Day 1 :
Arabian Gulf University, Bahrain
Amer Kamal Al Ansari was graduated from Basrah University/ College of Medicine in 1978; he received his Ph.D. in neurophysiology in 1986 from Lauvain University/ College of medicine. He worked in the University of Utrecht in the Netherlands as a senior researcher and University docent for about 20 years, and then joined the Arabian Gulf University/ College of Medicine and Medical Sciences staff in Bahrain. In addition to his teaching responsibilities, he worked as a consultant doctor in the Bahrain Defense Force hospital for the last 6 years. His research field belongs to electrophysiology of hippocampus, learning and memory, behavioral studies ageing and Diabetes mellitus.
The aim of this study was to determine whether EPO administration protects against the impairment of cognitive function and motor performance, as well as degenerative changes in the hippocampus, associated with long-term diabetes. Twelve male BALB/c mice aged 5-7 weeks (20-25g) were administered streptozotocin i.p. (STZ) 55mg/kg/day for 5 days. Diabetic mice were then randomly assigned to either control (i.e. sodium citrate buffer i.p.) (n=6), or EPO treatment 5U/g/day (dissolved in sodium citrate buffer; i.p.) (n=6), three times per week for a period of 10 weeks starting the day after the first administration of STZ. An additional group of six mice served as normal controls. At the end of the treatment period, cognitive performance was assessed in Morris water maze. Mice were killed by overdosing with ether and decapitated. The brains were processed for light microscopic evaluation of CA1, CA3 and dentate gyrus (DG) regions of the hippocampus, staining was with haemotoxylin-Eosin and cresyl violet (for Nissl granules). In the water maze, control animals showed improvement in escape latency and distance swam over the five days. There was a similar trend for the EPO-treated diabetics although this was not significant. By contrast, diabetics showed a deterioration in escape latency. There were evidence of neurodegeneration in all regions of the hippocampus of diabetic animals as well as a reduction in numbers of granule cells in the DG; these effects were reduced in EPO-treated diabetics. In conclusion, chronic EPO-treatment is protective against cognitive deficits and hippocampal neurodegeneration in diabetic mice.
cardiac exercise specialist, Ireland
Neil is a qualified British Association of Cardiovascular Rehabilitation "cardiac exercise specialist", personal trainer, fitness blogger and an online coach.
Neil took an interest in cardiovascular health and rehabilitation. Neil took his education to the next level earning a Master of Science in Cardiovascular Health and Rehabilitation from the University of Chester. Neil started blogging in mid-2017 while studying his master’s degree and was awarded the "Best Fitness Blogger" 2019 by the Irish Fitness Industry for his expertise knowledge and amazing life-changing results and testimonials from clients.
In this modern up to date world health care professionals are unable to provide any information to diabetic patients that concerned with their mental health. A diabetic patient suffering mentally too so there must be some counselling sessions that help diabetic patient to revive its mental health and it is important to comforting a diabetic person. Such individuals trapped into the situation of persistent stress and disappointment because of continuous problems of blood glucose. This lifelong disease disheartened persons and negatively affect patient care, putting them into mental trap of negative thoughts like diabetes is incurable disease, no good can come from it. Unaware of facts that how chronic diabetes mentally can be and what complications it going to cause next, the entire attention of doctors is on altering doses. A personal health monitoring diary of stress and glucose levels can be helpful in finding a pattern and in establishment of correlation between elevated glucose levels and raised stress levels.
Diabetes has its positive aspects too that makes you quite different from others such as this disease becomes you more self dependent and tough. A diabetic patient must set its target of fighting with diabetes and not put down by this disease. Diabetic goal of life is how harder the circumstances are how much blood pressure, cholesterol and HbA1c are bothering, I can cope up with all the situation, I am the one and I can turn it around. This is all about to accept your weaknesses and turn it into you strength. More a diabetic have to do a strict eye on its routine of life such as right diet intake, proper exercise and sleep requirements necessary for health. At last not cut off yourself from people just because you are diabetic, build up your social connection and spend prosperous time with people surrounds you. Maybe you have the ability to turn someone's life.
