE, 4-OH-lle and MF increased GSH levels and reduced lipid peroxidation and protein carbonyl levels, under both conditions, while, mitochondrial biogenesis and antioxidant response markers were significantly elevated by FSE and 4-OH-lle, under both conditions. This data has provided evidence for an in vivo model. Data from this study suggests that FSE and its active compound 4-OH-lle, in comparison to metformin and insulin may play an active role in improving mitochondrial biogenesis during diabetes. As a result, there will be an increase in the number of mitochondria. Therefore, fenugreek displays its possible potential as a reliable, cost effective, herbal therapeutic alternative to the current diabetic treatment regime.

S Yagubova is currently working with the group of V V Zakusov Institute of Pharmacology, Moscow, Russia. This group is working with the problem of neurotrophic factors insufficiency in the pathogenesis of diabetes and accompanying by behavioral disorders. Their correction with original peptide mimetics of NGF and BDNF designed in this Institute is also in the focus of this group activity.

4-methylcatechol (4-MC) was reported to increase the content of nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF). Proceeding from the data on neurotrophic factors deficiency in pancreatic beta-cells as important pathogenetic factors of diabetes, we studied the effects of 4-MC on streptozotocin (STZ) induced model of diabetes on Wistar male rats. Animals were divided into 5 groups: passive control (saline), active control (saline+STZ), group of prophylaxis (Pro: 4-MC+STZ), group of treatment (T: STZ+4-MC) and group of combined administration (PT: 4-MC+STZ+4-MC). 4-MC was used in doses of 10 mg/kg for 14 days, STZ as a single injection 45 mg/kg i.p. 4-MC reduced the STZ-induced hyperglycemia, its effect was more pronounced in case of preventive administration, while in passive control we got glucose level 6.83±1, STZ increased it up to17.38±2.19 (p<0.05). Pro group demonstrated glucose level 8.97±0.76 (p<0.05 compared to active control). STZ decreased the percentage of the animals ability to reach the active avoidance criterion to 36.4% from 71.4% in the passive control; rats pretreated with 4-MC successfully learned in 57%. Data obtained demonstrate 4-MC ability to attenuate the hyperglycemia and cognitive deficit caused by diabetogenic toxin STZ.

Jin Hyung Kim has completed his MD and is a Certified Ophthalmology Specialist from Yonsei University College of Medicine. He has published more than 5 papers in reputed journals and has been serving as a member of Department of Ophthalmology, Yonsei University College of Medicine.

This study evaluated the correlation between the thickness of the individual retinal layers in the perifoveal area of diabetes mellitus (DM) patients and the presence of diabetic mellitus retinopathy (DMR). This observational cross-sectional study enrolled a total of 70 eyes and eyes were divided into two groups: Diabetic patients diagnosed with diabetic mellitus retinopathy (DMR) and diabetic patients non-diagnosed DMR. All participants underwent full ophthalmic examinations and spectral domain optical coherence tomography (SD-OCT) was used to examine the thickness of each individual retinal layer in perifoveal area using segmentation technology in SD-OCT and we compared those parameters among above groups. In the results, the mean thickness of retinal nerve fiber layer (RNFL) in patients with DMR group was significantly lower than those in DM but no DMR group (10.91±1.81 in group with DMR vs. 12.04±1.69 in group without DMR; p=0.015). Photoreceptor thickness in DMR was significantly lower than that in no DMR (69.40±3.93 in group with DMR vs. 72.04±3.67 in group without DMR; p=0.009). Results were presented as mean thickness±standard deviation (μm). These findings in our study demonstrated that decrease in nerve fiber layer and photoreceptors layer was significantly associated with development of DMR. Using SD-OCT segmentation method, changes of these layers in diabetic patients could be used as an early detector of progression of DMR from patients with no visible sign of DMR in funduscopy.

Young Joo Cha is a Medical Doctor specialized in Laboratory Medicine, and has completed her PhD from Seoul National University College of Medicine in Seoul, Republic of Korea. She is a Professor and Chair of Department of Laboratory Medicine, in Chung-Ang University, Seoul, Republic of Korea. She has published more than 200 papers in reputed journals.

Objective: Self-monitoring blood glucose (SMBG) with a traditional glucose meter often misses peak post-prandial glucose and hypoglycemia. Currently, continuous glucose monitoring (CGM), which determines diurnal blood glucose patterns on a continuous basis, is being introduced to identify fluctuations and trends of blood glucose levels as soon as possible. This study was aimed to compare the accuracy of three continuous glucose monitoring (CGM) devices in subjects with normal glucose tolerance, type 1 and type 2 diabetes mellitus. Research Design & Methods: Nine subjects with normal glucose tolerance (age 23 to 58 years), 9 subjects with type 1 diabetes mellitus (age 27 to 58) and 9 subjects with type 2 diabetes mellitus (age 20 to 67) participated in 96-hour closed-loop blood-glucose control experiments. Capillary blood glucose (BG) obtained 7 times a day were paired in time with corresponding CGM glucose (CGMG) measurements obtained from three CGM devices, the Guardian (Medtronic), G5 (DexCom), and Freestyle Libre (Abbott Diabetes Care) worn simultaneously by each subject. Errors in paired BG–CGMG measurements and data reporting percentages were obtained for each CGM device. Results: The accuracy of each device did not change for 5 days. Compared with capillary BG reference readings, the G5 showed the lowest mean absolute relative difference (MARD), with 9.1% overall and 18.1% in the hypoglycemia range. For the Guardian and the Libre, MARD was 16.9%/32.2% and 11.7/14.2%, respectively. Also, the mean and SDs for all BG-ARD pairs associated with BG values within 70-300 mg/dL was lowest in the Libre (6.9±1.5) among 3 devices, indicating higher precision of the Libre. Regarding sensor to sensor variability, the SD for the Guardian was the highest, 14.3% and the Libre and G5 comparable results were 6.9% and 8.7%, respectively. Conclusions: This study with three CGM devices for BG values from 35 to 544 mg/dL revealed several differences in performance characteristics that include accuracy, precision and reliability. The G5 and Libre showed comparable accuracy and precision, of which the G5 showed the best accuracy and the Libre showed the best precision.