2^ndGlobal Experts Meeting on Diabetes, Hypertension & Metabolic Syndrome May 17-18, 2019 | Holiday Inn Atrium Singapore | Singapore

During gestation, about 4% of women develop a diabetes-like condition which affects how body cells react to glucose. It is primarily due to hormonal secretion and fat deposition during pregnancy which develops insulin resistance. In most of the cases, blood sugar level returns to normal after pregnancy but there is a risk for type 2 diabetes.

Neonatal Diabetes Mellitus is a form of diabetes which is regulated by one single gene (monogenic) in infants during the first six months. Infants accumulate a lot of glucose due to an inability to produce enough insulin. It is most commonly mistaken for Type 1 or Juvenile Diabetes which occurs after six months of age mainly in children. In Juvenile Diabetes the pancreas produces little to no insulin. It was termed Juvenile Diabetes as it usually appears in children and adolescents but can develop in adults too.

If left untreated, diabetes develops many health complications like Diabetic Ketoacidosis and Nonketotic Hyperosmolar Coma among others. Acute complications also include hyperglycemia and even diabetic coma. The most common serious diabetic complications are coronary artery disease (CAD) and stroke, kidney failure, blindness, and diabetic foot disease.

Diabetic Retinopathy or Diabetic Eye Disease is a group of ophthalmic problems in diabetic people due to prolonged hyperglycemia. In Diabetic Retinopathy, blood vessels in the eye swell and leak. In some people, the abnormal growth of blood vessels over the retina is also observed. Over time, it may lead to permanent loss of vision in both of the eyes. In the United States alone Diabetic Retinopathy claims 12% of all new cases of blindness.

Diabetic Nephropathy or Diabetic Kidney Disease is a complication where blood vessels in the kidney are damaged which may even lead to kidney failure in some cases. Due to improper function of the kidney, the body retains more water and salt which leads to weight gain and swelling of joints especially ankle.

Along with nutrition and exercise, genetics play a major role for a person to develop Type 2 Diabetes. The heritability of diabetes and metabolic syndrome is relatively high and several gene mutations have been linked to the development of type 2 Diabetes. About 70% of Type 2 diabetes patient inherited the disease from the previous generation. 

Biomarkers are molecular markers used as direct or indirect markers of the extent of a disease. HbA1c is considered as the biomarker in diabetes for assessing the risk factor related to retinopathy, nephropathy and other vascular diseases. Biomarkers enable preventive measures to be applied at the subclinical stage and the responses to preventive or therapeutic measures to be monitored.

Diabetes can be diagnosed by analysis of blood sample based on plasma and glucose criteria or A1C criteria. Glucose calculating finger stick devices can be used as a rapid indicator but they are not precise. To ensure that test results are accurate lab study of blood is required.

Diabetes can be managed through proper diet, nutrition, and exercise. Diabetic nursing also plays an important role in the management of diabetes. Patients diagnosed with diabetes have a higher risk of some kind of cancer. Hence proper management and education about diabetic care are needed.

Anti-Diabetic Medications work by either lowering down blood glucose level or by increasing sensitivity to insulin. Type 1 Diabetes is caused by lack of insulin hence, insulin has to be administered subcutaneously. Type 2 Diabetes is treated by oral hypoglycemic agents which act either by (a) increasing the amount of insulin secreted by the pancreas, (b) increasing the sensitivity of target organs to insulin or (c) decreasing the rate at which glucose is absorbed from the gastrointestinal tract.

The most common medical devices used in diabetes include blood-glucose meters, insulin pumps and insulin pens. An artificial pancreas is a machine which would monitor blood glucose levels using an array of sensors, and release insulin from a reservoir into the bloodstream, using an infusion pump, whenever it is required. Current gene therapy study highlights the transfer of insulin gene into other cells such as the liver, stomach, or intestines.

A successful bone marrow or stem cell transplant may help slow or halt the progression of certain metabolic syndromes including type 1 diabetes, but early diagnosis is critical to prevent irreversible disease progression. Pancreatic islet allotransplantation is a procedure in which islets from the donor pancreas are transferred into another person to treat type 1 diabetes and have been a promising cellular-based therapy. The recent advances in nanomedicine include smart drugs which only activate when needed, nanoformulations for efficient drug delivery, engineered microbes which produce human hormones, and even nanorobots, which would move autonomously around the body acting as a boost, for our immune system, red blood cells, or many other biological systems.

Herbal Medicines, also known as phytomedicines, have been utilized for health and restorative purposes for a long period of time. Plant sources like aloe vera, cardamom, bilberry extract, bitter melon, fenugreek, ginger, okra, garlic, Bauhinia forficata, ivy gourd, ginseng have shown anti-diabetic properties. Many herbal supplements are sold as tablets, capsules, powders, teas, extracts, and fresh or dry plants. 

A cluster of conditions like increased blood pressure, high blood sugar, excess body fat, abnormal triglyceride, and cholesterol levels lead to metabolic syndrome. Individuals having diabetes during pregnancy (gestational diabetes) or a family history of type 2 diabetes are more likely to have metabolic syndrome. Aggressive lifestyle changes can delay or prevent serious complications. If left uncontrolled, it increases the risk of insulin resistance, diabetes, cardiovascular diseases like high blood pressure and even stroke.

Diabetes intensifies the danger of long-term complications. Diabetes increases the risk of cardiovascular diseases such as Diabetic Cardiomyopathy. The chief complications of diabetes due to injury in small blood vessels comprise damage to the eyes, kidneys, and nerves.  It may also lead to Atherosclerosis caused by high blood pressure, lack of exercise, obesity, high blood cholesterol, poor diet, and excessive alcohol consumption among others.

Hypertension is a rise in blood pressure within the artery, vein or capillaries, resulting in shortness of breath, dizziness, fainting, swelling of legs and different symptoms. Hypertension is caused when blood vessels become narrowed, blocked or destroyed making it harder for the blood to flow through them. As the pressure builds, the heart's lower right chamber must work harder to pump blood through the lungs, eventually causing the cardiac muscles to weaken and eventually fail.  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. The various complications related to hypertension are Congestive Heart Failure, Blood Clotting, Liver Disease, Lupus, Rheumatoid Arthritis, Chronic Bronchitis, HIV Associated Pulmonary Hypertension, and Pulmonary Hypertension in Association with Sickle Cell Disease.

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. 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. 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, endothelins, and mineralocorticoid and glucocorticoid steroids.

Cholesterol is used by the body in production of vitamin D, certain hormones and building healthy cells. High cholesterol level and diabetes are linked to each other as diabetes can disturb the balance between HDL cholesterol and LDL cholesterol levels. LDL particles in diabetic people tend to stick to arteries and can easily damage blood vessel walls. Glucose coated LDL remains in the bloodstream longer and may lead to the formation of plaque. Low HDL levels are seen in the people with diabetes. Both of these increase the risk of heart and artery disease. There is a direct link between high blood pressure and high cholesterol also. When the arteries become narrowed and hardened with cholesterol plaque, the heart has to force much harder to pump blood through them. As a result, blood pressure becomes abruptly high.

In spite of scientific innovations and better healthcare amenities, diabetes continues to burden varied segments, particularly middle and low-income countries. The present trends designate the increase in premature mortality, imposing a serious threat to global development. The advancement in science and technology has discovered the expansion of newer generation of nanomedicine in drug discovery. Then, the documentation and clinical investigation of bioactive ingredients from plants have reworked the investigation of drug discovery and lead identification for diabetes control.