Shiraz University of Medical Sciences, Iran
Jalali is an Iranian nutritionist, which receive honorary doctorate as health education at the age of 20 years old and also has a traditional medicine certificate from Shiraz University of Medical Sciences with score 100. He is a member of Nutrition Research Center of Shiraz, Iran. He is specifically working on functional foods and nutraceuticals that can improve various metabolic disorders, and has obtained significant outcomes regarding important biomarkers. He also eminence in the field of meta-analysis studies.
Statement of the Problem: Diabetes mellitus is a complicated and metabolic disorder characterized by an increase in blood glucose level as a result of insulin resistance, impairment in insulin release, or both. In 2013, it had reported that 382 million people had type 2 diabetes mellitus (T2DM) worldwide and this number is expected to reach 592 million in 2035. However, in some studies cinnamon proved useful to treat T2DM, some others did not find a favorable effect. A present systematic review and meta-analysis aimed to provide more robust evidence on the use of cinnamon for treating T2DM.
Methodology & Theoretical Orientation: A systematic search was undertaken in PubMed, Embase, Scopus, Web of Sciences and Cochrane Library to identify clinical trials examining the effect of cinnamon supplementation on type 2 diabetic patients up to 9 August 2019. In the case of heterogeneity among studies, fixed or random effects models were done to calculate standardized mean difference (SMD) and its 95% confidence interval (CI).
Findings: After excluding nonrelated records, 14 full-text articles included to this meta-analysis. This study found a significant reduction in Fasting blood sugar (FBS) (SMD: -0.472 mg/dl, 95% CI: [-0.791, -0.153], P = 0.004), serum triglyceride (TG) (SMD: -0.538 mg/dl, 95% CI: [-0.933, -0.143], P = 0.008), total serum cholesterol (SMD: -0.580 mg/dl, 95% CI: [-1.080, -0.080], P = 0.023) and increase in high-density lipoprotein (HDL) (SMD: 0.167 mg/dl, 95% CI: [0.014, 0.320], P = 0.032). In addition, dose-based subgroup analysis indicated significant reduction in HbA1c, serum insulin and low-density lipoprotein (LDL). Also, no publication bias was found.
Conclusion & Significance: Cinnamon supplementation significantly improved FBS, TG, total serum cholesterol and HDL, with subgroup analysis highlighting improvements in HbA1c, serum insulin and LDL.
1Guy’s & St Thomas’ NHS Trust, UK
Giulia Rinaldi is an academic foundation doctor at St. Thomas’ Hospital in London. She has an interest in cost-effectiveness analysis and completed the MSc Global Health & Development at University College London.
Statement of the Problem: Type 2 Diabetes Mellitus (T2DM) is a chronic disease associated with insulin resistance and hyperglycaemia. Due to an ageing population and the increasing incidence of obesity, the prevalence of T2DM continues to rise. Simultaneously, technology has contributed to the rise of MHealth interventions for the prevention, monitoring and management of T2DM. The aim of this systematic review is to summarize and evaluate the quality of the published evidence on cost and cost-effectiveness of mHealth interventions for T2DM.
Methodology: A systematic literature search of PubMed, EMBASE, and Web of Science was conducted for papers up to end of April 2019. We included all partial or full economic evaluations providing cost or cost-effectiveness results for mHealth interventions targeting individuals diagnosed with, or at risk of, T2DM.
Findings: Overall 23 studies that met the inclusion criteria were identified. Eight of these were full economic evaluations and fifteen were partial economic evaluations. All the included interventions were reported as being low cost and all the cost-effectiveness ratios costed less than the GDP per capita of the country. Eighteen of the included studies were from high income country, five were from middle income countries and none were from low income countries. The quality of partial economic evaluations was on average lower than that of full economic evaluations.
Conclusion & Significance: Overall, mHealth interventions for T2DM are shown to be low cost or cost-effective. Higher quality partial economic evaluations and more full economic evaluations are warranted to further explore costs amongst different population demographics.
St. Paul Hospital Millennium Medical College, Ethiopia,
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.
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.188.8.131.52 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.
National Children’s Hospital, Philippines
Rinah Elaisse Dolores has completed her MD-MBA at the age of 27 years from Ateneo School of Medicine and Public Health. She is currently a 1st year pediatric resident at National Children’s Hospital in Manila, Philippines.
Statement of the Problem: Familial partial lipodystrophy of the Dunnigan type is a rare autosomal dominant disorder. It is frequently unrecognized, with no firm diagnostic criteria established. This case report aims to improve the clinical suspicion as well as to discuss the pathophysiology as well as review the current knowledge, trends and issues surrounding the diagnosis and treatment of lipodystrophy.
