Day 1 :
Keynote Forum
Andre Emanuilov Manov
Keynote: The role of continuous glucose monitoring/cgm/ in improving the quality of care of patients with diabetes mellitus/dm/ type -1 and – type 2 in internal medicine residency clinic
Time : 00
Biography:
Abstract:
Diabetes mellitus affects more than 34 million and pre- diabetes mellitus affects 88-million Americans and the prevalence is rising. The disease leads to micro and macrovascular complications if uncontrolled. Diabetes Mellitus is the number one cause of blindness, non-traumatic amputation and ESRD in the USA. In our study, we retrospectively looked at patients in which as a standard of care Continuous Glucose Monitoring (CGM) with Dexcom G6 Device was started in Internal Medicine Residency Continuity Community clinic in Mountain View Hospital, Las Vegas, Nevada in 11-patients with type- I and type- II diabetes mellitus uncontrolled on 3-4 injections of Insulin per day who were self- monitoring their blood glucose 4- times a day (SMBG). The CGM was initiated by internal medicine residents through a remote portal, and the subsequent titration of the insulin dose was done by the residents under the supervision of a board-certified endocrinologist who was also a member of the clinic. The goal of the present study was to demonstrate improvement of patients’ HbA1c measured by a glucose management indicator, a decrement of mild, defined as less than 70 mg/dl hypoglycemia and severe- defined as less than 54 mg/dl hypoglycemia to less than 4% and 1 % respectively, achievement of time in range between 70- 180 mg/dl blood sugar in 24-hour period of 50-70% of the time based on the patient’s age and have glucose variability less than 36%. The HbA1c was reduced in 3- months after introduction of the CGM from 10.5% to 7.47%, the mild hypoglycemia with blood sugar less than 70 mg/ dl happened on average 7- minutes a day (less than 4%) from 27- minutes and severe hypoglycemia happened 3- min a day (less than 1%) from 7 minutes while the patients were using SMBG. These were the goals with the use of CGM. Time in range we achieved was 62% which was between 50 and 70 %. Based on the average age of the patient of 53- years this is compatible with the goals using CGM. The glucose variability was 29% below the goal of 36% which is excellent. The patient satisfaction with the device measured by the CGM Quality of life questionnaire was very good. The unique feature of this study is that it demonstrates the successful introduction of the CGM was done by Internal Medicine Residents under the supervision of a Board-Certified Endocrinologist who was also a member of the clinic which we are not aware that it was done before.
- Diabetes | Endocrinology | Diabetes Mellitus Type 1 | Pediatric Endocrinology | Diabetes Mellitus Type 2 | Diabetic Nutrition and Diet | Thyroid Disorders | Lipid disorders | Endocrine Disorders | Case Reports and Others
Location: webinar
Session Introduction
Hazem Rayyan
King Salman Military Hospital-Tabuk, Saudi Arabia
Title: New Glp1a and Diabetes controlle
Biography:
Hazem Rayyan is a consultant endocrinologist in King Salman Military Hospital-Tabuk-KSA. His research interest was in Diabetes, cardiovascular disease and Drug Agency. He won many awards for his research. He ia a member for European Board of Endocrinology also Member of AACE, ESE.
Abstract:
The glucagon-like peptide-1 receptor agonist (GLP-1RA) semaglutide is the most recently approved agent of this drug class, and the only GLP-1RA currently available as both subcutaneous and oral formulation. While GLP-1RAs effectively improve glycemic control and cause weight loss, potential safety concerns have arisen over the years. For semaglutide, such concerns have been addressed in the extensive phase 3 registration trials including cardiovascular outcome trials for both subcutaneous (SUSTAIN: Semaglutide Unabated Sustainability in Treatment of Type 2 Diabetes) and oral (PIONEER: Peptide InnOvatioN for the Early diabEtes tReatment) semaglutide and are being studied in further trials and registries, including real world data studies. In SUSTAIN programme, Semaglutide was associated with consistent reductions in HbA1c and higher proportions of subjects achieving glycaemic targets of <7.0% and ≤6.5%, vs comparators. In SUSTAIN 6, Semaglutide treated patients experienced a significant 26% risk reduction in the primary composite outcome. Given the beneficial metabolic and cardiovascular actions of semaglutide, and the low risk for severe adverse events, semaglutide has an overall favorable risk/benefit profile for patient with type 2 diabetes.
