Global Experts Meeting On Diabetes, Hypertension & Metabolic Syndrome July 30-31, 2018 Melbourne, Australia

Several type of complications are seen due to uncontrollable diabetes. Complications of diabetes mellitus are acute and chronic. Acute complications include hypoglycemia and hyperglycemia, diabetic coma and nonketotic hyperosmolar coma. There are several chronic complications and its occur due to a mix of microangiopathy, macrovascular disease and immune dysfunction in the form of autoimmune disease or poor immune response, most of which are difficult to manage. The most common serious complications from diabetes are coronary artery disease (CAD) and stroke, kidney failure, blindness, and foot disease. All diabetes complications can require specialized medical treatment depending on their severity.

By reducing HbA1c and keeping blood pressure and cholesterol levels well controlled, people with diabetes can reduce their risk of diabetic complications.

Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of diabetes. People with diabetes are at risk for diabetic retinopathy, cataract and glaucoma.

Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina.

In some people with diabetic retinopathy, blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. The retina is the light-sensitive tissue at the back of the eye. A healthy retina is necessary for good vision.

If you have diabetic retinopathy, at first you may not notice changes to your vision. But over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes.

1. Diabetic eye disease comprises a group of eye conditions that affect people with diabetes. These conditions include diabetic retinopathy, diabetic macular edema (DME), cataract, and glaucoma.
2. All forms of diabetic eye disease have the potential to cause severe vision loss and blindness.
3. Diabetic retinopathy involves changes to retinal blood vessels that can cause them to bleed or leak fluid, distorting vision.
4. Diabetic retinopathy is the most common cause of vision loss among people with diabetes and a leading cause of blindness among working-age adults.
5. DME is a consequence of diabetic retinopathy that causes swelling in the area of the retina called the macula.
6. Controlling diabetes—by taking medications as prescribed, staying physically active, and maintaining a healthy diet—can prevent or delay vision loss.
7. Because diabetic retinopathy often goes unnoticed until vision loss occurs, people with diabetes should get a comprehensive dilated eye exam at least once a year.
8. Early detection, timely treatment, and appropriate follow-up care of diabetic eye disease can protect against vision loss.
9. Diabetic retinopathy can be treated with several therapies, used alone or in combination.

Diabetic kidney disease is a complication that occurs in some people with diabetes. It can progress to kidney failure in some cases. Treatment aims to prevent or delay the progression of the disease. 

With diabetes, the small blood vessels in the body are injured. When the blood vessels in the kidneys are injured, your kidneys cannot clean your blood properly. Your body will retain more water and salt than it should, which can result in weight gain and ankle swelling. You may have protein in your urine. Also, waste materials will build up in your blood.

What is diabetic kidney disease?

Diabetic kidney disease (diabetic nephropathy) is a complication that occurs in some people with diabetes. In this condition the filters of the kidneys, the glomeruli, become damaged. Because of this the kidneys 'leak' abnormal amounts of protein from the blood into the urine. The main protein that leaks out from the damaged kidneys is called albumin.

In normal healthy kidneys only a tiny amount of albumin is found in the urine. A raised level of albumin in the urine is the typical first sign that the kidneys have become damaged by diabetes. Diabetic kidney disease is divided into two main categories, depending on how much albumin is lost through the kidneys:

·         Microalbuminuria: in this condition, the amount of albumin that leaks into the urine is between 30 and 300 mg per day. It is sometimes called incipient nephropathy.

·         Proteinuria: in this condition the amount of albumin that leaks into the urine is more than 300 mg per day. It is sometimes called macroalbuminuria or overt nephropathy.

Track-5:Clinical Diabetes and Diagnostic Approaches

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels.

