Day 1 :
Keynote Forum
Pnina Vardi
Tel Aviv University, Israel
Keynote: Clinical research in diabetes
Time : 10:15-10:55
Biography:
Dr. Vardi serves as the director of the central unit of Pediatric Endocrinology & Diabetes in Haifa. She is also the director of the laboratory for Diabetes & Obesity research in Felsenstein research center of the Sackler Faculty of Medicine in Tel Aviv University. Dr. Vardi is a board certified pediatrician, general endocrinologist and pediatric endocrinologist. She graduated from the Faculty of Medicine in the Technion, institute of technology in Haifa, Israel. She did her fellowship in Diabetes Research, at the Joslin Diabetes Center, Harvard Medical school. Her work involves both clinical and basic research with main focus on characterization and prevention of diabetes, metabolic syndrome and their complications. Recently she initiated a novel clinical approach to treat diabetes by involving all family members of diabetic subjects in the efforts to slow aging process induced by components of metabolic syndrome, where each family further distributes the knowledge to the close community. In her laboratory her team is involved in exploring islet transplantation, pancreatic islet biology and tissue engineering of bio-artificial pancreas. Dr Vardi is the founder and chairperson of Beta o2 biothechnologies. Her genetic research was selected in 1997 to represent the BSF contribution in science as special, outstanding and science news-worthy. The genetic locus found by her and her partners was titled by the HUGO as IDDM17. Recently her team is involved in evaluating a novel approach to treat chronic neurodegenerative diseases by islet transplantation in the brain. Dr. Vardi published above 100 peer reviewed scientific papers, is invited lecturer in various national and international meeting on diabetes and served as a member of various diabetes organizing and scientific committees. She also serves as a member of the WHO committee on classification of diabetes and its complications
Abstract:
The rapidly world-wide growing frequency of diabetes, and the failure to achieve satisfactory glycemic control and prevention of secondary complications indicate an urgent need for a different approach toward diabetes management. Here we present initial data obtained from a novel diabetes strategy aiming to propagate and widen the range of successful individual management versus the enlarged family and community. Such strategy believes that urbanic loneliness has a major role in induction of diabetes, and education with programmed changes in community life style might support efforts to prevent diabetes development.
Subjects & Methods: First and second degree adult family relatives of diabetic, and obese, non-diabetic children were studied. Their mean age was 58±12yrs, and about 40% had either diabetes or dysglycemia (IFG, IGT, IFG/IGT). The majority of the adult subjects were of Arab ethnicity. In addition to diabetes, adult family members were diagnosed with overweight and dyslipidemia. About 50% had a history of multiplex family diabetes, and many had a history of early CVD morbidity and mortality. Recruitment of the adult group was obtained through their motivation to improve their diabetic child condition by increased family involvement, and by general education focusing on the role of overweight, the role of insulin resistance, hyperglycemia and dyslipidemia in acceleration of aging processes. In >50% adults a change or initiation of diabetic pharmacotherapy was initiated following the encounter.
Results & Conclusions: A significant improvement of familial life style was obtained in the majority of the adult subjects when the focus of education was switched from blood glucose level to accelerated aging process. Improvement was reflected by decreasing weight, fasting insulin level, fasting blood glucose level, lipid profile and HbA1c level even in the normal range. Moreover, the success of the adult family members to improve their condition empowered them to lead, spread knowledge and enlarge the circle community subjects interested in achieving similar changes. Thus doubling and tripling the success rate to prevent development of diabetes, metabolic syndrome and their complications can be achieved by changing the treatment aim and allowing active involvement of family members in diabetes education.
- Diabetes Pathophysiology
Diagnostics and Clinical Analysis
Diabetes: Clinical research and Case study
Diabetes and Skin complication
Genetics of Diabetes
Chair
Bruno Doiron
University of Texas Health Science Center, USA
Co-Chair
Alireza Jahan-Mihan
University of North Florida, USA
Session Introduction
Paras Kumar Mishra
University of Nebraska Medical Center, USA
Title: MicroRNA autophagy axis in diabetic hearts
Biography:
Paras Kumar Mishra has completed his BSc and MS in Biological Science with specialization in Zoology from India. His PhD dissertation was from Banaras Hindu University (a reputed university in India) on understanding the genetic basis of speciation. His Postdoctoral works was basically on cardiac physiology from USA. He was also interested in investigating the role of extracellular matrix (ECM) and matrix metalloproteinases (MMPs) in heart failure. The long term goal of his research is to discover an intervention tool to improve cardiac function in pathological heart using microRNAs and stem cells.
