20 - 22 February 2014
Grand Hyatt Conference & Convention Centre Dubai, UAE
Congress Book 16.75 CME hrs accredited by:
www.edec-uae.com Organised by
In Support with
Knowledge Partner
Congress Secretariat: MCI Middle East, Tel: +971 4 311 6300, Fax: +971 4 311 6301 E-mail: edec@mci-group.com 1 4 Emirates Diabetes & Endocrine Congress 2014 th
His Highness Sheikh Khalifa Bin Zayed Al Nahyan President of the U.A.E
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4th Emirates Diabetes & Endocrine Congress 2014
His Highness Sheikh Mohammed Bin Rashid Al Maktoum Vice President, Prime Minister and Ruler of Dubai
4th Emirates Diabetes & Endocrine Congress 2014
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His Highness Sheikh Hamdan Bin Rashid Al Maktoum Deputy Ruler of Dubai, Minister of Finance, UAE President of Dubai Health Authority
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4th Emirates Diabetes & Endocrine Congress 2014
Table of Contents Welcome Message ................................................ 06 Committees .......................................................... 07 Invited Faculty ....................................................... 08 General Information .............................................. 09 Conference Venue Map Locator ........................... 11 Exhibition Layout................................................... 13 Sceintific Program ................................................. 14 Faculty Profiles ...................................................... 17 Abstracts .............................................................. 25 Poster Presentations.............................................. 34 Sponsors ............................................................... 65 Experience UAE .................................................... 70 Acknowledgement ..................................................72
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Welcome Message
Dear Participants, Ahlan Wah Sahlan! Marhaba and Welcome! In 2012, we proudly hosted our 3rd Emirates Diabetes & Endocrine Congress. Thanks to the success and popularity with our international members, it is possible to continue this in the year 2014! The focus this year will be on our patients all over the world, with parallel sessions including hands-on courses and workshops. The latest advancements, reviews of current theories and practices, and problem-based learning are a few examples that will be accessible at this world class platform. Exciting and effective advances in diagnosis and management of diabetes and endocrine diseases will be shared and discussed amongst all participants. We began our vision to reduce the burden of disease across our region, and I feel with every passing year, our presence contributes to helping others significantly. The global fight against diabetes and endocrine diseases continues to strengthen because of the on-going collaboration of our communities, and i have the highest hopes and confidence in that it will continue to do so! I look forward to meeting you all again, and welcome all new and returning participants to Dubai!
Dr. Abdulrazzaq Ali Al Madani Congress President
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4th Emirates Diabetes & Endocrine Congress 2014
Committees Organizing Committee
Dr Abdulrazzaq Ali Al Madani Chief Executive Officer (CEO) Dubai Hospital-DHA United Arab Emirates
Dr Fatheya Al Awadi Head of Medical Dept & Endocrinology Section Dubai Hospital-DHA United Arab Emirates
Dr Iyad Ksseiry Consultant Endocrinologist Head of Internal Medicine Mediclinic City Hospital United Arab Emirates
Dr Bashar Afandi Member
Dr Elham Alamiri Member
Dr Ali Baqer Member
Dr Salem Arifi Beshyah Member
Dr Ahmed Hassoun Member
Dr Khaled Al Jaberi Member
Dr Jumaa Al Kaabi Member
Dr Ali Khalil Member
Dr Asma Malallah Member
Committees
Scientific Committee
Dr Hussain Al Saadi Member
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Invited Faculty
Invited Faculty
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Angelo Avagaro Italy
Emanuele Bosi Italy
Ian Campbell UK
Bart Clarke USA
Steven Edelman USA
Luc Van Gaal Belgium
Kenneth Strauss USA
Roberto Negro Italy
Neil Poulter UK
Farid Saad Germany
Wolfgang Schmidt Germany
Michael Stowasser Australia
Peter Trainer UK
Margaret Wierman USA
4th Emirates Diabetes & Endocrine Congress 2014
David Douglas Waters USA
General Information Badges: Name badges must be visible and used at all times, throughout the conference venue. Colors: Description:
Committee (all access) Delegate (all access, except speaker preview room) Exhibitor (no access to scientific sessions) Faculty (all access) Organiser (all access) Media/Press (all access)
CME Certification: This congress is accredited by Dubai Health Authority (DHA) for 16.75 CME hours. Certificates will be issued against receipt of feedback forms on 22nd February 2014 from the Registration Desk 15:00 hrs onwards. Conference Bags: Conference bags will be distributed to registered participants at the Registration Desk (The Conference Bag is not included for students). Speaker Registration: Committee and Speaker registration and badge collection can be done in the VIP Al Majlis Room (Speakers’ Preview Room) located on the lower level. Speakers’ Preview Room: All speakers are requested to report to the Speakers’ Preview Room (VIP Majlis) at least two hours before their session, for a final check on presentation material. The Speakers’ Preview Room is available for speaker’s convenience throughout the congress for final run-throughs of their presentation. Food & Beverage: Coffee breaks and buffet lunch will be provided to registered delegates. The hotel also offers a variety of all-day dining restaurants to choose from.
Exhibition: The 4th Emirates Diabetes & Endocrine Congress 2014 Exhibition is located in the Al Ameera Ballrooms. Rules: Smoking Policy- the Grand Hyatt Convention Centre is a non-smoking venue. Participants are requested to exit the building when smoking is desired, to the designated smoking corners. Parking: 24 hours courtesy valet parking is available at the congress venue. Prayer Room Prayer rooms are available for ladies and gents at the venue, Female prayer room is located next to the Registration desk & Male prayer room next to Al Remal.
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General Information
Automatic Teller Machines (ATM): An ATM dispenser is located at the Atrium Level of the Grand Hyatt Hotel, near the Panini Restaurant.
General Information
Congress Secretariat: MCI - Dubai Office P.O. Box 124752 Dubai, United Arab Emirates Phone: +971 (0)4 311 6300 Fax: +971 (0)4 311 6301 edec@mci-group.com Evacuation Assembly Point:
General Information
In case of an emergency evacuation procedure, please proceed in an orderly fashion to the open parking area in front of the Convention Centre. Please follow the instructions of the Hotel Staff Wardens at all times.
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Conference Venue Map Locator
AL KHALEEJ
AL MAASA
AL DANA
LEGEND
UPPER LEVEL
Conference Venue Map Locator
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4th Emirates Diabetes & Endocrine Congress 2014 Male Prayer Room
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REGISTRATION DESK
AL REMAL
AL AMEERA BALLROOM 1, 2 & 3
SPEAKER PREVIEW ROOM
BANIYAS BALLROOM 1, 2 & 3
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Exhibition
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LOBBY
Conference Venue Map Locator
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Scientific Program Thursday, 20th February 2014 - DAY 1 08:00-08:30
Registration & Welcome Coffee
08:30-09:00
Introduction & Opening Remarks
08:30-08:45 08:45-09:00
Congress Chair - Fatheya Al Awadi, Dubai Hospital, UAE Scientific Committee Chairman - Iyad Ksseiry, Mediclinic City Hospital, Dubai, UAE
(Al Baniyas 1 & 2)
Opening Session - Trends in the Management of Diabetes 09:00-09:30
UKPDS: From Initial Findings Through to Recent Data Ian Campbell, UK
09:30-10:00
What’s Essential in the Treatment of Type 2 Diabetic Patients Angelo Avagaro, Italy
10:00-10:30
Do we Still Need Tight Glycaemic Control in Type 2 Diabetes? Emanuele Bosi, Italy
10:30-11:00
Panel Discussion
11:00-11:30
OPENING CEREMONY - Dr Abdulrazzak Ali Al Madani, Dubai Hospital, UAE
(Al Baniyas 1 & 2)
11:30-12:15
Lilly Symposium: The Evolving Role of DPP4Is in Type 2 Diabetes Management: Updates & Evidence, Wolfgang Schmidt, Germany
(Al Baniyas 1 & 2)
12:15-13:30
Opening of Exhibition/Lunch
(Al Ameera Ballrooms & Events Lawn)
Session II - Endocrine Society Clinical Update
(Al Baniyas 1 & 2)
13:30-14:15
Management of Menopause Margaret Wierman, USA
14:15-15:00
New Therapeutic Targets for Osteoporosis: Now and Future Bart Clarke, USA
15:00-15:30
Coffee Break
15:30-17:00
Parallel Sessions
Scientific Program
Session I: Diabetes (Al Baniyas 1 & 2)
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(Al Baniyas 1 & 2)
15:30-16:15
Diabetes and Pregnancy Ian Campbell, UK
16:15-17:00
The Role of Insulin Therapy: When Do We Decide to Give it and How? Emanuele Bosi, Italy
4th Emirates Diabetes & Endocrine Congress 2014
Session II: Endocrine Society Clinical Update (Al Baniyas 3) Hyperparathyroidism: Diagnosis and Treatment Bart Clarke, USA
How Should we Evaluate Women with Androgen Excess? Margaret Wierman, USA
Scientific Program Friday, 21st February 2014 - DAY 2 Registration & Welcome Coffee
(Al Baniyas 1 & 2)
Session III - Controlling Cardiovascular Risks 08:30-09:00
Evaluation of Cardiovascular Risks for Diabetes Drugs Wolfgang Schmidt, Germany
09:00-09:30
Practical Aspects of New AHA Guidelines for the Management of Dyslipidemia David Douglas Waters, USA
09:30-10:00
Treatment of Hypertension in Diabetes: What is the Evidence? Neil Poulter, UK
10:00-10:15
Coffee Break
(Al Baniyas 1 & 2)
Session IV - Thyroid 10:15-11:00
Subclinical Thyroid Disease: To Treat or Not to Treat? Roberto Negro, Italy
11:00-11:30
Lilly Symposium: New Perspectives in the Management of Erectile Dysfunction in Diabetic & Non Diabetic Population, Jay C. Lee, Canada
(Al Baniyas 1 & 2)
11:30-12:00
Novartis Symposium: Modern Approaches to the Management of Type 2 Diabetes: Optimizing Patient Care, Emanuele Bosi, Italy
(Al Baniyas 1 & 2)
12:00-14:00
Prayer & Lunch
(Events Lawn)
Session V - Endocrine Society Clinical Update
(Al Baniyas 1 & 2)
14:00-14:30
Polycystic Ovary Syndrome: Cases Across the Life of Women Margaret Wierman, USA
14:30-15:00
Diagnostic Work up of Primary Hyperaldosteronism Michael Stowasser, Australia
15:00-15:30
Acromegaly Update Peter Trainer, UK
15:30-15:45
Coffee Break
15:45-17:15
Parallel Sessions Session I: Dyslipidemia & Thyroid (Al Baniyas 1 & 2)
Session II: Endocrine Society Clinical Update (Al Baniyas 3)
15:45-16:30
Preconception Counseling of Patients with Autoimmune Thyroid Disease Roberto Negro, Italy
Difficult Cases with Hypertension Michael Stowasser, Australia
16:30-17:15
How to Manage Dyslipidemia in High Risk Patients David Douglas Waters, USA
Pituitary: Cases based Presentation Hypopituitary and Hyperproalctinemia Peter Trainer, UK
17:15-17:30
Coffee Break
17:30-18:00
Janssen Symposium: Review of the Efficacy and Safety of SGLT2 inhibitors in patients with type 2 Diabetes Mellitus, Ian Campbell, UK
(Al Baniyas 1 & 2)
18:00-18:30
Sanofi Symposium: Advances in Glucagon-Like-Peptide-1 Therapy: Current Agents and What is in the Pipeline?, Luc Van Gaal, Belgium
(Al Baniyas 1 & 2)
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Scientific Program
08:00-08:30
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Scientific Program Saturday, 22nd February 2014 - DAY 3 08:00-09:00
Registration & Welcome Coffee
(Al Baniyas 1 & 2)
Session VI - Hot Topics 09:00-09:30
Testosterone Therapy in Hypogonadal Men Farid Saad, Germany
09:30-10:00
Medical Management of Cushing’s Syndrome Peter Trainer, UK
10:00-10:30
Rational of Using SGLT2 Inhibitors in Type 2 Diabetes Luc Van Gaal, Belgium
10:30-10:45
Coffee Break
10:45-11:45
New Frontiers in the Management of Type 1 Diabetes Steven Edelman, USA
11:45-12:30
Julphar Diabetes Symposium: Brining the Artifical Pancreas Home; the AP @Home Project and Beyond. J. Hans DeVries, Netherlands
(Al Baniyas 1 & 2)
12:30-13:30
Lunch
(Event Lawn)
13:30-15:30
Oral Presentations
(Al Baniyas 1 & 2)
15:30
Closing Ceremony and CME certificates
Workshops 20-21 Feb 2014 14:00-15:00
Scientific Program
20-21 Feb 2014 15:00-16:00
20-21 Feb 2014 16:00-17:00
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Use of Devices in the Treatment Of Diabetes: Insulin Pump and Continuous Monitoring Ghassan Nabulsi, Lebanon
(Al Maasa Meeting Room)
Diabetes Conversation Map Ghina Saleh, UAE
(Al Dana Meeting Room)
Insulin Injection Techniques (Lipohypertrophy: Overlooked Bumps in the Road to Successful Insulin Therapy Let’s Talk About It) Kenneth Strauss, USA
(Al Remal Meeting Room)
4th Emirates Diabetes & Endocrine Congress 2014
Faculty Profiles
Angelo Avagaro Professor of Endocrinology and Metabolism University of Padova Italy Positions and 1980 - 1986 1986 - 1988 1988 - 2001 2001 - 2011 Present
Employment Post Doc fellow in Metabolism. University of Padova. Italy NIH Fogarty Fellow. Washington University School of Medicine. St. Louis, MO. USA House Physician. University Hospital, Padova, Italy. Associate Professor of Endocrinology and Metabolism. University of Padova. Italy Professor of Endocrinology and Metabolism
Honors 1986 National Research Council Fellow. 2008 Castelli Pedroli Prize for the European Association of Diabetes 2011 Editorial Board of the Journal of the America College of Cardiology 2012 Editorial Board of Journal of Diabetes and its Complication 2013 Senior Editor of Diabetes and Nutrition 2013 Editorial Board of Diabetes Obesity and Metabolism 2013 Incoming member of the Editorial Board of Diabetes Care
Professor Emanuele Bosi
Emanuele Bosi is Associate Professor of Endocrinology at the Vita-Salute San Raffaele University, Director of the Diabetes Research Institute and of the Department of Internal Medicine at the San Raffaele Hospital Scientific Institute, Milan, Italy. Emanuele Bosi graduated in Medicine in 1979 from the University of Milan, Italy, where he also received a specialty diploma in diabetes and metabolic diseases and subsequently in clinical immunology. During his career he has received clinical training in Milan and worked as a clinical investigator at the Edouard Herriot Hospital in Lyon, France, and University College and St Bartholomew’s Hospitals in London, UK. Professor Bosi’s research activity has been entirely devoted to diabetes. He is a leader in clinical investigations and clinical trials on both type 1 and type 2 diabetes and diabetic complications. He has published over 150 scientific papers.
