Day 14 :
- Physiology of Diabetes | Diabetic Case Studies | Diagnosis of Diabetes | Diabetes and its complications | Diabetes and Associated Diseases | Diabetes Chronic Complication
Location: Buttes Chaumont
Chair
Alexander Dreval
Moscow Regional Research Clinical Institute, Russia
Co-Chair
Sasha Shafikhani
Rush University Medical Center, USA
Session Introduction
Liaqat Ali Chaudhry
King Salman Armed Forces Hospital, KSA
Title: Prevalence of diabetes-type-2 & pulmonary tuberculosis in Filipinos and treatment out comes: A surveillance study in eastern Saudi Arabia
Time : 12:20-12:55
Biography:
Liaqat Ali Chaudhry is the Head of Pulmonology department as well as a Consultant Pulmonologist of King Salman Armed Forces Hospital.
Abstract:
Objective: To study prevalence of diabetes type-2 and pulmonary tuberculosis among Filipino patients and treatment out comes. Tuberculosis centre of Dammam medical complex (MOH) is a referral centre for the Eastern Saudi Arabia where patients from all government and private hospitals having open pulmonary tuberculosis are admitted for isolation till they are rendered noninfectious. All patients are treated for 6 months under DOTS strategy with 4 drugs (2HRZE) for 2 months as initial intensive phase and 2 drugs (HR) for 4 months as continuation phase.
Method & Material: We retrospectively reviewed clinical records of 1388 patients admitted with open pulmonary tuberculosis between Jan-2003 and June-2010.
Result: Among 1388 patients, 39% (n=542) were Saudis and 61% (n=846) were non-Saudis. Among these 12.39% (n=172) were Filipinos, 153 males and 19 females, respectively. Out of 1388 patients, 114 (7.17%) were found to have diabetes type-2. Among these diabetics, majority n=91 (79.82%) were Filipinos. Sputum conversion was late in diabetic patients resulting in relatively longer hospital stay compared to fellow patients having only tuberculosis.
Conclusion: Our study has shown that one possible risk factor for tuberculosis is diabetes. Majority of TB patients having diabetes type-2, 79.82% (n=91) were Filipinos. Th eir sputum conversion was relatively late and their hospital stay was longer than their fellow patients having only tuberculosis. Our findings are in agreement with the current literature on the correlation of diabetes and tuberculosis.
Custodio Razel
University of the East Ramon Magsaysay Memorial Medical Center Graduate School, Philippines
Title: The effects of Diabetes Self-Management Support and Education through Text-messaging (DSMSET) in the health beliefs, diabetes care profile and HbA1C of diabetes mellitus patients
Time : 12:55-13:15
Biography:
Custodio Razel is currently working with the University of the Philippines-Philippine General Hospital as a nurse. He is a member of the Asia eHealth Information Network of the WHO since 2012 and has been involved in various research endeavors in eHealth adoption with the National Institutes of Health, HIV/AIDS related Stigma and Discrimination with University of the East Ramon Magsaysay Memorial Medical Center and Diabetes Self-Management with SMART Communications Inc and Ateneo Java Wireless Competency Center.
Abstract:
The study aims to explore the eff ects of the Diabetes Self-Management Support and Education through Text-messaging (DSMSET) in improving expanded health beliefs, diabetes care profi le and in decreasing HbA1C of adult patients with diabetes mellitus through automated sending of SMS. A randomized controlled trial, the research is based on the expanded health belief model that upholds sequential goal-settings to improve predictors of appropriate behavior towards glycemic control of the subjects as biological marker of adherence. The researcher together with Ateneo Java Wireless Competency Center developed DSMSET system, a low-cost, two-way text messaging system designed to deliver self-help, educational messages based on the 9 dimensions of health management and can work with SHINE OS+ enabled systems. A total of 122 eligible subjects from UERM PO Domingo OPD Services department of medicine and Sweet Diabetics Club based in CHAMP Wellness Clinic were enrolled. Using simple table random digits, subjects were divided equally to trial arms with n=61 for SMS group and n=61 for non-SMS group. Th e intervention group received DSMSET intervention for 90 days and was required to reply pre-set codes. Both groups answered two sets of survey questionnaires and blood samples were taken for glycated hemoglobin. Data such as demographics for both groups were also collected using SHINE OS+ at baseline and aft er 90 days. At follow-up 110 were subjected to analysis using descriptive and inferential statistics through STATA15 and SPSS23 and were distributed equally. As for the results, the median age of the participants was 64, with 8 out of 10 being female. 54% fi nished secondary education while the average HbA1C is 7.98. As for the results, total expanded health belief scores (8 constructs), diabetes care profi le score, likelihood to take action score of the SMS group increased compared to the non-SMS group with 377.71±33.33 to 398.65±30.86, P=0.0004; 84.4±16.69 to 103.13±14.06, P=<0.001; 26.44±4.80 to 29.31±3.59, P=<0.001, respectively. Combined expanded health belief scores also showed modest improvement in the SMS group with 404.15±34.09 to 427.96±32.38, P=0.001. For HbA1C however, SMS group only posted (-0.01% from 8.11±1.21% to 8.10±1.41%, P=0.963) decrease in the HbA1C while the non-SMS group have increased HbA1C on average. Generally, SMS group and non-SMS groups registered signifi cant diff erences statistically across the constructs, yet no signifi cant relationships were established between HbA1C and the predictors for both trial arms at any moment of the study period. In conclusion, DSMSET demonstrated effi cacy although health beliefs alone may be not suffi cient to take action towards modest glycemic
levels.
