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Diabetes - The Way Forward

Diabetes - The Way Forward, a presentation at my campus SSR MEDICAL COLLEGE, MAURITIUS

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Diabetes - The Way Forward

  1. 1. Diabetes - the way forward September 17-18, 2012 Abstract Book SSR Medical College, Mauritius SSR Medical College IAMBR
  2. 2. Symposium on Diabetes - the way forward September 17-18, 2012 Abstract Book Organized by SSR MEDICAL COLLEGE, MAURITIUS Website: & INTERNATIONAL ASSOCIATION OF MEDICAL AND BIOMEDICAL RESEARCHERS | IAMBR Website:
  3. 3. ABOUT IAMBR The International Association of Medical and Biomedical Researchers (IAMBR) was founded in a meeting held at SSR Medical College, Mauritius in December 2010 with the objective to motivate and sensitize the people of medical and related professions to participate in medical research through symposiums/workshops/conferences/etc. The IAMBR is an international organization and multidisciplinary in nature including the members of basis science and clinical medical faculty as well as the members from allied sciences. The International Association of Medical and Biomedical Researchers (IAMBR) was registered on February 16, 2011.
  4. 4. Contents Welcome Address 1-3 Organizing committee of the Symposium 4 Managing committee of the Association 5 Program of the Symposium 9-11 Scientific Sessions - Key notes 12-22 Poster Session - Abstracts 23-34 List of Speakers 6-8
  5. 5. About S S R Medical college SSR Medical College, Mauritius prides itself in offering an intimate, collegial environment which fosters human values and genuine learning. The school offers the best education in an environment that supports the practice of new skills as well as an individual student's capacity to learn and serve. A unique emphasis on understanding and discipline in every action is the focal point, and this nurtures the student's intellectual and personal growth. Progressing with a noble idea to transform education from being a cluster of well- understood subjects to becoming well-adapted aspects and principles of life, SSR Medical College has become a "Centre of Excellence" in medical education, medicare, training and research. Mr. R. P. N. Singh, an educationist and social planner from India is the Founder Chairman and Managing Trustee of the Trust. The College strives to excel in every aspect of education under the direct guidance of honorable chairman whose vision has made every success possible.
  6. 6. Message It is a matter of great pride that the "International Association of Medical & Biomedical Researchers (IAMBR)", an organisation formed by a group of faculty of the SSR Medical College, Mauritius, has taken initiative to organise a symposium on "Diabetes- the way forward" on the occasion of the founders Day of the SSR Medical College. It is hidden from none that Diabetes has acquired diabolic proportion today affecting almost 1/3rd of humanity as its potential victim and has become a scourge of humanity. Globally, an estimated 300 million people are affected by diabetes, with type 2 making up about 90% of the cases. Its incidence is increasing rapidly, and by next decade, this number is feared to almost double, unless some miraculous remedy is discovered. Unfortunately, the greatest increase in prevalence is expected to occur in our region i.e. in Asia and Africa. The increase in incidence in "emerging countries" follows the trend of urbanization and consequent lifestyle changes further aggravated by imperative and imitative junk diet and life style. Diabetes is not new to humanity and its reference is found as early as in early Egyptian manuscripts as well as in ancient Indian references as madhumeha or "honey urine". Its relation to life style was also established as early as from Roman times. Its classification as today's Type 1 and type-2 diabetes were identified as separate conditions by the Indian physicians MAHARISHIs Sushruta and Charaka in 400-500 CE. Though the disorder and disease has been known for so long, solutions have remained limited in scope and substance. Such a malicious malady requires a continuous dialogue and research for its containment, if not its complete eradication. I am sure that some speaker would certainly harp on the timeless wisdom of the Orient, a result of timeless delving into depths of human experience and experimentation with self and life, beyond the limits and limitations of labs; and on the preventive rather than curative usefulness of holistic oriental remedies like breathing exercises, meditation and 'Yoga', which are “more than useful”. Shri. R P N Singh Chairman, SSR Medical College, Mauritius Patron 1
  7. 7. Message The International Association of Medical and Biomedical Researchers is organizing its second symposium on "Diabetes- the way forward" on September 17th -18th, 2012 at SSR Medical College. Following the grand success of its first symposium on 'Microbial Resistance to Antibiotics' held in its inaugural year, the Association has been encouraged to take up the challenge of holding this scientific meeting on a much larger scale. There will be a galaxy of international and national speakers, all luminaries in their fields, with a veritable feast of multi-disciplinary deliberations that will cover every advance and stratagem in humanity's struggle against Diabetes mellitus. This symposium, indeed all our endeavours, would not be possible without the constant support, advice and encouragement of Hon. Chairman, and on behalf of the association I extend him our heartfelt gratitude. Our Principal as Chief Adviser too deserves our thanks for his inspirational inputs and facilitation. Our invited speakers have set aside their busy professional schedules to come and share with us their knowledge and ideas on the very forefront of diabetology as seen from their respective viewpoints, and it is they who will give this symposium its unique blend and flavor. For this we are ever grateful and we welcome them into our midst. The poster session promises to be a collage of recent scientific opinion at the vanguard of diabetic research. We would like to extend a warm welcome to all the delegates, the faculty, staff and students of SSR Medical College and thank them for their participation and contribution. Not least, I would like to thank the Organising Committee whose months of hard work and preparation is showcased before you today. Professor (Dr.) Sushil Dawka, MS Department of Surgery, SSR Medical College, Mauritius President (IAMBR) 2
  8. 8. Symposium on: Diabetes the way forward | September 17-18, Dear Delegates, I extend a warm welcome to all the participants of the symposium on “Diabetes the way forward” organized by International Association of Medical and Biomedical Researchers at SSR Medical College, Mauritius. The symposium intends to focus on the global solutions to a global problem of diabetes in the community at crisis levels. I am extremely grateful to our honourable chairman of SSR Medical College Shri R P N Singh for taking the initiative to organize this symposium and providing with all necessary facilities for this event. It is a matter of great joy that this event is being held at our institute. My gratitude also goes to Prof. A K Lavania (Principal in charge, SSR Medical College), Prof. Sushil Dawka (President, IAMBR), Prof. Theeshan Bahorun (Vice-President, IAMBR), Professor A P Singh (Treasurer), Prof. Okezie I Aruoma (International Advisor, Organizing committee) and last but not least my wife Prof Smriti Agnihotri (Assistant Treasurer, IAMBR) for their guidance and encouragement. I would be failing in my duty if I do not acknowledge the generosity and support of all members of the association, and also Miss Purgass Kirti. I am thankful to all the participants for an overwhelming response to the symposium. I am sure that the symposium would provide a platform for healthy scientific deliberations and interactions between the researchers and scientists. Prof. (Dr.) Arun Kumar Agnihotri, MD Department of Forensic Medicine & Toxicology, SSR Medical College, Mauritius Organizing Secretary WELCOME ADDRESS 3
  9. 9. ORGANIZING COMMITEE Patron Shri. R. P. N. Singh Chairman, IOMIT's, SSR Medical College, Mauritius Chief Advisor Prof. (Brig. Retd.) A. K. Lavania, MD Principal (In charge), SSR Medical College, Mauritius President Prof. (Dr.) Sushil Dawka, MS Department of Surgery, SSR Medical College, Mauritius Vice-president Prof. (Dr.) Theeshan Bahorun, PhD National Research Chair, Personal Chair in Applied Biochemistry, ANDI Centre of Excellence for Biomedical & Biomaterials Research, University of Mauritius, Mauritius Organizing Secretary Prof. (Dr.) Arun Kumar Agnihotri, MD Department of Forensic Medicine, SSR Medical College, Mauritius Co-organizing Secretary Prof. (Dr.) Rimli Barthakur, MS Department of Ophthalmology, SSR Medical College, Mauritius Treasurer Prof. (Dr.) Ashok Pratap Singh, MS Professor, Department of Anatomy, SSR Medical College, Mauritius Prof. (Dr.) Okezie I Aruoma, PhD Dean, American University of Health Sciences, Signal Hill, CA 90755, USA Prof. (Dr.) David Owens, CBE MD FRCP Clinical Professor, Department of Endocrinology & Diabetes, Cardiff University School of Medicine, Wales, UK Scientific Committee Dr. Smriti Agnihotri MD Professor, Department of Pathology, SSR Medical College, Mauritius Dr. Suranjana Ray MD Associate Professor, Department of Physiology, SSR Medical College, Mauritius Dr. Anishta Allock MBBS Assistant Professor, Department of Pathology, SSR Medical College, Mauritius Registration Committee Dr. Anju Bala Singh MS Associate Professor, Department of Obstetrics & Gynecology, SSR Medical College, Mauritius Ms. Smita Kachhwaha MSc Assistant Professor, Department of Anatomy, SSR Medical College, Mauritius Dr. Tasneem Ibrahim MBBS Assistant Professor, Department of Pharmacology, SSR Medical College, Mauritius Souvenir Committee Dr. Sudesh Gungadin MD Chief Police Medical Officer, Police Medical Division, Port Louis, Mauritius Dr. Namrata Chhabra MD Professor, Department of Biochemistry, SSR Medical College, Mauritius Dr. Vandna Jowaheer PhD Associate Professor, Department of Mathematics, University of Mauritius, Mauritius Reception Committee Dr. Nandish Mital MS Additional Professor, Department of Surgery, SSR Medical College, Mauritius Dr. Manas Kanti Ray PhD Professor, Department of Physiology, SSR Medical College, Mauritius Dr. Adiilah Soodeen MBBS Lecturer, Department of Anatomy, SSR Medical College, Mauritius International Advisors 4
