Scientific Program

Day 1

KEYNOTE SPEAKERS
  • A unified pathophysiologic construct of diabetes and its complications, including malignancies, in the context of the beta-cell–Classification of Diabetes

    Perelman School of Medicine
    USA
    Biography

    Dr. Schwartz received his MD from the University of Chicago, completed his residency at the University of Pennsylvania and an Endocrine Fellowship at the University of Chicago.

    Abstract

    We have previously presented a proposal for a new, beta-cell centric classification of diabetes based on a consilience of genetic, metabolic, and clinical research that have accrued since the current classification was instituted. It recognizes that the beta-cell is the core defect in all patients with diabetes. Differences in the genetics, insulin resistance, environment and inflammation/immune characteristics of the damage to the beta-cell in each individual will determine the phenotypic presentation of hyperglycemia and allow for a patient-centric, precision-medicine therapeutic approach, part of which we labeled ‘the Egregious Eleven’. We now recognize the same pathophysiologic mechanisms that account for damage to the beta-cells govern the susceptibility of the cells involved in the complications of diabetes to damage by the now well-defined abnormal metabolic environment that typifies beta-cell dysfunction. This abnormal metabolic environment is typified by oxidative stress which alters metabolic pathways a la Brownlee’s Hypothesis model, alterations in gene expression, epigenetics, and inflammation. This unified pathophysiologic construct of diabetes and its complications, including malignancies, in the context of the B-cell–Classification of Diabetes allows us to understand the varied risk of developing complications of diabetes with similar levels of glycemic control, how non-glycemic effects of some medications for diabetes result in marked complication risk modification and the value treating co-morbidities of diabetes in effecting complication risk. Principles we outlined in using ‘the Egregious Eleven’ model- use agents that preserve beta-cell function, treat with least number of agents that treat most number of mechanisms of hyperglycemia- can be extended to use those agents, in combination, that also engender weight loss, and decrease CV outcomes. This approach allows for a more accurate assessment and treatment of each patient’s disease and effecting true precision medicine. We also believe that the same pathophysiologic mechanisms that account for damage to the beta-cells and govern the susceptibility of the cells involved in the complications of diabetes are likely to explain the association of cancer and cognitive deficiencies to diabetes and obesity, explaining why a diabetic medication may affect cancer risk and therapy

  • The business of medicine: The top 10 regulatory risks faced by endocrinologists and their practices

    Abstract

    The business practices of Endocrinologists are under the regulatory microscope. Medicare, Medicaid and private payors are actively conducting audits of endocrinology claims for reimbursement. In this session, we will discuss a number of existing risk areas and what Endocrinologists and their practices should expect in 2019.Specific Objectives include: 1. Participants will learn about the current Federal and State enforcement efforts and initiatives to identify and prosecute health care fraud. 2. Participants will learn about the efforts of “Special Investigations Units” working for private payors to identify improperly paid claims and refer instances of fraud to the government for possible prosecution. 3. Participants will learn about a number of the common medical necessity, documentation, coding and billing errors identified when auditing medical records and claims documentation. 4. Participants will learn how to reduce their level of regulatory risk and liability.

Diabetes Metabolism and Obesity diseases | cardiovascular diseases | Diabetes Pathophysiology | Diabetes Complications | Diabetic Nutrition | Diabetes Science and Technology | Diabetes: Research | Alternative medicine for Diabetes
Chair
  • Allied Academies Obesity Summit 2018 Chair Speaker JMA Hannan photo
    JMA Hannan
    Independent University, Bangladesh (IUB)
    Bangladesh
Speaker
  • The result of clinical trial for the new Lonal drug for hepatoprotective effect in patient with drug induced steatosis: A randomized placebo-controlled double blind clinical trail
    Speaker
    Buyanjargal Darkhija,
    Bayangol Districts Health Center, Mongolia
    Mongolia
    Biography

    Buyanjargal Darkhijav is currently working at Bayangol Districts Health Center, Ulaanbaatar city, Mongolia.