Jannel Gentius
The University of the West Indies - St. Augustine Campus, Trinidad & Tobago
Title: Predictors of depression among patients with type 2 diabetes: Examining the impact of anxiety and social support on patients’ psychological wellbeing
Time : 14:00-14:35
Biography:
Jannel Gentius is a Lecturer at the University of the West Indies, St. Augustine Campus and has received her PhD in Psychology. Her research interests include attitudes towards health-related stigmatized conditions, health behavior, attitude change, attitudes towards marginalized groups and mental health. She has a keen interest in research and in developing a strong research culture in the Caribbean. She believes that evidence-based research is critical in understanding and addressing the social, psychological, and economic and governance challenges faced by the Caribbean.
Abstract:
Regardless of the many advances in medicine, there has been an alarming increase in the number of diabetics in the Caribbean. Furthermore, prevalence of diabetes in the region is projected to increase by 148% by the year 2030. The objective of this research was to examine the predictors of depressive symptomology among patients with type-2 diabetics in a Trinidadian sample. Data was collected from 200 patients with type-2 diabetes at hospitals and diabetes clinics in Trinidad using a self-administered questionnaire. The questionnaire measured their anxiety, depression symptomology, perceptions of social support and demographic information such as age and gender. The mean age of participants was M=55 and SD=15.9. Standard multiple regression was used to analyze the data. Multiple regression indicated that the four variables in combination significantly predicted patients’ depressive symptomology R2=0.16, F (4,189)=9.21, p<0.001, with 95% confi dence limits for R2 from 0.07 to 0.25. Th e size and direction of the relationships suggests that depressive symptomology is greatly infl uenced by increased anxiety β=0.34, t=5.05, p<0.001, decreased social support β=-0.14, t=-2.15, p<0.05 and that women experience higher depressive symptoms than men β=0.15, t=2.19, p<0.05. Understanding depression and some of the determinants of depression among persons with diabetes is important for diabetes care since depression can hamper diabetes self-care. Interventions to reduce anxiety and to increase social support of diabetic patients may prove benefi cial in reduction of depressive symptoms and consequently improve diabetes care. Depression management is necessary among persons with diabetes and special focus should be place on women.
Fawaz Alzaid
Sorbonne Universités-Université Pierre et Marie-Curie, France
Title: Transcriptional control of inflammation as an innate immune sensor of metabolic stress in diabetes
Time : 14:35-15:10
Biography:
Fawaz Alzaid is a Research Associate of the French National Institute of Health and Medical Research (INSERM). His recent research highlights include first author publications in Nature Medicine and JCI Insight deciphering mechanisms of tissue infl ammation in diabetes
Abstract:
In type-2 diabetes, sterile infl ammation eff erent from innate immunity is causal in the onset of insulin resistance and progression of complications and comorbidities. However, the precise metabolic stressors and their processing by innate immune cells remain elusive. Our aim is to determine which metabolic factors are immunogenic and to decipher the cellular metabolic pathways that integrate such signals and lead to an Infl ammatory activation. We recently demonstrated that the type-1 interferon response underlies diabetogenic, genetic deletion of its mediator, interferon regulatory factor (Irf)-5, rescues mice from insulin resistance and steatohepatitis. Unexpectedly, the Irf5-defi cient transcriptome in macrophages was characterized by up-regulation of pathways governing cellular lipid metabolism. In this capacity, we propose that Irf5 and its dependent transcripts, act as metabolic sensors, relaying glucolipotoxicity and mediating adaptive cellular metabolism for effective inflammatory activation. To address this we have carried out in-depth analysis of the macrophage cellular energetic and metabolic environment in response to metabolic stressors under Irf5-competence and Irf5-defi ciency. We observed that indeed Irf5 and its infl ammatory targets are responsive to specific metabolic stimuli. In a human study we analyzed Irf5 expression in circulating innate immune cells to determine the prognostic value of innate immunity’s sensitivity to metabolic cues. We observed that Irf5 expression is responsive in circulating cells from type-2 diabetic patients and is associated with specific serological parameters relating to dyslipidemia. Interestingly, Irf5 in monocyte and dendritic cell subtypes is specifically regulated in the presence of vascular and hepatic complications of long-standing diabetes. These data suggest that initiation of the type-1 interferon response is extremely sensitive to metabolic status and may be predictive of disease progression or susceptibility to diabetic complications. Further studies will delineate the pathways linking metabolic cues to activation of Irf5, developing novel immunotherapeutic targets in diabetes.