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Faculty Profiles
Associate Professor of Endocrinology Director, Department of Internal Medicine Director, Diabetes Research Institute San Raffaele Hospital Scientific Institute and Vita-Salute San Raffaele University Italy
Faculty Profiles
Ian Campbell Emeritus Professor of Medicine University of St Andrews Scotland Ian Campbell is Emeritus Professor of Medicine at University of St Andrews, Scotland. He graduated in medicine in 1969 at Edinburgh University. He was Consultant Physician with special interest in Diabetes and Endocrinology in Fife, 1978-2008. He was appointed to an Honorary Chair in Department of Medicine at University of St Andrews in 1996 and continues his academic work at the University. Professor Campbell has published extensively on the subject of diabetes, its complications and management and is author of over 200 research papers and reviews as well as several diabetes textbooks. His publications have a citation index of 33, and the career citations are over 5,000. He has lectured in over 50 countries. He co- chaired the presentations of the UKPDS results at the EASD in Barcelona in 1998 and in Rome in 2008. He is presently co-editor of British Journal of Diabetes and Vascular Disease.
Bart Clarke Associate Professor of Medicine Endocrinology, Diabetes, Metabolism and Nutrition Mayo Clinic East USA
Faculty Profiles
Bart L. Clarke, M.D. is Consultant and Chair of the Metabolic Bone Disease Core Group in the Division of Endocrinology, Diabetes, Metabolism, and Nutrition at the Mayo Clinic, and Associate Professor of Medicine in the Mayo Clinic College of Medicine. After obtaining his medical degree from the University of California, Los Angeles Geffen School of Medicine in 1986, and completing his residency in internal medicine and fellowship in endocrinology and metabolism at the Mayo Graduate School of Medicine in 1992, he completed further fellowship training in bone and mineral metabolism under the guidance of Drs. Lorraine A. Fitzpatrick and B. Lawrence Riggs at the Mayo Clinic in 1992-1994. He was Assistant Professor of Medicine at the University of Chicago Pritzker School of Medicine from 1994-1997. He assumed his current position at the Mayo Clinic in 1997. His current clinical research interests include serotonin skeletal effects, postmenopausal osteoporosis, new anabolic therapies, glucocorticoid- and transplantation-induced osteoporosis, tumor-induced osteomalacia, primary hyperparathyroidism, hypoparathyroidism, and biomechanical effects on the skeleton.
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Faculty Profiles
Steven Edelman Professor of Medicine Division of Endocrinology, Diabetes and Metabolism University of California, San Diego USA Dr. Edelman is a professor of medicine in the Division of Endocrinology, Diabetes & Metabolism at the University of California at San Diego (UCSD) and the VA Healthcare System of San Diego and the director of the Diabetes Care Clinic, VA Medical Center. He received his MD at the UC Davis Medical School, where he was validictorian,and his internal medicine training at the UC Los Angeles. He completed his clinical endocrinology fellowship training at the Joslin and Lahey Clinics in Boston, Mass. and a research fellowship at UCSD. Dr. Edelman is the founder and director of Taking Control of Your Diabetes, a not-for-profit organization with the goal of teaching and motivating patients in self-care. Dr. Edelman has written more than 200 articles and 5 books. He has been recognized by San Diego Magazine as a Top Doctor 8 of the last 9 years. He was chosen as the teacher of the year at UCSD numerous times. He was awarded the Diabetes Educator of the year by the ADA in 2009, the Distinction in Endocrinology award by the AACE in 2011 and named in US News and World Report amongst the top 1% of endocrinologists in the US.
Luk Van Gaal
Luc Van Gaal studied medicine at the University of Antwerp, where he graduated in 1978. He obtained a specialist degree in internal medicine and afterwards in endocrinology and metabolism in 1983. Since then, he has become responsible for the Metabolic Unit at the University Hospital Antwerp. In 1992 he became Professor of Medicine at Antwerp University and is currently head of the department of Endocrinology, Diabetology and Metabolism of the University Hospital. Professor Van Gaal’s main clinical and research interests are related to obesity, type 2 diabetes and lipid metabolism. He is a member of many scientific, national and international societies and a member of the Editorial Board of a series of scientific journals. He is board member of the Belgian Association for the Study of Obesity (BASO) and Past-President of the Belgian Diabetic Society. He is as a founding member also involved in the scientific activities of the Obesitas Forum (Belgium) and the International (IASO) SCOPE programme. He is the running secretary of the Belgian Endocrine Society. In 2000, he was the co-President of the 10th European Congress on Obesity, organized in Antwerp in May 2000. He has published more than 220 papers in international medical journals, mainly in the areas of general endocrinology, obesity, diabetes and lipids and has contributed to a number of textbooks about obesity.
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Faculty Profiles
Professor of Medicine Department of Endocrinology, Diabetology and Metabolism Antwerp University Hospital Belgium
Faculty Profiles
Roberto Negro Professor of Endocrinology School of Medicine University of Parma Italy 1995 graduated in Medicine University of Parma (Italy) 1999 Clinical Visitor at Department of Diabetes, Endocrinology and Internal Medicine; Guy’s, King’s and St Thomas’s School of Medicine, King’s College London 2000 postgraduated in Endocrinology University of Parma (Italy) Since 2005 Consultant endocrinologist “V. Fazzi” Hospital, Lecce (Italy) Since 2007 Professor of Endocrinology, University of Parma (Italy), School of Medicine, Post graduate Course in Endocrinology. 2009-2012 served as Reviewing Editor of Journal of Endocrinological Investigations. 2011 Visiting Professor, University of Southern California. Department of Internal Medicine, Division of Endocrinology and Diabetes, Keck School of Medicine, Los Angeles (California) 2011 Fellow American College of Endocrinologist (FACE) 2012 Visiting Professor, George Washington University Medical Center, Department of Endocrinology, Washington DC Since 2012 served as Reviewing Editor Journal Clinical Endocrinology & Metabolism Authored or coauthored over 40 articles Member of the panel of experts for Guidelines about Thyroid and Pregnancy published by the American Thyroid Association in 2011, and member of the panel of experts of the upcoming Guidelines sponsored by the European Thyroid Association. Awards: 2008 The Endocrine Society and Pfizer, Inc. International Award for Excellence in Published Clinical Research in The Journal of Clinical Endocrinology & Metabolism. 2007 The Endocrine Society and Pfizer, Inc. International Award for Excellence in Published Clinical Research in The Journal of Clinical Endocrinology & Metabolism.
Faculty Profiles
Neil Poulter
Professor of Preventive Cardiovascular Medicine Imperial College London UK
Professor Neil Poulter qualified at St Mary’s Hospital, London, in 1974, following which he trained in General Medicine. He then spent 5 years in Kenya co-ordinating a collaborative hypertension research programme at the Wellcome Trust Research Laboratories in Nairobi. On his return to the UK in 1985 he gained an MSc in Epidemiology with distinction at the London School of Hygiene and Tropical Medicine. Following this he was Co-PI of the WHO Oral Contraceptive case-control Study at University College London Medical School. In 1997 he was appointed Professor of Preventive Cardiovascular Medicine at Imperial College London, where he is currently co-Director of the International Centre for Circulatory Health and of the Imperial Clinical Trials Unit. He is an Honorary Consultant Physician and Epidemiologist at the Peart-Rose (Hypertension) Clinic based at St Mary’s Hospital, London, where he is actively involved in the treatment of patients with hypertension and related problems.
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Faculty Profiles He was President of the British Hypertension Society from 2003-2005 and is currently a Council Member of the International Society of Hypertension and also Chair, Research Working Group – World Heart Foundation, Scientific Policy and Advocacy Committee (SPAC). In 2008 he was elected as one of the Inaugural Senior Investigators of the NIHR and in 2009 was also elected as a fellow of the Academy of Medical Sciences. He has contributed chapters to several major textbooks and published over 350 papers in peer-reviewed medical journals, including co-authoring the 1998 and 2005 Joint British Recommendations on Prevention of CHD; the 2003 World Health Organisation/International Society of Hypertension Statement on Management of Hypertension; the 2003 European Society of Hypertension–European Society of Cardiology guidelines for the management of arterial hypertension; and the 2004 British Hypertension Society guidelines for management of hypertension. He has played a senior management role in several international trials including the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) and the ADVANCE study; other research activities include the optimal investigation and management of essential hypertension and dyslipidaemia; the association between birth weight and various cardiovascular risk factors; the cardiovascular effects of exogenous oestrogen and progesterone; the prevention and aetiology of type 2 diabetes; and ethnic differences in cardiovascular disease.
Kenneth Strauss USA
Education and Professional career Ken Strauss is the Global Medical Director for Becton Dickinson, and Director of Safety in Medicine for the European Medical Association, based in Brussels.
Dr Strauss speaks in English, French and Spanish to health care worker (HCW) audiences throughout Europe, Africa and the Middle East on topics related to diabetes, HIV disease and patient safety. As Medical Director he performs research trials at university hospitals throughout Europe and other parts of the world. In addition he develops disease management and educational tools for use in the clinical setting by doctors, nurses and patients. He publishes in peer-reviewed medical journals. Scientific interests Dr. Strauss’ scientific interests in Immunology has led to publications in HIV disease, cellular activation and natural killer cell function, tumor immunology, HLA-B27-related rheumatologic conditions and screening, transplant cross-matching and graph rejection, pathophysiology of multiple sclerosis, leukaemia diagnosis and minimal residual disease, platelet activation in vascular disease and stem cell transplantation in cancer patients. As an endocrinologist he has an overriding interest in diabetes. Publications cover the subjects of diabetes management and education, efficacy of insulin injecting devices, safe injection technique, intensive glucose management, GP office management of diabetes and the epidemiology of diabetes in developing regions of Africa and Eastern Europe. surgical devices, safety injection devices, sharps disposal units, spinal and epidural catheters and vaccination devices.
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Faculty Profiles
Dr. Strauss received his degree as a doctor from the University of South Carolina, USA. He did an Internal Medicine Internship and Residency at the Wake Forest University, USA. His Endocrinology Fellowship was at the Harvard Medical School and Joslin Diabetes Center. He was later on staff at the Harvard Medical School.
Faculty Profiles
Farid Saad Germany
Dr Farid Saad was born in Alexandria, Egypt. He did his studies in Human and Veterinary medicine in 19731980. From 1990-1998 he worked as a specialist for reproductive endocrinology, pediatricendocrinology, and andrology, Ferring GmbH, Kiel, Germany, after which till about 2001 he served as a leader of clinical development andrology, Jenapharm, Jena,Germany; and specialized in endocrinology of aging, male aging, male hormonal fertility control From 2001 – 2007 he served as Leader of the product group ”Male Health Care“, Schering AG, Berlin, Germany and from 2007 – 2012 Head of scientific affairs Men’s Healthcare, Bayer Pharma AG, Berlin, Germany Since April 2012 he has been appointed Head of Global Medical Affairs Andrology, Bayer Pharma AG In the years 2005-12-28 he received the Honorary professorship in clinical research and endocrinology at Gulf Medical College, Ajman, United ArabEmirates and from 2006-08-10 the Honorary professorship at Men’s Health Reproduction Study Center, Hang Tuah University, Surabaya, Indonesia
Wolfgang Schmidt Professor of Medicine Chair and Director, Department of Medicine St. Josef-Hospital Ruhr-University of Bochum School of Medicine Germany
Faculty Profiles
Wolfgang Schmidt is Chair and Professor of Internal Medicine at the Ruhr-University of Bochum School of Medicine and Director of the Department of Medicine at the University’s St. Josef Hospital. Professor Schmidt’s major clinical areas of expertise are wide-ranging and include gastroenterology, diabetology, hepatology, gastrointestinal (GI) endocrinology, GI oncology and general internal medicine. His major research areas are enteroinsular axis, incretins, regulatory gut brain peptides, type 2 diabetes (pathophysiology and novel therapeutic strategies), pancreatitis and GI malignancies. Professor Schmidt has published over 280 peer-reviewed articles, 30 book chapters and reviews and more than 300 abstracts. He has been the Editor-in-Chief of Regulatory Peptides for 10 years and has received 17 scientific awards and honours.
Michael Stowasser Professor, Co-Director Endocrine Hypertension Research Centre University of Queensland School of Medicine Australia
Michael Stowasser is Director of the Hypertension Units, and Co-Director of the Endocrine Hypertension Research Centre (EHRC), at Greenslopes and Princess Alexandra Hospitals, University of Queensland School of Medicine, Brisbane, Australia. He has 24 years clinical research experience in pathogenesis and management of hypertension and especially of endocrine varieties including primary aldosteronism, renovascular hypertension, pheochromocytoma and familial hyperkalemic hypertension Working with mentor Richard Gordon, he helped to demonstrate that PA is at least 10 times more 22
4th Emirates Diabetes & Endocrine Congress 2014
Faculty Profiles common than previously thought, and is the commonest specifically treatable and potentially curable form of hypertension. Ongoing studies are aimed at determining genetic bases for primary aldosteronism, examining non-blood pressure dependent effects of aldosterone excess, improving methods of detection, diagnostic workup and management of primary aldosteronism and exploring the pathogenesis and genetics of other salt sensitive forms of hypertension, including familial hyperkalemic hypertension.
Peter Trainer Professor of Endocrinology The Christie NHS Foundation Trust Manchester UK
Professor Peter Trainer qualified in Edinburgh and continued with his higher training in St. Bartholomew’s hospital London, Aberdeen, Utrecht Holland and Portland, Oregon, USA. He was a senior lecturer at Barts before becoming a consultant endocrinologist at The Christie Hospital in 1998. Professor Trainer is an active leader in the medical community. He has served on the senior executive committees of the Society for Endocrinology (UK), the American Endocrine Society and the European Society for Endocrinology. He chaired the programme organizing committee for the European Congress of Endocrinology (2011) and the clinical programme of the American Endocrine congress in 2007. He has published extensively with over 150 papers in peer-reviewed journals. He is a sought after lecturer and teacher and chair of the European Society for Endocrinology education committee. He has served on the editorial boards of Journal of Clinical Endocrinology and Metabolism, Clinical Endocrinology, Treatments in Endocrinology, and GH and IGF Research.
Professor, Medicine Director, Pituitary Program University of Colorado School of Medicine USA
Dr. Margaret E. Wierman is a Professor in Medicine and Director of the Pituitary Program at the University of Colorado School of Medicine. She is Chief of Endocrinology at the Denver VAMC. As a reproductive and neuroendocrinologist, she is clinically interested in hormonal disorders. Her basic research is in the genes that control the reproductive axis to understand disorders of pubertal development and acquired hormonal problems and pituitary tumorigenesis. Clinical research involves neuroendocrine dysfunction after traumatic brain injury. Her interest in osteoporosis involves understanding how hormones work in bone metabolism and alternative therapies to prevent fractures in patients where hormones are not an option. She is currently the Vice President, Clinical Scientist of the Endocrine Society and Chair of the Endocrine Society’s Clinical Guidelines on Androgens in Women.