    Abstract

    Introduction: Following researchers determined the chronic hepatitis C virus infection which was 8,2% (Davaalkham.J et al, 2003), 9,6%(Takahashi.M et al, 2004), 9,8% (Tsatsralt-Od.B et al, 2006), 11,8% (Dagvadorj.Ya et al 2005) in Mongolia. As researchers noted that hepatitis C genotype 1 and 3 enable to be triglyceride accumulation for liver because it often occurs simultaneously fatty liver disease. Although many types of traditional medicine have been used for for hundreds years, their effectiveness of the therapy is relatively small with inadequate use of poorly understood in practice. These types of medicine’s storage, form, flavor are to improve which are prepared based on scientific studying, is to make the clinical trial of drug acts as easily use, emerged as one of the need for market. Therefore, our research team has made the clinical trial based on the chemical and pharmacological study of hepatoprotective effect for lonicera altaica pall fruit, an established clinical studies and producing new drugs. Aim: The aim of the clinical trial was to determine hepatoprotective effect of the new lonal drug in patient with fatty liver disease with chronic hepatitis C. Material and Method: The research was considered such as clinical trial guideline for new drug issued by the WHO’s “Good Clinical Practice”. Based on permission given by biomedical ethical community of the health ministry of Mongolia approved diagnosis patient with fatty liver disease associated with chronic hepatitis C. Research design is randomized placebo-controlled, double blind clinical trial. We studied 3 groups of participants that was given the following treatment for 21 days: (I) Treatment group: Lonal drug 1.4 gr ×3 times, (II) Control group: Silymarin drug 67.5 mg ×3 times, (III) Placebo group: Placebo drug 1.4 gr ×3 times. We used on histo-morphometric analysis of liver biopsy DISKUS ver 4.80, Olympus BX microscopy. Results: Lonal drug decreases activation of syndrome hepatic cell cytolysis ALT (p=0.023), AST (p=0.037). Also decreases criteria of cholestasic syndrome such as indirect bilirubin (p=0.611), ALP (p=0.04), GGT (p=0.445). The Lonal medicine was taken during 21 days and comparing the results of lipid metabolism exchange before and after treatment, reduces TG (p=0,402), increases HDL (p=0.047). The participants have taken the Fibroscan analysis and liver biopsy. That was compared to determine before and after treatment such as steatosis and fibrosis degree. Before treatment degree of steatosis was S2: 278.4±75.3 dB/m and after treatment it was dropped from S1: 238.6±70.4 dB/m (p <0.05). And before treatment, such as fibrosis degree F2-3: 8.84 ± 2.2 kPa, after treatment it was decreased in F1-2: 7.18 ± 3.87 (p<0.01). In liver histology, comparing before and after treatment the results of liver cell inflammation-fibrosis area was reduced by 1,75 times and decreases hepatic steatosis degree (strong fatty change was improved mild fatty change). Conclusion: New lonal medicine is reducing activation syndrome hepatic cell cytolysis, cholestatic and some criteria of the metabolic syndrome in patient with fatty liver disease associated with chronic hepatitis C. Also new lonal medicine reduces the degree of liver steatosis and fibrosis by the analysis of fibroscan and liver biopsy. Key Words: Fibroscan, liver biopsy, Lonicera Altaica Pall, Lonal.

  • Potential benefits of Chia seeds in prevention of cardiovascular diseases
    Speaker
    Beatrice Nyanchama Kiage Mokua
    Jomokenyatta University of Agriculture and Technology, Kenya
    Kenya
    Biography

    Beatrice Nyanchama Kiage Mokua has completed her PhD at the age of 37 years from Christian Albrechts University (CAU), Kiel, Germany. She is a lecturer at Jomokenyatta University of Agriculture and Technology at the department of food science and technology. She has papers in reputed journals.

    Abstract

    Cardiovascular diseases (CVDs) are mainly caused by atherosclerosis which occurs when artery walls become thickened due to accumulation of fatty deposits, smooth muscle cells and fibrous connective tissues collectively termed plaque. Plaque may promote thrombosis within the artery which in turn narrows the lumen of arteries obstructing blood flow leading to heart attack and stroke. Low density lipoprotein cholesterol, decreased high density lipoprotein cholesterol, elevated triglycerides and excess calories are among of the risk factors that can promote atherosclerosis in the body. Modern diets are mostly low in omega-3 fatty acids and high in omega- 6 fatty acids and saturated fatty acids (SFA). Such imbalance is associated with increased risks of heart disease and support chronic inflammation. Chia seed (Salvia hispanica L.) is becoming among the popular foods of plant origin that contains the greatest amount of omega-3 fatty acid, ?-linolenic acid. Omega-3 fatty acids have been associated with potential physiological functions in human body. Additionally the seeds are rich in proteins, dietary fiber, minerals and phytochemicals such as myricetin, quercetin, kaempferol, chlorogenic acid and caffeic acid which exhibit cardio-protective, antioxidant and lipid-lowering properties. This review expounds the prevalence of cardiovascular diseases and the importance of chia seed in counteracting CVDs risk factors as evidenced by various in vivo and animal studies. Key words: Cardiovascular disease, chia seed, omega-3 fatty acids, risk factor and phytochemicals