Abdelkrim Berroukche
Dr Tahar-Moulay University of Saida, Algeria
Title: Assessment of hypoglycemic and hypolipidemic activities of aqueous extract of Trigonella foenum-graecum in streptozotocine-induced diabetic rats
Time : 15:10-15:45
Biography:
Abdekrim Berroukche is currently a Lecturer and Teacher-Researcher, Biology Department, Faculty of Science, University of Saida, Algeria. He has received his PhD in Cell Biology and Nutrition (with Oncology option) from University of Sidi-Bel-Abbes, Algeria. He is Member of Editorial Board of two scientific reviews and is a Peer Reviewer in several journals. He has 32 publications: 30 journal articles and 2 books. He is the Head of research team affiliated to Laboratory of Water Resources and Environment, Biology Department, Faculty of Science, University of Saida, Algeria.
Abstract:
Background & Aim: Diabetes mellitus is a common disease, treated either with insulin or oral anti-diabetics which have undesirable eff ects because of their chemical composition. As an alternative, diabetes could be treated by medicinal plants. This study aimed to assess the eff ects of Trigonella foenum graecum (TFG) seeds aqueous extract on biochemical parameters in streptozotocin-induced diabetic rats.
Materials & Methods: A population of forty (40) rats was divided into 4 groups; normal control, experiment control (diabetic rats by STZ), diabetic treated with TFG at the dose 1 mL (100 mg/mL) and non-diabetic treated (TFG). During 30 days of experiments, body weight and biochemical parameters were measured and statistically analyzed using SigmaPlot soft ware.
Results: No signifi cant diff erence in body weight was observed in diabetics animals (168±8.5 g/L) and animals treated with TGF (167±4.7 g/L). Significant decrease in blood glucose (1.16±0.15 g/L), triglycerides (0.64±0.21 g/L), serum urea (0.38±0.19 g/L) and creatinine (8.02 mg/L) levels were reported in diabetics treated with TFG compared to diabetic animals non-treated.
Conclusion: Trigonella foenum-graecum was able to regulate and maintain glycaemia and lipid profi le at normal levels at diabetic animals.
Zhiyong Zou
Peking University, China
Title: Fetal and infant exposure to severe Chinese famine increases the risk of adult dyslipidemia: Results from the China Health and Retirement Longitudinal Study
Time : 16:05-16:40
Biography:
Zhiyong Zou has received his Doctor of Medicine degree in Nutrition and Food Health from Peking University. Presently, he is working as a Lecturer at the Institute of Child and Adolescent Health, Peking University Health Science Center. His research interests are famine exposed and the risk of cardiovascular disease in adulthood; the population intervention of obesity and hypertension in school students. He had participated in Chinese national survey on students’ constitution and health in 2014 as a Member of National Research group and as Co-Investigator to fi nish the fi nal report of Chinese students’ common diseases and health risk behavior surveillance in 2016
Abstract:
Although studies have observed that early life famine exposure linked with hypertension, metabolic syndrome in adulthood, the association with dyslipidemia was unclear. To explore the association between fetal-stage exposed famine and risk of dyslipidemia in adults. 2,752 subjects were selected from the China Health and Retirement Longitudinal Study (CHARLS) 2011-2012 baseline survey to assess the association of fetal-stage famine exposure with dyslipidemia risk in adults aged 50 years. Dyslipidemia was diagnosed as TG/HDLc>5.0 or self-reported dyslipidemia. Birthdates of subjects were used to categorize famine exposure groups. Logistics regression model was used to examine association of famine exposure with dyslipidemia risk. We observed that the prevalence of dyslipidemia among adults in non-exposed, fetus, infant, and preschool stage-exposed cohorts were 15.7%, 23.1%, 22.0% and 18.6%, respectively. Th e early life famine exposure signifi cantly increased LDL cholesterol concentrations aft er adjusting for age. Th e risks of dyslipidemia in fetal (OR 1.58; 95% CI: 1.23-2.03; P<0.001) and infant (OR 1.52; 95% CI: 1.15-2.00; P=0.003) stage exposure cohorts were signifi cantly higher than the non-exposed cohort aft er adjusting for gender and current family economic status. Following gender stratification, we found that fetal (OR=1.80; 95% CI: 1.26-2.57; P=0.001), infant (OR=1.75; 95% CI: 1.17-2.62; P=0.006) and preschool (OR=1.63; 95% CI: 1.10-2.42; P=0.038) -stage exposed to severe famine aggravated the risk of dyslipidemia in female adulthood, however, various associations were not observed for male adulthood. Th erefore, early-life exposure to severe Chinese famine was associated with the higher risk of dyslipidemia in female adulthood, but not in male adulthood. Th is gender-specifi c might be due to son preference hypothesis.