  10. 10. Managing Committee of IAMBR President Professor (Dr.) Sushil Dawka, MS Department of Surgery, SSR Medical College, Mauritius Vice-president Professor (Dr.) Theeshan Bahorun, PhD ANDI Centre of Excellence for Biomedical & Biomaterials Research, University of Mauritius, Mauritius Secretary Professor (Dr.) Arun Kumar Agnihotri, MD Department of Forensic Medicine & Toxicology, SSR Medical College, Mauritius Assistant Secretary Professor (Dr.) Rimli Barthakur, MS Department of Ophthalmology, SSR Medical College, Mauritius Treasurer Professor (Dr.) Ashok Pratap Singh, MS Department of Anatomy, SSR Medical College, Mauritius Assistant Treasurer Professor (Dr.) Smriti Agnihotri, MD Department of Pathology, SSR Medical College, Mauritius Members Dr. Sudesh Gungadin MD, Chief Police Medical Officer, Police Medical Division, Victoria Hospital, Mauritius Dr. Pugo Gunsam Prity, MS Associate Professor, Department of Health Sciences, University of Mauritius, Mauritius Professor (Dr.) Namrata Chhabra, MD Department of Biochemistry, SSR Medical College, Mauritius Ms. Smita Kachhwaha, MSc Assistant Professor, Department of Anatomy SSR Medical College, Mauritius Auditor Dr. Vandna Jowaheer, PhD Associate Professor, Department of Mathematics, University of Mauritius, Mauritius 5
  11. 11. Mr. Henry Cruz Henry Cruz, diabetes advocate, patient ambassador, community organizer, and motivational speaker, is the youngest of 12 children of which only four of them are alive. Diabetes has created havoc on his family. Several years ago, in response to the impact this loss had created in his family and life, Henry chose to turn his pain into a weapon against diabetes. Personally the impact of diabetes is visible in Henry, a month before walking in the first college graduation in his family, and on his way to Law School, he became completely blind due to diabetes retinopathy, but miraculously regained sight in his left eye. Formerly, he served as the Liaison for the Novo Nordisk Community Diabetes Coalition, which in 2011 was launched in Houston, Los Angeles, and New York. Henry previously served as the Associate Director of Hospitals, where he was responsible for implementing accredited DSME programs at 7 major hospitals in the NYC Health and Hospital Corporation; he also spearheaded the implementation of peer-to- peer coaching into the HHC HouseCalls Telehealth program, which serves 300 patients living with uncontrolled diabetes. As a chair of the American Diabetes Association's Latino Advisory Committee, he served as the Manager of Latino Initiatives and was responsible for reaching 100,000s of Latinos in the NYC area with the message of diabetes prevention and management education. Dr. Vidushi Neergheen- Bhujun PhD Dr Vidushi Neergheen-Bhujun is a lecturer at the Department of Health Sciences of the Faculty of Science at the University of Mauritius. She is also a researcher in the Centre for Biomedical and Biomaterials Research (CBBR), a multi-disciplinary research centre based at the University of Mauritius and recognized as an African Network for Drugs and Diagnostics Innovation (ANDI) Centre of Excellence in Health Innovation. She graduated from the Biosciences department of the University of Mauritius with a PhD in Biochemistry and Pharmacognosy in 2008. That dietary or plant biofactors may influence genetic and epigenetic events associated with several non-communicable diseases involving oxidative stress, DNA repair, hormonal regulation, cell cycle, apoptosis and differentiation are novel facets which are important features of Dr Neergheen -Bhujun’s research interest. Prof. Okezie I Aruoma PhD, DSc Profesoor Okezie Aruoma is founding Chair of Global Pharmaceutical Education and Research for the School of Pharmacy at the American University of Health Sciences. Dr Aruoma also serves as the Dean of Biomedical Sciences and Chair of the Institution Review Board at the American University of Health Sciences. Prior to the current role, Dr Aruoma was part of the founding faculty to develop an innovative Doctor of Pharmacy program at Touro College of Pharmacy, New York. Dr Aruoma has authored numerous books including Molecular Biology of Free Radical in Human Diseases, DNA & Free Radicals: Techniques, Mechanisms and Applications and Free Radicals in Tropical Diseases and has had more than 130 papers published in high ranking scientific peer-reviewed journals. Dr Aruoma has over 23 years of experience in biomedical research focused on food biofactors, oxidative stress mechanisms, antioxidant pharmacology and the pharmaceutical indications of food biofactors as prophylactic agents. Dr Aruoma’s novel research and teaching endeavors is focused in addition, on promoting public health nutrition and management of disaeses of overt inflammation (including diabets) and translational science embracing pharmacogenomics and personalized medicine. Dr Aruoma received the 2012 Research and Publication Achievement Award from the Association of Black Health Systems Pharmacists. 6 Symposium on: Diabetes the way forward | September 17-18, 2012 Introduction to Speakers
  12. 12. Prof. Joseph Indelicato LCSW, PhD Professor Joseph Indelicato is a clinical social, and a research psychologist. He graduated from Fordham University with a degree in Social Work in 1976. His master's thesis focus on the techniques of increase patient compliance in the mentally ill and followed that with a second masters 1985 and a doctorate in psychology at Hofstra University 1987. Dr. Indelicato’s current research interests include research methodology, patient compliance, pain management, bariatrics, and statistics. He also works as a clinical psychologist and has testified in over a hundred court cases, on issues as varied as child custody to neurological damage. He is currently working on research on the use of Fermented Papaya Preparation to slow the progress of diabetes. He is involved in work on Mauritian tea for diabetes management. He is Director of Research for the American Association of Bariatric Counselors. He is licensed as both a psychologist and a social worker. Prof. David Owens CBE MD FRCP Professor David Owens has been involved in the management of diabetes and related research activities for more than 35years. His primary interests include the evolution of glucose intolerance and pathophysiology of type 2 diabetes including new and emerging therapies. He also has a keen interest in all micro-vascular complications of diabetes especially diabetic retinopathy and nephropathy, and introduced the first community wide National Diabetic Retinopathy Screening Service for Wales as its Director & Clinical Lead from its establishment in 2002 up to 2007. Professor Owens has published over 300 peer- reviewed papers, in addition to reviews and book chapters. Professor Owens is a member of the Association of Physicians of Great Britain and Ireland and is a Fellow of the Royal College of Physicians and Institute of Biology. His opinion has been sought by numerous diabetes-related advisory boards for both UK and International governmental organizations and the Pharmaceutical industry. In 2002 Professor Owens was awarded the CBE for his services to diabetes and the National Health Service. Prof. Rimli Barthakur MBBS, MS Professor Rimli Barthakur passed her MBBS in 1994 and completed her MS (Ophthalmology) in 2000 from Gauhati Medical College and Hospital, Guwahati, Assam, India. Subsequently, she joined the Faculty of Ophthalmology, Manipal College of Medical Sciences, Pokhara, Nepal and worked at Manipal Teaching Hospital till February 2009. In March 2009, she joined SSR Medical College, Mauritius, where she is currently Professor of Ophthalmology. She has a Fellowship in Glaucoma Diagnosis and Therapy from the Aravind-Zeiss Glaucoma Centre of Excellence, Aravind Eye Hospital, India. She is also a Primary Trauma Care Provider certified under the Primary Trauma Care Foundation, Oxford, UK. She has presented papers in many conferences and has publications in various national and international journals. She is also on the editorial board of a number of peer reviewed journals. Dr. Emmanuel Bourdon MCU, HDR, PhD Dr Emmanuel Bourdon completed his PhD in Biochemistry in 2000 at Dijon (France) and has been actively involved in research on the molecular aspects of diabetes and obesity. He completed his research formation by a two years postdoctoral position at National Institutes of Health (Bethesda, USA) and by a one year and a half postdoc in France. In 2004, he got a permanent position as researcher and Associate Professor in the “Groupe de Recherche sur l’Inflammation Chronique et l’Obésité » (GEICO) at the Université de la Réunion (La Réunion, France). Since 2004, Dr Bourdon has lead a working group on interactions between oxidative stress and cellular pathophysiology in diabetes and obesity context. He is the author/co-author of more than 35 high level publications in that field of research. He is a regular reviewer for the evaluation of scientific articles subjected to review by a peer. 7 Symposium on: Diabetes the way forward | September 17-18, 2012