Diabetic kidney disease is recognized as the leading cause of excess mortality in the population with type 1 diabetes. The prevailing theory is that excess calories are processed via the mitochondria resulting in accumulation of superoxide radicals via the electron transfer chain. Novel Paradigms in Diabetic Complications, Diabetes, Pre-diabetes represents an elevation of plasma glucose above the normal range but below that of clinical diabetes. Prediabetes and Metabolic Syndrome, To better study both the pathogenesis and potential therapeutic agents, appropriate animal models of type 2 diabetes (T2D) mellitus are needed  for Clinical trials on animal models,  sodium glucose co-transport inhibitors act as a novel strategy for the treatment of diabetes mellitus

Type 2 diabetes is by far the most common type of diabetes in adults (>90 percent) and is characterized by hyperglycemia and variable degrees of insulin deficiency and resistance in Clinical presentation and diagnosis of diabetes mellitus in adults.

People with type 1 or type 2 diabetes are diagnosed with more of some types of cancer -- and are more likely to die from cancer -- than people without diabetes, a new Australian study shows.

The brain is a hugely important organ which helps to be aware of, understand and interact with our surroundings and others.

As with many of our organs, the brain is susceptible to damage as a result of diabetes & brain

Diabetes foot care & management: Foot ulcers and amputations are a major cause of morbidity, disability, as well as emotional and physical costs for people with diabetes. Early recognition and management of independent risk factors for ulcers and amputations can prevent or delay the onset of adverse outcomes.

In Cardiac Resynchronization Therapy Arrhythmias are irregular heart rhythms and can be caused by a variety of reasons, including age, heart damage, medications and genetics. In heart failure patients CRT, or biventricular pacing, is used to help improve the heart’s rhythm and the symptoms associated with the arrhythmia.

Implantable Cardioverter Defibrillator An ICD is a battery-powered device placed under the skin that keeps track of your heart rate. Thin wires connect the ICD to your heart. If an abnormal heart rhythm is detected the device will deliver an electric shock to restore a normal heartbeat if your heart is beating chaotically and much too fast. It is important to understand that the decision to have angioplasty or coronary artery bypass graft (CABG) surgery to treat coronary artery disease (CAD) depends on many different things. A healthful eating pattern, regular physical activity, and often pharmacotherapy are key components of diabetes management. It is best to get vitamins and minerals from the foods you eat. In fact, research has not been able to prove that dietary or herbal supplements (including omega-3 supplements, cinnamon, and other herbs) help to manage diabetes.

Blood glucose (blood sugar) monitoring is the main tool you have to check your diabetes control. This check tells you your blood glucose level at any one time. The artificial pancreas bridges the gap between two pieces of diabetes technology that already exist: the insulin pump and the continuous glucose monitor (CGM). Relatively, a large percentage of world population is affected by diabetes mellitus, out of which approximately 5-10% with type 1 diabetes while the remaining 90% with type 2. Insulin administration is essential for type 1 patients while it is required at later stage by the patients of type 2. Current insulin delivery systems are available as transdermal injections which may be considered as invasive. Several non-invasive approaches for insulin delivery are being pursued by pharmaceutical companies to reduce the pain, and hypoglycemic incidences associated with injections in order to improve patient compliance.

Several factors have to come together for a person to develop type 2 diabetes. Elements like nutrition and exercise are extremely important. However, type 2 diabetes also has a strong genetic component. Diabetes constitutes a major public health problem. Although substantial progress has been made in defining the genetic risk for specific subtypes of diabetes

The burden of diabetes is much higher for racial/ethnic minorities than for whites. Minorities have a higher prevalence of diabetes than whites, and some minorities have higher rates of diabetes-related complications and death. Research results help in understanding these disparities and ways to reduce them.

Diabetes, the sixth leading cause of death in the United States, is a chronic disease characterized by persistent hyperglycemia (high blood glucose levels). Significant advances have been made in recent years in relation to the pathogenesis of T2DM. This has significantly improved our knowledge of one of the most serious health threats in the world, allowing identification of genes and pathways involved in the development and progression of the disease. It has recently become possible to acquire molecular and genetic level information from an individual.