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Faculty Profiles
Margaret Wierman
Faculty Profiles
David Douglas Waters Emeritus Professor Department of Medicine University of California, San Francisco USA
Faculty Profiles
Dr. David D. Waters is Emeritus Professor in the Department of Medicine at the University of California, San Francisco. He was Chief of Cardiology at San Francisco General Hospital and the Maurice Eliaser Jr. Distinguished Professor of Medicine at UCSF from 1999 to 2007. He completed medical school at the University of Western Ontario and did his Internal Medicine training at McGill University. After completing his cardiology fellowship training at Emory University, he was a Canadian Heart Foundation Research Fellow at Cedars-Sinai Medical Center in Los Angeles. From 1976 to 1992 he worked at the Montreal Heart Institute, where he was Director of the Research Center from 1988 to 1992. Dr. Waters has published more than 350 manuscripts, mainly related to coronary disease, has written more than 60 book chapters, and has lectured in more than 50 countries. For several years he has been named one of the Best Doctors in America. He is a member of the editorial boards of several major cardiology journals and for several years was an associate editor of the Journal of the American College of Cardiology. His early research involved vasospastic angina, risk stratification in acute coronary syndromes and trials of antiplatelet and antithrombotic therapy for unstable angina. For most of his career he has been involved in clinical trials assessing the effect of different therapies, particularly cholesterol lowering drugs, upon the progression of coronary disease or upon clinical endpoints
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4th Emirates Diabetes & Endocrine Congress 2014
Abstracts
DAY 1 - 20th February 2014
Opening Session I Ian Campbell UK UKPDS: From Initial Findings Through to Recent Data The United Kingdom Prospective Diabetes Study [UKPDS ] is the longest running study in type 2 diabetes mellitus [ DM ], with a database from 1977-2013, and over 90 publications. It has shown the natural history of type 2 DMover 30 years from diagnosis and has given guidance on the importance of interventions to control hyperglycaemia in protecting against complications. At diagnosis patients are not free of tissue damage; type 2 DM is not a mild disease. Type 2 DM is associated with a progressive hyperglycaemia despite treatment. Insulin resistance is well expressed but beta cell loss continues at a rate of 4% per year. Intervention to control hyperglycaemia is linked to significant reductions in microvascular complications and over time reduced mortality [ legacy effect ]. Metformin also appears to reduce CV and all cause mortality. New unpublished data presented at the EASD in Barcelona in September 2013, shows that the long term combination therapy of metformin with a sulphonylurea improves glycaemic control without harm. Antihypertensive treatment is highly effective in reducing CV complications and delaying the progress of diabetic retinopathy and nephropathy, and reducing stroke and heart failure. Elevated blood pressure and blood glucose are two of several risk factors that cluster together to create excess risk of ischaemic heart disease and correction of these must form the basis of type 2 DM management.
Angelo Avagaro Italy What’s Essential in the Treatment of Type 2 Diabetic Patients This session will focus on the following aspects:
Abstracts
Epidemiology: Prevalence of Diabetes Management through SU Cardiovascular Risk Associated with Diabetes Evidence through history on different OAD on Cardio & Renal protection Safety of SU in treating Diabetic patients
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Abstracts Emanuele Bosi Italy Do we Still Need Tight Glycaemic Control in Type 2 Diabetes? Submission Pending
Session II - Endocrine Society Clinical Update Margaret Wierman USA Management of Menopause Submission Pending
Bart Clarke USA New Therapeutic Targets for Osteoporosis: Now and Future
Abstracts
Treatments for osteoporosis over the last few decades have largely focused on antiresorptive agents that effectively prevent bone loss. Beginning with hormone therapy, a variety of new potent antiresorptive agents were developed, including oral and intravenous bisphosphonates, raloxifene and other selective estrogen receptor modulators, nasal spray calcitonin, and denosumab. Teriparatide and PTH 1-84 are the only approved anabolic agents to date that primarily build new bone density. A variety of new biologic agents that focus on molecular targets important for stimulation of new bone formation are being developed. The first of these is romosuzumab, a monoclonal anti-sclerostin antibody. Cathepsin K inhibitors appear to have mixed antiresorptive and anabolic actions because they inhibit one of the major osteoclast digestive enzymes without suppressing bone formation, thereby leading to anabolic effects on bone. New biologic agents in clinical trials include anti-dickkopf antibodies that stimulate the Wnt/-catenin pathway in osteoblasts, leading to new bone formation. These new agents will effectively stimulate new bone formation by different mechanisms, leading to improved bone mineral density and reduced fractures.
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Abstracts Parallel Sessions I - Diabetes Ian Campbell UK Diabetes and Pregnancy Obesity and gestational diabetes [ GDM ] are an increasing worldwide problem in obstetric practice. Both are related to ‘’unexplained stillbirth’’.Following the HAPO Study in 2008, new guidelines in 2010 defined GDM as a FPG equal to or more than 5.3 mmol/l [ 95 mg/dl ], and/or a 2 hour OGTT value equal to or greater than 8.6 mmol/l [155 mg/dl ]. GDM increases the risk of pregnancy hypertension, macrosomia, shoulder dystocia and polyhydramnios with an increased C-section rate. Treatment of GDM has been shown to reduce these adverse outcomes. There has been controversy regarding the use of metformin versus insulin in the treatment of GDM. The MiG Study in 2008 gave reassuring outcomes for metformin therapy and further studies have confirmed the positive benefits of metformin , which is safe, effective, well tolerated, and reduces the need for insulin, with less macrosomia and a reduced C-section rate. The interactive workshop will discuss all of these issues, and in particular ask the delegates of their own experience in GDM and its management.
Emanuele Bosi Italy The Role of Insulin Therapy: When Do We Decide to Give it and How? Submission Pending
Abstracts
Parallel Sessions II - Endocrine Society Clinical Update Bart Clarke USA Hyperparathyroidism: Diagnosis and Treatment Submission Pending
Margaret Wierman USA How Should we Evaluate Women with Androgen Excess? Submission Pending 4th Emirates Diabetes & Endocrine Congress 2014
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Abstracts
DAY 2 - 21st February 2014
Session III - Controlling Cardiovascular Risks Wolfgang Schmidt Germany Evaluation of Cardiovascular Risks for Diabetes Drugs Submission Pending
David Douglas Waters USA Practical Aspects of New AHA Guidelines for the Management of Dyslipidemia New guidelines for the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk were recently released in the United States. The guidelines were based upon the results of large randomized clinical trials. Treatment was recommended for 4 groups: patients with known ASCVD, patients with an LDL-C >190 mg/dl, patients aged 40-75 with diabetes and an LDL-C of 70-189 mg/dl, and patients aged 40-75 with a global 10-year risk of at least 7.5% with an LDL-C of 70-189 mg/dl. A high-intensity statin (atorvastatin 40-80 mg or rosuvastatin 20-40 mg) was recommended for patients with known ASCVD and for patients with an LDL-C > 190 mg/dl, as well as for patients in the diabetes category with a 10-year risk of 7.5% or more. For patients without diabetes but with a score of 7.5% or more (the 4th category), moderate or high-intensity statin is recommended. A high-intensity statin is expected to lower LDL-C by greater than 50% and a moderate-intensity statin by 30-50%.
Abstracts
These guidelines differ from previous guidelines in several important ways. Risk now includes stroke as well as MI and CV death. LDL-C treatment targets, an important feature of previous guidelines, are no longer included because the clinical trials on which the guidelines are based did not use targets, but rather fixed doses. Niacin and fibrates are not recommended because clinical trials of these drugs do not show additional risk reduction in statin-treated patients. Treatment recommendations are not made for patients who do not fall into one of these 4 categories, and the guidelines emphasize that treatment decisions should be discussed with the patient. The purpose of this presentation is to summarize the data supporting these guidelines and to apply them to representative patients who might benefit from treatment.
Neil Poulter UK Treatment of Hypertension in Diabetes: What is the Evidence? This session will focus on the below key points: Epidemiology: Prevalence, of Diabetes and Hypertension Measurement of Blood Pressure Cardio vascular Risk factors correlated Management of hypertension in diabetic patients with the need for combination. RAAS diuretic combinations with the evidence from ADVANCE, UKPDS RAAS CCB combinations with the evidence from ASCOT, ACCOMPLISH Target blood pressure needed.
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Abstracts Session IV – Thyroid Roberto Negro Italy Subclinical Thyroid Disease: to Treat or Not to Treat? Subclinical hypothyroidism (SCH) should be considered in two categories according to the elevation in serum thyroidstimulating hormone (TSH) level: mildly increased TSH levels (4.0–10.0 mU/l) and more severely increased TSH value (>10 mU/l). An initially raised serum TSH, with FT 4 within reference range, should be investigated along with thyroid peroxidase antibodies. Even in the absence of symptoms, replacement therapy with L -thyroxine is recommended for younger patients. For such patients who have been started on L -thyroxine for symptoms attributed to SCH, response to treatment should be reviewed after a serum TSH within reference range is reached. The oldest old subjects (>80–85 years) with elevated serum TSH ≤ 10 mU/l should be carefully followed with a wait-and-see strategy, generally avoiding hormonal treatment. If the decision is to treat SCH, then oral L -thyroxine, administered daily, is the treatment of choice. The aim for most adults should be to reach a stable serum TSH in the lower half of the reference range (0.4–2.5 mU/l). Once patients with SCH are commenced on L -thyroxine treatment, then serum TSH should be monitored at least annually thereafter.
Session V - Endocrine Society Clinical Update Margaret Wierman USA Polycystic Ovary Syndrome: Cases Across the Life of Women Submission Pending
Diagnostic Work up of Primary Hyperaldosteronism Primary aldosteronism (PA) is much more common than previously thought, accounting for up to 5-10% of hypertensives with most normokalemic. Aldosterone excess has adverse cardiovascular consequences independent of hypertension development. Because specific surgical (unilateral adrenalectomy) and medical (aldosterone antagonist) treatment effectively abrogates the morbidity associated with PA, this condition should be systematically sought and specifically treated. The aldosterone/renin ratio (ARR) is the most reliable method of screening for PA. Dietary salt restriction, pregnancy and treatment with diuretics (including spironolactone), dihydropyridine calcium channel blockers, ACE inhibitors and angiotensin II receptor blockers can all lead to false negative ratios by stimulation of renin secretion. Selective serotonin reuptake inhibitor antidepressants also lower the ARR. Because K+ is a chronic regulator of aldosterone, false negatives may also occur in the setting of uncorrected hypokalemia. Beta-blockers, alpha-methyldopa, clonidine and NSAIDs suppress renin and can cause false positive ratios. False positives may also be seen in patients with impaired renal function or advancing age. We have recently shown (1) females have higher ratios than males, (2) false positives can occur during the luteal phase of the menstrual cycle or while taking an oral ethinylestradiol/drospirenone contraceptive preparation but only if renin is measured as direct renin concentration and not plasma renin activity, while (3) subdermal insertion of an implantable form of etonogestrel did not affect the ARR. Where feasible, diuretics should be ceased for at least six weeks and 4th Emirates Diabetes & Endocrine Congress 2014
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Abstracts
Michael Stowasser Australia
Abstracts other interfering medications at least two before measuring the ratio, substituting other medications which have a lesser effect on results, such as verapamil slow-release, hydralazine and prazosin. Hypokalemia should be corrected and the patient encouraged to follow a liberal salt diet before ratio measurement. Sensitivity is maximized by collecting blood midmorning from seated patients who have been upright for 2-4 hr. The ratio is a screening test only, and should repeated at least once before deciding whether or not to go on to a reliable suppression test (e.g. fludrocortisone suppression testing) in order to definitively confirm or exclude PA. A new, upright (seated) version of the intravenous saline suppression test appears to be much more sensitive than the traditional recumbent version, and approximates FST in terms of reliability. Because computed tomography frequently misses aldosterone-producing adenomas and yet detects non-functioning nodules, the only reliable means of differentiating unilateral (surgically correctable) from bilateral (usually treated medically) forms of PA is by adrenal venous sampling. For the glucocorticoid-remediable familial form of PA (familial hyperaldosteronism type I, FH-I), genetic testing for the causative “hybrid� 11beta-hydroxylase/aldosterone synthase gene has greatly facilitated detection. It is important to recognize the potential inaccuracies of many currently available methods for aldosterone and renin (except in very well established and experienced laboratories). New, high-throughput mass spectrometric methods of measuring aldosterone have proven highly reliable and reproducible and represent a major step forward. Validation of new assays of plasma renin activity using similar technology is awaited with interest.
Peter Trainer UK Acromegaly Update Submission Pending
Parallel Session I: Dyslipidemia & Thyroid Roberto Negro Italy Preconception Counseling of Patients with Autoimmune Thyroid Disease
Abstracts
Thyroid diseases are common in women of childbearing age and it is well known that untreated thyroid disturbances result in an increased rate of adverse events, particularly miscarriage, preterm birth and gestational hypertension. Furthermore, thyroid autoimmunity per se seems to be associated with complications such as miscarriage and preterm delivery. While strong evidence clearly demonstrates that overt dysfunctions (hyper- or hypothyroidism) have deleterious effects on pregnancy, subclinical disease, namely subclinical hypothyroidism, has still to be conclusively defined as a risk factor for adverse outcomes. Additionally, other conditions, such as isolated hypothyroxinemia and thyroid autoimmunity in euthyroidism, are still clouded with uncertainty regarding the need for substitutive treatment. Although in absence of clear evidence, either guidelines sponsored by the American Thyroid Association or the Endocrine Society recommend to treat with Levothyroxine subclinical hypothyroidism. While no treatment is necessary for subclinical hyperthyroidism, overt hyperthyroidism deserves to be treated with anti-thyroid drugs; either the use MMI or PTU are associated with birth defects, but adverse obstetrical events associated with untreated hyperthyroidism looks like to be more serious and frequent than neonatal malformations.
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Abstracts David Douglas Waters USA How to Manage Dyslipidemia in high risk patients Submission Pending
Parallel Session II: Endocrine Society Clinical Update Michael Stowasser Australia
When hypertension (HT) appears to be “difficult” to control, it is pertinent to ask: (1) Is the patient truly hypertensive, and what is the true severity? (2) Is there an identifiable, specifically treatable underlying cause? Because BP varies from moment to moment and most patients demonstrate some degree of white coat effect, assessing severity of HT in these patients should include careful home or ambulatory monitoring (in addition to clinic readings) and assessment for the presence of target organ damage. When performed and reported by experienced operators, echocardiographic assessment of the left ventricular mass index can be a highly useful clinical tool, reflecting average BP levels over the previous 3-6 months, and able to be repeated from time to time to assess adequacy of HT control, and is a superior predictor of prognosis than measurement of BP itself. Reversible contributors to “difficult” hypertension include overweight, excessive salt and/or alcohol consumption, obstructive sleep apnoea, mental stress and drugs which raise BP levels (e.g. NSAIDs, glucocorticoids, nasal decongestants and some antidepressants). Primary aldosteronism is the commonest specifically treatable (with drugs such as spironolactone, eplerenone or amiloride which block aldosterone action) and potentially curable (unilateral adrenalectomy) form of HT, accounting for as many as 5-10% of patients, the majority normokalaemic. The plasma aldosterone/renin ratio is the most reliable available screening test but correct interpretation of results requires an appreciation of the effects of potential confounders (especially medications which, where necessary, may be substituted with non-interfering ones such as verapamil slow-release, hydralazine and prazosin prior to testing). Specific treatment can result in marked improvement in HT control (with cure in 50-70% of operated patients), parameters of cardiac and renal damage and quality of life, and abrogates the excess cardiovascular morbidity (over and above the level of HT) associated with condition. Clues to renovascular hypertension include recent onset, worsening or malignant HT, deteriorating renal function (especially in association with treatment with ACE inhibitors or angiotensin receptor blockers), presence of vascular disease elsewhere (e.g. coronary, carotid or lower limb), positive risk factors for vascular disease (e.g. smoking, diabetes, hyperlipidaemia), “flash” pulmonary oedema and young-middle aged females (fibromuscular dysplasia). Renal artery duplex ultrasound and renal isotope scanning are safe and complimentary in detecting renal artery stenosis, but functional testing by measurement of renal venous renin ratios is the only reliable means of determining whether the HT is truly renovascular in origin and therefore likely to respond to intervention . Phaeochromocytomas are rare but important not to miss as they are associated with high morbidity/mortality (especially during surgical procedures requiring general anaesthesia) if left undiagnosed and untreated. Screening by 24h urinary catecholamines and metanephrines (corrected for creatinine) and plasma free metanephines is highly sensitive. Treatment with antidepressants is a common cause of false positive results.