  13. 13. Prof. Theeshan Bahorun PhD Professor Theeshan Bahorun has been appointed as National Research Chair in Applied Biochemistry since January 2012 and is based at the ANDI Centre of Excellence for Biomedical and Biomaterials Research, University of Mauritius. His novel research endeavours are focused on promoting public health nutrition and disease prevention. He was awarded a “Doctorat Sciences de la Vie et de la Santé” in Plant Biotechnology at the University of Lille I (France). He also holds a DEA “Génie Enzymatique, Bioconversion et Microbiologie” from Université de Technologies de Compiègne (France), a “Maîtrise” in “Biochimie Alimentaire” and a “Licence” in Biochemistry from University of Lille I (France). He has 20 years of experience in biomedical research including pathophysiological mechanisms in diabetes, cancer and cardiovascular dysfunctions. Prof Bahorun has authored/co- authored more than 80 high level publications including the edition of 7 books/ special journal issues and 10 book chapters. In 2010, he received the CV Raman Senior Fellowship award for African researchers by the Government of India. Dr. Sandip Hindocha MBChB, MRCS Dr Sandip Hindocha, a plastic surgeon, worked for a number of hospitals in Manchester, Canada and the USA and now works as a senior registrar in plastic, reconstructive and hand surgery in Liverpool. He is a clinical lecturer at the University of Manchester and runs a surgical sciences course at the University of Mauritius. Sandip is the holder of a prestigious Royal College of Surgeons Research Fellowship and has won several academic prizes including the Society of Academic Research Surgeons prize at the annual Association of Surgeons in Training conference. He has published 41 papers and compiled 4 book chapters and presented his work internationally and nationally equating to over 65 peer reviewed presentations. His research interests include wound healing and understanding the etiopathogenesis of abnormal scar formation using Dupuytren’s disease as a model. Sandip is an enthusiast and keen to teach, research & operate. Mr. Arnold Joseph Arnie Joseph, has more than two decades of experience in public health, health communication, minority health, cardiovascular disease and diabetes, community relations, and partnership development. Arnie applies his experience and commitment to underserved communities, disease prevention, and health and wellness through collaborative community partnerships as the President and Founder of Chroma Multicultural Health Communications (Chroma). As the President of the agency, Arnie is primarily responsible for developing and implementing strategies to eliminate health disparities by empowering patients, building stakeholder collaborations, and improving physician and healthcare provider ability to engage their patients. Arnie is a native New Yorker and studied biology, inorganic chemistry, biochemistry, and psychology at the State University of New York at Binghamton. Dr. Shilpa Sinha MBBS, MD Dr Shilpa Sinha post-graduated in Obstetrics and Gynecology from T.N. Medical College, Nair hospital, Mumbai University in 2001. After post graduation she worked in Delhi for 1 year. From 2003-2007 she worked with Ministry of health and Quality of life, Mauritius at Dr A. G. Jeetoo hospital, Port Louis. She worked as junior and associate consultant at Fortis La Femme and SitaRam Bhartia Institute of Science and Research till June, 2010. Since July 2010, she is been working as Consultant in the department of Obstetrics and Gynecology at Apollo Bramwell Hospital, Mauritius. She has taken special training in infertility and IVF. She has attended many national and international conferences and published papers in medical journals. She is a life member of ‘Federation of Obstetrics and Gynecology societies of India’ and ‘Indian Fertility Society’. 8 Symposium on: Diabetes the way forward | September 17-18, 2012
  14. 14. Scientific Program Monday, September 17 8:15 – 9:00 hours Registration 9:00 – 9:30 hours Inauguration and Welcome Address (by Shri. R P N Singh, Chairman, SSR Medical College, Belle Rive, Mauritius) 9:30 - 9:45 hours Diabetes - A global health problem Henry Cruz, Chroma Multicultural Healthcare Communications, New York, USA 9:45 - 10:00 hours Tea Break 10:00 – 12:15 hours Session 1 - Pathophysiology of Diabetes and its complications (Chaired by Theeshan Bahorun, Chair in Applied Biochemistry, National Research Chair, ANDI Centre of Excellence for Biomedical and Biomaterials Research, University of Mauritius, Reduit, Mauritius and Joseph Indelicato, Chair of Touro College Health Sciences, Bay Shore, New York, USA ) 10:00 – 10:15 hours Introduction to topic and speakers - Session Chairs 10:15 – 10:40 hours Alterations in antioxidant status of patients suffering from diabetes mellitus and its associated cardiovascular complications Vidushi S Neergheen-Bhujun, Lecturer, Department of Health Sciences, Faculty of Science and ANDI Centre of Excellence for Biomedical and Biomaterials Research, University of Mauritius, Reduit, Mauritius 10:40 – 11:05 hours Integrative biological approaches to diabetic complications Okezie I. Aruoma, Dean, American University of Health Sciences, Signal Hill, CA 90755, USA 11:05 – 11:30 hours Proteomic biomarkers of diabetic complications Emmanuel Bourdon, Groupe d'Etude sur l'Inflammation Chronique et l'Obésité, Faculté des Sciences, La Réunion – France 11:55 – 12:15 hours Discussion and conclusion remarks by Chairperson 12:15 – 13:15 hours Lunch 11:30 – 11:55 hours Global clinical research in diabetes Fatima Morad, Apollo Bramwell Clinical Research, Mauritius September 17-18, 2012 Venue – SSR Medical College, Mauritius 9
  15. 15. 13:15 – 15:30 hours Session 2 - Diabetic complications (Chaired by Sandip Hindocha, Clinical Lecturer / Registrar Plastic Surgery, Whiston Teaching Hospital, Liverpool, UK and Emmanuel Bourdon MCU HDR, Groupe d'Etude sur l'Inflammation Chronique et l'Obésité, Faculté des Sciences, La Réunion – France ) 13:15 – 13:30 hours Introduction to topic and speakers - Session Chairs 13:30 – 13:55 hours Management of Cognition Deficit in Diabetes and Neurodegeneration Joseph Indelicato, Chair of Touro College Health Sciences, Bay Shore, New York, USA 13:55 – 14:20 hours The glycaemic management of persons with type 2 diabetes mellitus David Owens, Clinical Professor, Department of Endocrinology & Diabetes, Cardiff University School of Medicine, Wales, UK 14:20 – 14:45 hours Ocular complications of diabetes Rimli Barthakur, Professor, Department of Ophthalmology, SSR Medical College, Mauritius 14:45 – 15:10 hours Gestational diabetes - Risk or Myth? Shilpa Sinha, Consultant, Department of Obstetrics and Gynecology, Apollo Bramwell Hospital, Mauritius 15:10 – 15:30 hours Discussion and conclusion remarks by Chairperson 15:30 – 15:45 hours Tea Break 15:45 – 16:45 hours Session 3 - Poster Session (Venue - A hall near Examination Room, Second Floor) 10
  16. 16. 9:00 – 11:30 hours Session 4 - Prevention and management of diabetic complications (Chaired by Okezie I. Aruoma, Dean, American University of Health Sciences, Signal Hill, CA 90755, USA and David Owens, Clinical Professor, Department of Endocrinology & Diabetes, Cardiff University School of Medicine, Wales, UK ) 9:00 – 9:15 hours Introduction to topics and speakers - Session Chairs 9:15 – 9:40 hours Management of diabetic patients - molecular events and clinical trials Theeshan Bahorun, Chair in Applied Biochemistry, National Research Chair, ANDI Centre of Excellence for Biomedical and Biomaterials Research, University of Mauritius, Reduit, Mauritius 9:40 – 10:05 hours Role of surgery in diabetic patients Sandip Hindocha, Clinical Lecturer / Registrar Plastic Surgery, Whiston Teaching Hospital, Liverpool, UK 10.05 – 10:20 hours Tea Break 10.20 – 10:45 hours Oral health and diabetes David Owens, Clinical Professor, Department of Endocrinology & Diabetes, Cardiff University School of Medicine, Wales, UK 10:45 – 11:10 hours Effective health outreach to "multi-cultural" communities: the value of collaboration between a community's health-related stakeholders Arnold Joseph, CEO, Chroma Multicultural Healthcare Communications, New York, USA 11:10 – 11:30 hours Discussion and conclusion remarks by Chairperson 11:30 – 11:45 hours Vote of thanks and Adjournment 11:45hours onwards Lunch, Prize Giving Ceremony and Cultural Program Tuesday, September 18 11
  17. 17. Scientific Sessions Key notes of speakers
  18. 18. Diabetes - a global health problem Henry Cruz Chroma Multicultural Healthcare Communication, New York, USA The presentation will provide an overview and update on the Global Diabetes pandemic and also highlight common issues that affect the patient which transcends culture and borders. Although patient- centeredness in healthcare is becoming a global phenomenon its context appear to be poorly understood in medical practice. Health policies are important determinants of clinician and patient behavior, and an im- portant policy issue is what items are included in healthcare quality and performance measures. There is consensus that patient-centered care and self-management support are essential evidence-based compo- nents of good diabetes care. The indicators such as patient self-management goal(s), measures of health behaviors (e.g., healthy eating, medication taking, physical activity, and smoking status), quality of life, and patient-centered collaborative care are critical components in the assessment of patient-centered problems in an attempt to harmonize diabetes management on a global scale. 12 Alterations in the antioxidant status of patients suffering from diabetes mellitus and associated cardiovascular complications Dr. Vidushi S Neergheen-Bhujun, PhD ANDI Centre of Excellence for Biomedical and Biomaterials Research, University of Mauritius, Reduit, Mauritius Mauritius has a very high prevalence of type 2 diabetes mellitus (T2DM). Patients with T2DM have an increased risk of cardiovascular complications, which is the major cause of mortality, accounting for more than 50% of diabetic patients in the island dying from ischaemic heart disease. Oxidative stress has been implicated in the initiation and progression of diabetes and its associated complications and has been marked with an increased generation of free radicals and a decreased antioxidant defense system. Thus this study aimed at determining the total antioxidant capacity and the erythrocyte catalase activity of Mauritian type 2 diabetics with and without cardiovascular complications. 90 age-, gender- and body mass index-matched subjects were included in this study and divided into healthy subjects (Group I, n=30), T2DM patients (Group II, n=30) and diabetic patients with cardiovascular complications (Group III, n=30). Blood samples were collected from the eligible subjects and the samples were subjected to a number of biochemical tests and blood total antioxidant activity using the ferric reducing antioxidant power assay and erythrocyte catalase activity. The mean FRAP value of Group II and Group III were found to be significantly lower than that of Group I (p < 0.05). A significant decrease was also observed in the mean catalase level of Group II and Group III as compared to Group I (p < 0.05) while an increase in the level of cholesterol, triglycerides, LDL, uric acid, urea and creatinine was observed in Group II and Group III as compared to the healthy subjects of Group I. These data suggest that the in vivo antioxidant defense is highly compromised in patients with T2DM and associated cardiovascular complications indicating that oxidative stress plays an important role in the pathogenesis of T2DM, thereby suggesting the potential of exogenous antioxidants.