Drugs used in diabetes treat diabetes mellitus by lowering glucose levels in the blood. With the exceptions of Insulin, exenatide, liraglutide and pramlintide, all are administered orally and are thus also called oral hypoglycemic agents or oral antihyperglycemic agents. There are different classes of anti-diabetic drugs, and their selection depends on the nature of the diabetes, age and situation of the person, as well as other factors.
Diabetes mellitus type 1 is a disease caused by the lack of insulin. Insulin must be used in Type I, which must be injected.
Diabetes mellitus type 2 is a disease of insulin resistance by cells. Type 2 diabetes mellitus is the most common type of diabetes. Treatments include (1) agents that increase the amount of insulin secreted by the pancreas, (2) agents that increase the sensitivity of target organs to insulin, and (3) agents that decrease the rate at which glucose is absorbed from the gastrointestinal tract.
Several groups of drugs, mostly given by mouth, are effective in Type II, often in combination. Insulin sensitizers address the core problem in Type II diabetes—insulin resistance.
Thiazolidinediones (TZDs), also known as "glitazones," bind to PPARγ, a type of nuclear regulatory protein involved in transcription of genes regulating glucose and fat metabolism.
Secretagogues are drugs that increase insulin output from the pancreas. Meglitinides help the pancreas produce insulin and are often called "short-acting secretagogues".
Alpha-glucosidase inhibitors are "diabetes pills" but not technically hypoglycemic agents because they do not have a direct effect on insulin secretion or sensitivity. Dipeptidyl peptidase-4 (DPP-4) inhibitors increase blood concentration of the incretin GLP-1 by inhibiting its degradation by dipeptidyl peptidase-4.

Dyslipidemia is one of the major risk factors for cardiovascular disease in diabetes mellitus. The characteristic features of diabetic dyslipidemia are a high plasma triglyceride concentration, low HDL cholesterol concentration and increased concentration of small dense LDL-cholesterol particles.

There are many risk factors for type 2 diabetes such as age, race, pregnancy, stress, certain medications, genetics or family history,  high cholesterol and obesity. However, the single best predictor of type 2 diabetes is overweight or obesity. Almost 90% of people living with type 2 diabetes are overweight or have obesity. People who are overweight or have obesity have added pressure on their body's ability to use insulin to properly control blood sugar levels, and are therefore more likely to develop diabetes. The number of diabetes cases among American adults increased by a third during the 1990s, and additional increases are expected. This rapid increase in the occurrence of diabetes is mostly attributed to the growing prevalence of obesity in the United States.

The Bioinformatics/Computational Biology Service branch will provide basic capabilities to the Joslin Diabetes Center to analyze a wide range of high-throughput data. Housed on-site at the Joslin, the group and associated resources will be available to Joslin investigators and fellows who are either planning high-throughput experiments or need analysis of multi-scale data.

We prospectively followed 51,552 Finnish men and women 25–74 years of age without a history of Parkinson's disease at baseline. History of diabetes and other study parameters were determined at baseline using standardized measurements. Ascertainment of the Parkinson's disease status was based on the nationwide Social Insurance Institution's drug register data. Hazard ratios of incident Parkinson's disease associated with the history of type 2 diabetes were estimated. The entire spectrum of diabesity, including all of its complications–diabetes, elevated blood sugar, blood pressure, and cholesterol–are simply downstream symptoms that result from problems with diet, lifestyle, and environmental toxins interacting with our unique genetic susceptibilities. Bariatric surgery may be an option for adults with severe obesity. Body mass index (BMI), a measure of height in relation to weight, is used to define levels of obesity. Clinically severe obesity is a BMI > 40 or a BMI > 35 with a serious health problem linked to obesity. Such health problems could be type 2 diabetes, heart disease, or severe sleep apnea (when breathing stops for short periods during sleep).

Endocrinology is a specialty of medicine; some would say a sub-specialty of internal medicine, which deals with the diagnosis and treatment of diseases related to hormones. Endocrinology covers such human functions as the coordination of metabolism, respiration, reproduction, sensory perception, and movement. Endocrinology also focuses on the endocrine glands and tissues that secrete hormones. The human endocrine system consists of a number of glands. These glands produce and secrete hormones which control the body's metabolism, growth, sexual development and function. When the hormones leave the glands they enter the bloodstream and are transported to organs and tissues in every part of the body.