Methodology & Theoretical Orientation: We examined a suspected case of lipodystrophy in a 10-year old child. Patient underwent a series of diagnostic and laboratory work-up. Genetic analysis was also done. Literature was reviewed regarding the diagnosis and management of lipodystrophy, particularly in the pediatric population.
Findings: This is a case of a 10-year-old Filipino diabetic female with a history of persistently elevated blood glucose. On physical examination, she demonstrated loss of subcutaneous tissue in the extremities and gluteal area, with accumulation of fat on the face, neck and abdominal area. Further work-up revealed hyperinsulinemia with insulin resistance, dyslipidemia and focal fat infiltrated areas in the left liver lobe. Dual-energy x-ray absorptiometry showed a higher percentage of fat tissue in the trunk compared to the extremities. High-resolution chromosomal analysis revealed a normal female chromosome complement in all cells examined.
Conclusion & Significance: Diagnosis of lipodystrophy is primarily based on history, physical examination, body composition and metabolic status. More often than not, it can lead to misdiagnosis with metabolic syndrome, diabetes or Cushing syndrome. This case highlights the importance on the awareness of the triad of lipodystrophy followed by careful clinical assessment of fat distribution. This leads to earlier detection hereby preventing further complications.
Canakkale Onsekiz Mart University, Turkey
Cagla Cakaloglu is a master student in neuroendocrinology. The model organism in her study is photoperiodic animals such as Syrian hamster. The thesis that she works is ‘Effects of lavender (Lavandula angustifolia) extract on melatonin and testosterone levels and testicular composition in Syrian hamsters (Mesocricetus auratus)’. The results of the thesis will allow the benefit of such medical plants.
Statement of the Problem: Diabetes mellitus, known as chronic hyperglycemia and resulted from insulin deficiency, is a metabolic ailment. Diabetes disorders are related to long-term damages, such as dysfunction and shortness of eyes, nerves, heart and kidneys. Plants have generally used for traditional medicine to treat various diseases. Lavandula angustifolia is an important herb for alternative medicine. L. angustifolia essential oil is utilized to protect from various diabetes symptoms, such as increased blood sugar level (BGL), metabolic disorders, liver and kidney diseases, which are resulted from diabetes. The aim of the study is to investigate the effects of L. angustifolia ethanolic extracts on BGL of male Syrian hamster (Mesocricetus auratus). Methodology & Theoretical Orientation: L. angustifolia plant was purchased from the local herbalist in Çanakkale. The flower parts of the plant were extracted. The obtained extracts were dissolved in saline solution. The animals, used in this study, were divided into two groups, control and experimental. L. angustifolia extract doses were injected to experimental animals intraperitoneally for 20 days, one dose per day. Blood samples were taken from all animals on the 10th and 20th days and the blood sugar values were measured by commercial kit. Findings: The results of this study was summarized in figure 2. The L. angustifolia extract increased on BGL on the 20th day. Conclusion & Significance: L. angustifolia essential oils and extracts are utilized for the treatment of various diseases. These oils and extracts are also used as complementary medicine for the treatment of diabetes. The BGL is indicating diabetes disorder. However, there are little researches about the effect of L. angustifolia oil and extracts BGL. Our result indicates that L. angustifolia flower extracts increase BGL. Therefore, due to its effect on glucose level in long-term use of L. angustifolia should be considered.
Akdenız Universıty, Turkey
Zeynep Avcil is a Ph.D. student in department of clinical Biochemistry. She has her expertise in diabetes and obesity.
Objective: Type 2 diabetes (T2DM) is a metabolic disease characterized by hyperglycemia which results from insulin resistance and relative insulin secretion. Insulin inhibits hepatic glucose production, stimulates glucose uptake in cells, and inhibits lipolysis in adipose tissue . When insulin resistance develops, this metabolic process is damaged which causes ectopic fat accumulation. Insulin signaling is mainly controlled by hormones and nutrient-sensitive signaling pathways and pro-inflammatory signals [2, 3]. Accumulating evidence suggests that n-3 PUFA, especially eicosapentaenoic acid (EPA), is known to increase insulin sensitivity in diabetic animal models [4, 5]. However, the molecular mechanism of omega-3 in reducing insulin resistance has not yet been fully elucidated. The aim of the present study was to evaluate for the first time the direct potential anti-diabetic effect of EPA on AdipoR1 and T-cadherin in liver.