Dalida Badla
Damascus University, Syria
Title: Recurrent pregnancy loss and Poly Cystic Ovary Syndrome (PCOS)
Time : 17:50-18:20
Biography:
Dalida Badla, MD at the age of 27 years from Faculty of Medicine in Damascus and Aleppo Universities .D.MAS from World Association of Laparoscopic Surgeons in 2017. She did fellowship in Assisted Reproductive Technology at WLH, NCR Delhi in 2017. She is head section of Obstetrics and Gynaecology department in Mediclinic Al Bateen, Abu Dhabi. She is a member in MEFS and speaker of many conferences.
Abstract:
Loosing pregnancies before 20 weeks of pregnancy is a frequent obstetric complication and has several reasons such as parental chromosomal anomalies, maternal thrombophilic disorders, uterine structural anomalies and antiphospholipids antibodies. In 50% of cases the pathophysiology remains unknown. The clinical association between RPL (Recurrent Pregnancy Loss) and PCOS is more than common however the incidence rate uncertain till now. The high LH and obesity are risk factor of spontaneous abortion. Hyperinsulinemia has been proposed as pathway for the effect on obesity although its effect on androgen production (theory of Insulin Resistant) acts as a key factor behind PCOS/obesity and risk of RPL. So therefore PCOS, miscarriages symptoms and how to avoid miscarriages with PCOS, their treatment options and then planning to get pregnant again after miscarriage is a great issue now a days.
Raja Chaaba
University of Monastir, Tunisia
Title: Genotypic interactions of genes implicated in lipoprotein metabolism with type-2 diabetes in Tunisian population
Time : 16:40-17:15
Biography:
Raja Chaaba has completed her PhD in Biological Engineering in 2006 and is interested in research about lipids, diabetes and cardiovascular disease. She is a Member of research laboratory “Nutrition-Functional Foods and Vascular Health”, Faculty of Medicine, Monastir, Tunisia. She is an Assistant Professor in Superior Institute of Applied Sciences and Technology, Mahdia, Tunisia.
Abstract:
The relationship between diabetes and lipids is complex. Lipid disturbance can be the result of diabetes but also can be the reason of disturbed glucose metabolism. Apolipoprotein A5 (apo A5), Apolipoprotein E (Apo E) and CETP (Cholesteryl Ester Transfer Protein) are involved in lipoprotein metabolism. To explore the role of genetic variants of apo A5, Apo E and CETP as predictors of diabetes risk and to examine their combined eff ects on type-2 diabetes mellitus (T2DM), 149 type-2 diabetic patients are compared to 101 controls. Th e genotypic frequencies for all three genes alone were associated with increased risk of developing diabetes. Logistic regression analysis of classic coronary risk factors and the genetic polymorphisms demonstrated that B2B2 and CC genotypes of CETP and apo A5 respectively were the most significant contributors to T2DM. However, those genotypes were not associated with higher CETP activity in diabetics. For the three genes, the risk of T2DM in individuals with one risk genotype was 2.5 (95% CI: 2.0-4.1, p=0.004) higher than those with zero risk genotype. Individuals who carried two risk genotypes had a 3.8 (95%CI 3.2-4.8, p=0.018) times higher risk of T2DM than those who did not carry any risk genotypes. Most interestingly, the risk of T2DM for individuals with three risk genotypes was 3.7 (95% CI: 3.5-4.2, p=0.015) higher than those with zero risk genotype. In conclusion, the results imply that genotyping of genes implicated in lipoprotein metabolism could become an important part of the clinical process of risk identifi cation for T2DM.