Endocrine disorders  are often quite complex, involving a mixed picture of hyposecretion and hypersecretion because of the feedback mechanisms involved in the endocrine system. For example, most forms of hyperthyroidism are associated with an excess of thyroid hormone and a low level of thyroid stimulating hormone. Patients with multi-transfused thalassemia major may develop severe endocrine complications due to iron overload. The anterior pituitary is particularly sensitive to iron overload which disrupts hormonal secretion resulting in hypogonadism, short stature , acquired hypothyroidism and hypoparathyroidism. Glucose intolerance and diabetes mellitus are also common in thalassaemic patients. Delayed or absent puberty and hypogonadism may result in fertility problems which affect enormously the life of thalassemics. Glucose intolerance in adolescence and diabetes mellitus later in life are also frequent complications mainly due to iron overload, chronic liver disease and genetic predisposition. Primary hypothyroidism and hypoparathyroidsm usually appear in the second decade of life; are related to iron overload and may be reversible at an early stage by intensive chelation. Osteopenia and osteoporosis due to a complicated pathogenesis represent prominent causes of morbidity in young adults of both genders with thalassaemia. Early recognition and prevention of the endocrine complications, by early and regular chelation therapy, is mandatory for the improvement of the quality of life and psychological outcome of these patients.

Endocrinology is a perplexing investigation of the different hormones and their action and disorder in the body. Endocrine Glands are organs that make hormones. These are substances that control exercises in the body and effectively affect the digestion system, multiplication, nourishment retention and use, development and improvement and so on. Hormones likewise control the way a living being reacts to their environment and help by giving sufficient vitality to different capacities. Diabetes is brought about by a diminished creation of insulin or by a diminished capacity to utilize insulin. Insulin, the hormone delivered by the beta cells in the pancreas, permits (glucose) cells to have the capacity to utilize glucose.

Endocrinology is a branch of biology and medicine dealing with the endocrine system, its diseases and its specific secretions known as hormones, growth promotion and malignancy. Behavioral endocrinology is the study of hormonal processes and neuroendocrine systems that influence or regulate behaviour. Endocrinology includes the wide area that not only affects our endocrine system, but also has effects on skin which shows indirectly involvement of dermatology.

Metabolic syndrome is a medical disorder results in formation of cluster of conditions that includes, increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels that occur together, increasing your risk of heart disease, stroke and diabetes. Metabolic syndrome is closely linked to overweight or obesity and inactivity and also linked to a condition called insulin resistance. Genetic factors influence each individual component of the syndrome, and the syndrome itself. Metabolic syndrome is also known as syndrome X, insulin resistance syndrome, or dysmetabolic syndrome.

Cardiovascular disease refers to more than one disease of the circulatory system including the heart and blood vessels, whether the blood vessels are affecting the lungs, the brain, kidneys or other parts of the body. Coronary artery disease, stroke, and peripheral artery disease involve atherosclerosis. This may be caused by high blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol, poor diet, and excessive alcohol consumption, among others.

Polycystic ovary syndrome (PCOS) is associated with higher prevalence of cardiovascular risk factors but the relative prevalence of cardiovascular disease in women with PCOS has not previously been reported. High blood pressure results in 13% of CVD deaths, while tobacco results in 9%, diabetes 6%, lack of exercise 6% and obesity 5%. The effect of the use of aspirin in people who are otherwise healthy is of unclear benefit. Treatment of those who have CVD improves outcomes. Cardiovascular diseases are the leading cause of death globally. Coronary artery disease and stroke account for 80% of CVD deaths in males and 75% of CVD deaths in females. Most cardiovascular disease affects older adults.

Endocrine glands are a group of glands in the body which secrete hormones. The endocrine system influences how your heart beats, how your bones and tissues grow, even your ability to make a baby. It plays a vital role in whether or not you develop diabetes, thyroid disease, growth disorders, sexual dysfunction, and a host of other hormone-related disorders. Endocrine disorders are typically grouped into two categories:

·         Endocrine disease that results when a gland produces too much or too little of an endocrine hormone, called a hormonal imbalance.