  • Entrenched obesity deterrents demand radical measures
    Speaker
    James L. DeBoy
    Lincoln University
    New Zealand
    Abstract

    Despite multiple, well-intentioned individual-based strategies to reverse America’s obesity epidemic for the past 30 years, obesity rates continue to climb: almost 40 percent of adults were obese in 2016 with another 27 percent classified as pre-diabetic (CDC, 2018). Missing from this battle of the bulge is a population-based approach that would model the one deployed during the anti-smoking campaign of the 1980s and beyond. Societal/legislative actions, while perceived by many as draconian and “un-American”, must be implemented if we are ruly serious about addressing this national health crisis. A 15 PowerPoint slide presentation will identify obesity prevention deterrents, limitations of individual-based approaches, the nutritional shift in today’s food supply, and suggested societal, legislative interventions as well as the rationale that accompanies them.

  • Motivational self monitoring and digital healthcare technology
    Speaker
    James Minor
    LLC Diabetes Care by Designs, USA
    USA
    Abstract

    Diabetes and consequent complications are creating a global epidemic costing billions of dollars in healthcare expenses. Our biofeedback concept can improve patient healthcare and avoid such complications. This talk introduces simple diagnostic images of the daily impact of diabetes on blood sugar that will encourage and motivate patients toward more effective self monitoring and improved blood glucose control. Recent publications reported these patterns hidden within the multiday profiles of blood glucose fluctuations. The studies support clinical benefits such as an accurate 24-hour advanced alert for incident extreme glycemia, such as hypoglycemia. The patterns measure healthcare effectiveness and indicate actions necessary to control expected glycemic conditions. This talk reports the benefit of these diagnostic images in a clinical case spanning multiple months.

  • Impact of providing working lunch on health: A case study in stich right limited firm at Tongi in Dhaka
    Speaker
    Rafia Rahman
    University of Dhaka
    Bangladesh
    Biography

    Rafia works with national and international NGOs for around nine years then an academician. Her wishes to increase, ensure health care services by registered trained provider in the countries, with this view this frame work was make. Being a physician, academician and a researches, she fell this model will work for all developing countries.

    Abstract

    This study was designed to determine the impact of working lunch on employees health in terms of BMI and identify the employees were at risk to develop different disease, with the vision to assist employer and/or authority to take necessary intervention for improvement of health status and reduce risk to develop disease among the employees. It was a cross sectional mixed method study. The study period was from October’10 to October’11 and the intervention was given in a factory with name ‘Stich Right Limited (SRL)’which was been selected purposively. All the workers (total of 742) of that factory received the intervention were surveyed. Body Mass Index (BMI) of each worker was calculated both in the base line (October’10) and end line (October’11). The study revealed that during baseline 13.6 percent workers had under-nutrition (according to WHO which classified as workers with BMI less than 18.5) as compared to that of 8.6 percent at the end year. Hence, under-nutrition statuses of the workers were corrected by 4.9 percent. Standard nutritional status (BMI is 18 to 25) improved by 1.5percent. Percent of workers with ‘overweight’ (BMI is26 to 30) and ‘obese’ (BMI greater than 30) status also proportionately increase by 3.2 and 0.3 percentage point respectively thought he increases were not statistically significant. Further, it was found that, among male employees under nutrition correct by 2.66percent and among female employees under nutrition correct by 6.26. Successful and effective implementation of any intervention through service center (work place) is possible. Employee’s positive health, well-being could ensure in work place by the intervention of employer that actually takes a role for increase the productivity of work and employees were able to lead a socially and economically productive life.