Saba Noor
Aligarh Muslim University, India
Title: Culture-based screening of aerobic microbiome in diabetic foot subjects and developing nonhealing ulcers
Time : 17:15-17:50
Biography:
Saba Noor is a Research Scholar and presently pursuing PhD in Endocrinology, Faculty of Medicine, Aligarh Muslim University, India. She has completed her Masters and Graduation in Biochemistry from same institute. She has published two articles and two reviews in peer-reviewed reputed international journals and working to improvise diagnostic tools implemented in exploring microbial spectrum and immunological studies among diabetic foot patients.
Abstract:
The study was carried on diabetic foot patients to deduce clinical attributes, the occurrence of the range of aerobic microbial fl ora and to assess their comparative in vitro susceptibility to the customarily used antimicrobials. We also studied the potential risk factors involved in the development of non-healing ulcers. A total of 87 organisms were isolated from 70 specimens, including Escherichia coli (19.5%) among the Gram-negative and Staphylococcus aureus (18.4%) among the Gram-positive as the predominant aerobes explored. Pseudomonas aeruginosa and Escherichia coli were predominant isolates of non-healing ulcers. Th e antimicrobial sensitivity pattern revealed that Vancomycin (100%) and Amikacin (90.4%) exhibited highest sensitivity to Gram-positive cocci, while all strains of Pseudomonas aeruginosa were sensitive towards Imipenem (100%). Th e prevalent of uncontrolled glycemic status, altered lipid spectra, the existence of neuropathy and peripheral vascular disease, suggested the predisposition towards the development of non-healing lesions. Th e study has underlined the need for continuous surveillance of bacteria and their antimicrobial sensitivity blueprints to provide the basis for empirical therapy and to minimize the risk of complications. Further, stringent clinical evaluation and medical history will help in revealing the risk of developing non-healing status in diabetic foot ulcers.
- Diabetes Research | Treatment of Diabetes | Complementary and Alternative Medicine | Diabetes in Market | Biomarkers for Diabetes | Therapy for Diabetes
Location: Buttes Chaumont
Chair
Bandar Manawer Al Harbi
DMU University, UK
Session Introduction
Bernadette Dian Novita
Widya Mandala Catholic University, Indonesia
Title: Metformin associated AFB smears reversion in diabetes-tuberculosis coinfection patients
Biography:
Bernadette Dian Novita is currently a Medical Doctor and Lecturer in Widya Mandala Catholic University Surabaya Faculty of Medicine. Her major is pharmacology and therapy, focusing in diabetes mellitus, infection and immunology. She has completed her PhD from Airlangga University Faculty of Medicine. She has got several national and international publications in diabetes mellitus area.
Abstract:
Metformin (MET) has possibilities of utilizing as a combination drug with existing antibiotics for TB therapy and controlling the growth of drug-resistant Mycobacterium tuberculosis (M. tuberculosis) strains via production of mitochondrial reactive oxygen species and facilitates phagosome-lysosome fusion. MET that is given to type-2 DM newly TB co-infection patients were improved the SOD level and inhibited of NF-ĸβ activation. Th e clinical effect, especially smear reversion, during metformin applied with anti-tuberculosis and insulin in patients with type-2 DM newly TB co-infection were remain unknown and this result contributes much to our understanding the use of MET in type-2 DM-TB co-infection management. An observational clinical study was done in DM newly TB co-infection outpatients at Surabaya Paru Hospital. We evaluated MET accompanying therapy with gold standard therapy of DM-TB co-infection, insulin and TB treatment regimens. MET therapy was given for at least 2 months and we compared to comparison group, whom were given insulin and TB treatment regimens. The AFB smear was measured for two purposed: (1) For diagnostic, three times measurements before therapy and (2) For evaluation, two times measurement. From 42 participants in this study, 22 participants of observation group that received additional MET therapy, 100% had AFB smear reversion conversion aft er anti tuberculosis intensive therapy. Whereas 25% of 20 participants of comparison group did not undergo reversion inserts AFB smear and needed one-month intermittent therapy. AFB smear reversion difference test using Fisher’s exact test showed results of different test p=0.046 (p<0.005), which means that there is a significantly difference of smear conversion between the observation group and the comparison group. Moreover for mechanism purposes, microtubule-associated protein1 light chain 3B (MAP1LC3B), superoxide dismutase (SOD), interferon (IFN)-γ and interleukin (IL)-10 levels were measured and also increased after MET therapy during intensive phase of anti TB and insulin therapy. Thus we concluded that MET use DM-TB co-infection increases smear reversion. Metformin has the potential of being an additive combination therapy to enhance the eff ect of anti TB bactericidal on DM infected patients. Metformin enhances the effects of anti TB and insulin therapy in increasing the smear reversion by increasing levels of microtubule-associated protein1 light chain 3B (MAP1LC3B), superoxide dismutase (SOD), interferon (IFN)-γ and interleukin (IL)-10 levels. In addition, metformin therapy use during intensive phase of TB treatment regimens and insulin did not result in elevated lactate levels and also MALA, so it concluded that metformin therapy is relatively safe for DM TB co-infection patients.