Biography:
Okhunov Alisher Oripovich, Doctor of Medical Sciences, Professor, Head of the Department of General Surgery of the Tashkent Medical Academy, Head of the Center and Chief Consultant on Surgical Complications of Diabetes. Full member of the American Society for Surgical Infection (SIS), the International Federation for the Surgery of Obesity (IFSO), twice the best healthcare worker of the Republic of Uzbekistan (2019, 2021), the best professor of the year of the Republic of Uzbekistan (2019). Author of more than 300 scientific papers on surgical complications of diabetes, obesity, surgical infection. Including 12 monographs, 32 inventions and 4 textbooks on surgery. Speaker of international congresses and conferences on diabetes in the USA, Great Britain, Germany, Spain, Turkey, India, Thailand and other countries.
Abstract:
Diabetes and COVID-19 are closely related in terms of the mechanism of vascular pathology. Statistics show that in patients with diabetes, after COVID-19, angiopathy is much more severe. This leads to the development of gangrene of the limb, an increase in amputation, disability and a decrease in the quality of life. The aim of our study was to improve the results of treatment of patients with diabetic angiopathy, after COVID-19, through the use of active methods of endovascular interventions. Studies conducted in 125 patients with diabetes after COVID-19 revealed 245 occlusive-stenotic changes in the vessels of the lower extremities. In addition, 10.5% of occlusions in the arteries of the medial tibial artery were eliminated. Of the 245 endovascular surgical treatments performed in patients with diabetic foot syndrome after COVID-19, 74.3% were translumbar balloon angioplasty. Most of all, translumbar balloon angioplasty was performed in 2 segments (figure 1). 58 balloon angioplasty were performed in three or more segments. Within one vascular segment, 32 balloon angioplasties were performed. The use of X-ray endovascular methods for the treatment of diabetic foot syndrome in the complex of therapeutic measures after COVID-19 made it possible to reduce the percentage of limb amputations by 3.2 times. The use of X-ray endovascular methods of treatment made it possible to avoid cases of amputation at the level of the thigh and limit amputations in 7.2% of cases at the level of the lower leg, to reduce mortality from 10.3% to 4.0%. The use of X-ray endovascular methods of surgical correction of ischemia of the lower extremities in patients with diabetic foot syndrome who underwent COVID-19 made it possible to increase the proportion of positive treatment results in the form of limb preservation from 67% to 88.8%.
Brisik Gardi
Zakho General Hospital, Iraq
Title: Risk factors associated with poor glycemic control in patients with type 2 DM in Zakho city
Biography:
He is affiliated to Zakho General Hospital, Iraq. He is a recipient of many awards and grants for his valuable contributions and discoveries in major area of subject research. His international experience includes various programs, contributions and participation in different countries for diverse fields of study. His research interests reflect in his wide range of publications in various national and international journals.
Abstract:
Diabetes Mellitus (DM) is a chronic condition caused by relative lack of insulin due to impaired insulin secretion or insulin resistance. The aim of this study was to investigate the prevalence of poor glycemic control in Zakho city and to explore the modifiable risk factors that may help controlling the disease. Materials and Methods: We recruited patients with known history of diabetes receiving oral anti-diabetic medications. Those patients were registered in Zakho Diabetes center with regular visits. The measurement of anthropometric indices was conducted by trained personnel. Plasma glucose was determined using colorimetric enzymatic method with glucose oxidase. HbA1c concentrations were measured in whole blood samples using high performance liquid chromatography. Results: In this study, 520 patients were recruited. The average age of the patients was 56.92±9.62. Among those, 190 were male. The blood sugar was controlled in 122 (23.4%) patients. We found a significant association between sex and HbA1C level (p=0.000; OR=0.4796; CI=0.3175-0.7243). In addition, waist circumference was significantly associated with HbA1C levels (p=0.018; OR=1.02; CI=1.0031-1.0373). Conclusions: The vast majority of the patients had uncontrolled diabetes. We found that sex and waist circumference were risk factors for uncontrolled diabetes. Any diabetes controlling program should focus on those two factors.