Day 2

KEYNOTE SPEAKERS
  • Spirulina platensis stimulates glucose-stimulated insulin secretion in perfused rat pancreas and BRIN-BD11 cells through the cAMP-dependent PKA pathway

    Independent University, Bangladesh (IUB)
    Bangladesh
    Abstract

    The antihyprglycemic effects of Spirulina platensis has previously been reported in rats and humans. In this study the effects of S. platensis were evaluated on insulin secretion together with exploration of its mechanism underlying insulin action in isolated perfused rat pancreas and BRIN-BD11 cells. The ethanolic extract was successively partitioned using hexane, chloroform, ethylacetate and 1-butanol. Butanol part was dissolved in Krebs-Ringer bicarbonate (KRB) buffer solution (pH adjusted to 7.4), continuously bubbled with O2 and perfused, via a cannula into the aorta, to the celiac and mesenteric arteries of pancreas, isolated by surgery under pentobarbital anesthesia. Insulin in the effluent (collected from a cannula in the portal vein at 1 min interval) was measured by an ELISA technique with a rat insulin assay kit. Insulin secretory activity was also observed using rat clonal ?-cells (BRIN-BD11 cells). For the studies on the mechanism underlying the insulin secretory activity, 16.8 mM glucose, 30 mM KCl, 50 µM verapamil, 300 µM diazoxide and 10 mM theophylline were used.

Diabetes Science and Technology | Diabetes: Research | Diabetic Nutrition | Obesity and diet | Maternal Obesity | Weight Management | Diabetes Pathophysiology | Diabetes Complications
Chair
Speaker
  • Type 2 Diabetic Nepalese Immigrant’s Knowledge of Diabetes Self-Management in England
    Speaker
    Ramji Tiwari
    University of Southampton
    United Kingdom
    Biography

    Ramji Tiwari PhD Student ( Diabetes Selfmanagement) Building 45 Centre for Innovation and Leadership in Health Sciences High Field campus University of Southampton University Road, Southampton

    Abstract

    The study has examined the effect of age, diabetes related perceived and actual knowledge on body mass index (BMI) amongst type 2 diabetic Nepalese immigrants of Rushmoor in Hampshire County, England. A cross-sectional questionnaire survey was carried out among type 2 diabetic patients from 30 September to 7 November 2017. A total of 43 (male 29, female 14) individuals with diabetes were recruited through purposive convenient sampling. They were consented, completed a questionnaire and self-reported HbA1c and cholesterol. Blood pressure, height, and weight were measured. Data were collected at local community centres using the translated version of study materials including the questionnaire.

  • Anti-diabetic and anti-obesity efficacy of selected Kenyan plant extracts on rats fed a High fat and fructose diet
    Speaker
    Beatrice Nyanchama Kiage Mokua
    Jomokenyatta University of Agriculture and Technology, Kenya
    Kenya
    Biography

    Beatrice Nyanchama Kiage Mokua has completed her PhD at the age of 37 years from Christian Albrechts University (CAU), Kiel, Germany. She is a lecturer at Jomokenyatta University of Agriculture and Technology at the department of food science and technology. She has papers in reputed journals.

    Abstract

    Plants are reported to have anti-diabetic and anti-obesity effects hence can be explored in the treatment of these disorders. In this study, ethanolic and aqueous extracts were prepared from Mangifera indica L, Lonchocarpus eriocalyx (Harms), Urtica massaica Mildbr., Schkuhria pinnata (Lam) and Launaea cornuta. Ethanolic extracts of all plants (1:100 dilutions), in vitro, showed at least 29% inhibition of pancreatic lipase, but no effect on ?-glucosidase activity. The administration of the extracts for 74 days caused a significant reduction of liver triglycerides in male Wistar rats that had been fed on a high fat and fructose diet (HFFD). There was also a tendency by the extracts to prevent liver steatosis by reducing ALT and AST levels. Additionally, glycemia and atherogenicity improved but hyperinsulinemia and insulin resistance did not decrease. Conversely, there were inconsistencies on the effects of the extracts on the evaluated parameters evaluated. However, Urtica massaica was consistent in reducing glycaemia (fasting blood glucose, urinary glucose, % HbA1c) and markers of hepatic steatosis (ALT and AST), which were lower than the control. Hence, findings of this exploratory study imply that these plants inhibit pancreatic lipase and therefore may be beneficial in obesity treatment. Moreover, Urtica massaica could be further investigated for anti-diabetic properties. Keywords: Diabetes, Plant extracts, Triglycerides, High fat high fructose, Liver steatosis, Obesity.