  19. 19. Integrative biological approaches to diabetic complications Professor (Dr.) Okezie I Aruoma, PhD, DSc Dean, American University of Health Sciences, Signal Hill, CA 90755, USA Diabetes mellitus is a group of chronic disorders of the pancreas traditionally regarded as a metabolic disturbance that involves the elevation of blood glucose, abnormal abdominal fat deposition and insulin resistance. The insulin dependent diabetes mellitus (Type 1 diabetes) is an autoimmune disease of younger patients with a lack of insulin production causing hyperglycemia and ketosis and non-insulin dependent diabetes mellitus (Type 2 diabetes), is a metabolic disorder resulting from the body’s inability to produce enough or properly utilize insulin. Diabetes is associated with a number of complications including cardiovascular diseases, nephropathy, neuropathy, retinopathy leading to blindness and embryopathy or congenital malformations. In diabetic nephropathy, the production of activated protein C in the glomerulus is abnormal, in part because of hyperglycemia-induced repression of thrombomodulin expression. The decreased functional activity of activated protein C can affect the permeability of the glomerular capillary wall enhancing apoptosis of glomerular endothelial cells and podocytes. There is growing emphasis to assess the integrity of protein C in the subjects and to monitor this biomarker through the commencement of drug therapy and correlate with the development of atheroma. Further, activated protein C is an endogenous protein that promotes fibrinolysis and inhibits thrombosis and inflammation. Thus protein C is not only an important modulator of the coagulation and inflammation associated with severe sepsis but a biomarker of potential relevance to the pathophysiology of diabetic nephropathy. LDL has been identified as a major risk factor for atherosclerosis in the general population as well as in diabetic patients. Native LDL, however, is not atherogenic; the circulating LDL must first undergo some kind of postsecretory modification. Modifications of LDL (including oxidation and glycation) can facilitate foam cell formation driven in part by the rapid uptake of the modified LDL by macrophage. Glucose can increase monocyte binding to the endothelial cells, and as the adhesion of monocytes to the vascular endothelium is a key event in the development of atherosclerosis (mechanism by which elevated glucose leads to atherosclerosis). Modified LDL contributes to the fomation of the fatty streak by restricting the macrophage mobility within the arterial wall and stimu-lates platelets aggregation and procoagulant activity on the surface of the endothelial cells. Interestingly, lipoprotein lipase may promote the uptake of atherogenic LDL by the different vascular cell types which eventually contribute to lipid accumulation within the arterial wall. B-type natriuretic peptide (BNP) is a neurohormone synthesized in the cardiac ventricles, which is released as N-terminal pro-brain natriuretic peptide (NT-proBNP) and then enzymatically cleaved in to the NT fragment and the immunoreactive BNP. BNP (and to a lesser extent, N-terminal (pro) BNP) plasma levels are higher in patients with HF and diabetes, than in those without diabetes. This may be associated with the diastolic dysfunction observed in these patients, and may have an impact on prognosis. B-type natriuretic peptide is synthesized in the cardiac ventricles and released as N-terminal pro-brain natriuretic peptide (NT-proBNP) and then enzymatically cleaved in to the NT fragment and the immunoreactive BNP. 13
  20. 20. Proteomic biomarkers of diabetic complications – Enhanced glycoxidative modifications impair albumin properties in diabetes Dr. Emmanuel Bourdon , MCU, HDR, PhD Groupe d'Etude sur l'Inflammation Chronique et l'Obésité , Faculté des Sciences et Technologies , La Réunion – France Oxidative stress and oxidative modifications of proteins are involved in many physiological and pathological processes such as aging, neurological diseases, metabolic syndrome, type 2 diabetes, obesity and cardiovascular disease, leading cause of death in Western countries. Albumin is the most abundant serum protein. Among the variety of biological mechanisms which have been proposed to explain the beneficial effects of higher albumin concentrations, there is now ample evidence for a significant antioxidant activity of albumin. Alterations in the structure of albumin may result in impairments of its biological properties. These modifications could occur in diabetes, which is one of the pathological conditions associated with early occurrence of vascular complications, together with functional alterations of albumin, which undergoes increased glycation. This phenomenon corresponds to the nonenzymatic attachment of a glucose molecule to a free primary amine residue. Amadori rearrangement of the glycated protein gives rise to the deleterious advanced glycated end products (AGE). Interaction of AGE with their receptors (RAGE) induces several cellular phenomena potentially relating to diabetic complications. A recent study showed that AGE- modified bovine serum albumin can be endocytosed by adipocytes via CD36. The objectives of our work are: • to analyze the structural and functional properties (antioxidant and binding capacity of pharmaceutical molecules) of albumin purified from plasma from patients with diabetes, • to study albumin pro-inflammatory or antioxidant action on cultured human adipocytes and monocytes, and • to clarify the involvement of the CD36 receptor in oxidative disturbances in cell cultures of monocytes and human adipocytes treated with AGEs, and in rats made diabetic by chemical treatment with streptozotocin. Our work first revealed oxidative modifications of albumin purified from diabetic patients. We showed that albumin can act as a biomarker of oxidative stress in diabetic pathology. We established correlations between biochemical parameters of patients with the structural and functional properties of albumin (antioxidant properties and binding capacities of biological molecules and pharmaceuticals). Oxidative damage were then shown in cell culture (monocytes and adipocytes) incubated in the presence of AGEs formed by glycated albumin. In particular, we observed in cells treated with AGEs: an increased oxidative stress, an accumulation of oxidized proteins, increased expression of RAGE, an alteration of the multicatalytic system, the proteasome, involved in the degradation of oxidized proteins. In addition, we have clarified the role of apolipoprotein E (apoE) in adipocytes. ApoE participates in cholesterol homeostasis and metabolism of plasma lipoproteins. Despite the major involvement of ApoE in both neurological disorders (Alzheimer's) and metabolic (metabolic syndrome) its role in adipocyte was very poorly documented. With the development of SW872 cell lines over-expressing apoE, we were able to evidence an antioxidant action of ApoE in adipocytes subjected to AGEs-mediated oxidative stress. These data may suggest an association of oxidative damage in albumin with the progression of diabetes disorders at the cellular level. Further experiments are under progress in our laboratory on a rat model of diabetes in order to achieve a better understanding of glycoxidation impact on albumin properties. 14
  21. 21. Diabetics frequently have the concomitant problem of suffering from cognitive deficits and cognitive degeneration. Managing and treating these deficits and slowing the degeneration involves both an understanding of the etiology of both the cognitive deficits and degeneration themselves in order to focus interventions which may delay or totally impaired the disease processes. The affects of these cognitive impairments on the actual behaviors of the diabetic will be addressed and interventions both currently being used and those which are still theoretical. Measurement of the impairment must be part of the process to determine both the severity of the condition and the effects of the treatment. While Diabetes and Alzheimer’s have been determined to be two of the most common causes of dementia in the world, generally diabetics have not been screened for cognitive impairment although diabetes has been frequently shown to be a precursor of dementia. There have been a number of theoretical etiologies for these cognitive deficits including duration of the diabetic, hypertension, dyslipidemia, and small vessel diseases of brain, amongst others, but evaluation of the level of the cognitive deficits are still not part of the normal screening process. These concerns are more than just theoretical in nature, since about one third of adults with diabetes have shown evidence of cognitive impairment. This impairment interferes with a number of processes including their likelihood to participate in exercise programs, their ability to do basic self care, and their tendency to stay on appropriate diets or for that matter track a diet and track blood glucose levels. This issue becomes paramount in the case of diabetes where compliance stands not only in the singular area of medication but also frequently includes major lifestyle changes. These impairments are not only related to the elderly but research has also shown their effects much younger patients in which cognitive impairments are rarely looked for by medical practitioners. Impairments in cognition can worsen the course of diabetes in a number of ways; interventions must follow multiple paths depending upon the patients stressors and severity of cognitive impairment. While the multifactorial ways in which diabetes worsen dementia are not completely understood, these deficits are evident in neurophysiologic effects on the brain. These stressors cause a speed the course of the neurological deficits leading to a vicious cycle which must be addressed to truly and fully treat the diabetic condition. 15 Management of Cognition Deficit in Diabetes and Neurode- generation Professor Joseph Indelicato, LCSW, PhD Touro College School of Health Sciences , New York, USA
  22. 22. The prevalence and incidence of type 2 diabetes mellitus (T2DM) continues to increase at an alarming rate globally and especially in developing countries accompanied by a worrying trend towards younger persons. Currently 366 million people world wide are estimated to have diabetes which is projected to reach 552 million by 2030 of which more than 90% will have T2DM. As the leading cause of blindness, renal failure, amputations and cardiovascular disease T2DM represents a significant health-economic burden underlying the urgent need for the implementation of effective management strategies. The relationship between glycaemic control and both micro-vascular and macro-vascular complications is well established, thereby providing a focus for therapeutic intervention along with the recognised need to control existing co-morbidities such as hypertension and dyslipidaemia. Historically, several International and National guidelines/consensus statements have been generated over the years in an attempt to provide the clinician with a structured approach to the total management of persons with T2DM. The increasing plethora of pharmacological agents presents an additional level of complexity and controversy to the current unsatisfactory situation. Consequently the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) recently issued a Position Statement on ‘A patient Centred Approach to the Management of Hyperglycaemia in T2DM’, which is the subject of this presentation. In addition to the need to understand the pathogenesis of T2DM and its clinical expression based on the stage of the disease process, age, racial, ethnic and genetic differences, the risk-benefit of the various therapeutic modalities and overcoming clinical inertia addressing the specific needs of the person with T2DM is an essential pre-requisite for a successful outcome. In the management of hyperglycaemia a key consideration is arriving at an appropriate glycaemic target for the individual concerned. Defining the individualised intervention strategy, be it more or less intensive, necessitates an evaluation of the person’s attitude and expected treatment outcome, disease duration, life expectancy, important co-morbidities and established vascular complications. Other aspects include the potential risk of hypoglycaemia and other adverse events from therapeutic agents along with the question of available resources and support system availability. Pivotal among the spectrum of options for intervention, is the ‘first-line’ personalised lifestyle adjustments. Subsequent failure to achieve glycaemic goal requires consideration for the introduction of oral and injectable anti-diabetic agents. Metformin continues to be the primary oral agent, unless otherwise contraindicated. Thereafter, based on an inadequate HbA1c response at approximately 3 months, there is the choice to add a second agent either a sulphonylurea, thiazolidinedione (TZD), DPP-4 inhibitor, GLP-1 receptor agonist or insulin usually as basal insulin. After a further 3 months if glycaemic control remains inadequate a third alternative agent can be introduced or in the context of insulin, a more complex insulin strategy can be employed. At each stage from initial drug monotherapy, progressing to two and then three drug combinations there is need to evaluate efficacy (HbA1c reduction), frequency and severity of hypoglycaemia, weight, side effect(s) and also costs need to be taken into consideration. The presence of co-morbidities such as coronary heart disease, heart failure, chronic kidney and liver disease will also determine the treatment choice. Education and understanding is central to the whole management process of persons with T2DM, with structured self-monitoring of blood glucose an essential aid to support the making of appropriated decisions conjointly between the individual concerned and the responsible clinician based on preferences, needs and values. 16 The glycaemic management of persons with type 2 diabetes mellitus Emeritus Professor David R Owens, CBE MD FRCP Department of Endocrinology & Diabetes, Cardiff University School of Medicine, Wales, UK