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Abstracts
Difficult Cases with Hypertension
Abstracts Peter Trainer UK Pituitary: Cases based Presentation- (Hypopituitary and Hyperproalctinemia) Submission Pending
22 February 2014 - Day 3 Farid Saad Germany Testosterone Therapy in Hypogonadal Men
Abstracts
Epidemiological studies show a very robust inverse association between obesity parameters (body mass index, waist circumference) and testosterone levels. The prevalence of hypogonadism has been reported to be up to 52% in obese men and 75% in men with excessive obesity, defined by a BMI ≼ 40 kg/m2. It is now also generally accepted that men with type 2 diabetes have a high prevalence of hypogonadism in the range of 50%. In men undergoing testosterone deprivation for palliative therapy of advanced prostate cancer, a rapid and progressive deterioration of body composition (increase in fat mass, decrease in lean mass, weight gain) and glycaemic control occurs. The changes in insulin sensitivity may have been shown to be independent of changes in body composition. Men on testosterone deprivation therapy are at an increased risk of developing type 2 diabetes. Testosterone replacement therapy in hypogonadal men leads to an increase in lean mass in a magnitude of 4 to 5 kg within one to two years and a similar decrease in fat mass. These changed are maintained during at least two years. Within the same period of time, HOMA-IR improves significantly. Anthropometric parameters have been followed in long-term registry studies of approximately 1000 hypogonadal men with varying degrees of obesity. Over a period of up to six years, all obese men progressively lost weight in a magnitude of 15 to 20% of their initial body weight. In parallel, a progressive improvement of glycaemic control (fasting glucose and HbA1c) was recorded. Obese men with type 2 diabetes had a decrease of HbA1c by 1.9% by adding testosterone to the standard diabetes treatment they were receiving. In conclusion, testosterone treatment in hypogonadal men is a promising approach to manage body weight control and improve diabetic control.
Peter Trainer UK Medical Management of Cushing’s Syndrome Submission Pending
Luc Van Gaal Belgium Rational of Using SGLT2 Inhibitors in Type 2 Diabetes Submission Pending
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Abstracts Steven Edelman USA New Frontiers in the Management of Type 1 Diabetes The discovery of insulin was over ninety years ago and remains one of the greatest medical discoveries. Although insulin has keep people with type 1 diabetes alive, glycemic control has been difficult leading to end stage microvascular complications and a reduced quality of life for many patients. In the last several years we are seeing “other� therapies for people with type 1 diabetes in addition to insulin. In 2005, pramlintide, an amylin analog, was approved in the US for patients with type 1 diabetes. Pramlintide has been shown to reduce primarily the postprandial glucose values by reducing the appetite, normalizing gastric emptying and blunting postprandial glucagon levels. Patients also experience a reduction in fluctuations that is commonly experienced with this type of diabetes. Currently there are two classes of medications, traditionally developed for type 2 diabetes, being studied in type 1 diabetes. GLP-1 agonists such as exenatide and liraglutide have been shown to be very effective at lowering insulin requirements, improving the A1c, reducing daily glucose fluctuations and leading to weight loss. In addition, the new class of SGLT-2 inhibitors are now being investigated and used off label in type 1 diabetes. Medications like canagliflozin and dapaglifozin represent the first oral medications showing some promising results for patients with type 1 including improved A1c, reduced fluctuations and weight loss.
Abstracts
The availability of continuous glucose monitoring devices has made a tremendous impact on the lives of people with type 1 diabetes and taken much of the unpredictability out of managing diabetes. Knowing where the glucose values have been coming from, where it is now and which direction it is going has helped to make therapeutic adjusting in not only insulin but also life style modification. Reducing mild and severe hypoglycemia, especially in patients with hypoglycemia unawareness, has been an additional life saving benefit. As these devices get more accurate they will replace home glucose monitoring and will play an important role in the development of the artificial pancreas. New advances in insulin pump therapy will also be discussed.
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Poster Presentations Iyad Hassan Chair of Surgery Alain Hospital UAE
PO-1
Fist Detection of Multiple Endocrine Neoplasia Type I and Type IIA at Alain Hospital. A Report of Two Cases Abstract: Multiple endocrine neoplasia syndromes have since been classified as types 1 and 2, each with specific phenotypic patterns. MEN1 is usually associated with pituitary, parathyroid and paraneoplastic neuroendocrine tumours. Some cutaneous lesions (angiofibromas, collagenomas, melanosis guttaca, lipomas, melanomas, ‘cafe au lait macules’) have been associated to this syndrome.The hallmark of MEN2 is a very high lifetime risk of developing medullary thyroid carcinoma (MTC) more than 95% in untreated patients. The clinical subtype MEN2A, has been defined based on the risk of pheochromocytoma, hyperparathyroidism. We report the detection of two case referred to surgical Department of AAH for treatment of non endocrine disorders. Case of MEN I: 51 years old female Sudanese patient referred to surgery due to tumor in right upper quadrant. Despite upper abdominal pain and history of open cholecystectomy no further symptoms. Clinically multiple skin fibromas. The CT scan should bilateral Kidney calcifications, adrenal tumor on left side as well as pancreatic head tumor. Initially von Hippel Lindau syndrome was suspected due to skin fibromas. Catecholamine in Urin exam excluded Phaeochromocytoma and due to renal calcification calcium and parathormon were estimated and showed elevated results. Sestamibi scan showed suspicious of Adenoma on left side. Parathyroidectomy was done and histopathology confirmed Adenoma followed by laparotomy with Adrenalectomy and enuclation of pancreatic head tumor and a further one on pancreatic tail. Histopathology showed two Somatostatinoma of the pancreas and non functional Adrenal tumor.The further workup showed elevated prolactin as well as pituitary tumor as prolactinoma. So all together a classical presentation of MEN I. The twodaugters of the patient were screen for Hyperparathyroidism and showed doppel- Adenoma by the first and single Adenoma by the second daughter. Both were resected. Due to insurance issue further MEN workup is still pending.
Poster Presentations
Case of MEN IIA: A 24 years old Philippina was referred to us while pregnancyin 2d trimester due to severe Hypercalcemia, Parathormon was highly elevated. US and MRI neck showed left sided solitary thyroid nodule and suspicious of lower right sided parathyroid Adenoma. Basal calcitonin and FNA of thyroid nodule showed suspicious of medullary thyroid cancer. Catecholamine in Urine was negative for Phaeochromocytoma. Since Hypercalcemia is associated with high rate of fetomaternal complications a minimally invasive parathyroidectomy in Local anesthesia was performed and after delivery of healthy baby a total thyroidectomy with Lymphnode dissection was done showing medullary thyroid cancer. The patient need close clinical followup for the detection of Phaechromocytoma. Conclusion: To our knowledge those are the first 2 published MEN cases in the UAE with surgical Treatment. Thus, it is recommended that MEN patients and their families should be cared for by multidisciplinary teams comprising relevant specialists with experience in the diagnosis and treatment of patients with endocrine tumors.
Asif Iqbal Mediclinic Hospital Dubai
PO-2
Parental Transmission and Type 2 Diabetes Mellitus: A Cross Sectional Study among Patients attending a Tertiary Care Hospital Aim: To identify the role of parental transmission in Type 2 diabetic patients with family history of diabetes. Materials and Methods: This was a cross-sectional study carried out among individuals diagnosed with Type 2 34
4th Emirates Diabetes & Endocrine Congress 2014
Poster Presentations Diabetes Mellitus (DM) and having a family history of the same attending the General Medicine OPD in a tertiary care hospital. Consenting consecutive patients fulfilling the inclusion criteria were enrolled into the study. Demographic characteristics, age at onset of Type 2 Diabetes and parental history of the disease were obtained in detail. Results: Of the 174 participants enrolled into the study nearly 66% were males. Maternal history of DM (65%) was more commonly observed as compared to paternal history (57%) and nearly 23% had a history of both parents being diabetic. Fifty two percent gave a sibling history of type 2 DM. Siblings of patients with affected mothers had a greater likelihood of diabetes (77.8%) than those with affected fathers (51%) (P=0.001). More males had a brother who was diabetic (66%), likewise more females had a sister who was diabetic (55%). Conclusion: Maternal inheritance of DM was marginally more common among these subjects, which was not significant but there appears to be a greater inheritance among siblings with affected mothers. Further, there appears to be a significant association between early paternal age of onset and early onset of type 2 DM in the offspring. These apparent associations need to be further explored. A longitudinal study could throw more light in this direction. Key words: Type 2 Diabetes Mellitus, inheritance, father, mother Author / Authors: Asif Iqbal1, Manasi Gupta2 ,Suma Nair3, Muralidhar Varma4, Sudha Vidyasagar5 1 Hospitalist, Internal Medicine , Mediclinic City Hospital, Dubai , 2Medical student, 3Department of Community Medicine, 4,5Department of General Medicine, Kasturba Medical College and Hospital, Manipal University, Manipal-576104, Karnataka, India
Areej Almousa Clinical Dietician Rashid Centre for Diabetes and Research UAE
PO-3
The Glycemic Index of Traditional Types of Bread in UAE
Relevance:
The Glycemic Index (GI) of traditional bread has not been measured previously in UAE.
Methods: The study was conducted at the Rashid Center for Diabetes and Research in the UAE. Subjects (n=14) were served 50 g glucose (reference) on 3 occasions, followed by a selection of 50 g of available carbohydrates in the breads. Each bread was tested by 7 subjects, and these breads were 3 traditional breads (rigag, chbab, and khameer) and 3 commercial breads widely consumed in the UAE (white pita bread, khobuz; white bread roll, summon; whole-meal bread). After an 8- to 10-hour overnight fast, the subjects’ capillary blood glucose was measured via finger-prick samples over 120 min. The GI (%) of a specific bread for each subject was measured geometrically (trapezoids rule) by calculating the incremental area under the blood glucose response curve (IAUC) divided by the average IAUC for the reference (in triplicate) multiplied by 100. Then, the GI of the bread was calculated as the mean value across all subjects who consumed that bread. Analysis: First, we calculated the incremental area under the curve (IAUC) in a subject (reference/tested bread) (as the sum of the surface of triangles and trapezoids between the blood glucose curve and horizontal baseline parallel to the X-axis from the beginning of blood glucose at time 0 to 120 min and ignoring the area under fasting reading. Second, the mean of the IAUCR1, IAUCR2, and IAUCR3 for the reference food was calculated. Third, the GI (%) for each subject was calculated by dividing the IAUC for the tested bread by the mean IAUCR for the reference food and multiplying the result by 100. The following formula was used: IAUC (tested bread)×100 GI(%) = 1 / 3(IAUCR1+ IAUCR2 + IAUCR3) 4th Emirates Diabetes & Endocrine Congress 2014
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Poster Presentations
Abstract Purpose: To determine the GIs of 3 traditional breads and 3 commercial breads widely consumed in the United Arab Emirates (UAE).
Poster Presentations Fourth, the GI of each bread was calculated as the mean value of GI (%) across all subjects consuming that bread. The statistical significance of the differences between values was assessed using a paired t-test. P Results: Compared to the control (50 g glucose), the GIs of the traditional UAE bread ranged between low and medium; the GIs for rigag, chbab, and khameer were 48.21(15.6), 63.95 (7.06), and 63.91 (11.49), respectively. AllGIs exhibited a significant difference (P However, the GIs of the 3 commercial breads ranged between medium and high. The GIs of khobuz, summon, and whole-meal bread were 70.11 (15.42) (P0.05), and 66.71 (14.68) (P Conclusion: The GI values of these traditional UAE breads provide valuable information to healthcare providers, researchers, and the public. The difference between our GI values and that of previously tested food proves the importance of testing the food consumed in a particular country.
Ayman A. Al Hayek Department of Endocrinology and Diabetes, Diabetes Education Unit, Prince Sultan Riyadh Military Medical City Riyadh, KSA
PO-4
Prevalence of Low Testosterone Levels in Men with Type 2 Diabetes Mellitus: a Cross-Sectional Study Background: A high prevalence of low serum testosterone (LST) in men with type 2 diabetes have been reported worldwide. The aim of this study was to determine the prevalence and associated factors of LST in men with type 2 diabetes.
Poster Presentations
Materials and Methods: This was a cross-sectional study, conducted among 1,089 men (aged 30-70 years) with type 2 diabetes who consecutively attended a major diabetes center in Amman, Jordan, between August 2008 and February 2009. The patientsâ&#x20AC;&#x2122; demographic characteristics were collected using a prestructured questionnaire. Duration of diabetes, smoking habits, presence of retinopathy, neuropathy, and nephropathy were collected from the medical records. All participants were asked to complete the Androgen Deficiency in Ageing Male (ADAM) questionnaire. Venous blood sample was collected to test for total testosterone (TT), free testosterone (FT), sex hormone binding globulin (SHBG), follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), serum lipids, and glycosylated hemoglobin (HbA1c). LST was defined as TT <3 ng/ml. Results: Overall, 36.5% of patients with diabetes had TT level <3 ng/ml and 29% had symptoms of androgen deficiency. Of those with serum testosterone level <3 ng/ml, 80.2% had symptoms of androgen deficiency, 16.9% had primary hypogonadism (HG), and 83.1% had secondary HG. Univariate analysis showed a significant relationship between age, income, education, body mass index (BMI), smoking, duration of diabetes, diabetic nephropathy, diabetic neuropathy, and HbA1c. Multivariate logistic regression analysis indicated age, income, BMI, and diabetic neuropathy as the independent risk factors of LST. Conclusions: The prevalence of LST among men with type 2 diabetes is high. Age, income, BMI, and diabetic neuropathy were found to be the independent risk factors for LST. Keywords: Diabetes mellitus, low serum testosterone, prevalence
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Poster Presentations
Ahmed Ouda Boehringer Ingelheim
PO-5
Linagliptin in Elderly Patients With Type 2 Diabetes: Safety and Efficacy Analysis From a Phase 3 Clinical Trial Program Purpose: Renal impairment (RI) is common in elderly patients with type 2 diabetes mellitus (T2DM), and progression of kidney disease is associated with increased morbidity and mortality. Renal safety is therefore an important consideration in the selection of appropriate treatments for this population. As several drugs are either contraindicated or require dose adjustment in patients with RI, it is important to identify well-tolerated treatments for elderly T2DM patients with or at risk of declining renal function. This analysis of pooled data from a large clinical trials programme investigated the efficacy and renal and overall safety of the DPP-4 inhibitor linagliptin in elderly patients with T2DM.
