11^th Diabetologists Conference & Drug Market Summit May 23-24, 2018 New York, USA

The Diabetic Complications chiefly includes injurious effects of hyperglycemia which are primarily separated into macro vascular complications and micro vascular complications. Macro vascular complication chiefly includes retinopathy and micro vascular includes neuropathy. Diabetic retinopathy is also the foremost common micro vascular complication of diabetes. It is responsible for ? 10,000 new cases of blindness every year in the United States alone. The risk of developing diabetic retinopathy or other micro vascular complications of diabetes depends on both the duration and the severity of hyperglycemia. Diabetic nephropathy is the leading cause of renal failure in the United States. It is defined by proteinuria > 500 mg in 24 hours within the setting of diabetes; however this can be preceded by lower degrees of proteinuria, or “micro albuminuria.

everal gene mutations have been linked to the development of type 2 diabetes. These gene mutations can interact with the environment and each other to further increase your risk. Type 2 diabetes is caused by both genetic and environmental factors.
Scientists have linked several gene mutations to a higher diabetes risk. Not everyone who carries a mutation will get diabetes. But many people with diabetes do have one or more of these mutations.
It can be difficult to separate genetic risk from environmental risk. The latter is often influenced by your family members. For example, parents with healthy eating habits are likely to pass them on to the next generation. On the other hand, genetics plays a big part in determining weight.
Mutations in any gene involved in controlling glucose levels can increase your risk of type 2 diabetes. These include genes that control:

·         production of glucose

·         production and regulation of insulin

·         how glucose levels are sensed in the body

Diabetic retinopathy is caused by changes in the blood vessels of the retina, the thin, light-sensitive inner lining in the back of your eye. This damage, called retinopathy, occurs to small blood vessels in the retina, which are easily harmed by high levels of glucose in the blood. There are two stages of diabetic retinopathy—an initial stage, which is called nonproliferative retinopathy, and a more serious stage called proliferative retinopathy, in which there is a greater risk of hemorrhage into the vitreous or detachment of the retina leading to severe vision loss. Another condition, called diabetic macular edema, can occur with either stage.
In the early nonproliferative stage, high levels of blood glucose cause damage to the blood vessels in the retina. They actually can leak fluid, which can collect and cause the retina to swell. If fluid collects in the central part of the retina (macular edema), blurred vision may occur. Macular edema can be treated with laser surgery when central vision is threatened.
A more dangerous stage of eye disease from diabetes is proliferative retinopathy. During this stage, abnormal blood vessels grow over the surface of the retina. These fragile blood vessels may rupture and bleed into the vitreous humor, the clear gel that fills the center of the eye. With vitreous hemorrhage, the blood blocks the passage of light to the retina and loss of vision or even blindness may occur. A further problem can occur when these blood vessels cause scar tissue, which may pull on the retina and cause it to become detached from the back of the eye. About half of the people with proliferative retinopathy also have macular edema. Proliferative diabetic retinopathy can also be treated with laser surgery to preserve vision and reduce the risk of severe vision loss to less than 5%.  Additionally, vitreous hemorrhage that does not resolve, or scar tissue causing traction on the retina, can be removed by a surgical procedure called vitrectomy.

Diabetes causes injury to small blood vessels in the body.
When the blood vessels in the kidneys are injured, your kidneys cannot clean your blood properly. Your body will retain more water and salt than it should, which can result in weight gain and ankle swelling. You may have protein in your urine. Also, waste materials will build up in your blood.
Diabetes also may cause damage to nerves in your body. This can cause difficulty in emptying your bladder. The pressure resulting from your full bladder can back up and injure the kidneys. Also, if urine remains in your bladder for a long time, you can develop an infection from the rapid growth of bacteria in urine that has a high sugar level.
About 30 percent of patients with Type 1 (juvenile onset) diabetes and 10 to 40 percent of those with Type 2 (adult onset) diabetes eventually will suffer from kidney failure.
The earliest sign of diabetic kidney disease is an increased excretion of albumin in the urine. As your kidneys fail, your blood urea nitrogen (BUN) levels will rise as well as the level of creatinine in your blood which causes nausea, vomiting, a loss of appetite, weakness, increasing fatigue, itching, muscle cramps (especially in your legs) and anemia (a low blood count).

Type 1 diabetes results from the destruction of insulin-producing cells in the islets of the pancreas. Islet cell transplantation involves extracting islet cells from the pancreas of a deceased donor and implanting them in the liver of someone with Type 1. This minor procedure is usually done twice for each transplant patient, and can be performed with minimal risk using a needle under local anaesthetic. Islet transplants have been shown to reduce the risk of severe hypos. Results from UK islet transplant patients showed that the frequency of hypos was reduced from 23 per person per year before transplantation to less than one hypo per person per year afterwards.

Islet transplants usually also lead to improved awareness of hypoglycaemia, less variability in blood glucose levels, improved average blood glucose, improved quality of life and reduced fear of hypos. Long-term results are good and are improving all the time. For example, the majority of transplant patients can now expect to have a functioning transplant after six years and some people have had more than 10 years of clinical benefit.

