Day 2 :
Keynote Forum
Shrouq Mahameed
Ajman University, College of Pharmacy & Health Sciences, 346 ajman, UAE
Keynote: Assessing health literacy of Diabetic Mellitus patients in UAE using validated tools
Time : 10:00AM- 11:00AM
Biography:
Shrouq Mahameed a DAAD scholarship holder who finished MSc in analytical toxicology from the University of Jordan, she has the bachelor degree in pharmacy from Palestine since 2010. She holds several positions such as a licensed pharmacist, research assistant, and lecturer in the Hebron University in Palestine. Shrouq now working in AJMAN UNIVERSITY since 2017 as a researcher in the area of clinical pharmacy practice specialized in Diabetes Mellitus scope.
Abstract:
The purpose of this study to assess health literacy among diabetic patients in UAE to explore the relationship between health literacy and diabetes glycemic control.
Diabetes is an important health problem that affects the quality of life and leads to severe complications such as heart attacks, blindness, and end-stage renal disease. The economic load of prediabetes and diabetes in the UAE estimated to be around US$8.52 billion if the current attitude remain with medical costs swelling to US$1.04 billion by 2020.
Health literacy skills include the ability to read and understand information in documents, the ability to speak and communicate about health-related information; the ability to make suitable health decisions; and the ability to use numeric information for tasks, such as dose, food labels, and blood glucose measurements. These skills are accomplished with more confidence for higher health literacy patients. Thus, patients with inadequate health literacy may not benefit from such educational efforts. Three hundred and fifty patients with diabetes who lives in UAE were administered to validated Arabic version instruments to assess health literacy. Both LAD and DNT scores and HbA1c level were found to be significantly associated with patient literacy (P = .004 and P = .02, respectively). Based on the multivariable model, patients with less than a fourth-grade literacy level had 13% lower DKT scores and 1.36% higher HbA1c levels relative to those with a high school literacy level. Low health literacy was significantly associated with worse glycemic control and poorer disease knowledge in patients with diabetes.
Keynote Forum
Chery Wang
Shengli Oilfield Central Hospital
Keynote: Call for neater team healthcare for patients with diabetic foot
Time : 11:00-12:00PM
Biography:
Cheryl Wang, MD, PhD, earned her MD at Binzhou Medical College, MSc. in Endocrinology and metabolism, internal medicine from Medical School of Shanghai Jiaotong University (formerly Shanghai Second Medical University), PhD in Endocrinology and metabolism, internal medicine at PLA medical college.
She did internship with all specialties at Zibo Central Hospital, internal medicine residency and trained as an Endocrinologist in Donying People’s Hospital, China, did surgery residency at Mount Sinai and Rutgers in the United States.
She was a fellow of obesity at Pennington, of Diabetes at UTHSCSA, of endocrinology at Mayo clinic, of Anesthesia at UB and Columbia Uni, of immunology, surgery, and OB & Gyn at Pitts, of hematology and oncology at UM, a CRC at Cetero, a tech at RIKEN, a RA at UTHSCSA, a translator, medical writer, and editor of Medimedia and many companies, an assistant professor at UB and Pennington, a professor and endocrinologist at Affiliated Hospital of Taishan Medical College. She also had short training at Harvard medical school, Brigham and Women Hospital, Massachusetts General Hospital, Joslin Diabetes Center, Beth Israel Hospital, Boston Children Hospital, MIT, Cleveland Clinic, Cornell, Banner health, SUNY, UB, Ruijin Hospital, Shanghai Institute of Endocrinology and Metabolism, PLA hospital, etc. She is currently a distinguished professor and endocrinologist at Shengli Oilfield Central Hospital.
Abstract:
Regardless of enormous effort we put, diabetic foot remains challenging for physicians, surgeons, scientists, patients, and the society. Diabetic foot is a complicated pathogenesis progress, with nerve, vessels, local pressure, inflammation and infections involved. Better blood sugar control, local debridement, wound care, and tissue regenerative are quite essential for better outcome. Neater team healthcare is essential to prevent leg amputation.