Method: We examined the anti-diabetic effect of EPA on adiponectin receptors (T-cadherin, AdipoR1) in normal diet (ND), high-fat diet (HFD), and HFD-low dose STZ-induced T2DM rats.
Results: EPA supplementation was found to alleviate AdipoR1 mRNA level of Rat fed with ND and T2DM rats. Our results suggest that, at least in rat liver EPA supplementation ameliorated their hyperglycemia by increased activity of Adiponectin/AdipoR1 signaling pathways. We also found that T-cadherin levels were increased in response to EPA treatment in HFD fed Rats liver. This result suggests that EPA/T-cadherin balance may be an important predictor of the risk of developing HFD-induced abdominal obesity and obesity-related diseases.
Conclusion: Taken together, these observations support the hypothesis that EPA exerts an antidiabetic effect in ND-fed rats and T2DM rats, possibly through its action on Adiponectin/AdipoR1 signaling pathway. In addition to its anti-diabetic effects, EPA may contribute to improving HFD-induced obesity-related diseases by increase T-cadherin levels. These results need to be confirmed with further research.
Imperial College London, United Kingdom
Sharan and Mubarak are current third year medical students at Imperial College London. They are interested in teaching and research, particularly in the fields of public health, with a focus on diabetes and cardiovascular disease. Sharan has carried out previous research in improving adherence to cardiovascular medications and has developed an interactive app prototype to target this problem. Mubarak has also carried out previous research, investigating the eﬀects of point-of-care C-Reactive Protein testing on the length of stay of paediatric A&E patients. They hope to develop new methods to target public health problems within the community setting, as they have done with their current research in investigating the potential for focus group sessions in general practice, with the aim to improve medication adherence and to reduce the potential for any disease-specific complications.
Statement of the Problem:
Diabetes is a poorly managed condition in the community with diabetes drug adherence as low as 36% among different populations . 31.4% of the local population in Shepherd’s Bush do not speak English as a main language, demonstrating how language barriers could be affecting their healthcare . We carried out a need’s analysis survey showing 70% wanted more information about medications and 45% said they did not know what to do if they experienced a side effect. Our aim was therefore to produce a leaflet and organise small focus group sessions targeting these concerns, with translations being provided.
Methodology: The main barriers to diabetic care management were identified in our research as being poor medication adherence, travel, language barriers in communication and health illiteracy. In collaboration with Diabetes UK, a leaflet was created in both Arabic and English addressing these barriers. Diabetic patients in a practice in Shepherds bush (n=650) were recruited by text message to participate in an interactive focus group. Partaking patients (n=20) filled in questionnaires on various adherence parameters before and after the focus group. Data was then analysed using Mann-Whitney-U tests and compared.
Results: The focus group enabled certain barriers to adherence to diabetic medication to be overcome with patients showing a statistically significant decrease in concern over perceived side effects of medications (p<0.001), and an increase in understanding of efficacy of medications (p<0.01). 90% of patients said they now felt more confident in managing their diabetes.
Conclusion Significance: Ten-minute consultations in general practice settings are often insufficient to gage patient understanding on their condition, and this was reflected in our pre-focus group survey. Regular focus group sessions are a simple but effective way of educating patients on their condition, encouraging them to be more proactive in managing their condition, and preventing complications.
Dawit Simegnew Ali is currently a master student at Tsinghua University, China. He has been also among few influential and young researchers in Bule Hora University, Ethiopia, where he worked as a lecturer before joining Tsinghua University. He has publications on reputed journals.
Type 2 Diabetes Mellitus (T2DM) patients are increasingly using herbal remedies due to the fact that sticking to the therapeutic regimens is becoming awkward. However, studies towards herbal medicine use by diabetic patients are scarce in Ethiopia. Therefore, the aim of the current study was to explore the prevalence and correlates of herbal medicine use with different sociodemographic variables among type 2 diabetes patients visiting the diabetic follow-up clinic of University of Gondar comprehensive specialized hospital (UOGCSH), Ethiopia.