Post-transplantation diabetes mellitus (PTDM), also known as new-onset diabetes mellitus (NODM), occurs in 10–15% of renal transplant recipients and is associated with cardiovascular disease and reduced lifespan. In the majority of cases, PTDM is characterized by β-cell dysfunction, as well as reduced insulin sensitivity in liver, muscle and adipose tissue. Glucose-lowering therapy must be compatible with immunosuppressant agents, reduced glomerular filtration rate (GFR) and severe arteriosclerosis. Such therapy should not place the patient at risk by inducing hypoglycaemic episodes or exacerbating renal function owing to adverse gastrointestinal effects with hypovolaemia.

Pediatrics is the field of medicine that is concerned with the health of infants, children, and adolescents; their growth and development; and their chance to attain full potential as adults. General medicine includes the essential treatments concerned for the betterment of pediatric health. The most significant problems can be due to nutritional deficiencies to the overall health of infants and kids as a result of growth and development is seriously hindered by shortages in essential vitamins or nutrients. The aim of the study of pediatrics is to reduce infant and child rate of deaths, management the unfold of communicable disease, promote healthy lifestyles for a long disease-free life and help ease the problems of children and adolescents. It can be acknowledged that this can be reached by learning the major and primary subject on Pediatrics.

There is wide research going on in the field of cure, prevention and management of Diabetes. Researchers are trying to develop therapies and drugs which should not create any side effects to the patients of Diabetes. New researches are opening the help door for patients having rare form of Diabetes too for e.g. Diabetes caused by single gene mutations which is called as “monogenic” form of diabetes. They have also created insulin patches that imitated the body’s beta cells by both sensing blood glucose level and releasing insulin. Many more researches are going on in the field of Diabetes i.e. Diabetes –depression connection, very low effort muscular activity and Diabetes risk and aerobic exercise improve brain function for people with prediabetes.

Heart disease is a complication that may affect people with diabetes if their condition is not managed well for a prolonged period of time.Coronary heart disease is recognized to be the cause of death for 80% of people with diabetes; however, the NHS states that heart attacks are largely preventable. People suffering from type 1 and type 2 diabetes are more likely to be at risk from heart attacks, strokes and high blood pressure. Vascular problems, such as poor circulation to the legs and feet, are also more likely to affect diabetes patients. Like diabetes itself, the symptoms of cardiovascular disease may go undetected for years.

There can be many types of diseases associated with skin which can be caused by diabetes:

• Necrobiosis Lipoidica
• Acanthosis Nigricans
• Cutaneous Infections associated with DM
• Granuloma Annulare
• Diabetic Bullae
• Diabetic Dermopathy (shin spots)

Like Diabetic Dermopathy occur in up to 40% of people with diabetes. It is the most common cutaneous manifestation of diabetes (not pathognomic.) In these initial dull red papules, 0.5-1cm in diameter appears and are Generally bilateral and asymptomatic.

The supervision of diabetes has been resolutely grounded in scientific advances that endure to stipulate our understanding of the pathophysiology of diabetes and direct our selection in selecting optimal therapies for type 1 and type 2 diabetes. Common risk factors or symptoms of Diabetes include increased weight, blood pressure, cholesterol and triglyceride (blood fat) levels. The main goal of diabetes management is, as far as possible, to restore carbohydrate metabolism to a normal state. To achieve this goal, individuals with an absolute deficiency of insulin require insulin replacement therapy, which is given through injections or an insulin pump. Research on Insulin is extensively discussed in National Diabetes Conference and Diabetes associations

Endocrinology can be defined as a branch of biology that mainly deals with the study of endocrine system and related functions, secretions and diseases. Endocrine contains various glands. Every gland has its own secretion, known as hormone that performs specific functions.
Clinical endocrinology is a branch of medical sciences that involves the diagnosis, cure, prevention and treatment of irregular secretion and modified action of hormones. Molecular endocrinology, basically deals with the study of various functions of hormones secreted by different glands, at molecular level.
Molecular and Cellular Endocrinology focuses on molecular and cellular mechanisms in endocrinology by including: gene regulation, cell biology, signaling, mutations, transgenics, hormone-dependant cancers, nuclear receptors. Basic and pathophysiological studies at the molecule and cell level are considered.

The concept of and new discovery and emerging therapies like  reverse diabetes for the treatment of diabetes has expanded in recent years. There is a lot of latest research on diabetes happening and elaborated at IDF diabetes 2016 and the latest includes some very rare forms of diabetes which are caused by single gene mutations. They are called "monogenic" forms of diabetes and new research is opening the door to specific treatments for these patients. With the advanced  type1 diabetes treatment  various devices e.g. insulin pumps which is used for the administration of insulin , rapid HbA1c monitoring, insulin pen, biomarkers, biostator, artificial pancreas and etc. are formed for the treatment. Number of innovation and treatment are increasing with the increase in research work by Research and development department in various sectors and endocrinology is getting treatment with these devices. Continuous Glucose Monitoring (CGM) is a relatively new technology which has the potential to assist people living with type 1 or type 2 Diabetes and treated with insulin to achieve the goal of optimum control of blood glucose. This will remove the diabetes cholesterol.