Results: The pooled population comprised 1293 elderly patients randomised to either linagliptin (n=823) or placebo (n=470). Baseline characteristics (mean ± SD) were similar between the linagliptin and placebo groups: age, 71.1 ± 4.6 vs. 70.9 ± 4.7 years; HbA1c, 8.0 ± 0.8 vs. 8.1 ± 0.8%. In the linagliptin group, 56.4%, 14.8%, and 4.5% of patients had mild (eGFR 60 to <90 mL/min), moderate (eGFR 30 to <60 mL/min), and severe RI (eGFR <30 mL/min) with similar proportions found in the placebo group (51.3%, 18.7%, and 5.1%, respectively). Overall renal function was not significantly altered by treatment with linagliptin from baseline to Week 24 (adjusted mean ± SE eGFR [−1.8 ± 0.7 mL/min] vs. placebo [−1.1 ± 0.9 mL/min], resulting in a placebo corrected difference of −0.7 ± 1.0 mL/min [95% CI: −2.6, 1.2; P=0.4912]). Changes in urine albumin-to-creatinine ratio trended toward improvement with linagliptin. In total, 71.3% and 72.8% of patients who received linagliptin or placebo, respectively, experienced adverse events (AEs). Drug related AEs were less frequent with linagliptin (18.1%) than with placebo (20.0%). Renal and urinary AEs were experienced by 5.5% and 4.3% of linagliptin and placebo patients, respectively. Acute renal failure was a rare event and occurred in 0.5% and 0.2% of patients, respectively. Incidence of investigator-defined hypoglycaemia was lower in patients who received linagliptin (21.3%) compared with placebo (24.7%), with most events occurring in the trials that included a sulphonylurea or basal insulin as background therapy. Severe hypoglycaemic events were experienced by 1.0% and 1.7% of linagliptin and placebo patients, respectively. Linagliptin achieved placebo-corrected adjusted mean ± SE changes from baseline to Week 24 of −0.6 ± 0.1% (95% CI: −0.7, −0.5; P<0.0001) for HbA1c, and −0.8 ± 0.2 mmol/L (95% CI: −1.2, −0.5; P<0.0001) for fasting plasma glucose. Conclusion: In an elderly patient population with renal function ranging from normal to severe RI, linagliptin was well tolerated, providing meaningful efficacy with a reassuring renal safety profile. Author / Authors: Sanjay Patel 1, Guntram Schernthaner 2, Anthony H. Barnett 3, Susanne Crowe 4, Maximilian von Eynatten 5 1 Boehringer Ingelheim Ltd, Bracknell, UK; 2 Rudolfstiftung Hospital, Vienna, Austria; 3 Diabetes Centre, Heart of England NHS Foundation Trust and University of Birmingham, Birmingham, UK; 4 Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany; 5 Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA Presented: IDF 2013 4th Emirates Diabetes & Endocrine Congress 2014
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Poster Presentations
Methods: This post hoc analysis evaluated data from 7 randomised, placebo-controlled Phase 3 trials of linagliptin5 mg once daily as monotherapy or add-on to common glucose-lowering therapies for ≥24 weeks (including all subjects ≥65 years not receiving pioglitazone background therapy). Renal function was assessed by estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease formula.
Poster Presentations
Ahmed Ouda Organisation : Boehringer Ingelheim
PO-6
Renal Safety and Outcomes with Linagliptin: Meta-Analysis of Individual Data for 5466 Patients with Type 2 Diabetes Purpose: Long-term glycaemic control in diabetes is associated with reduced risk of renal microvascular complications. Linagliptin has been associated with significantly reduced albuminuria in patients with type 2 diabetes mellitus (T2DM) and renal dysfunction. As this effect was not directly related to short-term glycaemic improvements, it has been speculated that linagliptin may have beneficial renal effects. The aim of this study was to evaluate renal outcomes with Linagliptin in completed Phase 3, randomised, double-blind, placebo-controlled trials (≥12 wks). Method: Predefined events from 13 trials were analysed using a composite primary endpoint: new onset of a) microalbuminuria, b) macroalbuminuria, c) new onset chronic kidney disease (CKD; serum creatinine increase ≥250 μmol/L), d) worsening CKD (loss in estimated glomerular filtration rate [eGFR] >50% vs. baseline), e) acute renal failure (standardized Medical Dictionary for Regulatory Activities query), and f) death by any cause. Statistical analyses included hazard ratio (HR) using cox regression. Results: Of 5466 participants (mean baseline HbA1c, 8.2%; eGFR, 91.5 mL/min/1.73 m2), 3505 received linagliptin 5 mg qd and 1961 received placebo. Cumulative exposure was 1756 and 1057 person years, respectively. Events in the composite endpoint occurred in 448 (12.8%) patients receiving linagliptin vs. 306 (15.6%) with placebo, resulting in an HR in favour of linagliptin of 0.84 (95% confidence interval [CI]: 0.72, 0.97; P<0.05). For white patients and Asian patients, HRs (95% CI) were 0.82 (0.68, 0.98) and 0.89 (0.68, 1.15), respectively. Among patients <65 years and ≥65 years, HRs (95% CI) were 0.77 (0.64, 0.92) and 1.04 (0.80, 1.35), respectively. HRs (95% CI) for individual renal endpoints were: microalbuminuria, 0.82 (0.69, 0.98); macroalbuminuria, 0.86 (0.61, 1.20); new onset of CKD, 0.32 (0.10, 1.01); worsening of CKD, 1.42 (0.24, 8.52); acute renal failure, 0.94 (0.61, 1.45); and death by any cause, 1.09 (0.29, 4.09).
Poster Presentations
Conclusion: This large meta-analysis of the linagliptin global Phase 3 development programme supplements the overall safety evidence for linagliptin and supports its potentially favourable renal safety profile. These combined findings support the hypothesis of a potential direct effect of linagliptin on the onset and progression of renal disease in T2DM. Author / Authors: M. von Eynatten 1, M. Cooper 2, V. Perkovic 3, J. Rosenstock 4, C. Wanner 5, U. Hehnke 6, H.-J. Woerle 6; 1 Boehringer Ingelheim, Ridgefield, CT, USA, 2 The Baker IDI Heart and Diabetes Institute, Melbourne, Australia, 3 The George Institute for Global Health, Sydney, Australia, 4 Dallas Diabetes and Endocrine Center at Medical City, Dallas, TX, USA, 5 University Hospital of Würzburg, Würzburg, Germany, 6 Boehringer Ingelheim, Ingelheim, Germany. Presented: EASD 2013
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Poster Presentations
Ahmed Ouda Boehringer Ingelheim
PO-7
A Randomised Controlled Trial of Linagliptin Monotherapy Versus Initial Combination With Linagliptin and Metformin in Newly Diagnosed Type 2 Diabetes Patients Purpose: The incidence of type 2 diabetes (T2D) has risen dramatically in recent decades and glycaemic control in early stages of T2D is crucial to prevent long-term complications. While antihyperglycaemic monotherapy could be sufficient in mild to moderate hyperglycaemia, initial combination of glucose-lowering agents may be considered in pronounced hyperglycaemia. We compared 2 common treatment strategies (monotherapy or initial combination) for controlling marked hyperglycaemia in previously untreated patients with newly diagnosed T2D by utilizing the DPP-4 inhibitor linagliptin. Method: This international double-blind clinical trial randomised 316 treatment naïve subjects with recently diagnosed (≤12 months) and uncontrolled T2D (baseline HbA1c 8.5–12.0%) to receive linagliptin 5 mg QD (n=157) or the initial combination of linagliptin 5 mg QD + metformin BID (uptitrated in the first 6 weeks; maximal dose 2000 mg/d) (n=159) for 24 weeks. The primary endpoint was the difference in change from baseline HbA1c between groups in the per-protocol cohort of subjects completing the trial exclusively on study drug (linagliptin, n=113; linagliptin + metformin, n=132).
Conclusion: Linagliptin as monotherapy or in initial combination with metformin achieved clinically significant improvements in glucose control in patients with newly diagnosed T2D and marked hyperglycaemia; the large HbA1c reductions were notable, particularly with the dual therapy. This previously untreated cohort was chosen to explore the efficacy of oral DPP-4 inhibition in T2D patients with short disease duration. Author / Authors: Stuart A. Ross 1, A. Enrique Caballero 2, Stefano Del Prato 3, Baptist Gallwitz 4, Diane Lewis D’Agostino 5, Zelie Bailes6, Sandra Thiemann 7, Sanjay Patel 6, Hans-Juergen Woerle 7, Maximilian von Eynatten 7 1 University of Calgary, LMC Endocrinology Centres, Calgary, Alberta, Canada; 2 Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA; 3 University of Pisa, Department of Endocrinology and Metabolism, Section of Diabetes, Pisa, Italy; 4 Universitätsklinikum Tübingen, Dept. Medicine IV, Tübingen, Germany; 5 Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA; 6 Boehringer Ingelheim Ltd, Bracknell, UK; 7 Boehringer Ingelheim Pharma GmbH & Co.KG, Ingelheim, Germany Presented in IDF 2013
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Poster Presentations
Results: Subjects (54% females) were mainly Whites (58%) or Asians (38%) with a mean (±SD) age, HbA1c, and BMI of 48.8 (11.0) years, 9.8 (1.1) %, and 29.7 (5.6) kg/m2. After 24 weeks both linagliptin monotherapy as well as the initial combination of linagliptin and metformin significantly reduced HbA1c (±SE) levels by –2.0% (0.1) and –2.8% (0.1), respectively. The treatment difference of –0.8% (95% CI –1.1 to –0.5) showed superiority for the initial combination over monotherapy (p<0.0001). Notably, 40% and 61% of patients in the monotherapy and combination arms achieved HbA1c <7.0%. Treatments were well tolerated overall with very few drug-related or serious adverse events. Hypoglycaemia occurred in ≤3.2% of each arm. Body weight was stable with linagliptin and decreased in the combination arm (–1.3 kg between group difference; p=0.0033).
Poster Presentations
Ahmed Ouda Boehringer Ingelheim
PO-8
Renal Safety of Linagliptin in Elderly Patients with Type 2 Diabetes: Analysis of Pooled Patient Data from 7 Phase 3 Clinical Trials Purpose: Renal impairment (RI) is common in elderly patients with type 2 diabetes mellitus (T2DM), and progression of kidney disease is associated with increased morbidity and mortality. Renal safety is therefore an important consideration in the selection of appropriate treatments for this population. As several drugs are either contraindicated or require dose adjustment in patients with RI, it is important to identify well-tolerated treatments for elderly T2DM patients with or at risk of declining renal function. This analysis of pooled data from a large clinical trials programme investigated the efficacy and renal and overall safety of the DPP-4 inhibitor linagliptin in elderly patients with T2DM. Method: This post hoc analysis evaluated data from 7 randomised, placebo-controlled Phase 3 trials of linagliptin 5 mg once daily as monotherapy or add-on to common glucose-lowering therapies for ≥24 weeks (including all subjects ≥65 years not receiving pioglitazone background therapy). Renal function was assessed by estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease formula. Results: The pooled population comprised 1293 elderly patients randomised to either linagliptin (n=823) or placebo (n=470). Baseline characteristics (mean ± SD) were similar between the linagliptin and placebo groups: age, 71.1 ± 4.6 vs. 70.9 ± 4.7 years; HbA1c, 8.0 ± 0.8 vs. 8.1 ± 0.8%. In the linagliptin group, 56.4%, 14.8%, and 4.5% of patients had mild (eGFR 60 to <90 mL/min), moderate (eGFR 30 to <60 mL/min), and severe RI (eGFR <30 mL/min) with similar proportions found in the placebo group (51.3%, 18.7%, and 5.1%, respectively). Overall renal function was not significantly altered by treatment with Linagliptin from baseline to Week 24 (adjusted mean ± SE eGFR [−1.8 ± 0.7 mL/min] vs. placebo [−1.1 ± 0.9 mL/min], resulting in a placebocorrected difference of −0.7 ± 1.0 mL/min [95% CI: −2.6, 1.2; P=0.4912]). Changes in urine albumin-to-creatinine ratio trended toward improvement with linagliptin.