Regular checkup shall be performed by patients themselves on daily basis, by podiatrists on routine visits.
Better diabetes control effort shall be carried by diabetologists, patients, nutrition, diabetic educators and family and social support. Agents softening arteries, blood thinner, anti-platelets, and lipid-lowering may be used on regular basis. Positive attitude and stress management can be practiced by patients, family, psychiatrists, psychologists, activists, social workers.
The local necrotic tissues, infections, inflammation and other insults block the oxygenation and nutrition of the vessels and tissues, and as such prevent the wound from healing. Thorough debridement carried by wound care nurses, surgeons, and practitioners shall lay a whole picture of the patient’s situation, as well as the local blood supply and infections, cautions shall be paid for the direction of tunnels and oozing to make sure excessive discharge drained well, to offer a fresh, better oxygenated, and relatively healthier setting that promotes the growth of new tissues and vessels. Tips like avoiding pressure/weight on the foot, elevation of the lower limbs, comfort and fit footwear and shoes, regular self-checking of the feet with/without mirror shall reminded and urged by patients themselves, the family, nurses and physicians. Vascular surgeons may do their best to reconstruct the blood supply. Orthopedic surgeons may take effort to salvage as neat as possible.
Stem cell bioengineering can be applied for tissue and vessel regeneration after the debridement, with a nice scientific team work consist of bioengineers, cell scientists, immunologists, bioconduct companies, pharmacists, physical therapists, experts for regenerative medicine etc. Mesenchymal derived stem cells (MDSC) and adipocytes derived stem cells (ADMS) can be autologous or endogenous. Endogenous stem cells and tissue-engineered implant can be applied with immunopression with scalable tech using biconstruct transplantation. Exosome from stem cells culture media is found rich in MALAT1 that is essential for wound healing. Local injection of neural growth factor (NGF), TPO, soluble stem cell recruitment factors (SDF-1), inflammation-modulators, progenitors, nitrate oxide (NO), hypoxia indicible factor (HIF-1a) can promote the growth of vessels, angiogenesis, and the regeneration of the tissues. Local light energy can also be used for better outcome.
No man can move the mountain along. With neater team healthcare, not only it will benefit diabetic foot, but wound care and regenerative medicine of any kind.
- Diagnosis of diabetes
Session Introduction
Oyebola Oluwagbemiga Sonuga
Benjamin S. Carson (Snr.) School of Medicine, Babcock University Teaching Hospital, Ilishan-Remo, Nigeria.
Title: Insulin resistance index and pro-atherogenic lipid indices in offspring of people with diabetes
Biography:
Dr Sonuga completed his MBBS at the age of 26 years, had his MSc degree in Chemical Pathology at University of Ibadan, Nigeria. He is a Fellow of West African College of Physicians (Laboratory Medicine) and a member of Association of Pathologists of Nigeria. He was a former Medical Officer at the Emergency Department, University College Hospital, Ibadan. Nigeria. He is presently a Lecturer and Hospital Consultant at Benjamin Carson School of Medicine, BABCOCK UNIVERSITY, Nigeria. His area of research interests are prevention and management of type II diabetes mellitus in young adults and cardiovascular diseases.