  • Anti-hyperglycemic action of Gynura procumbens is partly mediated by inhibition of carbohydrate digestion and absorption in the gut
    Speaker
    Kazi Ishtiaq Ahmad
    Independent University, Bangladesh (IUB)
    Bangladesh
    Biography

    Independent University

    Abstract

    Gynura procumbens leaf has been widely used as a traditional therapy for diabetes all over the world. Present study aims to investigate effects of G. procumbens in sucrose digestion and absorption in the gut to explore the anti-hyperglycemic activity of this plant. The dried-powder-leaves of G. procumbens were extracted with methanol. Sucrose malabsorption in GI Tract was evaluated in 20-hrs-fasted Long Evan rats by determining the amount of sucrose remaining in six different parts of gastrointestinal tract after sucrose load (2.5 g/kg b.wt), with or without 500 mg/kg dose of G procumbens extract. For evaluation of disaccharides activity, the extract was fed to 20-h-fasted rats. After 60 min, the rats were sacrificed, and the small intestines were isolated and homogenized. The homogenate (20 ?l) was incubated for 60 min at 37 °C with 40 mmol sucrose. Disaccharides activity was calculated by glucose converted from sucrose as ?mol-mg glucose/protein/h. When the extract of G procumbens was administered simultaneously with the sucrose load, the residual sucrose content in the gastrointestinal tract was increased significantly (p<0.01), especially in the upper intestine at 30 min, in the whole intestine as well as cecum at 1 and 2 h. At 4 h, sucrose was not detected in the gut in both groups. When extract was supplemented with the glucose solution, the percentage absorption of glucose was decreased by 13 - 19% during whole perfusion period (p<0.05). It inhibited disaccharides (sucrose) activity significantly (p<0.05) in rats. The anti-hyperglycemic activities of G procumbens in rats are partly mediated via delaying intestinal carbohydrate digestion and absorption

  • Maternal risk factors associated with retinopathy of prematurity among patients in east avenue medical center from 2010 to 2015
    Speaker
    Ida Fidelis E Denosta
    East Avenue Medical Center
    Philippines
    Biography

    East Avenue Medical Center

    Abstract

    Objectives: This study aims to determine the maternal risk factors associated with the development of retinopathy of prematurity (ROP). Design: A retrospective cohort study. Setting: The study was done in a tertiary government hospital. Patients: This study included admitted premature neonates in neonatal intensive care unit (NICU) who underwent ROP screening. All patients with congenital abnormality of the eyes were excluded in the study. Methodology: List of admitted premature patients who underwent ROP screening was collected within the study period. Demographic data was collected from the patient’s medical records. Statistical Analysis: Descriptive statistics were presented for categorical outcome measures. Wilcoxon rank sum test was used to compare two averages. Chi-square test, Yates’ chi-square test and Fisher’s exact test were used to compare proportions. Univariate and multivariate regression analyses were used to estimate crude and adjusted odds-ratios, corresponding 95% CI and based on p-value ? 0.05 statistical significance. Result: This study showed 57% cases of ROP, majority with Stage 1 (66%), mostly female infants (53.4%; p<0.001), mildly asphyxiated (51.2%, p=0.290; 77.2%, p=0.117) and were small for gestational age (57.3%; p<0.001). On the average, these infants underwent 1 day of either invasive or non-invasive mechanical ventilation, 2 days with FiO2 of >0.5 liters per minute, had two blood transfusions, and with shorter hospital stay (17 vs 26 days; p<0.001). The average age of mothers who delivered infants with ROP was 26 years old, multipara (59.2%), and underwent normal spontaneous delivery (67%). About half reported adequate prenatal check-ups (53.8%), and diagnosed with urinary tract infection (40.1%). Conclusion: Data showed that mothers with urinary tract infection and preeclampsia are more likely to deliver infants with retinopathy of prematurity thus significant maternal risk factors of ROP. Keywords: Retinopathy of Prematurity, Neonates, Prematurity