Abstract:
Diabetes is a complex multifactorial disease that increases the incident of heart failure. However, the underlying molecular mechanism of diabetic heart failure is unclear. Diabetic hearts show down-regulation of several cardioprotective miRNAs including the most abundant miRNA in the heart, the miR-133a. Recently, we demonstrated that in diabetic heart failure patients, down-regulation of miR-133a is associated with up-regulation of cardiac autophagy. We hypothesized that attenuation of miR-133a in diabetic hearts induces cardiac autophagy. To test the hypothesis, we treated Insulin2 mutant (Ins2+/-) diabetic Akita mice, which show down-regulated miR-133a in the heart with miR-133a mimic and measured the level of autophagy markers in the heart. To determine the cellular mechanism, we also treated HL1 cardiomyocytes with high glucose and miR-133a mimic and measured the level of autophagy markers. Further, we treated these cells with Bafilomycin A1 to assess autophagy flux. Our results demonstrated that miR-133a mimic treatment normalized the up-regulated autophagy in hyperglycemic cardiomyocytes. These in vitro findings were supported by the in vivo results, where miR-133a mimic treatment restored autophagy markers in Akita hearts. We conclude that miR-133a plays pivotal role in regulating autophagy in diabetic hearts.
Alireza Jahan-Mihan
University of North Florida, USA
Title: The role of dietary proteins in maternal diet in risk of development of glucose intolerance and diabetes mellitus in offspring
Biography:
Alireza Jahan-mihan, PhD RD is an Assistant Professor in the Department of Nutrition and Dietetics at the University of North Florida. He has more than twenty years’ experience in research, food industry and clinical practice. He completed his doctoral degree at University of Toronto in the field of Nutrition. His primary research focus is on the role of functional foods and their dietary bioactive components in health and diseases. The specific focus of his research program is on physiological and nutritional functions of dietary proteins and peptides. Both animal and clinical approaches are applied to reveal underlying mechanisms of functional foods and also to examine the applicability of research outcomes. The results of his research have been published in peer-reviewed journals. Moreover, he has been invited to various national and international seminars and conferences to present his research findings.
Abstract:
The overarching role of impaired insulin resistance and central obesity has been suggested. The role of dietary proteins in maternal diet in health outcome of the offspring has been examined. Offspring born to low protein fed dams have impaired glucose tolerance at 15 months of age and diabetes at 17 months of age. In another study, pregnant gilts were fed either high protein/low carbohydrate (HP-LC) or a low protein/high carbohydrate diet or a standard diet. HP-LC fetuses had intrauterine growth restriction (IUGR) and asymmetrical growth of fetuses within the same litter. Offspring born to twin-pregnant sheep fed a low energy, low protein diet in late gestation developed insulin resistance compared with those fed a normal diet. Interestingly, the lambs’ post-natal high CHO, high fat diet exaggerated the adverse effect of low protein low calorie maternal diet fed during late gestation as evidenced by higher glucose AUC. The role of low protein diet fed during pregnancy in aging-related development of dysfunction of insulin metabolism has also been studied. The results suggest that a low protein maternal diet fed during pregnancy has a negative impact on aging-associated glucose-stimulated insulin secretion loss in rats; therefore, authors propose that developmental programming is a major factor in aging-related development of dysfunction of insulin metabolism. Impaired glucose tolerance was also found in adult femalesand their insulin responseto an oral glucose preload was low if they were born to rat dams fed a low protein diet during gestation but not males. In contrast, male but not female Wistar rats born to dams fed low protein diets were more hyperinsulinemic and insulin resistant at 20 weeks of age.Moreover, protein source in a nutritionally adequate diet during gestation and lactation influenced glucose metabolism in offspring of rats in a sex-dependent manner. Dams’ soy protein-based diet resulted in higher fasting glucose, glucose response to glucose preloads and the HOMA-IR index, in male offspring but not in females. In conclusion, both protein content and protein source fed during development influence the risk of glucose intolerance and diabetes in offspring in a sex-dependent manner.