Mehnoosh Samadi
Kermanshah University of Medical Sciences, Iran
Title: Predictive power of Fat Mass Index, Visceral Adiposity Index, and Body Shape Index in presence of type 2 diabetes mellitus
Biography:
Mehnoosh Samadi has completed PhD at the age of 32 years from Ahvaz Jundishapur University of Medical Sciences. She is the assistant professor of Nutritional science department in School of Nutritional Science and Food Technology of Kermanshah University of Medical Sciences, Iran. She has published many papers in reputed journals and has been serving as an editorial board member of repute.
Abstract:
Obesity and fat mass accumulation are the main culprits in metabolic disorders and insulin resistance, which predispose to diabetes and metabolic syndrome. Recent studies have proposed tools such as anthropometric indices to predict diabetes. In this study, we examined the FMI (Fat Mass Index), VAI (Visceral Adiposity Index) and ABSI (A Body Shape Index) wich are related to fat mass and its distribution in the body, in incidence of type 2 diabetes (T2D). This study is a cross-sectional study that used RaNCD cohort data. The RaNCD study is a prospective population-based study that has been conducted to evaluate chronic diseases in Ravensar since 2014 on 10051 adults age 35-65 years. The area under the receiver operating characteristics (ROC) curves (AUC) was calculated to compare the discriminative power of anthropometric variables for incident T2D. Also, the cut-off points of each index were calculated through the ROC curve anlysis. According to our findings, all indices except ABSI had a significant relationship with the incidence of T2D. FMI in men (OR, 1.13; 95% CI,1.09-1.18) And VAI in women (OR, 1.10; 95% CI,1.07-1.12) had the highest association whit incident of T2D. the, Results of ROC curve analysis showed that VAI had the largest area under the curve (0.67), and ABSI had the lowest area (0.53). Also cut-off points for FMI and VAI were 7.5 and 4.82 in men and 11.7 and 5.10 in women, respectively. Identification of diabetes risk factors can help to prevent this chronic disease. We suggested that VAI and FMI can be a good predictor of T2D incidence in comparison with other conventional indices.
Carlos E. Cabrera Pivaral
University of Guadalajara, Mexico
Title: Effect of a medical study plan on competencies for the identification and management of diabetes mellitus 2
Biography:
Carlos E. Cabrera Pivaral is affiliated to University of Guadalajara, Mexico. He is a recipient of many awards and grants for his valuable contributions and discoveries in major area of diabetes research. His international experience includes various programs, contributions and participation in different countries for diverse fields of study. His research interests reflect in his wide range of publications in various national and international journals.
Abstract:
Objective: To evaluate the effect of the study plan of the Bachelor of Medicine at the University on the professional skills to identify and manage DM”. Material and Methods: Quasi-experimental study of a pre-experimental type compared with a static group. Location: Campus Vallarta. Period: September-December 2019. Universe: 182 medical students. Sample: Non-probabilistic, n = 114 medical students, 62 from the first semester (G1, intervention moment "A"), 52 from the sixth semester (G2, intervention moment "B"), and 84 G3 medical interns, plus 50 students of first semester of degree not related to health (G0, control). Sampling: Proactive. Selection criteria: Any age and sex, and answer instruments. Variables: Age, sex and professional skills`for health promotion and social participation. Instruments: Instrument in Spanish to Evaluate Professional Competences. Procedures: The evaluations were carried out at the end of the 2019B semester. Analysis: Comparison using non-parametric inferential statistics (p ≤ 0.05). Results: Levels of professional skills to identify and manage DM2: G0 100% little or not competent, G1 64.5% little or not competent and 35.5% moderately, G2 11.5% little or not competent and 88.5% moderately. The level of competence was higher when exposed to the curriculum, and increased with longer exposure time (χ2, p ≤ 0.05 in all cases). Conclusions: The evaluated medicine curriculum develops in its students professional skills for health promotion and social participation, but it is likely to be improved.