Daniel Martin Arsanios
Sabana University, Colombia
Title: Insulin, more than a metabolic hormone: Focus in sepsis
Biography:
Daniel Martin Arsanios is a Doctor at Sabana University in Colombia. He has experience in molecular biology and in conjunction with issues of sepsis and sought to go deeper into issues related to the development and complications of microvasculature in sepsis.
Abstract:
Sepsis is defined as deleterious response of host towards a pathogen, in which the number of physiopathological phenomenon implied lead to cell dysfunction, multi-organ failure and death. In this unregulated response, hormones change its functions and metabolism. One example is insulin, a peptide hormone which is not only implied on the glucose’s homeostasis and growth pathways but also function as a mediator of inflammatory, hemodynamic and micro-vascular processes involving sepsis. Insulin inhibits the production and secretion of substances implied in systemic inflammatory response syndrome like tumor necrosis factor, reactive oxygen species and nuclear factor-kB (NF-kB). Also, it is able to activate protective molecules such as Janus kinase by boosting a counter-regulation mechanism to the damage induced by NF-kB and to the phosphorylation of pathways related to mitogen-activated protein kinases, inhibiting pro-inflammatory proteins (ERK, P38) involved in cell damage, by activation of P21-RAS. Evidence supports the contribution of insulin resistance to the inflammatory phenotype that is similar in obesity microvasculature. This also leads to endothelial cell dysfunction, manifested as an impaired capacity of microvasculature to relax in response to endothelium-dependent vasodilators, favoring the binding of both leukocytes and platelets to the vascular wall. Insulin administration can attenuate this response as well as suppress genes commanding inflammatory cytokines. Based on its anti-inflammatory, hemodynamic, hormonal and regulating mechanisms of fatty acids, carbohydrates and proteins, attempts have been made to support the use of insulin during sepsis and septic shock in practice. On one side, there is evidence of mortality reduction rate of up to 3% in the ICU patient after its use greater than 28 days additionally showed a reduction in morbidity by decreasing renal injury until 8.9%, mechanical ventilation and ICU stay (p=0.05). It is important to know all the possible pathways where the insulin works to improve the utility in septic patient.
Bushra Yunis
Meuhedet, health-care provider, Israel
Title: A clinical nurse practitioner as a consultant to medical staff in the arab sector - Is this the right working model?
Biography:
Bushra Yunis is a Clinical Nurse Practitioner (CNP) Diabetic Nurse. She has worked as Director of Basics in Diabetes for Nurses Program in Rambam Hospital. She has completed her Master’s degree in Nursing, with specialty in Emergency Medicine and Diabetes
Abstract:
Background & Aim: Diabetes is one of the most common chronic diseases. Recent surveys shows increase in the prevalence of diabetes in the Arab population in Israel. European studies show the contribution of the diabetic clinical nurse practitioner (CNP) in improving the glucose outcome measures. Recently, the nursing administration organization in Israel recognized the role of CNP. This gives the nurse authorization to treat diabetes, including diagnosis, regulation and balance of the disease, counseling for patients and teams, prescribing prescriptions and more. The primary target is to examine the effectiveness of intervention model of CNP in primary care physician’s treatment of diabetic patients in the Arab sector. The secondary targets are improving the glucose outcome measures of diabetic patients in the Arab sector by CNP consulting with the physician and the nurse in the clinic and to improve the patient’s adherence to treatment.
Methods: The methods are: 1) Selection of two clinics from the Arab sector at the northern district, 2) Focusing on unbalanced patients with HbA1c>9%, 3) Discussion of 5 cases at each advisory meeting between CNP and primary physician and 4) Involving the nurse in the treatment plan. Arranged meeting with the primary physician and a weekly meeting with the physician. The physician fully cooperated. Both clinics had about 100 unbalanced patients. During the year, 22 meetings were held with staff of the chosen clinics.
Results: Improvement in glucose outcome measures with HbA1c>9%. In one clinic: Improvement from 14.3% to 11.9%, decrease of 17% and in the second clinic: 23.5% to 18.5% decrease of 21% in HbA1c>9%. (One of the physicians have joined the class on "Treatment of diabetes").