A hospital-based cross sectional study was employed on 387 T2DM patients visiting the diabetes illness follow-up care clinic of UOGCSH from October 1 to November 30, 2016. An interviewer-administered questionnaire regarding the demographic and disease characteristics as well as herbal medicine use was completed by the study subjects. Descriptive, univariate and multivariate logistic regression statistics were performed to determine prevalence and come up with correlates of herbal medicine use.
From 387 participants, 62% were reported to be herbal medicine users. The most prevalent herbal preparations used were Garlic (Allium sativum L.) (41.7%), Giesilla (Caylusea abyssinica (fresen.) (39.6%), Tinjute (Otostegia integrifolia Benth) (27.2%), and Kosso (Hagenia abyssinicaa) (26.9%). Most of herbal medicine users (87.1%) didn’t consult their physicians about their herbal medicine use. Families and friends (51.9%) were the frontline sources of
information about herbal medicine followed by other DM patients who used herbal medicines (28.9%).
The present study revealed a high rate of herbal medicine use along with a very low rate use disclosure to the health care professionals. Higher educational status, a family history of DM, duration of T2DM and presence of DM complications were identified to be strong predictors of herbal medicine use. From the stand point of high prevalence and low disclosure rate, it is
imperative for health care providers to strongly consult patients regarding herbal medicine use.
Passmores Academy Essex, United Kingdom
Reynand F. Dumala-on currently working in Passmores Academy Essex, England, United Kingdom. He was worked in High School Department, Scott's Branch High School, United States of America.
Asthma Weed (Euphorbia hirta Linn.) is an endemic plant species that is rich in phytochemicals which may offer potent cure for diseases especially in treating hyperglycemia. This experimental study was conducted to evaluate the anti-hyperglycemic potency of Asthma Weed (Euphorbia hirta Linn.) leaves crude extract in blood glucose level of female white mice (Mus musculus). The major findings of the study were: (1) The mean blood glucose level of the female white mice before the experimental phase was “moderate.”; (2) The blood glucose levels of female white mice (Mus musculus) among the treatments administered were all considered moderate; (3) The blood glucose levels of female white mice (Mus musculus) 30 and 60 minutes after the treatments had been administered were described as “moderate”; (4) There were no significant differences in the blood glucose levels of female white mice (Mus musculus) considering the different treatments; (5) There were no significant differences in the blood glucose levels of female white mice (Mus musculus) among the time intervals after the administration of the treatments; (6) There was a significant difference in the blood sugar levels of the female white mice (Mus musculus) before the experimental phase and 30 and 60 minutes after the treatments had been administered. Outcomes of the study highly recommend the following: (1) The Department of Health in linkage with the Department of Environment and Natural Resources and the Bureau of Plant Industry may substitute expensive commercial anti-hyperglycemic agents with Asthma Weed (Euphorbia hirta Linn.) leaves crude extract. In addition, this may encourage the agencies to plan out programs and projects to propagate the plant and produce capsules, tablets and solutions as an alternative medicinal drug of choice; (2) The pharmaceutical industries may be encouraged to isolate the bioactive compounds in Asthma Weed (Euphorbia hirta Linn.) leaves and to produce cheap but effective commercial drugs from these as an anti-hyperglycemic agent possibly even at the 50 μL dosage concentration; (3) The researcher is encouraged to work with the local chemists to pursue the processing of plant leaves in dry crude preparation and so to produce capsulated product subjected to the Bureau of Food and Drugs (BFAD) approval; (4) The community, especially the hyperglycemic individuals may be informed of the results and advised to try the use of Asthma Weed (Euphorbia hirta Linn.) leaves crude extract as an alternative and easily prepared medicinal plant for hyperglycemia; (5) Other researchers may be motivated to conduct assays on Asthma Weed (Euphorbia hirta Linn.) like its allergenicity, mutagenicity, and toxicity to evaluate possible adverse effects; (6) Dissemination of information, propagation of the plant species, linkage with concerned agencies that could facilitate in-depth and wide implementation of project plan about the medicinal significance of Asthma Weed (Euphorbia hirta Linn.) are also recommended; and, (7) The whole of Asthma Weed (Euphorbia hirta Linn.) plant can be further evaluated for its various phytochemical structures and medicinal applications. Further tests can be conducted in terms of its potential antioxidant activity, antibacterial and antiangiogenic property.