Bruno Doiron
University of Texas Health Science Center, USA
Title: The challenge and hype of stem cells research to replace insulin injection: Many hurdles remain
Biography:
Bruno Doiron is a Faculty Member at the University of Texas Health Science Center at San Antonio. He has received his undergraduate degree from University of Moncton, Canada and graduate degrees from University of Montreal, Canada and University of Paris Descartes, Paris, France. As Project Leader he has made major discoveries in the field of gene regulation by nutrients and has 4 patents on the modulation of glucose metabolism as it relates to the treatment diabetes and cancer. He has extensive experience in basic research at the physiologic and molecular levels and in respective applications to the biotechnology field.
Abstract:
The quest to replace insulin injection treatment has focused on two strategies: In vivo islet transplantation and in vitro nuclear reprogramming to produce differentiated beta cells. Ultimately, both strategies rely on encapsulation to implant islets or culture cells into the human body. The many hurdles involved with islet transplantation have yet to be overcome and, even if successful, the paucity of pancreatic donors limits this approach. An alternative approach has attempted to recapitulate the embryonic development of pancreatic beta cell in vitro using stem cells. However, the stem cell approach requires in vitro cell culture and still has to overcome the hurdle of encapsulation. Beyond the capsulation hurdle, there remains a lack of knowledge about the basic molecular/cellular events via which a completely undifferentiated cell can be transformed into a functioning tissues/organ which can be integrated into whole body homeostasis. Mark Twain said: “What gets us into trouble is not what we don’t know; it’s what we know for sure that just isn’t so.”
Claude K Lardinois
University of Nevada, USA
Title: Cardiovascular Disease (CVD) and Diabetes-Know Your Risk-Is it time for a paradigm shift?
Biography:
Claude K Lardinois is an Emeritus Professor, University of Nevada School of Medicine in Reno, NV and Medical Director, American Health Care, Rocklin, CA. He has earned his Medical degree at George Washington University in Washington, DC and Internal Medicine Residency at Travis Air Force Base, Fairfield, CA. He has completed a Fellowship in Endocrinology and Metabolism with a focus on insulin research at Stanford University in Palo Alto, CA, under the mentorship of Gerald Reaven, MD. His research interests include work in nutrition, diabetes, hypertension and dyslipidemia. He has a notable interest in eradicating heart disease, the major cause of death in the US.
Abstract:
Cardiovascular Disease is a major complication of diabetes and the leading cause of early death among people with diabetes about 65 percent of people with diabetes die from heart disease and stroke. Annually in the United States 1,000,000 people will suffer a myocardial infarction: One-third of those will occur in people who have already suffered an event. Modification of traditional risk factors, such as smoking cessation, decreasing blood pressure and lowering of cholesterol in high risk individuals has resulted in reducing CVD and stroke remarkably. However, the current standard of care using traditional modifiable risk factors alone is frequently inadequate to identify some individuals with CVD. Therefore, it is important to not rely solely on risk factor modification when assessing for CVD, but also to incorporate a disease platform. A new paradigm focusing on the disease (atherosclerosis) is necessary. Non-invasive endothelial testing [coronary calcium score (CCS), carotid intima media thickness (cIMT)], genetics assessment [Apolipoprotein E (ApoE), kinesin-like protein 6 (KIF6), 9 region p21 locus (9p21), lipoprotein (a) (LPA) and haptoglobin genotype (Hp 1-1, Hp 1-2, Hp 2-2)] and measurement of major biomarkers [F2-Isoprostanes (F2-IsoPs), high sensitivity C-reactive protein (hs-CRP), urine albumin creatinine ratio (UACR), myeloperoxidase (MPO), lipoprotein associated phospholipase A2 (Lp-PLA2), fibrinogen, and homocysteine (Hcy)] enhance the ability to identify disease (atherosclerosis) earlier. When disease is found, the causes must be identified and treated. A paradigm shift focusing on arteriology (disease platform) is mandated to reduce the high rate of recurrence of CVD and stroke.