Poster Presentations
In total, 71.3% and 72.8% of patients who received linagliptin or placebo, respectively, experienced adverse events (AEs). Drug related AEs were less frequent with linagliptin (18.1%) than with placebo (20.0%). Renal and urinary AEs were experienced by 5.5% and 4.3% of linagliptin and placebo patients, respectively. Acute renal failure was a rare event and occurred in 0.5% and 0.2% of patients, respectively. Incidence of investigator-defined hypoglycaemia was lower in patients who received Linagliptin (21.3%) compared with placebo (24.7%), with most events occurring in the trials that included a sulphonylurea or basal insulin as background therapy. Severe hypoglycaemic events were experienced by 1.0% and 1.7% of linagliptin and placebo patients, respectively. Linagliptin achieved placebocorrected adjusted mean ± SE changes from baseline to Week 24 of −0.6 ± 0.1% (95% CI: −0.7, −0.5; P<0.0001) for HbA1c, and −0.8 ± 0.2 mmol/L (95% CI: −1.2, −0.5; P<0.0001) for fasting plasma glucose. Conclusion: In an elderly patient population with renal function ranging from normal to severe RI, linagliptin was well tolerated, providing meaningful efficacy with a reassuring renal safety profile. Author / Authors: S. Patel 1, G. Schernthaner 2, A.H. Barnett 3, U. Hehnke 4, M. von Eynatten 5, H.-J. Woerle 4; 1 Boehringer Ingelheim, Bracknell, UK, 2 Rudolfstiftung Hospital, Vienna, Austria, 3 University of Birmingham and Heart of England NHS Foundation Trust, Birmingham, UK, 4 Boehringer Ingelheim, Ingelheim, Germany, 5 Boehringer Ingelheim, Ridgefield, CT, USA. Presented: EASD 2013 40
4th Emirates Diabetes & Endocrine Congress 2014
Poster Presentations Ahmed Ouda Boehringer Ingelheim
PO-9
Empagliflozin as Add-On to Basal Insulin for 78Weeks Improves Glycemic Control with Weight Loss in Insulin-Treated Type 2 Diabetes (T2DM) Purpose: Empagliflozin (EMPA) is a selective SGLT2 inhibitor in development for the treatment of T2DM. We assessed the efficacy and safety of EMPA added-on to basal insulin in T2DM patients Method: T2DM patients (mean age 58.8 yrs; HbA1c 8.2%; BMI 32.2 kg/m2) on basal insulin. T2DM patients (mean age 58.8 yrs; HbA1c 8.2%; BMI 32.2 kg/m2) randomized to double-blind EMPA 10 mg (n=169) or 25 mg qd (n=155) or placebo (PBO; n=170) for 78 weeks. Basal insulin dose remained constant for the first 18 weeks, then adjustments were allowed at investigator discretion. Primary endpoint was change from baseline in HbA1c at week 18. Key secondary endpoints were changes from baseline in insulin dose and HbA1c at week 78. Analysis and Results: Further analyses showed reductions in FPG, body weight, and systolic BP (Table). Hypoglycemia (glucose ≤70 mg/dL and/or requiring assistance) was reported similarly in 36.1% of patients on EMPA 10 mg and 25 mg and 35.3% on PBO; 2 patients on EMPA 25 mg required assistance. AEs consistent with urinary tract infection were reported in 14.8%, 11.6% and 8.8% on EMPA 10 mg, EMPA 25 mg and PBO, respectively. AEs consistent with genital infection were reported in 7.7%, 5.2% and 1.8% on EMPA 10 mg, EMPA 25 mg and PBO, respectively. Conclusions: In conclusion, EMPA 10 mg and 25 mg for 78 weeks as add-on to basal insulin improved glycemic control, led to reductions in body weight without increase in hypoglycemia risk, and were well tolerated except for increased genitourinary infections. Author / Authors: Julio Rosenstock, 1 Ante Jelaska, 2 Fei Wang, 2 Gabriel Kim, 2 Uli C Broedl, 2 Hans J Woerle3
Presented: ADA 2013 – EASD 2013
Ahmed Ouda Boehringer Ingelheim
PO-10
Empagliflozin Improves Glycaemic Parameters and Several Cardiovascular Risk Factors in Patients with Type 2 Diabetes (T2DM): Pooled Data from Four Pivotal Phase III Trials Method: We analyzed pooled data from 2477 patients with T2DM (mean [SD] age 55.6 [10.2] years, HbA1c 7.99 [0.85], BMI 28.7 [5.5]) from four randomized, placebo-controlled Phase III trials that investigated Empagliflozin (EMPA) 10 mg or 25 mg given for 24 weeks as monotherapy, add-on to metformin (MET), add-on to MET + SU, or add-on to pioglitazone ± MET. Effects on HbA1c, fasting plasma glucose (FPG), weight, systolic and diastolic blood pressure (SBP and DBP) were evaluated in the full analysis set (placebo [PBO]: n=825, EMPA 10 mg: n=831, EMPA 25 mg: n=821). Effects on lipids and uric acid were evaluated in all treated patients (PBO: n=825, EMPA 10 mg: n=830, EMPA 25 mg: n=822). Effects on SBP and DBP were also evaluated in patients with uncontrolled BP (SBP≥130 mmHg or DBP ≥80 mmHg) at baseline (PBO: n=501, EMPA 10 mg: n=517, EMPA 25 mg: n=506). 4th Emirates Diabetes & Endocrine Congress 2014
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Poster Presentations
1 Dallas Diabetes and Endocrine Center at Medical City, Dallas, Texas 2 Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA 3 Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
Poster Presentations Analysis and Results: EMPA significantly reduced HbA1c, FPG, weight, SBP, DBP and uric acid at week 24 vs PBO. Reductions in SBP and DBP were more pronounced in patients with uncontrolled BP at baseline. Small increases in HDL- and LDL-cholesterol and small decreases in triglyceride levels were observed with EMPA vs PBO. Conclusion: In conclusion, in a pooled analysis of data from four Phase III trials, 24 weeks’ treatment with EMPA10 mg or 25 mg provided clinically meaningful improvements in glycemic parameters, weight, and BP, with positive effects on uric acid and small effects on lipids. Author / Authors: Thomas Hach 1, John Gerich 2, Afshin Salsali 1, Gabriel Kim 1, Stefan Hantel 3, Hans J. Woerle 1, Uli C. Broedl 1 1 Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany 2 University of Rochester School of Medicine, Rochester, New York, USA 3 Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
Ahmed Ouda Boehringer Ingelheim
PO-11
Empagliflozin as Add-On to Metformin for 24 Weeks Improves Glycemic Control in Patients with Type 2 Diabetes (T2DM): Purpose: A Phase III trial investigated the efficacy and safety of Empagliflozin (EMPA) in patients with T2DM on background metformin
Poster Presentations
Methods: T2DM Patients with background metformin (mean age 55.7 [SD 9.9] years; mean BMI 29.2 [SD 5.5] kg/m2). Patients (mean age 55.7 [SD 9.9] years; mean BMI 29.2 [SD 5.5] kg/m2) were randomized double-blind and treated with EMPA 10 mg (n=217) or 25 mg qd (n=213) or placebo (PBO; n=207) for 24 weeks. The primary endpoint was change from baseline in HbA1c at week 24. Key secondary endpoints were change from baseline in weight and mean daily glucose (MDG) at week 24. ANALYSIS and RESULTS: EMPA significantly reduced HbA1c, weight and MDG vs PBO (table). Further analyses showed significant reductions in systolic blood pressure (SBP), FPG and 2h PPG vs PBO. Weight loss of >5% was achieved by 21.2% of patients on EMPA 10 mg, 23.0% on EMPA 25 mg and 4.8% on PBO. Adverse events (AEs) were reported by 57.1%, 49.5% and 58.7% of patients on EMPA 10 mg, 25 mg and PBO, respectively. Hypoglycemia (plasma glucose ≤70 mg/dL and/or requiring assistance) was reported in 1.8% of patients on EMPA 10 mg, 1.4% on EMPA 25 mg and 0.5% on PBO; none required assistance. AEs consistent with urinary tract infection were reported in 5.1% of patients on EMPA 10 mg, 5.6% on EMPA 25 mg and 4.9% on PBO. AEs consistent with genital infection were reported in 3.7% of patients on EMPA 10 mg, 4.7% on EMPA 25 mg and none on PBO. Conclusion: To conclude, EMPA 10 mg and 25 mg for 24 weeks as add-on to metformin improved glycemic control, and reduced weight and SBP versus PBO, and were well tolerated in patients with T2DM. Author / Authors: Hans-Ulrich Häring,1 Ludwig Merker,2 Elke Seewaldt-Becker,3 MarcWeimer,3 Thomas Meinicke,3 Uli C Broedl, 4 Hans J Woerle4 1 University of Tübingen, Tübingen, Germany 2 Diabetes- und Nierenzentrum, Dormagen, Germany 3 Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany 4 Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany 42
4th Emirates Diabetes & Endocrine Congress 2014
Poster Presentations Iyad Hassan Chair of Surgery Alain Hospital UAE
PO-11
Do We Really Need Intraoperative Parathyroid Hormone Level for Minimally Invasive Parathyroidectomy: Experience From A Hospital Under Continues Developing ? Background: There is no doubt that the success of minimally invasive parathyroidectomy (MIP) has changed the whole treatment of patients with primary hyperparathyroidism, especially the approach towards traditional bilateral neck exploration. A single adenoma is the most common cause of primary hyperparathyroidism and its removal results in cure. Hence, it is worth the effort to localise and excise the single adenoma using modern technologies such as high-quality sestamibi scans. Recently, the importance of Intraoperative parathyroid hormone level has been put to question. The purpose of this study is to determine the success of parathyroidectomy in the presence of frozen section without Intraoperative parathyroid hormone level Materials And Methods: This research involved the retrospective study of 20n patients, who underwent Parathyroidectomy at Alain Hospital, a hospital under continues developing, India, for primary Hyperparathyroidism (pHPT) between 2010-2013 parathyroid adenoma. All patients with evidence of unifocal disease on sestamibi scanning and cervical ultrasonography (cUS). underwent Minimally invasive Parathyroidectomy via 1.5-3 cm median collar incision. Blood samples for measurement of IOPTH were taken at the time of induction of anaesthesia and 10 min after the adenoma excision. Reduction of parathormone (PTH) levels of more than 50 % in the postexcision sample was taken as evidence for complete extirpation of parathyroid adenoma.
Conclusion: Our data demonstrates that the added operating time associated with IOPTH may not be justified for patients undergoing minimally parathyroidectomy who have 2 concordant imaging preoperatively in the presence of frozen section and experienced Endocrine surgeon. For Patients with negative preoperative Localization Bilateral Neck exploration with possible intraoperative Parathormon level may be considered in selected cases. Author / Authors: Hospital/UAE
Iman Al Baloushi, Iyad Hassan. Department of General and Endocrine Surgery at Alain
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Poster Presentations
Results: A solitary adenoma was suspected preoperatively via cUS and or. Sestamibi in 13 Patients. and Minimally Invasive Parathyroidectomy was performed successfully in all the cases ( in 4 cases in local Anesthesia one of them during pregnancy). In 7 cases preoperative Imaging was negative so bilateral neck exploration was done and in 6 cases a single adenoma was found and only in one case doppel Adenoma were presents. In one of the cases with bilateral exploration were a huge cystic adenoma was removed the disease persisted. In Follow-up imaging a medistinal Adenoma was detected and removed via re-exploration of the neck with partial Thymectomy. And the patient was cured. In All cases there was no Vocal cord palsy or any other surgical complications.The final histopathological examination confirmed the diagnosis of parathyroid adenoma in All cases.
Poster Presentations Susan Jacob Neda Hammoudeh & Wafaa Al Ajmani Dubai Hospital
PO-13
Self Monitoring of Blood Glucose Outcome Objective: To identify the effectiveness achieving hemoglobin A1c targets .
of
SMBG
and
reinforcement
education
on
Description: Since February 2013, we started to distribute free glucometer and strips for diabetic patients attending Dubai Hospital outpatient department. We instructed them how often to check blood glucose, their target(Fasting 70-130 mg/dl and 2hrs after meal less than 180mg/dl) ) to achieve in each visit, how to manage hypo and hyper glycaemia and lifestyle modifications. Recorded their A1c before giving the glucometer, reinforcement education continued and followed them up for 8 months duration Findings: We found that those who did SMBG could adjust their insulin doses according to the readings specially type 1 cases and those who are on basal bolus regimen, they were able to identify and self treat hypoglycemia by using rule of 15 and modify their diet and exercise. Newly diagnosed patients showed more compliance and very good outcome in diabetes control (58%). But 34% remained the same A1c and 8 % didnâ&#x20AC;&#x2122;t show any control over diabetes.
Poster Presentations
Conclusion: SMBG and knowledge about diabetes management is essential for improving A1c level in diabetes cases especially type 1 who were able to adjust their insulin doses according to blood glucose level. Reinforcement education is very important for motivating the patient to maintain the achieved targets.
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Author / Authors: Susan Jacob, Neda Hammoudeh & Wafaa Al Ajmani
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4th Emirates Diabetes & Endocrine Congress 2014
Poster Presentations Alaaeldin Mohammed Bashir Dubai Hospital
PO-14
Challenges in Management of Diabetic Ketoacidosis In Haemodialysis Patients, Case Presentation and Review of Literature Abstract: Chronic kidney disease is associated with accumulation of uremic toxins that increases insulin resistance which will lead to blunted ability to suppress hepatic gluconeogenesis and reduce peripheral utilization of insulin. (1) CKD patients fail to increase insulin secretion in response to insulin resistance because of acidosis, 1,25 vitamin D deficiency, and secondary hyperparathyroidism. (2-4) Hemodialysis causes further fluctuations in glycemic control due to alterations in insulin secretion, clearance and resistance. DKA is uncommon in hemodialysis patients because of the abscense of glycosuria and osmotic diuresis which accounts for most of the fluid and electrolyte losses seen in DKA, anuric patients may be somewhat protected from dehydration and shock, although still subject to hyperkalemia and metabolic acidosis. (5) However substantial volume loss can still occur due to a prolonged decrease in oral intake or increased insensible water losses related to tachypnea and fever(2) there is no current guidelines for the management of diabetic ketoacidosis in anuric haemodialysis patients considering their differences than general population , we review of the literature for management protocols and expertise opinions in view of which we suggest to consider the following recommendations While managing DKA in haemodialysis patients : Recommendation 1: diagnosis of DKA should be suspected if there is persistent profound acidosis that does not respond to hemodialysis, or patients with marked symptoms of nausea and vomiting.
Recommendation 3: Dialysis patients might be fluid overloaded and are unable to excrete fluid load used routinely for management of DKA in non-CKD patients, therefore if fluids are required, small boluses should be used, with continuous monitoring and frequent re- evaluation of hydration status. If the patient is fluid overloaded then consider hemodialysis. (1,7) Recommendation 4: Patients with CKD fail to excrete acid load and are already fluid overloaded. Ketogenisis associated with ketoacidosis further adds to acidosis. This should be corrected with hemodialysis. There is no place for sodium bicarbonate infusion in management of DKA, and the associated sodium, volume and osmotic overload might be problematic in those patients. (1,7) Recommendation 5: Patients with CKD are immune compromised. They are also at high risk of cardiovascular events. These are very common precipitating factors that should be sought when managing any patient with DKA. (1 ) Recommendation 6: Increasing the frequency of dialysis might be helpful as it clears the overload, improves electrolyte imbalance and corrects acidosis .(1) References : 1. Jamie Blicker, Anthony M. Herd, Joanne Talbot . Diabetic ketoacidosis in the dialysis-dependent patient: two case reports and recommendations for treatment , Can J Emerg Med 2004;6(4):2814 2. MakRH.Intravenous1,25-dihydroxycholecalciferol correctsglucose intolerance in hemodialysis patients. Kidney Int 1992; 41:1049â&#x20AC;&#x201C;1054. 3. Hajjar SM, Fadda GZ, Thanakitcharu P, Smogorzewski M, Massry SG. Reduced activity of Na(+)-K+ ATPase of pancreatic islet cells in chronic renal failure: role of secondary hyperparathyroidism. J Am 4th Emirates Diabetes & Endocrine Congress 2014
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Poster Presentations
Recommendation 2: Patients on dialysis have high total body stores of potassium and should not be started on potassium replacement until acidosis is corrected, and hypokalemia is documented. All HD patients should be monitored and if there is evidence of hyperkalemia (clinically or on ECG) immediate treatment with potassium lowering agents or dialysis should be initiated. (1,6)
Poster Presentations Soc Nephrol 1992; 2:1355–1359. 4. Mak RH. Impact of end-stage renal disease and dialysis on glycemic control. Semin Dial 2000;13(1):4-8. 5. Viallon A, Zeni F, Lafond P, Tardy B, Page Y, Bertrand JC. Does bicarbonate therapy improve the management of severe diabetic ketoacidosis? Criti Care Med 1999;27:2690-3. 6. Serum potassium concentration in hyperglycemia of chronic dialysis. Rohrscheib, M., Tzamaloukas, A. H., Ing, T. S. Advances in Peritoneal Dialysis, (2005). 21,102−105. 7. Body fluid abnormalities in severe hyperglycemia in patients on chronic dialysis: review of published reports. A.H. Tzamaloukas et al. Journal of Diabetes and Its Complications (2008) 22, 29–37 Author / Authors: Ayman Aly Seddik, Alaaeldin Mohammed Bashir, Amna Khalifa Alhadary, Fakhryia AlAlway, Hind Hassan Alnour, Mohammed Jaffer Railey. Nephrology and Endocrinology Units, Dubai Hospital, Dubai Health Authority
Medical Team Novartis
PO-15
To Evaluate the Safety and Efficacy of Diovan® (Valsartan 320mg) in Hypertensive Patients, with or Without Type 2 Diabetes Mellitus with Albuminuria in a Real-World Setting
Poster Presentations
Design: Open label, multi center, prospective, observational study Settings: Total of 1728 patients was initially enrolled in the study at multi-centers in Lebanon, UAE and Qatar Participants: Patients aged ≥ 18 years and ≤65 years with established diagnosis of hypertension, treatment naive or treated (with/without antihypertensive treatment excluding RAAS blockers), with/without type 2 diabetes (HbA1c at baseline <11%) and with albuminuria, for whom an antihypertensive therapy with the Diovan® (320 mg Valsartan) daily was medically recommended Investigational Product: Valsartan 320, Valsartan 320/HCT (Hydrochlorothiazide) Main Outcome Measures: Primary outcome measures were change of albuminuria measurement, frequency of patients who achieved remission (shift from albuminuria to normoalbuminuria), regression (50% reduction in the ACR from baseline) of albuminuria. Secondary outcome measures were blood pressure reduction, percentage of patients reaching blood pressure control, investigator’s opinion about treatment using the subjective assessment form and adverse events. Results: Efficacy analysis on 1717 patients showed that the mean relative change in albuminuria for the sample was 58.1% with SD of 48.3 (between groups p=0.026). It was seen that 73.8% of patients achieved regression of albuminuria, with the highest number being in the monotherapy group, followed by combination group and then add-on group (between groups p=0.0007). The percentage change in albuminuria was higher in non-diabetic patients (Mean= 63.8% SD=25.5) as compared to diabetic patients (Mean=56.2% SD=52.9) (between groups p=0.0015).The mean relative change in systolic blood pressure from baseline value of 158.4 mmHg (SD=15.2) for the sample was 15.7% with SD=10.3 (between groups p=0.008) while the mean relative change in diastolic pressure from baseline value of 93.4 mmHg (SD=12.0) was 14% with SD=57.2 (between groups p=0.882). Only 30% of the patients in the sample achieved the therapeutic goal for blood pressure, with the highest proportion (35.5%) being reported in the monotherapy group (between groups p<0.0001). The overall assessment of tolerability showed higher proportion of patients being assessed as ideal in all the treatment groups (84.0%). Only 0.8% of patients reported any adverse event and no serious adverse event was reported. One death which was not related to the treatment was reported. 46
4th Emirates Diabetes & Endocrine Congress 2014
Poster Presentations Conclusions: The effectiveness of Valsartan 320 mg as monotherapy, combination and add-on therapy in reducing albuminuria, inducing regression and reducing blood pressure levels with minimal adverse events in a large proportion of patients with hypertension and albuminuria was established by this study.