Abstract:
Diabetes mellitus and cardiovascular diseases significantly contribute to the medical morbidity and mortality worldwide, especially in developing countries like Nigeria. Insulin resistance, a characteristic finding of type 2 diabetics and their offspring is associated with abnormal lipid metabolism and cardiovascular disease. Aims: This study therefore aims to determine the pattern of lipid biomarkers of atherogenesis and their relationship with insulin resistance index in young people with family history of diabetes mellitus. Methods: This is a cross-sectional study carried out among 150 apparently healthy young adults between 18 to 25 years of age; 76 with family history of diabetes mellitus in first and or second degree relatives (YWFH) and 74 with no family history of diabetes mellitus (YWoFH). Anthropometric characteristics, insulin resistance index, plasma glucose, fasting lipid profile ( plasma TC, TG, HDL-C, LDL-C) and serum levels of insulin, Lp(a), ApoB, ApoA-1 and ApoB/ApoA-1 ratios were compared in the two groups and all parameters were determined using standard methods. Statistical analysis was performed using SPSS version 20.0. Results: Offspring of diabetics (YWFH) have significantly higher median BMI [p=0.015], WHR [p=0.002], IRI [p=0.038], TC [p=0.017], TG [p=0.004], Lp(a) [p=0.045], ApoB [p=0.002] and ApoB/ApoA-1 ratio [p=0.001], than their age-matched control group with no family history of diabetes mellitus (YWoFH). There is no correlation between insulin resistance index and each of the lipid biomarkers of atherogenesis except with Lp(a), with which it is negatively correlated. Conclusion: This study has demonstrated that a positive family history of type 2 diabetes mellitus is associated with higher insulin resistance index and elevated atherogenic lipid indices; thus a positive family history of diabetes mellitus in first or second degree relatives when the index person is not diabetic confirms a significant cardiovascular risk.
Oyebola Oluwagbemiga Sonuga
Benjamin S. Carson (Snr.) School of Medicine, Babcock University Teaching Hospital, Ilishan-Remo, Nigeria.
Title: Insulin resistance index and pro-atherogenic lipid indices in offspring of people with diabetes
Biography:
Dr Sonuga completed his MBBS at the age of 26 years, had his MSc degree in Chemical Pathology at University of Ibadan, Nigeria. He is a Fellow of West African College of Physicians (Laboratory Medicine) and a member of Association of Pathologists of Nigeria. He was a former Medical Officer at the Emergency Department, University College Hospital, Ibadan. Nigeria. He is presently a Lecturer and Hospital Consultant at Benjamin Carson School of Medicine, BABCOCK UNIVERSITY, Nigeria. His area of research interests are prevention and management of type II diabetes mellitus in young adults and cardiovascular diseases.
Abstract:
Diabetes mellitus and cardiovascular diseases significantly contribute to the medical morbidity and mortality worldwide, especially in developing countries like Nigeria. Insulin resistance, a characteristic finding of type 2 diabetics and their offspring is associated with abnormal lipid metabolism and cardiovascular disease. Aims: This study therefore aims to determine the pattern of lipid biomarkers of atherogenesis and their relationship with insulin resistance index in young people with family history of diabetes mellitus. Methods: This is a cross-sectional study carried out among 150 apparently healthy young adults between 18 to 25 years of age; 76 with family history of diabetes mellitus in first and or second degree relatives (YWFH) and 74 with no family history of diabetes mellitus (YWoFH). Anthropometric characteristics, insulin resistance index, plasma glucose, fasting lipid profile ( plasma TC, TG, HDL-C, LDL-C) and serum levels of insulin, Lp(a), ApoB, ApoA-1 and ApoB/ApoA-1 ratios were compared in the two groups and all parameters were determined using standard methods. Statistical analysis was performed using SPSS version 20.0. Results: Offspring of diabetics (YWFH) have significantly higher median BMI [p=0.015], WHR [p=0.002], IRI [p=0.038], TC [p=0.017], TG [p=0.004], Lp(a) [p=0.045], ApoB [p=0.002] and ApoB/ApoA-1 ratio [p=0.001], than their age-matched control group with no family history of diabetes mellitus (YWoFH). There is no correlation between insulin resistance index and each of the lipid biomarkers of atherogenesis except with Lp(a), with which it is negatively correlated. Conclusion: This study has demonstrated that a positive family history of type 2 diabetes mellitus is associated with higher insulin resistance index and elevated atherogenic lipid indices; thus a positive family history of diabetes mellitus in first or second degree relatives when the index person is not diabetic confirms a significant cardiovascular risk.
Tigist W. Leulseged
Department of Internal medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
Title: Time to optimal glycemic control and prognostic factors among Type2 Diabetes Mellitus patients in Public Teaching Hospitals in Addis Ababa, Ethiopia
Biography:
Tigist W. Leulseged is a medical doctor and public health specialist currently working as a lecture at Endocrinology unit under Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College in Addis Ababa, Ethiopia. Her research interests are chronic illnesses particularly diabetes epidemiology including gestational diabetes, treatment, patient involvement in effective management and quality of services provided. She has experience in related research areas in both hospitals and teaching institutions.