Joseph Fomusi Ndisang
University of Saskatchewan, Canada
Title: Hemeoxygenase ameliorates diabetic cardiomyopathy by potentiating electrocardiographic and hemodynamic parameters in obese Zucker rats
Biography:
Joseph Fomusi Ndisang is an Associate Professor in the Department of Physiology of University of Saskatchewan, College of Medicine. He has completed his Postdoctoral training in Physiology at the University Of Saskatchewan, College of Medicine. He has received his PhD in Pharmacology & Toxicology from the University of Florence, Italy and received a Doctor of Pharmacy degree from University of Florence, Italy. He has got several distinguished awards and distinctions including: Associate Fellow of the Scientific Council of the International College of Angiology (2007).
Abstract:
Deregulated insulin signaling is associated with progressive alterations in cardiac structure and function. We investigated the effects of the heme-oxygenase (HO) inducer, hemin, on cardiac dysfunction in obese Zucker rats, a model characterized by impaired insulin signaling. Administering hemin to obese Zucker rats enhanced insulin sensitivity and potentiated important components of insulin signal transduction pathway including IRS-1, PI3K and GLUT4. These were associated with the amelioration of several hemodynamic parameters including mean arterial pressure, arterial systolic pressure, +dP/dt and arterial diastolic pressure as well as electrocardiographic parameters related to the performance of the cardiac conduction system such as the PR-interval, QRS-duration, ST-segment and QT interval. Furthermore, hemin reduced LV-hypertrophy, abated diastolic/systolic LV-wall thickness, abolished cardiac fibrosis, suppressed inflammatory/oxidative mediators and attenuated extracellular matrix/pro-fibrotic proteins, whereas treatment with HO-blocker, stannous-mesoporphyrin, abolished the effects of hemin. We conclude that up-regulating the HO system with hemin improved altered cardiac structure and function in obese Zucker rats by attenuating inflammatory/oxidative insults, suppressing extracellular-matrix/profibrotic, while concomitantly potentiating insulin signaling and glucose metabolism.
Alain Ulrich Kabongo
University of South Wales,UK
Title: Meta-analysis of the benefits of inhaled insulin in young diabetic patients above 12 years of age
Biography:
Dr Alain is an academic researcher, graduated from African, European and American prestigious universities, trained from old and sophisticated setting with a medical experience of more than 20 years in advanced medical fields; includeding: internal medicine, Diabetology, Paediatric and Clinical Research. He is a member of International Society of Pediatric and Adolescent Diabetes (ISPAD) and Danish Academic of Diabetes and he has published more than 10 articles on the management of diabetes.
Abstract:
Diabetes mellitus is a major cause of death and disability. Individuals have had to deal with painful injections; inhaled insulin may be beneficial for glycaemic control.The primary objective of this study was, to assess the benefits of inhaled insulin for glycaemic control in insulin-dependent and insulin-resistant patients older than 12 years. ADA website, Cochrane databases, and Medline were searched for randomised clinic trials published in English between 2000 and 2003. Relevant studies were identified and selected for our review and meta-analysis. Data extractions were assessed by two reviewers. Seven randomised control trials were included, involving 1689 participants in total. Four studies included patients with type 1 diabetes and three those with type 2 diabetes. All were open label, comparing inhaled insulin to subcutaneous insulin for the duration of ≥ 12 weeks. There was no difference in the proportion of participants achieving HbA1C ≥7%. The estimated average relative risk was equal to 0.1420 (95% CI: -0.0313 to +0.3154). The results suggest that the benefits in the treatment group is on average 14.2% less than the risk that in the control group. The null hypothesis that the average true effect is equal zero is only marginally rejected (z=1.606, p=0.108), i.e. at about 10% significance level. Statistically, the differences in results were not quite significant, i.e. they lead toward the same conclusion. Therefore, we concluded that there is evidence that Inhaled insulin may offer similar benefits for glycaemic control compared to subcutaneous insulin for patient’s ≥ 12 years-old of age. Further studies are suggested regarding its benefits in diabetes-related acute and chronic events and its effectiveness alone.