  23. 23. The current global epidemic of diabetes mellitus is responsible for an unprecedented magnitude of human suffering and death. Diabetics are at heightened risk for cardiovascular, renal and neurological complications. Compounding the morbidity of these patients is the threat of visual impairment and eventual blindness. According to the World Health Organization, of the 37 million cases of blindness due to eye diseases worldwide, diabetic retinopathy is responsible for 4.8%. 10% of people who have diabetes for 15 years develop severe visual problems and about 2% become blind. More than 75% of diabetics will have developed retinopathy after 20 years. The retinal complications of diabetes mellitus occur due to damage to the retinal microvasculature. The main risk factor for developing retinopathy is the duration of diabetes. The other risk factors include poor glycaemic control, hyperlipidemia, hypertension, pregnancy, renal disease etc. Retinopathy may be non- proliferative (mild, moderate or severe) or proliferative. Fundus findings in non-proliferative retinopathy include micro-aneurysms, hard exudates, retinal haemorrhages, oedema, cotton wool spots, intra-retinal microvascular abnormalities etc. Diabetic maculopathy may also occur leading to severe visual impairment. Eventually, the retina becomes hypoxic and vascular endothelial growth factors are released, leading to the development of proliferative retinopathy. Neovascularization may occur on the optic disc or elsewhere on the retina. These vessels are abnormal and bleed easily, leading to vitreous haemorrhage and ultimately tractional retinal detachment with serious visual consequences. Fortunately, diabetic retinopathy can be treated and therapeutic options include laser photocoagulation, use of intra-vitreal steroids (triamcinolone acetonide), intra-vitreal vascular endothelial growth factor inhibitors (bevacizumab, ranibizumab), vitrectomy etc. Diabetics also tend to develop cataracts early and retinopathy may worsen following lens extraction. The diabetic population is also seen to have a higher risk of developing open angle glaucoma. Proliferative retinopathy may cause iris neovascularization, which in turn may progress to neovascular glaucoma. Diabetic peripheral neuropathy may predispose towards reduced corneal sensitivity and some patients may develop corneal trophic ulcers. Other ocular complications include oculomotor, trochlear and abducent nerve palsies, pupillary dysfunctions, vascular occlusions, refractive changes, conjunctival abnormalities and increased risk of ocular bacterial or fungal infections etc. Ocular complications of diabetes mellitus are increasingly becoming a major cause of blindness throughout the world. Regular ocular examination of diabetics is of utmost importance in early recognition of complications. Patient education, cost-effective screening methods and appropriate treatment when needed can prevent most blindness caused by diabetes. 17 Ocular complications of diabetes Professor Rimli Barthakur, MS Head, Department of Ophthalmology, SSR Medical College, Mauritius
  24. 24. Gestational Diabetes is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. The prevalence may range from 1 to 14% of all pregnancies depending on the population studied and the diagnostic tests employed. Importantly the prevalence of Gestational Diabetes is increasing, probably because of increased rates of overweight and obesity. Pregnancy is characterized by insulin resistance and hyperinsulinemia. Gestational Diabetes occurs when pancreatic functions are not sufficient to overcome the insulin resistance created by changes in diabetogenic hormones secreted by placenta during pregnancy. Several reasons could contribute to this like family history, defects in earlier pregnancy (still born, large for date baby), obesity and maternal age over 30 years. There are many myths regarding Gestational Diabetes. A diabetes condition is not developed by consumption of too many sweet products. Sugar contains high amount of glucose and if it is consumed as a part of a balanced diet (along with exercise), then people can consume it without the risk of Diabetes. Life style acts as a trigger to development of Diabetes. Lack of activity may lead to Diabetes. This condition is associated within increased risks for the fetus and newborn, including congenital abnormalities, macrosomia, late still born, shoulder dystocia, hyperbilirubinemia, hypoglycemia, Respiratory distress syndrome and childhood obesity. Offspring of Gestational Diabetic mother are prone to developing type - 2 Diabetes later in life. Maternal risks include preeclampsia, caesarean delivery and are at increased risk of developing type -2 diabetes later in life. It is controversial whether all pregnant patients should be screened for Gestational Diabetes. The American Diabetes Association has proposed that screening be limited to women with risk factors for Gestational Diabetes. In September 2011, the committee on obstetric practice of the American College of Obstetricians and Gynecologists recommended a two step approach to screening and diagnosis. All pregnant women should be screened for Gestational Diabetes whether by patient’s history, clinical risks factors or 50 grams, 1 hour glucose challenge test at 24-28 weeks of gestation. The diagnosis of Gestational Diabetes can be made on the result of the 100 grams, 3 hours oral glucose tolerance test. It is important that multidisciplinary approach be used to improve pregnancy outcome. Effective treatment regimens consisting of dietary therapy, blood glucose monitoring and administration of insulin if target blood concentrations are not met with diet alone can decrease maternal and fetal morbidity. Since Gestational Diabetic have increase risk of type-2 diabetes life style modification, education, follow up and intervention is important later in life. Offspring should be closely followed up for the development of obesity and abnormality of glucose intolerance. 18 Gestational diabetes - Risk or Myth? Dr. Shilpa Sinha, MD Consultant, Department of Obstetrics and Gynecology, Apollo Bramwell Hospital, Mauritius
  25. 25. Diabetes is a ROS-mediated pathology with a worldwide prevalence estimated to increase alarmingly in the coming years. A major effort is ongoing to find therapeutic means to improve health conditions of diabetic patients. Our group has been actively involved in clinical trials and molecular studies demonstrating that supplemental natural antioxidants from polyphenolic rich plant foods represent a potential strategy as adjunct therapy. We hereby report the analyses of twenty-one varieties of tropical citrus fruits for their total phenolic, flavonoid and vitamin C contents and antioxidant activities. Furthermore in randomized clinical trials we investigated the effect of a fermented papaya preparation (FPP® ) and polyphenolic rich green tea infusate on diabetic risk factors of pre-diabetics. Using a diabetes-like oxidative stress model, the potential protective effect of antioxidative flavedo, albedo and pulp extracts of selected citrus species were investigated on human adipocytes. In the clinical trials, study groups consumed 6 g FPP® /day or 1 standard cup of green tea (without additives) 3 times a day before main meals for 14 weeks followed by a 2-week wash-out period while the control groups followed a water regimen. Anthropometric and biochemical characteristics of pre-diabetics were assessed. Our data show that besides retarding free radical-induced hemolysis of human erythrocytes, non-cytotoxic concentrations citrus flavedo extracts significantly reduced the levels of protein carbonyls in response to AGEs generated by albumin glycation in SW872 cells. Flavedo extracts lowered carbonyl accumulation in H2O2-treated adipocytes while flavedo, albedo and pulp extracts suppressed ROS production in SW872 cells with or without the addition of H2O2. The FPP clinical trial data show C-reactive protein levels significantly decreased (P=0.018), LDL/HDL ratio was considerably changed (P=0.042), and uric acid levels were significantly improved (P=0.001). ANOVA results also validated the same findings with significant differences in C-reactive protein, LDL/HDL ratio, uric acid and in serum ferritin levels. Green tea modulated the level glucose of women and prevented a significant elevation after week 14. Its consumption non- significantly reduced ferritin in men by 3.0 % and significantly increased the antioxidant potential of men and women sera by 2.7 % (P < 0.1) and 5.1 % (P < 0.01) respectively after week 14. Our data show that citrus fruit extracts represent an important source of antioxidants with a novel antioxidative role at the adipose tissue level and that FPP® and green tea regimens could form part of a healthy lifestyle that might ameliorate features of metabolic syndrome and subsequent risks for type 2 diabetes. 19 Management of diabetic patients - molecular events and clinical trials Professor (Dr.) Theeshan Bahorun, PhD National Research Chair, ANDI Centre of Excellence for Biomedical and Biomaterials Research, University of Mauritius, Reduit, Mauritius
  26. 26. Diabetes poses a challenge for the surgeon at pre, peri and post operative stages of surgical treatment. It is imperative that the patients diabetes is under control so as to avoid post operative complications such as infection, poor wound healing, osmotic diuresis and dehydration. The insulin deficiency can also lead to keto-acidosis and protein catabolism. Non-insulin dependent diabetic patients are at risk of hypoglycaemia which if not managed appropriately can lead to brain injury. Diabetic patients should be placed first on the operating list and oral hypoglycaemic drugs should be stopped and as with insulin dependant diabetics started on an insulin sliding scale. The increase in prevalence of diabetes increases the number of diabetic related surgical procedures such as peripheral vascular by-pass grafts, major abdominal surgery, amputations and the need for more extensive reconstructions following wound breakdown or trauma as a result of poor wound healing. This is in addition to the rising obesity epidemic fueling the diabetic epidemic increasing the number of gastric by-passes and body contouring following massive weight loss. It is absolute that the surgeon and the physician work in harmony and in collaboration in order to reduce these complications when the diabetic patient is to face the knife. 20 Role of surgery in diabetic patients Dr. Sandip Hindocha, MBChB, MRCS Registrar Plastic Surgery , Whiston Teaching Hospital, Liverpool, UK