  • Functional potential of a sub-GWAS noncoding variant in modulating the trait phenotype
    Speaker
    Khushdeep Bandesh
    National Institute of Diabetes and Digestive and Kidney Diseases, USA
    USA
    Abstract

    Decades of rigorous genetic efforts have established Type 2 Diabetes (T2D) as apparently an outcome of altered metabolic traits. In this regard, C-peptide, a byproduct of insulin synthesis has been largely neglected. Owing to a higher plasma half-life (~30mins) than insulin (~4 mins), C-peptide is a precise measure for insulin secretion and presents independent functional activity. We performed a two-staged Genome Wide Association Study (GWAS) for plasma C-peptide in Indians (N = 2,706) and identified a novel variant rs4454083 at sub-GWAS significance residing in intron of a GABA receptor-subunit gene - GABRA6 and simultaneously, in exon of a novel antisense lncRNA, which we named ARBAG. Expression of GABRA6 triggers fast inhibitory neurotransmission in human cerebellum and its recruitment to postsynaptic sites is administered by C-peptide. Imputation and targeted sequencing of associated region ensured that rs4454083 is a ‘stand-alone’ SNP. The variant allele (G) which is a minor allele across all world populations, was seen to be associated with remarkably higher ARBAG expression in cerebellum. A strong correlation was detected in expression of GABRA6 and ARBAG in human cerebellar cell-line. Presence of G allele was observed to stabilize lncRNA transcripts therefore leading to cellular abundance of ARBAG. Overexpression of ARBAG led to cleavage of full-length GABRA6 mRNA at/ around the site of complementarity between both RNAs and ended up in a dissociated GABRA6 protein which is rendered non-functional owing to separation of its ligand binding domain from trans-membrane domain. The findings demonstrate role of a sub-GWAS intronic variant in regulating functional mRNA isoforms of associated protein gene.

  • FROM WEIGHT MANAGEMENT VIA DIABETES CONTROL TO CARDIOVASCULAR RISK REDUCTION
    Speaker
    Gerald C. Hsu
    EclaireMD Foundation
    USA
    Biography

    Gerald C. Hsu received an honorable PhD in mathematics and majored in engineering at MIT. He attended different universities over 17 years and studied 7 academic disciplines. He has spent 20,000 hours in T2D research. First, he studied 6 metabolic diseases and food nutrition during 2010-2013, then conducted his own diabetes research during 2014-2018. His approach is a “quantitative medicine” based on mathematics, physics, optical and electronics physics, engineering modeling, signal processing, computer science, big data analytics, statistics, machine learning, and AI also known as “math-physical medicine”. His main focus is on preventive medicine using prediction tools. He believes that the better the prediction, the more control you have.

    Abstract

    Introduction: Since 1997, the author has been diagnosed with obesity, type 2 diabetes (T2D), hypertension, hyperlipidemia, and suffered five cardiac episodes. He spent 20,000 hours since 2010 to study and research his chronic diseases in order to save his own life. This abstract tells his story. Method: He created a math-physical medicine approach, instead of using the traditional biochemical method, to conduct his research. Initially, he defined inter-relationships among 11 categories and 500 elements of a human metabolism system. He collected and processed 1.5 million data of his lifestyle details and medical conditions. Furthermore, utilizing physics, mathematics, engineering modeling, and artificial intelligence (AI), he developed four prediction models with 99% accuracy, including weight, fasting plasma glucose,post prandial glucose, and hemoglobin A1C. Finally, he developed a risk probability calculation model of having heart attack or stroke. Results: From the period of 2013-2018, he has reduced his weight from 220 lbs. to 167 lbs., waistline from 44” to 32”, and BMI from 33.1 (obese) to 24.7 (normal). Based on his acquired knowledge, he developed AI-based prediction tools to reduce his average glucose value from 279 mg/dL to 116 mg/dL, A1C from 10% to 6.5%. Since 2016, his hypertension and hyperlipidemia are no longer health concerns along with dropping his cardiovascular risk from 74% to 31%. Conclusion: Over eight years, the author was able to control his weight and T2D along with greatly reducing his cardiovascular risk. In addition to his willpower and persistence, his diligence in acquiring medical knowledge from reading hundreds of textbooks and medical papers has assisted him. More importantly, his knowledge from other disciplines in mathematics, physics, engineering, statistics, computer science, and technology have provided him the necessary tools.

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