Medical Team Novartis
PO-16
The Effect of Vildagliptin Relative to Sulphonylurea as Dual Therapy with Metformin (or as Monotherapy) in Muslim Patients with Type 2 Diabetes Fasting During Ramadan in the Middle East: the VIRTUE Study Objectives: To assess the effect of vildagliptin relative to sulphonylurea on hypoglycemic events, in type 2 diabetic Muslim patients who fast during Ramadan. Primary endpoint was proportion of patients with at least one hypoglycemic event during the fasting period. Secondary endpoints included change in weight, HbA1c levels, treatment adherence and overall safety. Design and Methods: This multicentre, prospective, observational cohort study enrolled patients from the Middle East into two cohorts: vildagliptin (n=308) and sulphonylurea (n=265), administered either as dual therapy with metformin or monotherapy.
Poster Presentations
Results: Vildagliptin cohort had a significantly fewer patients reporting at least one hypoglycemic event (11, 3.7%) compared to sulphonylurea cohort (66, 25.5%) (p<0.001). The mean change in HbA1c levels from baseline at the end of study was –0.26% in the vildagliptin (Baseline:Mean=7.2%;SD=0.86) group compared to -0.08% in the sulphonylurea (Baseline:Mean=7.4%;SD=1.00) group(–0.18% between treatment difference; p=0.001). The mean body weight change at the end of study from baseline was -0.97 kg in the vildagliptin group compared to -0.29 kg in the sulphonylurea group (–0.68 kg between treatment difference; p<0.001). Treatment exposure and adherence was high and similar in both cohorts. The proportion of patients reporting adverse events was higher in the sulphonylurea cohort (4.3% in Vildagliptin compared to 25.3 % in the sulphonylurea cohort) with hypoglycemia being the most experienced event in both cohorts. Conclusion: Anti-hyperglycemic treatment with vildagliptin led to favorable outcomes in comparison to sulphonylurea treatment among diabetic patients who fast during Ramadan. Good glycemic control, weight control and safety results supported this outcome. Author / Authors: Ahmed Hassoun1, Monira Al-Arouj2, Mohamed Ibrahim3, 1Dubai Diabetes Center, Dubai, UAE, 2Dasman Diabetes Institute, Dasman, Kuwait, 3Novartis Pharma services AG, Dubai, UAE
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Poster Presentations
Omran B Gatee FRCP Burjeel Hospital
PO-17
Status of Serum Calcium and Parathormone Level in Patients Underwent 99-mTc-Sestamibi Scan for Hyperparathyroidism. Background: Sestamibi scan is used to determine gross underlying pathological changes in the parathyroid glands. Aim: To review the outcome of parathyroid scan results in a cohort of patients with hyperparathyroidism with special attention paid to the associated serum calcium. Patients and Methods: Results of 129 patients with the diagnosis of hyperparathyroidism were reviewed. The scan was performed using99-mTc-sestamibi (2-methoxyisobutylisonitrile) injected IV .Parathormone hormone( PTH) was assayed by chemiluminscentmicroparticle immunoassay (CMIA, Abbot) ( N=15-68 pg/ ml)& serum calcium estimation bycresolphalein complex method ( N=8.4-10.2 mg/dl) .Diagnosis of hyperparathyroidism was based on PTH levels of > than 70 pg/ml.
Poster Presentations
Results: The age of patients ranged between 14-81 years. Female predominance was evident 77vs. 52. The PTH level ranged between 77.1-503 pg/ml in the whole group (mean of 152 +/-74.9)and serum calcium between 8.02-12.5 mg/d ( mean of 10+/- 0.88) . 35 patients had parathyroid (single) adenoma (27%),52 had parathyroid hyperplasia (40%), and 42 (32.5%) expressed negative results. The mean level of PTH was not different in the three subgroups ( 147+/- 79.8, 145 +/-54.4 & 163+/-92.4 pg/ml respectively, p=NS). Likewise was the mean of serum calcium (9.95 +/-0.82 , 10.1 +/-0.84 & 10.1 +/- 1.00mg/dl) respectively, p=NS. Nonetheless, the frequency of eucalcemia was higher than hypercalcemiain the entire group ((75 patients (58%) vs. 54 (42%) with hypercalcemia (10.2mg/dl and above) ,p=0.012)). The same pattern of frequency was also observed in the sub groups respectively (( 22 ( 64%) vs. 13 (36%) in the adenoma group , p=0.05 , 28 (54%) vs. 24 (46%) in the hyperplasia group , p= 0.55 & 25 ( 59.5%) vs. 17 (40.5%) in the negative group , p= 0.12. Moreover, the mean of raised PTH was not different in between eucalcemic&hypercalcemic patients in the subgroups ( adenoma, vs. hyperplasia subgroups , p= 0.062 and p= 0.26 respectively) but not in those with negative scan outcome where PTH was significantly lower in the eucalcemic patients than that of the hypercalcemic ones (137 +/-55.1 vs .200 +/-120), p= 0.026. Conclusions: The profile of serum calcium and raised serum PTH did not appear discriminatory in these patientswith hyperparathyroidism of different scan outcome. Moreover, the emergence of eucalcemia as being the most frequent biological marker in these patients poses a challenge to the expected laboratory finding of hypercalcemiathat is usually associated with functioning parathyroid adenoma. Further studies to substantiate the above findings however, are warranted. Author / Authors: Dr. Omran B Gatee FRCP andDr. Haider M Al AttiaFRCP, Dr. Zuhair Al-Haider Nuclear medicine MD M.ScPh.D , BurjeelHospital , Abu Dhabi, UAE
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Poster Presentations Eman Mokbel Alissa KSA
PO-18
Insulin Resistance in Postmenopausal Women and its Association With Vitamin D Deficiency Purpose: There is increasing interest in the non-skeletal effects of vitamin D and the relationship between vitamin D deficiency and chronic conditions like diabetes mellitus. We aimed to investigate the relationship between surrogate indices of insulin resistance (IR), and vitamin D deficiency/ insufficiency in postmenopausal Saudi women with and without metabolic syndrome (MetS). Relevance: Although the prevalence of metabolic syndrome in adults living in Saudi Arabia has been investigated, no study has examined the relationship between surrogate measures of IR and MetS. Furthermore, it remains uncertain whether the presence of MetS and IR are linked to the greater rates of hypovitaminosis D observed in Saudi postmenopausal women. Participants: The study population consisted of 300 postmenopausal women aged 46â&#x20AC;&#x201C;88 years enrolled consecutively from women attending the Outpatient Clinics of King Abdulaziz University Hospital (KAUH). The study was approved by the ethical review board of KAUH. Methods: Demographic and anthropometric were recorded. Biochemical variables included fasting blood glucose (FBG), fasting lipids profile, intact parathyroid hormone, insulin, and 25(OH)-vitamin D were estimated. Indirect indices of IR include: homeostasis model assessment for insulin resistance, quantitative insulin sensitivity check index, and McAuley formulas. The American Heart Association/National Heart, Lung and Blood Institute definition of MetS was used. Subjects with serum 25(OH)-vitamin D levels <50nmol/L were categorized as having 25(OH) D deficiency.
Results: Abdominal obesity, IR, and hypovitaminosis D were highly prevalent within our population sample. Of the components used to define MetS; waist circumference, serum triglycerides (TG), high density lipoprotein-cholesterol, and FBG were significantly correlated with all surrogate measures of IR. Significant inverse correlations were found between serum vitamin D with serum TG, FBG, and diastolic blood pressure, within the study cohort. Conclusions: These observations suggest that hypovitaminosis D may be associated with the risk of developing MetS. Interrelationships between IR, MetS, and hypovitaminosis D are of particular interest in Saudi population, given the high prevalence of these conditions in this region. Author / Authors: Eman M Alissa(1), Wafa A Alnahdi(1), Nabil Alama(1), Gordon A Ferns(2) (1) Associate Professor, Department of Clinical Biochemistry, Faculty of Medicine, King Abdul Aziz University Assistant head of Nutrition Unit, King Fahd Medical Research Center (2) Medical Education and Metabolic Medicine, Brighton and Sussex Medical School, University of Brighton, UK
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Analysis: Data were analyzed for women with and without MetS. All analyses were performed in SPSS (version 21.5). All reported p values were from two-sided tests and compared to a significant level of 5%.
Poster Presentations
Bachar Afandi Tawam Hospital
PO-19
E-Referral Impact on Specialty Clinic Objectives: e-Referral model was recently adopted in Al Ain City to facilitate referral from primary to specialty care. The purpose of this audit is to evaluate the appropriateness of referrals and the impact of the process on the endocrine clinic in a tertiary care center. Methods: We reviewed charts for 104 patients who were e-referred in the month of January 2014 to be seen within one to two weeks in the endocrine clinic. Electronic records were accessed in the Cerner System by using the Enterprise Patient Index “EPI”. Results: Only 33 cases “32%” of all referrals were for new patients, 14 patients “14%” had wrong referral and 27 % of referrals were already 4-5 days overdue. 22% of referrals were for established patients who have existing future appointments in the clinic and 27% for known patients who missed previous appointments. 50% of reviewed records had no documentations of referral, no clear consult question or inadequate prereferral investigations. 9 % of referrals were for patients referred for evaluation of thyroid nodules and 10% were for pregnant women. The details of 14/104 patients “13 %” who did actually require 1-2 weeks visit reveal 7 pregnant women with DM/GDM and 7 endocrine urgencies namely hypercalcemia, hypocalcemia, thyrotoxicosis, hyperprolactinemia, hypopituitarism and thyroid cancer.Overall; 79% of referred cases did not have the medical necessity for early evaluation. Conclusions/Recommendations: The main goal of e-referral is to assure pre-visit communications between referring and specialty clinicians in order to enhance patient care. Referring primary care physicians should be obligated to review the hospital records and to combine the e-referral with phone contact in order to discuss urgent referrals with specialists and to assure adequate pre-referral investigations. If used inappropriately; e-referral will waste resources, instigate patient and physician frustration, overburden subspecialties and most importantly it might lead to delay of patient care and adverse outcomes.
Poster Presentations
References: Judy E. Kim-Hwang, MD, Alice Hm Chen, MD, MPH, [...], and Margot B. Kushel, MD. Evaluating Electronic Referrals for Specialty Care at a Public Hospital. J Gen Intern Med. 2010 October; 25(10): 1123–1128 Erin Keely, MD, FRCPC, Clare Liddy, MD, MSc, CCFP, FCFP, and Amir Afkham, Ben. Utilization, Benefits, and Impact of an e-Consultation Service Across Diverse Specialties and Primary Care Providers. Telemed J E Health. 2013 October; 19(10): 733–738 Author / Authors: Fatima Al Kuwaiti, MD, Bachar Afandi, MD, FACE, Tawam Hospital in affiliation with Johns Hopkins International, SEHA, Al Ain, UAE References: 1. Judy E. Kim-Hwang, MD, Alice Hm Chen, MD, MPH, [...], and Margot B. Kushel, MD. Evaluating Electronic Referrals for Specialty Care at a Public Hospital. J Gen Intern Med. 2010 October; 25(10): 1123– 1128, 2. Erin Keely, MD, FRCPC, Clare Liddy, MD, MSc, CCFP, FCFP, and Amir Afkham, Ben. Utilization, Benefits, and Impact of an e-Consultation Service Across Diverse Specialties and Primary Care Providers. Telemed J E Health. 2013 October; 19(10): 733–738
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Poster Presentations Duaa Salem Jawhar Saqr Hospital UAE
PO-20
Empagliflozin as Add-On to Basal Insulin for 78Weeks Improves Glycemic Control with Weight Loss in Insulin-Treated Type 2 Diabetes (T2DM) Objectives: Osteoporosis is a silent disease which has an effect on bone structure. Studies on the association between bone mineral density (BMD) and type 2 diabetes mellitus (T2DM) revealed conflicting results. We conducted this study to assess the prevalence of osteoporosis in females with T2DM and to determine the main risk factors influencing BMD, as well as identifying common comorbidities and medications affecting BMD in diabetic patients.
Results: We recruited 635 patients; 141 diabetic group and 428 control group, the mean age was 63.55 ± 9.15 years in diabetic group, and 58.88 ± 11.71 years in control group. Most of patients were obese and postmenopausal. Prevalence of osteoporosis was significantly higher (P ≤ 0.01) in diabetic group than control group [relative risk (RR) = 1.2, 95 % CI = 1.1-1.2], despite similar BMD and T-score values. Distribution of risk factors between groups showed significantly high percent of liver impairment (P ≤ 0.01) and renal impairment (P ≤ 0.001) in diabetic group. However, more diabetic patients had significantly higher comorbid conditions such as depression (P ≤ 0.01), hypertension (P ≤ 0.001), dyslipidemia (P ≤ 0.001), Ischemic Heart Disease (IHD) (P ≤ 0.001), osteoarthritis (P ≤ 0.01), cataract (P ≤ 0.01) and glaucoma (P ≤ 0.01). As well patients were taking significantly higher amount of medications that affect BMD such as loop diuretics (P ≤ 0.01), thiazide diuretics (p ≤ 0.001), proton pump inhibitors (PPI) (P ≤ 0.001) and antacids (P ≤ 0.05) compared with control group. Regression analysis showed that in diabetic group weight and age were the most common variables associated with BMD. Systolic blood pressure, diastolic blood pressure, hypothyroidism, stroke, presence of other fracture, using oral corticosteroids and anticonvulsants played a role in the predicting of BMD at some skeletal region. Conclusion: Females with T2DM had higher prevalence of osteoporosis with similar BMD and T-score values. Many diseases and medications-related variables can predict BMD values in both groups. Author / Authors: Duaa Jawhar, M.Sc (1), Nageeb Hassan, Ph.D (2), Mohammed Shamssain, Ph.D (2) College of Pharmacy and Health Sciences, Ajman University of Science and Technology, Ajman, UAE. Pharmacy Department, Saqr Hospital, Ras Al Khaimah, UAE. College of Pharmacy and Health Sciences, Ajman University of Science and Technology, Ajman, UAE.
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Materials and Methods: We retrospectively analyze hospital records and dual energy x-ray absorptiometry (DEXA) scan output of all female patients who had lumbar spine (L1-L4) and left femur-total hip DEXA-scan measurements between 2010-2012 at tertiary hospital in Ajman, United Arab Emirates (UAE). The measurements were : BMD, T-score and Z-score. The relationship between BMD and different demographic, disease and medications related variables were analyzed using Pearson’s correlation coefficient. Significant variables were then entered in stepwise multiple linear regression analysis.