  27. 27. Periodontal disease (PD) evolves from exposure to pathogens in the oral cavity in a susceptible host. The process is based on an initial immuno-inflammatory response which leads to the formation of a dental biofilm (plaque), gingivitis (bleeding, swollen gums) followed by periodontitis with local connective tissue degradation, alveolar bone loss and finally tooth detachment. This situation represents an inter-play between environmental, acquired and genetic putative risk factors. Periodontal disease and diabetes have a bi-directional relationship with periodontal disease able to adversely impact on glycaemic control by virtue of deteriorating insulin sensitivity whilst chronic poor metabolic control in a person with diabetes will increase the hosts’ susceptibility to infection thus enhancing the risk of gingivitis which in the presence of continuing dysglycaemia will eventually result in periodontal disease. Therefore periodontal disease has for sometime been regarded as the sixth complication of diabetes following on to visual impairment/blindness, amputations, cardiovascular disease, hypoglycaemia and sexual dysfunction. Improving oral health and diabetes appears to have a positive influence on each other. Smoking is a strong environmental risk factor for periodontal disease that cannot be ignored. Other oral complications observed in persons with diabetes include xerostomia (dry mouth), fungal infections – candidiasis, alteration in taste, burning mouth syndrome and dental caries. There are two clinical questions for the diabetic community which were addressed in the IDF Oral Health Guideline published in 2008. They were: (i) what level of surveillance for periodontal disease should be recommended, in persons with diabetes? and (ii) is active management of periodontal disease recommended for people with diabetes? In 2008 the evidence to support the adoption of specific surveillance programmes as part of structured diabetes care was not available nor the suggestion that periodontal disease managed more efficiently in diabetes results in immediate or long-term gain. This was due to the evidence being derived from studies of variable quality highlighting the need for more and higher quality research. However in the meantime it is recommended that efforts to prevent periodontal disease in people with diabetes should be encouraged. Day-to-day dental care should be part of normal diabetes self-management. Enhancement of professional education and awareness, oral health education for people with diabetes, communication between the dental and diabetic professionals and collaboration in future research both basic and clinical is being strongly advocated. A review of the evidence on the interaction between diabetes and periodontal disease will be presented. 21 Oral Health in persons with Diabetes Mellitus Emeritus Professor David Owens, CBE MD FRCP Department of Endocrinology & Diabetes, Cardiff University School of Medicine, Wales, UK
  28. 28. What are ‘working’ community-based diabetes Coalitions? ‘Working’ Coalitions are comprised of organizations that collaborate in order to address the barriers to improved diabetes outcomes in those cities’ African American and Latino communities Why are Coalitions necessary? What role do they serve? Despite the combined efforts of many health-related organizations, there are significantly higher rates of diabetes in most cities’ African American and Latino communities than in the general population. In addition, racial and ethnic disparities in diabetes morbidity and mortality continue to grow. Barriers to stakeholders’ efforts to improve diabetes outcomes may include: ο Patients with diabetes may remain undiagnosed until they present with complications ο Many patients are unaware that while they are being treated for diabetes, they are not treated to ‘goal’ ο Patients do not understand the importance of diabetes self-management in the prevention of complications ο Patients sometimes do not comply with physician and healthcare provider recommendations to be more physically active, to improve nutrition, or to take medicines as prescribed ο Health-related organizations often work “in silos”, and do not work together to share resources and best practices ο Patients and their physicians and healthcare providers are often unaware of, or not connected to, the local health-related resources that are available How do the Coalitions achieve their objective? Coalitions provide a vehicle to address key barriers to patient engagement ο Improving synergy and collaboration between health-related stakeholders ο Developing and implementing culturally relevant local strategies to improve patient engagement ο Improving patient, physician, and healthcare provider awareness and usage of local resources and organizations How do the Coalitions work? ο The Coalitions meet every 2-3 months to share ‘best practices’ for improving patient engagement ο Coalition members volunteer to participate in Working Groups, which meet every 2 months to discuss development of city-specific strategies to address local barriers to improved engagement What types of organizations are a part of successful Coalitions? A few examples include: Managed care organizations; Local chapters of medical, nursing, and healthcare provider organizations; Community-based healthcare organizations; Large medical clinics; “Lay health” organizations; Patient advocacy groups; “Ethnic” media outlets; Civic agencies; Faith-based organizations; Employers; Professional schools; Medical institutions and hospital clinics 22 Effective health outreach to "multi-cultural" communities: the value of collaboration between a community's health- related stakeholders Arnold Joseph, CEO, Chroma Multicultural Healthcare Communications, New York, USA
  29. 29. Abstracts Poster Session
  30. 30. Screening of medical students for future risk of type 2 Dia- betes Mellitus using IDRS AR Joshi, A Pranita, JS Kharche, AV Phadke Bharati Vidyapeeth Deemed University, Medical College, Pune - 411 043, India Incidence of type 2 Diabetes Mellitus is on the rise even in developing countries like India due to urbanization and socioeconomic development. As of today every fifth diabetic person in the world is Indian. A disease which was conventionally known to have onset at middle age, is now being identified in younger age group. This underscores the need for mass awareness and screening programs to detect diabetes at an early stage. In our study we have used a simplified Indian Diabetic Risk Score (IDRS) for prediction of risk of diabetes in undergraduate medical students. In India, Mohan et al have developed a simple screening tool, namely Indian Diabetes Risk Score (IDRS) to determine the risk of developing type 2 diabetes mellitus for general population. Step 1 is to determine this score which is a simple and inexpensive procedure. It includes age, waist circumference, physical activity and family history of DM. Accordingly scoring is made for IDRS. Step 2 consists of estimation of Random Capillary Blood Glucose (RCBG) in those with high IDRS score (score ≥ 60). Step 3 consists of estimation of post glucose blood sugar level in those having RCBG >113mg/dl during step 2, for definitive diagnosis of type 2 D M. Those having post glucose blood sugar level >140 mg/ dl are labeled as diabetics and those having post glucose blood sugar level ranging between 100 to 140mg/ dl are labeled as prediabetic. In our study 261 medical students (18-22 years) were screened for IDRS score. In step 1, we observed that 5 % students had high risk(score ≥ 60), 55 % students had moderate risk (score 30-50) and 38% had low risk (score < 30) of developing type 2 diabetes mellitus in future. In step 2 random capillary blood glucose was estimated in 21 students having IDRS score more than 50. Two students showed RCBG > 113 mg/dl. In these two students, step 3 was performed i.e. estimation of FBG and blood glucose 2 hour post 75 gms of glucose load. After performing this step, one student was found to have FBG level > 100 mg/dl but post glucose level was less than 140 mg/dl and was labeled prediabetic. This underscores the need for investigation of all those who are found to have high risk after applying IDRS score to detect diabetes at an early stage so that its complications can be minimized with aggressive treatment. Prevention of obesity and promotion of physical activity should be the integrated approach for population in general and for those having high risk of developing type 2 DM in future in particular. 23
  31. 31. Subtle changes in nerve conduction is the first reliable sign of nerve complications from diabetes and this changes can be measured long before other symptoms or signs of nerve damage develops. About 60 to 70% people with diabetes develop some type of nerve damage (neuropathy) caused indirectly by high blood sugar levels. Distal symmetric sensorimotor polyneuropathy is most common type, affects the most distal extremities first, and extends up the legs & upper extremities. It is insidious from the beginning and progressive in nature that has a long asymptomatic stage. Hence it is important to identify neuropathy in the asymptomatic stages. The present study was undertaken to find out the correlation between peripheral nerve conduction velocity and type 2 diabetes in obese people ( BMI >30). Type 2 diabetes often remains undiagnosed until the pa- tient presents with chronic complications. 42 normal non-diabetic healthy male, body mass index (BMI <25), Michigan Neuropathy Screening Instrument (MNSI score >15); and 42 male, no history of diabetes (BMI >30), (MNSI score >15), age in the range of 25-50 years were included. Exclusion criteria was age less than 25 and more than 40 yrs, suffering from any neuromuscular or musculoskeletal disorders, tri- cyclic anti-depressants, Pregabalin medication. The nerves tested were median (motor, sensory), ulnar (motor, sensory), common peroneal (motor, sensory) by clinical electromyography (Neuroperfect EMG- 2000). Orthodromic motor and antidromic sensory parameters of the nerves were measured. Sural nerve (sensory) conduction velocity was measured antidromically by using surface electrodes, active electrode was placed just below the lateral malleolus. The stimulating electrode was kept at a distance of 14 cm from the active electrode and kept constant in every subject. For ulnar nerve, stimulating electrode placed at 5 cm below the medial epicondyle and the recording electrode were placed over the abductor digiti minimi (ADM) muscle on the ulnar side of the hand. Average age, weight, height and BMI in normal and obese people were ( 34.4 ± 9.3 yrs, 72.5 ± 9.5 kg, 171 ± 11.1 cm, 23.7 ± 0.85) compared to (42.1 ± 7.2 yrs, 98.3 ± 18.6 kg, 167 ± 7.6 cm, 34.8 ± 3.3) re- spectively. The mean velocity for median nerves (motor & sensory) were 54.87 ± 3.46 m/s and 53.58 ± 6.92 m/s; ulnar nerves (motor and sensory) were 61.12 ± 4.08 m/s and 53.42 ± 5.16 m/s in subjects (BMI <25). Median and ulnar nerves (motor & sensory), mean velocity in obese people were significantly low (p<0.01), median motor (49.81 ± 4.92 m/s), sensory (51.32 ± 6.17 m/s) and in ulnar nerves, motor (60.23 ± 4.67 m/s) and sensory (52.38 ± 4.29 m/s). Common peroneal (motor) nerve velocity was (50.63 ± 3.46 m/s), sural nerve sensory (48.42 ± 3.81 m/s) was significantly lower in obese people (49.80 ± 3.12 m/s) and (48.0 ± 3.21 m/s) (p <0.05) respectively. This study demonstrates that BMI (Kg/m2 ) can affect the nerve conduction velocity in obese people (BMI >30) and that type 2 diabetes can be detected at an early stage (i.e. asymptomatic stage). Early detection of type 2 diabetes by nerve conduction veloc- ity in obese people Manas Kanti Ray*, Suranjana Ray*, Sundeb Sanyal** *SSR Medical College, Mauritius; **North Bengal Medical College, West Bengal, India 24
  32. 32. The human microbiome, especially the gut microbiome have a role, in protecting the body from harmful bacteria. The factors that shape and cultivate each person’s interior microbial world are both genetic and environmental. Emerging evidence suggest, that the relationship between certain gut microbes and the immune system may be a critical factor in the development of both Type I and Type II diabetes. Mutually beneficial host-microbe interactions, is critical for immune maturation. Type II diabetes is a life-style disease which has a major genetic preponderance. Life style factors like high waist-hip ratio, lack of physical activity, poor diet (sweetened carbonated drink, trans fatty acids intake), stress, urbanization and obesity (BMI> 30). Whereas Type I is an autoimmune disease which may be due to the presence of the wrong type of gut bacteria in plentiful. Scientist found that defective copy of a gene called Toll-like Receptor-2 (TLR-2) plays an important role in pathogen recognition and innate immunity, which can lead to diabetes related symptoms like obesity, glucose intolerance, insulin resistance and increased weight gain on high fat diet. Persons having defective TLR-2 have higher proportion of a group of bacteria called Firmicutes and a reduction of another kind of bacteria called Bifidobacterium in their gut microbiome. Those who have higher levels of Firmicutes are obese, as these bacteria helps extract energy from food by producing enzymes which break down otherwise indigestible compounds. Bifidobacterium are important in maintaining the gut barrier as increased gut permeability allows a molecule called LPS (Lipo Polysaccharide) to get into the blood stream. The immune system recognises LPS as a toxin and responds causing inflammation and liver-related insulin- resistance. Hence, the constituent of a person’s gut microbiota can be linked to metabolic diseases like Type-II diabetes. A modification of this microbiota that is a change in the ratio of Firmicutes to Bacteroidetes characterizes the ability of the individual to combat the development of the disease. Genetic engineered non-pathogenic E. coli can make Glucagon like peptide 1 (GLP-1), which is a transcription product of pro-glucagon gene. It is secreted by intestinal L cells and dependent on presence of nutrients in the gut. It is a potent antiglycaemic hormone inducing glucose dependent stimulation of insulin secretion while suppressing glucagon secretion. GLP-1 appears to restore the glucose sensitivity of pancreatic β-cells with the mechanism involving increase expression of GLUT-II and glucokinase. It is known to inhibit pancreatic β-cells apoptosis or to stimulate the proliferation and differentiation of β-cells. World-wide it has been found that genetic mutation of gut microbes compromise the immune system causing obesity and insulin resistance. They also found that healthier the child more diverse the human microbiome. Bacterial markers which could predict the occurrence the given metabolic phenotype (diabetes prone or obesity prone) and genetically engineered nutritional additives can be given to genetically prone diabetic persons targeting intestinal microbiota to predict or reduce the risk of development of diabetes. This can be given as probiotics in yogurt or smoothies or pre-biotics and fibre-laden foods. Human microbiome and diabetes Suranjana Ray, Manas Kanti Ray SSR Medical College, Mauritius 25