Bruno Doiron
University of Texas Health Science Center at San Antonio, USA
Title: Cellular networking, integration and processing in vivo as a reductionism antidote methodology in research to create innovation and discovery in diabetes field
Biography:
Bruno Doiron, PhD is a faculty member at University of Texas Health Science Center at San Antonio. He received his undergraduate degree from University of Moncton, Canada and graduate degrees from University of Montreal, Canada and University of Paris Descartes, Paris, France. As a project leader, he has made major discoveries in the field of gene regulation by nutrients and has 4 patents on the modulation of glucose metabolism as it relates to the treatment diabetes and cancer. He has extensive experience in basic research at the physiologic and molecular levels and in respective applications to the biotechnology field.
Abstract:
Cellular networking, integration and processing (CNIP) represents a novel approach that stands in contradiction to the widely accepted scientific doctrine of one molecule to one cellular control process. Two important distinctions characterize the CNIP approach: First, it is essential to integrate 3 levels of cellular physiology: intracellular carbohydrate metabolism, membrane receptor function, and gene transcription. Second, integration of multiple levels of cellular physiology is essential to produce a synergistic effect on cell function and control, i.e. beta cell formation. Synergy is a key factor whereby multiple molecules work together to produce an effect that is greater than the sum of their individual effects. Decades of assumptions that a complex disease such as diabetes could be understood or treated with the premise of one molecules action or by inadequate animal model and molecular tools considerably slows the advancement of scientific knowledge and innovation in the diabetic field. The scientific community has created inertia to used transgenic, immune-deficiency, knockout mice because it continues to recognize these mouse models as a gold standard for predicting the utility of drugs. CNIP approach is an alternative way to reverse the situations in diabetes research that are lost in translation. Other approaches integrate the complexity of biology as to be created as CNIP for the advancement of science in diabetes research.
Biography:
Marie Wallace has completed her Bachelor’s degree from Smith College and Master’s from The University of Texas at Austin, USA. She manages her own psychotherapy practice where she sees Type 1 diabetic children, adolescents and their families. She also serves as a Specialist on the Transition Team Board for ‘Especially for Children Endocrinology’, helping teenagers’ transition out of pediatric care. She is a type 1 diabetic herself and strives to provide the diabetes community with support and empathy through her work.
Abstract:
“You have Type 1 Diabetes” is not just a life-altering medical diagnosis given (typically) to a young child. That phrase changes a person’s reality, sense of self and vision for the future. Its implications permeate the entire family, social group and social network of the patient. A parent now encounters endless restless nights filled with worry and fear of a low blood sugar. A friend now carries extra glucose tabs and juice in her back pack. A teacher needs to learn the signs of hypo and hyperglycemia. A summer camp has to reject a potential camper because it is not prepared to deal with possible medical issues. A significant other has to learn how to administer glucagon. Each one of these changes heavily impacts the child with Diabetes. The psychological effects of Type 1 diabetes are far-reaching enough to critically alter socio-emotional well-being. Psychotherapy is a crucial component of the diabetes care team, not only for the child with diabetes, but also for the family. The period of adjustment is a difficult and stressful one and can produce long-lasting negative results if not worked through fully and thoughtfully. This talk will discuss the importance of psychotherapy for people with diabetes and their families as well as examine some of the big psychological hurdles and challenges typically caused by type 1 diabetes. I will conclude the talk with observations and deductions from my own case studies to highlight therapy’s role in the management of this disease.
Pranaya Mishra
American University of the Caribbean School of Medicine, Netherlands Antilles
Title: Impact assessment of pharmacist-supervised intervention on health-related quality of life of newly diagnosed diabetics in Nepal: A randomized controlled trial approach
Biography:
Dr. Mishra earned his Ph.D. from the Department of Pharmacology and Pharmacotherapy, the Danish University of Pharmaceutical Sciences, Copenhagen, Denmark and has over 20 years of teaching and research experience in Medical Pharmacology. Dr. Mishra has held numerous faculty positions at universities across the world, including Assistant Professor in the Department of Pharmacology at Manipal College of Medical Sciences, Pokhara, Nepal and Assistant Dean of Student Affairs at Saba University. During his faculty position in Nepal, Dr. Mishra has been involved in teaching Pharmacology in problem-oriented, integrated curriculum of Kathmandu University.
