Day 2 :
University of Nevada, USA
Time : 9:30-10:10
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.
CVD 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.
Bangabandhu Sheikh Mujib Medical University, Bangladesh
Keynote: Gestational diabetes and postpartum persistence of glucose abnormality, ethnic variability: Bangladesh perspective
Time : 10:10-10:50
M A Hasanat has completed his studies from Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh. Presently he is a Chairman of Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. He has published about 50 original articles in reputed journals and presented papers at national and international level. He is also a Member of Editorial Board of American Research Journal of Endocrinology.
Variation in prevalence of gestational diabetes mellitus (GDM) among different ethnic groups imposes the need for universal screening and investigation of risk factors. According to International Diabetes Federation (IDF), South-East Asia has the highest prevalence of hyperglycemia in pregnancy (24.2%). Unlike others, an alarming frequency of GDM in Bangladeshi population has been observed recently which were as high as 36.6% and 40.9% by ‘WHO’ 1999 and ‘WHO’ 2013 diagnostic criteria respectively. Genetic predisposition may be responsible for this. We noticed higher frequency of rs7903146 polymorphism of TCF7L2 in Bangladeshi GDM mothers having relatively lower age and body mass indexes (BMI). Advanced maternal age, high BMI and family history of diabetes were found to be important risk indicators of GDM. Moreover, we observed high frequency (50%) of postpartum persistence of abnormal glucose tolerance (AGT) in women with glucose abnormality in pregnancy. AGT in early gestation, use of insulin during pregnancy, higher maternal age and BMI were predictors for it. Recently, another study found 22% persistence of AGT at postpartum in GDM (excluding DM in pregnancy, DIP). Of pregnancy outcome, premature rupture of membrane was significantly higher in GDM whereas incidence of vaginal candidiasis was higher in non GDM mothers. Neonatal hypoglycemia and hyperbilirubinemia were higher in GDM mothers though not significant. High prevalence of postpartum persistence of AGT reinstates the fact that our ethnicity as South-East Asian confers the greatest risk of diabetes mellitus (DM) among our pregnant and post-pregnant mothers which may be considered as an extrapolation of the ‘thrifty phenotype’. In conclusion, multinational broad based comparative studies are needed to explore the genetic predisposition and risk factors for GDM among the ethnic groups of different countries.