  33. 33. The association between periodontal disease and diabetes mellitus has been explored by many researchers over the years. Periodontitis, now considered as the ‘sixth complication of diabetes’ can induce or aggravate systemic conditions. Hence a proper periodontal treatment may curb the sugar level in diabetic patients. In this project, a programmed systematic longitudinal study has been conducted to evaluate the effect of professional periodontal maintenance therapy on the serum levels of glycated haemoglobin (Hb A1c) in patients suffering from type 2 diabetes from Mauritius. Forty subjects with type 2 diabetes mellitus were included in the study and all of them were treated in dental clinic for periodontal maintenance therapy (scaling & root planning). Doxycycline 100mg/day was prescribed to all for 14 days after which the parameters - the plaque index, probing depth, clinical loss of attachment and Glycated Hb A1c were recorded. Those subjects who had less than 7% of Hb A1c were not included in the study, hence 10 patients were excluded. Based on this the patients were randomly put under two groups – the control and the study groups. All of them prescribed Doxycycline 50mg/day for 1 month. Home care was instructed for both groups for 3 months and they were called periodically every month for 3 months. Plaque index was recorded every month for both the groups. Periodontal maintenance care was given in the clinic for the study group every month. At the 3rd month clinical data - Hb A1c, probing depth and clinical loss of attachment were recorded for all patients in both groups. Data exploration indicates that the measurements of plaque index, probing depth, clinical loss of attachment and the values of Hb A1c for both samples’ comparativity decreased after the period of 3 months. However, as compared to control group, treatment group shows much more decrease in Hb A1c levels. The analytical result indicate that this therapy significantly helped in reducing the plaque index, probing depth and clinical loss of attachment. The reduction in Hb A1c levels were found to be statistically significant in patients who followed periodontal maintenance therapy in addition to home care maintenance as compared to the control group subjected only to home care maintenance. Periodontal maintenance therapy improved the sugar level in diabetic patients. However in order to understand the potential of this treatment to improve glycaemic control among people with diabetes, large sample studies are needed. Periodontal maintenance therapy in type 2 diabetes Lily Misra*, Vandna Jowaheer**, Suranjana Ray* *SSR Medical College, Mauritius; **University of Mauritius 26
  34. 34. Neurological problems are the major complications in early onset of Type I diabetes mellitus which causes the potential physiomorphological changes on central nervous system which can’t be ignored during the early childhood cognitive behavior. The early recognition and initiation of treatment can prevent possible complications especially in the young children with early onset of diabetes mellitus. The ancient good old alternative medical science Ayurveda has mentioned substantial use of many herbs and herbal formulations to combat diabetes and its complications, one such herb known as Salacia chinencis is selected for our experimental research trials by considering its antihyperglycemic effect to treat diabetes in its early stage. Diabetes was induced in 22 days (post natal) wistar rats by giving intraperitoneal injection of Streptozotocin at a dose of 60mg/kg body weight. After the confirmation of diabetic state the treatment with alcoholic root extract of Salacia chinencis at a dose of 100mg/Kg body weight was started immediately and it is continued for one month of duration. At the end of 30 days treatment schedule the animals were scarified and the brain tissue was collected; after completing the histological tissue processing and sectioning it was stained with cresyl violet and it was subjected to histological studies by considering the changes in frontal cortical neurons. The sections with Golgi staining were subjected to camera Lucida drawings and later they were analyzed by considering changes in its dendritic arborization. Salacia chinencis show significant impact on the gross neuronal morphology of frontal cortex along with their increased dendritic arborization when compared with age matched normal and diabetic control groups. The phytochemicals present in the alcoholic root extract of Salacia chinencis might have interfered directly or indirectly on the glucose metabolism of early juvenile diabetic rat brain cortex by preventing possible adverse changes. This herbal root extract not only supports the effective glucose control but also can influence the dendritic growth which is essential for cognitive functions during the early childhood by influencing the effective survival of neurons. Effect of root extract of salacia chinencis (Linn) on frontal cortical neuron morphology and its dendritic arborization in early diabetic young rat experimental model Mathada V Ravishankar JN Medical College, KLE University, Belgaum, Karnataka, India 27
  35. 35. Four hundred is the number of limb amputations carried out every year for non-traumatic cases of gangrene foot out of a population of 1.2 million. This occurs in a small island where healthcare facilities are provided free of charge in government institutions. Yet, this small island in Indian Ocean has the second highest prevalence of diabetes mellitus in the world and first in Africa. The aim of this survey is to see how far the young generation stands from diabetes. They might be among the future diabetics patients. Diabetes leads to many dreadful complications, are those youngsters aware of this fact? If yes, what precautions are they taking? To answer these questions and many others, a questionnaire based study was carried out. 250 youngsters (age 14 -25 years) coming from secondary schools across the island and tertiary institutions (UOM, UTM and SSRMC) were made to fill in questionnaire. Their eating habits, sports activities and background knowledge about DM were inquired. The results clearly demonstrates the nibbling habits of those Mauritians - 55% eat in between breakfast and lunch, 62% in between lunch and dinner and 53% before going to bed. Surprisingly, in an island with vast economic exclusive zone, 20.4% do not eat fish at all while 12.4% only consume fish about thrice a week. About 50% participants eat only one fruit per day and 13.6% do not like fruits. Furthermore, 38.4% said that they do not drink a cut of tea/coffee without adding two teaspoons of sugar. A significant amount (43.2%) affords to take out only 1 hour per week to practice some physical activities and 12.4% seem to have no time at all. Regarding complications of diabetics, 13.2% clearly are ignorant about those.67.9% agree that DM leads to eye problems, 49.6% agreed about foot ulcers, 46.8% were aware of kidney damage and 39.2% knew that CVS problems/MI/stroke are among the complications. 75% of the interviewees have a family history of Diabetes. But 50.4% of the participants say they are not taking any precautions at all. The majority of those taking some precautions think that only controlling sugar intake is going to protect them from this disease. These alarming results should be taken into consideration. Else, Mauritius will come out first worldwide with the highest prevalence of Diabetes. Also, it will increase the burden of the healthcare department and the economic process of this small island. The young Mauritians need to be educated again and again on a regular basis. In addition, physical activities should be made compulsory at all levels. Adding Nutritional Studies as part of the curriculum and organizing health camps during vacations will be of great help. Act today for a healthier population with a low prevalence of Diabetes Mellitus type ll, for a better progress of the whole country. A preliminary study to investigate prevalence of diabetes among young Mauritians Chut-Kai Nuzhah Widaad*, Rassool M. Yusuf Ali*, Sadally Mouneerah Bibi** *SSR Medical College, Mauritius; **University of Mauritius, Mauritius 28
  36. 36. The prevalence and incidence of diabetes are growing steadily, affecting an estimated 285 million adults worldwide, out of which approximately 85% to 95% have the type 2 diabetes (T2DM). The conventional agents used to treat type 2 diabetes frequently display reduced efficacy over time and their use is often limited by adverse effects such as weight gain and hypoglycemia. With the increased awareness of pathophysiologic mechanisms of diabetes mellitus, clinical attention has shifted to the incretin system. The two most recently approved therapies in T2DM are based on this pathway. These molecules have proved to help better glycemic control while reducing the common adverse effects of conventional anti diabetic agents. The pathophysiology of type 2 diabetes mellitus (T2DM) has so far been based on the triad of a progressive drop in insulin-producing pancreatic beta cells, a rise in insulin resistance as well as an increased hepatic glucose production. Recent research has indeed revealed that other factors such as the defective actions of the gastrointestinal (GI) incretin hormones glucagon-like peptide–1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) also have a substantial role to play. These endogenous incretins are secreted from endocrine cells in the small intestine. Within minutes of nutrient ingestion, GLP- 1 is secreted from intestinal L cells in the distal ileum and colon, while GIP is released by intestinal K cells in the duodenum and jejunum. GLP-1 and GIP trigger their insulinotropic actions by binding beta-cell receptors. GLP-1 also inhibits glucose-dependent glucagon secretion from alpha cells on the pancreas. A key limitation to therapeutic use of the endogenous incretins is their rapid turnover (1- to 2-minute half- lives), resulting from the action of the circulating enzyme dipeptidyl peptidase 4 (DPP4), which rapidly inactivates GIP and GLP1. Promising therapeutic approaches for T2DM therefore include stabilizing endogenous GLP1 using a DPP4 inhibitor (sitagliptin, vildagliptin or saxagliptin) or supplying an exogenous, more stable molecule with the action of GLP1 (the GLP1 mimetic, exenatide, or the human GLP1 analogue, liraglutide). As peptide-based therapies, the GLP1 receptor agonists require subcutaneous administration. Clinical studies have shown beneficial effects of the GLP-1 receptor agonists on weight, blood pressure and lipid profile and this may imply substantial benefit in terms of macrovascular outcomes. Oral DPP4 inhibitors increase the availability of endogenous GLP1, thus enhancing glucose-induced insulin secretion and inhibiting glucagon release. These agents have no effect on gastric emptying and are weight neutral. Current statistics are highly encouraging with regards the safety and efficacy of incretin based therapy in T2DM. Due to their original glucose-dependent action, they reduce the incidence of hypoglycemia and decrease the β-cell stress therefore preserving the β-cell function. These alternative forms of treatment appear very promising and will contribute positively to the available therapeutic field. Having already gained widespread use in the developed world, they will indeed help remedy weight-gain related issues, hypoglycemia and also lead to effective glycemic control in patients. Incretin-based therapy as a new alternative treatment in type 2 diabetes Oodesh Kumar Ramdin, Reshad Kurrimbukus, Neelkant Rai Rajcumar Dr. Jeetoo Hospital, Port Louis, Mauritius 29