Conclusion: To extended this program to additional areas in accordance with the worsening level of glucose outcome measures. Build a direct computerized consulting program between CNP and physicians.
Biography:
Suhad Bahijri has obtained her BSc in 1975 and her PhD in Clinical Biochemistry in 1979, both from The University College of Wales, Aberystwyth, UK. She then joined the Faculty of Medicine at King Abdulaziz University as an Assisstant Professor. Her studies helped to establish standards for infants formulas for the Saudi market. She also established Food, Nutrition, and Lifestyle Research Unit at King Fahad Medical Research Center, establishing a possible link with excessive fluoride intake and the beneficial effect of chromium on glucose tolerance and lipid profile in Saudi individuals. In 2010, she founded the Saudi Diabetes Research Group (SDRG).
Abstract:
Most type-2 diabetes (T2DM) Saudi patients remain uncontrolled, thus increasing their risk of developing cardiovascular disease (CVD). We aimed to investigate relationship between known factors associated with increased CVD risk, such as glycaemic control, components of metabolic syndrome (MS) and novel possible predictors of CVD risk namely: Serum levels of γ-glutamyl transferase (GGT) and C-reactive protein (CRP) in Saudi T2DM patients. 71 men and 82 women were recruited for the study. Anthropometric measurements and blood pressure (BP) were taken. Treatment plan was recorded. Fasting blood samples were obtained to measure glucose, glycated hemoglobin (HbA1c), lipids profile, highly sensitive (hs)-CRP and GGT. Higher mean GGT was associated with poor glycemic control, dyslipidemia, hypertension and abdominal obesity. GGT correlated significantly (P<0.05) directly with triglycerides in men (r=0.401) and Diastolic BP (r=0.279 for men, r= 0.194, for women), but inversely with high density lipoprotein-cholesterol (r=-0.298 for men, r=-0.171 for women). hs-CRP correlated with waist circumference (P<0.05, r=0.312, for men, r=0.305, for women), with a higher mean being found in men with poor glycemic control (P=0.015), hypertensive women (P=0.030) and abdominally obese persons (P<0.05). Therefore, it was concluded that since high levels of GGT and hs-CRP are associated with components of MS and poor glycaemic control, indicating increased cardiovascular risk, they should be included in routine monitoring of type-2 diabetic patients as independent risk predictors of CVD risk.
Abdelkrim Berroukche
Dr Tahar-Moulay University of Saida, Algeria
Title: Cypermethrin and medicinal plant antagonist effects on glycaemia in healthy animal model
Biography:
Abdekrim Berroukche is currently a Lecturer and Teacher-Researcher, Biology Department, Faculty of Science, University of Saida, Algeria. He has received his PhD in Cell Biology and Nutrition (with Oncology option) from University of Sidi-Bel-Abbes, Algeria. He is Member of Editorial Board of two scientific reviews and is a Peer Reviewer in several journals. He has 32 publications: 30 journal articles and 2 books. He is the Head of research team affiliated to Laboratory of Water Resources and Environment, Biology Department, Faculty of Science, University of Saida, Algeria.
Abstract:
Background: Uncontrolled and excessive uses of insecticides, in agriculture, will expose the human and animal health to a high risk of chemical toxicity. Cypermethrin (CYP), as pesticide, is widely handled in tomato growing fields in Algeria. In addition to brain and lung tissue damage, CYP induced metabolic disorders. Medicinal plants widely used, as folk remedies, by rural population. This study aimed to compare both medicinal plant and CYP effects on blood glucose level in rats.
Materials & Methods: Experiments conducted in 30 days, on 70 rats, divided into seven groups: A (controls), B (CYP at 20 mg/kg~<1/10 DL50), C (Artemisia herba alba), D (Myrtus communis), E (Eucalyptus globulus), F (Cinnamomum verum), G (Ocimum sanctum). CYP and aqueous plant extracts (as hot decoction at 50 g/L) were orally administered to animals.
Results: A significant difference in body weight gain was reported (respectively, 54.67, 15, 39.67, 12.65, 8.34, 39.63 and 4.66 g). No significant different results found about blood glucose levels and their mean values were respectively, 0.82±0.01, 0.94±0.03, 1.51±0.17, 0.73±0.08, 0.72±0.05, 0.71±0.03 and 0.81±0.02 g/L. Furthermore, serum levels of renal markers showed slight variation such as urea (respectively, 0.66±0.02, 0.61±0.05, 0.83±0.03, 0.47±0.13, 0.52±0.05, 0.72±0.01 and 0.44 ± 0.2 g/L) and creatinine (respectively 7.4±0.2, 8.17±0.14, 9.6±1.25, 6.56±1.38, 7.13±0.07, 7.63±0.64 and 8.23±0.08 mg/L).