Abstract:
Background: Diabetes is a chronic, progressive disease characterized by elevated levels of blood glucose. Poorly managed diabetes leads to serious complications and early death. The prevalence of diabetes has been increasing over the past few decades. Ethiopia is one of African countries with the highest number of people living with diabetes. Studies conducted in Ethiopia and other countries mainly focused on level of glycaemic control at one point in time. Studies targeting the time that a patient stayed in a poor glycaemic level are lacking.
Objectives: To estimate time to first optimal glycaemic control and to identify prognostic factors among type 2 diabetes mellitus (T2DM) patients in public teaching hospitals in Addis Ababa, Ethiopia.
Methods: A hospital based retrospective chart review study was conducted from April to July 2018 at diabetes clinic of Addis Ababa’s public teaching among randomly selected sample of 685 charts of T2DM patients who were on follow up from January 1 2013 to June 30 2017. Data was collected using pretested data abstraction tool. Data was checked, coded and entered to Epi-Info V.7.2.1.0 and exported to SPSS V.23.0 and STATA V.14.1 for analysis. Descriptive statistics is presented with frequency tables, Kaplan Meier plots and median survival times. Association was done using Log-rank test and Cox proportional hazard survival model, where hazard ratio, P-value and 95% CI for hazard ratio were used for testing significance and interpretation of results.
Results: Median time to first optimal glycaemic control among the study population was 9.5 months. The major factors that affect it are age group (HR=0.635, 95% CI: 0.486-0.831 for 50-59 years, HR=0.558, 95% CI: 0.403-0.771for 60-69 years and HR=0.495, 95% CI: 0.310-0.790 for >=70 years), diabetes neuropathy (HR=0.502, 95% CI: 0.375-0.672), more than one complication (HR=0.381, 95% CI: 0.177-0.816), hypertension (HR=0.611, 95% CI: 0.486-0.769), dyslipidemia (HR=0.609, 95% CI: 0.450-0.824), cardiovascular disease (HR=0.670, 95% CI: 0.458-0.979) and hospital patient treated at (HR=1.273, 95% CI: 1.052-1.541).
Conclusions: Median time to first optimal glycaemic control among T2DM patients is longer than expected which might imply that patients are being exposed to more risk of complication and death.
Biography:
The author received an honorable PhD in mathematics and majored in engineering at MIT. He attended different universities over 17 years and studied seven academic disciplines. He has spent 20,000 hours in T2D research. First, he studied six metabolic diseases and food nutrition during 2010 to 2013, then conducted his own diabetes research during 2014 to 2018. His approach is “quantitative medicine” based on mathematics, physics, optical and electronics physics, engineering modeling, signal processing, computer science, big data analytics, statistics, machine learning, and artificial intelligence. His main focus is on preventive medicine using prediction tools. He believes that the better the prediction, the more control you have.
Abstract:
Introduction:
This paper discusses glucose measurement results and their impact on health from two different methods, finger piercing and testing strip (Finger) and a continuous glucose monitoring system (Sensor).
Method:
The author has been collecting a total of 9,490 glucose data by finger measurement, including both fasting plasma glucose (FPG) once a day since 1/1/2014 (1,825 days) and postprandial plasma glucose (PPG) three times a day since 1/1/2012 (2,555 days).
Recently, he has further collected 19,280 glucose data by applying a sensor on his upper arm to collect his glucose values continuously. This sensor measurement is conducted in parallel with his routine finger measurements. During the period of 5/5/2018 to 12/13/2018 (223 days), he has collected and recorded his glucose values about 70 times per day. The measurement rate is approximately every 15 minutes during the day and every hour during the night. In summary, he has collected a total of 15,655 glucose data and 892 waveforms (223 FPG and 669 PPG). Other waveforms generated between meals or from eating snack/fruit are not included in this analysis.