  37. 37. There has been an appalling rise of type 2 diabetes mellitus in the pediatric population in the past 10-15 years in the U.S., in parallel to the rise of obesity in this age group. Studies among the Japanese, Indian, British, Chinese, Taiwanese, Libyan, Bangladeshi and Australian populations also have shown similar trends in the U.S. during early 1990s it was rare to have a child with type 2 diabetes in a pediatric clinic. By the year 2000, it accounted for 8-45% of new cases depending on geographic location and ethnicity. Potential risk factors for type 2 diabetes are genetic and environmental and out of these obesity appears to be the most significant one. In the United States, 1 out of every 5 children was found to be overweight and had double the risk of developing diabetes as compared to children with normal weight. Among youth with Type 2 diabetes in USA, the prevalence of overweight was 10.4% and obesity was 79.4%. 45–80% had a parent with type 2 diabetes. Other risk factors include minority ethnic groups (American Indian, African- American, Asian, or Hispanic/Latino), sedentary lifestyle, puberty, intrauterine exposure to diabetes and female sex. The mean age range of onset of type 2 diabetes is 12-16 years, with earlier onset in females than males. 60–90% of children present with acanthosis nigricans, which is the most important physical sign of insulin resistance. The earlier the onset of diabetes, the earlier is the risk of long-term complications like atherosclerosis, nephropathy, retinopathy. Elevated apoB and dense LDL were common lipoprotein abnormalities in youth with type 2 diabetes, which explains the high risk of cardiovascular problems as early as second decade of life. Co-morbidities usually present in these children because of co-existing obesity are hypertension, fatty liver, obstructive sleep apnea, orthopedic and behavioral problems. Screening for children with risk factors may begin at age 10 years or at onset of puberty, if puberty occurs at a younger age and should be performed every 2 years, thereafter. ADA recommends fasting plasma glucose as the preferred screening study. Ideally, management of diabetes should involve a pediatric endocrinologist, a diabetes nurse educator, a nutritionist, and a behavioral specialist. Treatment of type 2 diabetes in youth is a combination of various strategies. Less than 10% children are treated with diet and exercise alone. Pharmacological intervention appears to be necessary in form of either insulin or one of the oral drugs. The persistence of obesity interferes with the response to treatment. WHO encourages to strengthen the national policies for prevention and control of diabetes as well as promotes research in the field. Population strategies focusing on increasing the physical activity and improving nutrition must be implemented. Every member of the community plays a role to put an end to the rise of this debilitating disease in children. Pediatric type 2 diabetes: a modern epidemic Bhanu Gogia*, Supriya Singh Toor, Rajat Mehta** *SSR Medical College, Mauritius; **Civil Hospital, Sonipat, India 30
  38. 38. Diabetes Mellitus (DM) a lifelong disease has put a considerable morbidity burden in the worldwide population including Mauritius. It is estimated that 150 million people worldwide have DM, as per textbook. The Non Communicable Disease (NCD) Survey with Mauritius and Australia Collaboration done in January,2010 by Ministry of Health and Quality of Life found 18% DM in 1995,19.3% DM in 2004 and 23.7% DM in 2009. While participating in health camps conducted by Positive Approach to Total Health (PATH) an NGO in Mauritius, from 17th April 2011 to 9th July 2012 a period of 15 months we found 163 Type2 DM, a percentage of 11.8%. During our clinical posting in three major hospitals (Victoria, JNH and Moka Eye hospital), we got a morbidity data of 110 case in a period of seven months (Jan’12-July’12). Out of these cases, 56 had ocular complication, 19 had Gestational Diabetes Mellitus (GDM) and 35 had other complication like podiatric and surgical. Of the Ophthalmic complication, 41.7% were Retinal Detachment (RD) and others cataract (both early age and post vitrectomy). Of the patient having GDM the number below the age of 30 were more and smoking and alcohol consumption was found to be contributing factor and they also had a diet which include more of saturated fat. Some of them had GDM even in previous pregnancies. Fetal macrosomia was the most common complication. Of the surgical and podiatric cases complication like gangrene, amputation, non-healing ulcers and wounds were observed. In all the cases of observed DM in both community and out-patient we found that poor lifestyle i.e. more intake of saturated fat, low fiber diet, abnormal Basal Metabolic Index (BMI), and increase stress were contributing factors. Also those having DM were smoker and consumed alcohol and lacked physical activity. The incidence of DM rose from 1995 to 2009 as observed by the survey by Ministry of Health and Quality of Life. Hence Diabetes and Vasculopathy Center was established under the collaboration of UK and Mauritius in 2010. This center does screening and registration of all diabetic patients in Mauritius. It is fully equipped with podiatric unit, retinal screening and other modern equipment. They advise diabetic diet, life style changes and proper management and follow up. The therapy advised are oral (Gliclazide, metformin) and Actrapid (insulin). But now new therapies are being used in other countries like ICRETINS are intestinal hormones which potentiate glucose induced insulin response. With all said and done, around 53.4% of Mauritius population is pre diabetic or diabetic. With every person detected to have diabetes another remains undiagnosed. Despite management and follow up the control rate remains poor because of undetected cases, sedentary life style, lack of physical activity and lackadaisical behavior towards screening and follow up. Hence we plan to conduct diabetes awareness camps in Mauritius with Ministry of Health and Quality of Life permission. Current trends in type 2 diabetes mellitus in Mauritius and the impact of prevention, management and complications Kumar Sourabh, Daurat Marie Dominique, Suranjana Ray SSR Medical College, Mauritius 31
  39. 39. Diabetes is a major public health concern in Mauritius. The control of diabetes in the population is based on primordial prevention of dietary risk factors and primary prevention of behavioral risk factors. The present survey attempted to find the clustering pattern of risk factors for the young and middle aged diabetics. A total of 40 diabetics were interviewed regarding their environmental, behavioral and anthropometric risk factors. A quarter (n=10) of them were young (i.e. less than 35 years of age). The data was collected in paper format and then entered using epi-data software. Differences were analyzed by chi square and significance of difference reported at p<0.05. The female to male ratio for identified diabetic patients was roughly 1:3. About 83% of the diabetic patients had a family history of diabetes. About 67% of the diabetics had adverse body habitus. About 85% of the diabetic were not undertaking exercise. However, only 12.5 % of the diabetic patients were not consuming fruits and vegetables regularly. A third of the diabetics (35%) were smokers and quarters (25%) of them were also reported to be suffering from hypertension. The prevalence of risk factors in young diabetics and middle aged diabetics was not significantly different (p>0.05) indicating the long standing pre-existence of risk factors well before diabetes mellitus was diagnosed. The high level familial clustering of diabetics (83%) and adverse body habitus (67%) indicate the fact that diabetes is more commonly afflicting families not following the healthy life styles. The important finding is also corroborated by the observation that 85% of the diabetic patients are not exercising. A primary prevention program targeting high risk population segment suffering from metabolic syndrome is the need of the hour. Primary prevention interventions like behavior change communication aiming to increase physical activity and primordial prevention measures like provision of sporting facilities to enable activity based leisure time life style activity would be very important in reducing the prevalence of diabetes mellitus in the general population. Screening activities for secondary prevention of metabolic syndrome and smoking are a missing service in the healthcare service of Mauritius. The survey indicates an urgent need to introduce these secondary prevention services. The prevalence of smoking is also high (35%) and important co-morbidities like hypertension are also seen correlated to the diabetic status. An important observation of the study is the high proportion of diabetics reporting regular fruits and vegetable consumption. This indicates successful implementation of primordial prevention based population strategies of control in Mauritius. The results of this survey might help prioritize the interventions and consequently optimize the existing control strategies. The future control strategies should focus upon controlling the high prevalence of smoking in the general population. This can be achieved by decentralising the smoking cessation clinic services to all Area Health Centres. In addition, behaviour change communication aiming to increase awareness about the importance of adequate exercise should be implemented The high prevalence of comorbidities like hypertension justifies the integration of the existing health care services for the various non-communicable diseases like hypertension and diabetes. Clustering of environmental, behavioral and anthropometric risk factors in young and middle aged Mauritian diabetics Mahabir CA, Mahadeo AM, Uddin H, Beniwal R SSR Medical College, Mauritius 32
  40. 40. There are strong evidences of abnormal metabolism of several micronutrients in diabetic individuals. The study was planned to determine the alterations in plasma level of magnesium and zinc; and to correlate them with the degree of hyperglycemia and the presence of complications in diabetic patients. The study included 50 patients of type 2 diabetes mellitus and 50 normal healthy control subjects. All the subjects were evaluated for serum magnesium, zinc, fasting blood sugar and lipid profile (Total cholesterol, triglycerides, low density lipoprotein, high density lipoprotein) estimations. The patient’s group had significantly lower serum magnesium (p<0.001) and serum zinc levels (p<0.001) in comparison to control subjects. A negative correlation of these two parameters was observed with the degree of hyperglycemia and the presence of complications. Statistically significant variations were also observed in serum cholesterol, triglyceride and high density cholesterol levels (HDL) in the patients group in comparison to control group. In type-2 diabetic mellitus the concentration of both Mg and Zn levels are significantly reduced, probably suggesting lower antioxidant status in this condition. The implication of this is the greater susceptibility of LDL-cholesterol oxidation and the risk of development of premature coronary heart disease. Thus Magnesium and zinc should be essentially supplemented to the diabetic patients to prevent the progression of the disease and to improve the quality of life. Role of micronutrients - Magnesium and Zinc, in the therapeutics of Type 2 Diabetes Mellitus Chhabra N*, Chhabra S*, Sodhi KH**, Ramessur K* *SSR Medical College, Mauritius; **MMIMS & Research, Mullana, Ambala (Haryana), India 33
  41. 41. Variations in uric levels have been increasingly associated with insulin resistance, hyperinsulinemia and diabetes mellitus. The present study was undertaken to evaluate alterations of serum uric acid levels and to correlate then with glycemic control in patients of type 2 diabetes mellitus. The study subjects were distributed in to three groups A, B and C. Group A included 30 normal healthy individuals to serve as controls, group B comprised of 30 patients of Type 2 diabetes mellitus on oral hypoglycemic drugs with HbA1c<7% and Group C included 30 patients of Type 2 diabetes mellitus on oral hypoglycemic drugs with HbA1c>7%. Fasting blood glucose, glycated hemoglobin (HbA1c), serum uric acid, BUN and serum creatinine were estimated for all the subjects under study. The mean serum uric acid levels of Group B study subjects were significantly higher than Group C (p<0.001) whereas levels of mean serum uric acid in Group C subjects were significantly lower than Group A study subjects (p=0.014). Thus, suggesting that there are relatively higher serum uric acid levels in patients with HbA1c <7% and lower serum uric acid levels in patients with HbA1c >7%, showing a bell- shaped relationship. Possibly, glomerular hyperfiltration occurring with progressing and poorly controlled type 2 diabetes mellitus lowers the serum uric acid by increasing the renal clearance of urate. Hypouricemia can predict the future progression of incipient nephropathy in type 2 diabetes mellitus. “Diabetic hypouricemia, an indicator of clinical nephropathy”-A case control study to determine the relationship between serum uric acid levels and glycemic control in patients of type 2 Diabetes Mellitus Chhabra S*, Chhabra N*, Kukreja S**, Ramessur K* *SSR Medical College, Mauritius; **Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, India 34
  42. 42. Symposium on - Diabetes - the way forward Sponsored by SSR Medical College, Belle Rive, Mauritius  Telephone: 230 6985395 / 6978619  Fax: 230 6988414  Email:  Website:  IOMITs’ Sir Seewoosagur Ramgoolam Medical College, Mauritius Vision: “Producing excellent doctors and keeping the flame of knowledge alive since 1999”