·         Endocrine disease due to the development of lesions (such as nodules or tumours) in the endocrine system, which may or may not affect on hormone levels.

Being overweight or obese predisposes an individual to many medical problems including diabetes, high blood pressure, heart disease, stroke, depression and some types of cancer. Endocrinologists work closely with dieticians, exercise physiologists, behavioural therapists and bariatric surgeons as part of the Comprehensive Weight Loss Centre to help patients achieve realistic weight-loss goals and improve health.

Nutrition & Metabolism focuses on the integration of nutrition, exercise physiology, clinical investigations, and molecular and cellular biochemistry of metabolism. The areas of interest of Nutrition & Metabolism encompass studies in obesity, diabetes, lipidemias, metabolic syndrome and exercise physiology that have an underlying basis in metabolism. Metabolic effects of dietary protein are complex. In persons with type 2 diabetes, protein ingestion results in little or no increase in plasma glucose concentrations but a stimulation of insulin and glucagon secretion. The nutritional requirements of a neonate are significantly greater than those of an adult because not only are there requirements for substrate intake to fulfil basic metabolic needs, but there are metabolic needs to maintain rapid and continued growth and development.

Hypertension, additionally called as high vital sign or blood vessel cardiovascular disease could be a chronic medical condition during which the blood pressure within the arteries is elevated. This session mainly covers the different types of hypertension and their assessment.  Isolated systolic hypertension, resistant hypertension are all recognized hypertension sorts with specific diagnostic criteria. A sphygmomanometer, is a device used to measure blood pressure, composed of an inflatable cuff  to collapse and then release the artery under the cuff in a controlled manner, and a mercury.

Globally, the overall prevalence of raised blood pressure in adults aged 25 and over was around 40% in 2010. Because of population growth and ageing, the number of people with uncontrolled hypertension ranges from 600 million in 1980 to nearly 1 billion in 2010.The national Million Hearts initiative endeavors to increase the number of persons whose hypertension is under control, by 10 million, as part of its goal to prevent 1 million heart attacks and strokes by the year of 2018.

Pulmonary hypertension (PH) is a rise of blood pressure within the artery, vein, or respiratory organ capillaries, resulting in shortness of breath, dizziness, fainting, leg swelling and different symptoms. This type of hypertension that affects the arteries in the lungs and the right side of your heart, then it begins when tiny arteries in your lungs, called pulmonary arteries, and capillaries become narrowed, blocked or destroyed. This makes it harder for blood to flow through your lungs, and raises pressure within your lungs' arteries.

As the pressure builds, your heart's lower right chamber must work harder to pump blood through your lungs, eventually causing your cardiac muscle to weaken and eventually fail. Pulmonary hypertension is a serious illness that becomes progressively worse and is sometimes fatal. Pulmonary hypertension worsens over time and is life-threatening because the pressure in a patient's pulmonary arteries rises to dangerously high levels, putting a strain on the heart. There is no cure for pulmonary hypertension, but several medications are available to treat symptoms. The various complications to related to pulmonary hypertension are congestive heart failure, blood clotting, liver disease, Lupus, Rheumatoid Arthritis, chronic bronchitis, HIV Associated Pulmonary Hypertension, and PH in Association with Sickle Cell Disease.

Gestational hypertension or pregnancy-induced hypertension (PIH) is the development of new hypertension in a pregnant woman after 20 weeks’ gestation without the presence of protein in the urine or other signs of preeclampsia and eclampsia. Gestational hypertension is usually defined as having a blood pressure higher than 140/90 measured on two separate occasions, more than 6 hours apart, without the presence of protein in the urine and diagnosed after 20 weeks of gestation. There is no specific treatment, but is monitored closely to rapidly identify pre-eclampsia and its life-threatening complications.

Drug treatment options are limited, as many antihypertensive may negatively affect the fetus. Methyldopa, hydralazine, and labetalol are most commonly used for severe pregnancy hypertension. The fetus is at increased risk for a variety of life-threatening conditions, including pulmonary hypoplasia (immature lungs). If the dangerous complications appear after the fetus has reached a point of viability, even though still immature, then an early delivery may be warranted to save the lives of both mother and baby. An appropriate plan for labor and delivery includes selection of a hospital with provisions for advanced life support of newborn babies.