Abstract:
Patients’ knowledge and self-care skills of diabetes are corner stone to improve their health-related quality of life. The study aimed to assess the impact of pharmacist-supervised intervention through pharmaceutical care program on health-related quality of life of newly diagnosed diabetics in Nepal following a non-clinical randomized controlled trial approach.
Materials & Methods: An interventional, pre-post non-clinical randomized controlled trial was conducted among randomly distributed 162 [control (n=54), test 1 (n=54) and test 2 (n=54) groups] newly diagnosed diabetics by a consecutive sampling method for 18 months. An ADDQoL questionnaire investigated patients’ health-related quality of life scores at baseline, three, six, nine and twelve months. Test groups’ patients received pharmaceutical care while control group patients were under physician/nurse’s care. Non-parametric tests i.e., Friedman test, Mann-Whitney U test and Wilcoxon signed rank test were used to find the differences in average weighted impact scores among the groups before and after the intervention (p≤0.05).
Results: Friedman test identified significant (p<0.001) improvement in average weighted impact scores among test groups’ patients. However, differences in scores were significant between test groups at 6-months (p=0.033), 9-months (p<0.001) and 12-months (p<0.001); between control and test 1 groups at 12-months (p<0.001) and between control and test 2 groups at 9-months (p<0.001) and 12-months (p<0.0010) on Mann-Whitney U test.
Conclusions: Pharmaceutical care intervention significantly improved average weighted impact scores of diabetics in test groups compare to control group. This signifies the improvement in health-related quality of life of test groups’ patients and hence describes the pharmacist’s contribution and key role in Nepali healthcare system.
Srinivasa Rao Gadala
National Health Mission, India
Title: Obesity related diabetes in youth: The role of health belief modeling the promotion of healthy eating and exercising
Biography:
Dr Srinivasa Rao Gadala, is a Public Health Specialist, currently working as a Chief Programme Officer, National Health Mission, Telangana State, INDIA since April 2015. He is also an in-charge Joint Director for the programme of Non-Communicable Diseases for the State of Telangana, working on the health & wellness of the people of Telangana state by conducting research & evaluation studies and implementing preventive strategies to prevent cancer, stroke, and cardiovascular diseases including diabetes prevention. Dr Srinivasa Rao Gadala has done his undergraduate course of Bachelors in Medicine & Bachelors in Surgery from one of the India's top most reputed medical institutes named osmania medical college, hyderabad, Andhra Pradesh later pursued his Master’s programme in Social & Preventive Medicine/Community Medicine from the same institute of osmania medical college, hyderabad, andhra pradesh. After pursuing his Maters in Community Medicine, he joined in the Department of Medical & Health in the year 2000, beginning as a Medical Officer, at Blood Bank Units, Municipal Corporation,later as an Officer on Special Duty in the Department of Medical & Health. With the background of Public Health & Community Medicine, Dr Srinivasa Rao Gadala and team is now working on implementing preventive strategies in preventing diseases both communicable & non-communicable diseases rather management/treatment of the diseases. In this process, attending the 9th Diabetologists Conference 2016 would be of a great learning exposure and a platform to learn about the various methods/strategies in preventive diseases like diabetes which is affecting even the pediatric age group apart from the elderly group.
Abstract:
Type 2 Diabetes (T2D) is one of the most common chronic diseases in youth. T2D among youth is emerging as a major health concern. This study investigates the factors contributing to the disease development, severity of the disease and the benefits of and barriers to healthy eating and exercising. The review of literature of health science articles is the method used for this study. The review of literature interprets that childhood obesity; genetic factors and physical inactivity play a major role in the development of T2D. Literature review also investigates that the increased prevalence of T2D parallels the prevalence of childhood obesity. Hence the preventive measures in minimizing the T2D prevalence focus on decreasing the prevalence of risk factors like obesity and physical inactivity through health education based on health belief model. The importance of diet, activity and behavior change approach in preventing T2D among the youth is also emphasized.