Conclusion: Medicinal plants, used in this study, showed more or less significant hypoglycemic effects in contrast to CYP slightly hyperglycemic. Other studies are expected to consolidate this thesis.
Biography:
Sako Mirzaie has PhD in biochemistry and a faculty member of Azad University of Sanandaj. He has more than 24 papers in international journals. He is expert in molecular modeling, protein engineering and enzyme kinetic assay. In his new research, he is looking for the new formulation for increased stability of insulin in certain intelligent implant.
Abstract:
Statement of the Problem: One of the most worldwide health problems, which is a disorder in glucose metabolism and causes diverse dangerous symptoms, is diabetes mellitus (DM). Two types, diabetes mellitus type 1 (T1DM) and diabetes mellitus type 2 (T2DM) are the major forms of DM. In 2013, it has been estimated that 382 million people had DM. Among them, about 90% cases were T2 DM.
Methodology & Theoretical Orientation: In the current study, at first, interventional and experimental studies on 45 patients with T2DM were occupied and the effects of restricted diet, metformin and insulin in the absence or presence of vitamin D were evaluated on certain blood biochemical parameters. Also, molecular dynamics (MD), molecular docking and MM/PBSA were employed to analyze the flexibility of vitamin D receptor (VDR), in free or ligand bound form, during 50 ns.
Findings: Experimental data showed that the combination of metformin/ vitamin D or insulin/ vitamin D treatments can decrease the fasting blood glucose. Vitamin D alone or in combination with insulin or metformin decreases the LDL and cholesterol of patient’s serums. Vitamin D along with insulin decreases the insulin resistance and increases the insulin sensitivity in patients with T2DM. Glut 4, which is not detected in the lymphocyte of healthy people or patients with T1DM, was found in the patient’s peripheral lymphocytes. The MD results showed that in the presence of metformin, the flexibility of helix 12 residues from vitamin D bound VDR were decreased. Also, metformin decreased the radius of gyration of agonist bound VDR. However, metformin has no effect on the binding free energy between VDR and vitamin D.
Conclusion & Significance: Our data showed that metformin, in the presence of vitamin D could stimulate the interaction between VDR and co-activator receptor.
Raja Chaaba
University of Monastir, Tunisia
Title: Fatty acid profile and genetic polymorphisms (FADS1, FADS2, ELOVL2) in diabetic patients
Biography:
Chaaba Raja has completed her PhD in Biological Engineering in 2006 and is interested in research about lipids, diabetes and cardiovascular disease. She is a Member of research laboratory “Nutrition-Functional Foods and Vascular Health”, Faculty of Medicine, Monastir, Tunisia. She is an Assistant Professor in Superior Institute of Applied Sciences and Technology, Mahdia, Tunisia.
Abstract:
Diabetes constitutes a real problem of public health. Both genetic and environmental factors are involved in the etiology of diabetes. Several genes have been associated with increased risk of diabetes such as those encoding proteins involved in the mechanisms of desaturation and elongation of fatty acids. To search for a possible association between these rs174556 of the FADS1, rs174617C>T FADS2 and rs3756963C>T ELOVL2 genes polymorphisms and diabetes in Tunisian population, a case/control study was conducted. The genotyping was performed by PCR-RFLP method in 130 diabetic patients and 186 normal subjects. Obtained results showed that the polymorphisms of the genes FADS1, FADS2 and ELOVL2 are diabetes predisposing genes. An association was found between FADS1, FADS2 and ELOVL2 polymorphisms and severity of the diabetes. Individuals who carried two risk genotypes and three risk genotypes had a higher risk of diabetes than those who did not carry any risk genotypes of the three genes. To search a correlation between the three polymorphisms and the fatty acid profile, no significant difference was found for the different fatty acids analyzed between diabetic patients and controls. On the other hand, fatty acids [vaccenic, linoleic, linolenic, Dihomo-γ-linolenic (DGLA), Docosatetraenoic, Eicosapentaenoic (EPA), Clupanodonic (DPA) and Docosahexaenoic (DHA)] are significantly correlated with diabetes. An association was found between the three polymorphisms and fatty acids studied (p<0.05). In conclusion, further studies of the relationship between the polymorphisms of these three genes and the fatty acid profile are warranted, for better understanding their roles in diabetes.