During gestational hypertension, a woman must be offered an integrated package of care, covering admission to hospital, treatment, measurement of blood pressure, testing for proteinuria and blood tests.

Gestational hypertension in a future pregnancy ranges from about 1 in 8 (13%) pregnancies to about 1 in 2 (53%) pregnancies.

Diabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period. Serious long-term complications include cardiovascular disease, stroke, chronic kidney failure, foot ulcers, and damage to the eyes.

Hypertension and diabetes are two of the leading risk factors for atherosclerosis and its complications, including heart attacks and strokes. There is substantial overlap between diabetes and hypertension, reflecting substantial overlap in their etiology and disease mechanisms. Cardiovascular risk factor prevalence study, only 42% of people with diabetes had normal blood pressure and only 56% of people with hypertension had normal glucose tolerance.

Diabetes causes hyperinsulinemia and raises the risk of hypertension. This condition increases the amount of sodium that the body absorbs. It also promotes the stimulation of the sympathetic nervous system. This is thought to cause changes in blood vessel structure, which affects the function of the heart and blood pressure.

Hypertension is the most prevalent and powerful modifiable risk factor for stroke. Persons with hypertension are about 3 or 4 times more likely to have a stroke. Hypertension remains the single most important modifiable risk factor for stroke, and the impact of hypertension and nine other risk factors together account for 90% of all strokes. The two major types of stroke include ischemic stroke (caused by blood clots), which accounts for 85% of strokes, and hemorrhagic stroke (bleeding in the brain), which accounts for 15% of strokes.

Prevention of stroke is a major public health priority, but needs to be based on a clear understanding of the key preventable causes of stroke. Therefore, although the highest BP levels predict the highest relative risk of stroke, the conceptual pendulum has swung in the direction of the continuum of absolute BP levels and somewhat away from the construct of “hypertension”. Furthermore, as discussed below, recent evidence points to the fact that mediators of hypertension, such as Angiotensin II, may influence stroke risk independently of Blood pressure elevation.

Heart disease describes a range of conditions that affect the heart. Diseases under the heart includes blood vessel diseases, such as coronary artery disease; heart rhythm problems (arrhythmias); and heart defects you're born with (congenital heart defects), among others. Heart disease term is often used interchangeably with the cardiovascular disease. It generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke. Other heart conditions, such as those that affect your heart's muscle, valves or rhythm, also are considered forms of heart disease. Many forms of heart disease can be prevented or treated with healthy lifestyle choices.

Heart disease is the study of the effects of drugs on the entire cardiovascular system, which includes the heart and blood vessels. The various complications to related to diabetes are Cerebrovascular disease, Inflammatory, Hypertensive heart disease, Ischemic, Rheumatic heart disease, Acute heart failure and Heart transplantation.

Hypertension, or high blood pressure, is the leading risk factor associated with death in the world but is largely asymptomatic and often undetected in patients. Hypertension is typically asymptomatic and only detected through opportunistic screening. Once hypertension has been diagnosed, further tests should be conducted, including urine testing, blood tests, an eye examination and a 12-lead electrocardiogram (ECG). Primary hypertension, in which no specific cause is found, affects 95% of patients. Blood pressure is expressed in terms of systolic blood pressure (higher reading), which reflects the blood pressure when the heart is contracted (systole), and diastolic blood pressure (lower reading), which reflects the blood pressure during relaxation (diastole).

Hypertension can be diagnosed when either systolic pressure, diastolic pressure, or both are raised. Blood pressure is determined by the cardiac output balanced against systemic vascular resistance. The process of maintaining blood pressure is complex, and involves numerous physiological mechanisms, including arterial baroreceptors, the renin–angiotensin–aldosterone system, atrial natriuretic peptide, endothelin’s, and mineralocorticoid and glucocorticoid steroids.