Poster Presentations Naser Elkum /Mohamed Abufarha Dasman Diabetes Institute Kuwait
PO-21
Cardiovascular Disease Risk Factors in South Asian Population Living in Kuwait: a Cross-Sectional Study Background: High rates of diabetes and cardiovascular disease (CVD) have been reported in South Asian immigrants in many countries. However, the prevalence and characteristics of CVD risk factors among South Asian population living in Kuwait have not yet been investigated. This study was therefore designed to estimate the prevalence of CVD risk factors and determine whether they are independently associated with diabetes in such population. Methods: A population based cross-sectional study was conducted on 1094 (781 men and 313 women) South Asians, mainly Indian and Pakistani, participants (≥ 18 years of age), of which 75.1% were Indians. Participants were interviewed during which socio-demographic and anthropometric data were collected, followed by a physical examination and collection of fasting blood samples for laboratory investigations. Diabetes was defined by fasting plasma glucose ≥ 7 mmol/l or on treatment, and/or self-reported previously diagnosed T2DM. Results: The prevalence of diabetes was 21.1%, of which 3.4% were newly diagnosed. Using body mass index (BMI); 24.0% of participants were obese and 46.1% as overweight. Dyslipidemia was found in 77.6%, and Hypertension in 44.8%. Advancing age (≥ 40 years), male gender, high low density lipoprotein (LDL), high total cholesterol, hypertension, and positive family history of diabetes were significantly associated with increased risk of diabetes. Conclusion: Our study shows that the prevalence of CVD risk factors in South Asian expatriates in Kuwait exceeds prevalence rates reported in their homeland and other countries. This may suggests the added stress of environmental factors on the development of CVD risk factors in such populations. Specialized prevention programs targeting such high-risk ethnic populations is paramount and need to be implemented. Author / Authors: N. Elkum, M. Al-Arouj, M. Sharifi, K. Behbehani, A. Bennakhi, Dasman Diabetes Institute, Kuwait
Poster Presentations
Naser Elkum / Mohamed Abufarha Dasman Diabetes Institute
PO-22
Association Between Ghrelin and Traditional Cardiovascular Risk Factors in Arab Population Background: Cardiovascular Diseases (CVD) are one of the leading causes of death in the Arab world. Ghrelin is a stomach produced hormone that has been shown to have protective role against development of CVD. The objective of this study is to examine, for the first time, the association between traditional CVD risk factors and plasma ghrelin levels among Arab population. Methods: A cross-sectional population-based survey was undertaken on 359 Arab participants (≥20 years old). CVD risk factors including; fasting blood glucose (FBG), glycated haemoglobin (HbA1c), fasting insulin, and lipid profile that included triglycerides (TG), total cholesterol (TC), low density lipoprotein (LDL), and high-density lipoprotein (HDL) and blood pressure (BP) were measured. Plasma levels of circulating ghrelin were assessed using the Luminex-based assay.
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Poster Presentations Results: Least square mean of ghrelin plasma levels were significantly higher in women (0.935±0.078 ng/ mL) compared to men (0.763±0.065 ng/mL) (p= 0.0007). Investigation of correlation between ghrelin levels and CVD risk factors showed significant inverse association with waist circumference (WC) (r=-0.17, P=0.001) and HbA1c (r=-0.20, P =0.0093) as well as systolic (r=-0.11, P = 0.033) and diastolic (r=-0.13, P = 0.015) blood pressure, respectively. In multivariate analysis, ghrelin showed independent inverse association with HbA1c (P Trend = 0.001), BMI (P Trend = 0.017) and waist/hip ratio (P Trend = 0.0009). Conclusion: In this study we report for the first time that ghrelin was negatively associated with traditional CVD risk factors and central obesity in Arabs supporting its cardio-protective role in other populations. Author / Authors: M. Abu-Farha, F. Noronha, A. Tiss, M. Alarouj, A Bennakhi, N. Elkum, Dasman Diabetes Institute, Kuwait
Maisa Mahmoud Kamkar Dasman Diabetes Institute Kuwait
PO-23
Implementing Family Health History Approach as a Potential Screening Tool for Disease Risk Prediction in Genetic Studies Purpose: To evaluate usefulness of family health history to identify the presence of genetically determined disorders that may affect a person’s disease risk.
Participants: A total of 544 subjects (272 males and 272 females) were recruited from 2011- 2013 as part of a larger obesity genetic study; the mean age of these subjects was 41 years and 42 years respectively. Informed consent forms were obtained and blood samples were collected from all participants. Methods: A questionnaire was developed to collect family history for five diseases [cardiovascular disease (CVD), hypertension (HT), diabetes (DM), hyperlipidemia (HLP) and obesity (OBS)]. Demographics, medical history, lifestyle, diet and environmental risk factors were documented. Moreover, glucose levels and blood pressure were measured. Analysis: SPSS statistical software V.20 was used for data analysis. Initial univariate descriptive statistics were obtained for the entire study. Pearson χ² test was used to examine various factors associated with presence and absence of familial diseases such as CVD, HT, DM, HLP and OBS. For all analysis P value <0.05 was considered significant. Results: Analysis showed that 406 (74.6%) had family history of DVD, 397 (72.9%) had family history of DM, 381 (70%) had family history of HT, 309 (56%) had family history of HLP and 288 (52%) had family history of OBS. Subjects with family history of CVD had shown significant association with DM (P <0.0001), HT (P =0.0195) and CVD (P =0.0015); subjects with family history of DM had shown significant association with DM and OBS (P <0.0001); subjects with family history of HT shown significant association with DM (P =0.0354), HT (P =0.0177) and OBS (P =0.0005); subjects with family history of HLP shown significant association with HLP (P <0.0001); subjects with family history of OBS shown significant association with 4th Emirates Diabetes & Endocrine Congress 2014
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Relevance: Several genetic disorders are associated with increased risk of premature symptoms. Early detection of these disorders can help reduce the burden of common diseases such as heart diseases, hypertension, obesity, diabetes and hyperlipidemia in the person’s with premature symptoms as well as in their family members. Family health history is an important risk factor implies genetic susceptibility, shared environment, and common behaviors. The importance of family history can be emphasized by the number and variety of problems transmitted by Mendelian inheritance, multifactorial influences or chromosomal abnormalities.
Poster Presentations DM (P =0.0242) and HLP (P <0.0001). In summary, our data further suggesting obesity is a risk factor for these disorders. Conclusion: A tendency toward CVD, DM, HT, HLP and OBS can cluster in families; thus, family medical history offers important information for identifying risk in individuals. Such histories can capture the effects and interactions of shared genetic and environmental factors that lead to disease in a family. Understanding how to take and interpret a family health history is essential to provide grounds for early disease prediction in modern genomics. In the future, genetic testing for common disease such as CVD, DM, HT, HLP and OBS can be used to determine personal risk estimates. Author/Authors: Kamkar M, Devarajan S, Thomas D and Alsmadi O
Nasrullah Ghuman Zayed Military Hospital Abu Dhabi UAE
PO-24
Management of Patients with Type2DM Optimal control of Blood glucose, BP and Lipids as per International Standards/Guidelines Background: This retrospective study was intended to aid in determining the current level of care at our facility and to find out the residual gaps as per international guides and standards. Methods: HBA1c (Glycosylated Hemoglobin), LDL (low density lipoprotein) and BP (blood pressure) of consecutive 200 patients who attended the Diabetes and Endocrine clinic at Zayed Military hospital (ZMH) in Abu Dhabi, retrospectively analyzed. The purpose was to evaluate the status of risk factors of cardiovascular disease (CVD) in this cohort as representing the population of our patients.
Poster Presentations
Results/Analysis: The data from 200 consecutive patients was collected, including 87 female and 113 male patients. Although the majority of the diabetic patients were found to be middle aged (45-64years), still this data was a reasonable representation of all the age groups. The majority of the patients were obese (BMI >30kg/m2-53%), 34% had BMI greater than 34kg/m2 and only 15% of the patients had BMI in the normal range. The three selected parameters (HBA1c, LDL, BP) were at target values in 28.5% of the patients. HBA1c of less than 7% was found in 48% and 9.5% had more than 9% of all the participants. LDL less than 100mg/dl was found in 77.5% and 41% had LDL less than 70mg/dl. Three percent of patients were seen to have LDL more than 160mg/dl. Blood pressure of less than 140/90mmHg was achieved in 70.5% patients, 29.5% had BP more than 139/89mmHg and 5.5% had BP more than 160/100mmHg. Conclusions: Analysis of our results is comparable to National Health and Nutrition Survey (NHANES)(9). There were residual gaps between the targets achieved, both in our and NHANES population and the targets recommended in the international guidelines. We need to put greater effort in organizing a better team approach and better comprehensive DM care to prevent/delay both micro and macro-vascular complications including CV Risks. Author/Authors: Dr Nasrullah Ghuman Dr. Duha Shaeen; Dr. Majdi Al Najjar, Department of Diabetes/ Endocrinology Zayed Military Hospital, UAE
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Poster Presentations Mohamed Gaber El Nebrisi Dibba hospital, Fujairah UAE
PO-25
Silent Inflammation and Vitamin D Deficiency What is vitamin D? Some descriptions treat it as a vitamin, some as a vital nutrient, some as a hormone and some as a medical treatment . In a sense, all of these descriptions are true. There is a lot more still to come. In the last few years, there has been a remarkable change in our understanding of the health benefits of vitamin D. Vitamin D deficiency are became worldwide issue in the elderly and remains common in childhood Low blood level of vitamin D are associated with many diseases as obesity , dyslipidemia , endothelial dysfunction , hypertention , athma , multiple sclerosis , SLE , type 1 diabetes militus , some cancers , infectious disease , immune system and silent inflammation • •
There are two types of inflammation. The first type is classical inflammation, which generates the inflammatory response which associate with pain such as, heat, redness, swelling, pain, and eventually loss of organ function. The other type is cellular inflammation, which is below the perception of pain. Cellular inflammation is the initiating cause of chronic disease because it disrupts hormonal signaling networks throughout the body.
Most major health problems are initiated or promoted by chronic, silent inflammation ... including cardiovascular disease, cancer, dementia, asthma, allergies, auto-immunity, and diabetes. As the new evidence suggests – low vitamin D blood levels are linked to higher risk for cardiovascular disease, common cancers, osteoporosis, muscle weakness, infections, and autoimmune disease.
Calcitriol mediates its biological effects by binding to the vitamin D receptor (VDR), which is principally located in the nuclei of target cells The binding of calcitriol to the VDR allows the VDR to act as a transcription factor that modulates the gene expression of transport proteins , which are involved in calcium absorption in the intestine, The vitamin D receptor belongs to the nuclear receptor superfamily of steroid/ thyroid hormone receptors, and VDRs are expressed by cells in most organs, including the brain, heart, skin, gonads, prostate, and breast. VDR activation in the intestine, bone, kidney, and parathyroid gland cells leads to the maintenance of calcium and phosphorus levels in the blood (with the assistance of parathyroid hormone and calcitonin) and to the maintenance of bone content. Vitamin D increases expression of the tyrosine hydroxylase gene in adrenal medullary cells. It also is involved in the biosynthesis of neurotrophic factors, synthesis of nitric oxide synthase, and increased glutathione levels VDRs are expressed in several white blood cells, including monocytes and activated T and B cells Apart from VDR activation, various alternative mechanisms of action are known. An important one of these is its role as a natural inhibitor of signal transduction by hedgehog (a hormone involved in morphogenesis). Vitamin D has broad, effects, and it has not been clear how it produces all of its apparent healthprotections.
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High blood levels of vitamin D are linked to reduced risk for at least two auto-immune disorders: type 1 diabetes and multiple sclerosis ... presumably through “normalizing” influences on the immune system.
Poster Presentations Reports that vitamin D affect the expression of sets (groups) of genes linked to immune-system health (monocytes and macrophages) including inflammation control Reports revealed that high blood levels of vitamin D had beneficial effects on these gene sets … benefits similar to those brought by dietary polyphenols. Conversely, vitamin D deficiency promoted gene switches related to persistent inflammation and cell damage. Vit D status, with vitamin D sufficiency defined as levels over 50 nmol/l, and deficiency as levels below 37.5 nmol/l. The researchers also found links between vitamin D levels and the expression of pro-inflammatory genes … which fits with the nutrient’s general anti-inflammatory actions. The free radicals generated by inflammation trigger pro-inflammatory “switches” in our cells. Each of those pro-inflammatory switches commands certain genes to “express”, which produces more inflammation and free radicals. Chronic, silent inflammation causes heart, immune-system, and metabolic diseases. Fortunately, the damaging inflammation cycle can be disrupted by diets rich in the “antioxidant” food polyphenols help dampen oxidation and inflammation via so-called “nutrigenomic” effects on the gene switches in our cells. The polyphenols in plant foods activate genes known to moderate inflammation and stimulate the body’s own antioxidant network … thereby producing indirect anti-inflammatory and antioxidant effects. Polyphenols’ nutrigenomic effects tend to moderate inflammation and stimulate the body’s own antioxidant network . The richest known food sources of polyphenols are berries, plums, prunes, tea, coffee, extra virgin olive oil, beans, and whole grains.
Shabnam Saquib Dubai Hospital UAE
PO-26
Obstetric and Perinatal Outcome in Pregnancies Complicated with Diabetes: Dubai Hospital Data Objectives: To study types of diabetes in pregnancy in multiracial population of Dubai and assess the maternal and perinatal outcome.
Poster Presentations
Methods: This is a prospective analysis of pregnant women with diabetes seen in combined diabetic clinic of Dubai Hospital Obstetric Department, from January 2012 to December 2012. The International Association of Diabetes in Pregnancy Study Group cut-offs were considered for the diagnosis of GDM. Type of diabetes, antenatal problems, mode of delivery, birth weight and perinatal outcome were studied. Results: A total of 799 diabetic patient seen during the study period. 623(78%) had GDM controlled with diet, 63(7.8%) had GDM controlled on metformin, 41(5.1%) had GDM controlled with insulin. 11(1.3%) had Type 1 diabetes and 61(7.6%) had Type 2 diabetes. Among these 799 patients, 710 delivered in Dubai hospital till the outcome was studied. Pregnancy induced hypertension seen in 44(5%) cases and preeclampsia in 11(1%) cases. Preterm delivery occurred in 50(7%). Cesarean section rate was 38% in the study group compared with 25% in general. Rate of macrosomia was 5% (35 cases). Shoulder dystocia occurred in 5 cases. Neonatal complications included hypoglycaemia 61 cases (8.1%), hyperbilirubinemi a in 45 cases(6 %) and respiratory distress syndrome 20 cases (2.7%). Conclusion: This study demonstrates a high percentage of gestational diabetes on diet control. This could be due to reduced cut –off value for fasting in diagnosis of gestational diabetes by IADPSG. We found a significant increase in hypertension, preterm delivery, macrosomia, caesarean section rate and neonatal complications in diabetic pregnancies. Author / Authors: Shabnam Saquib, Sabaa Alkindi, Suaad Ahmed, Manal Hassan 56
4th Emirates Diabetes & Endocrine Congress 2014
Poster Presentations Ermakova Ekaterina Russia
PO-27
State Budget Institution of Additional Professional Education (GBOU DPO RMAPO ) Moscow, Heart Rate Variability in Patients with Diabetes 2 Types Depending on the Level of Glycemic Control Objective: To evaluate the features of heart rate variability and corrected interval QT (QTc) (as predictors sudden increase of cardiovascular mortality from arrhythmia) due to hypoglycemia mild and moderate severity. Methods: It was conducted joint monitoring of blood glucose (CGMS) and Holter monitoring, 40 patients diagnosed with type 2 diabetes: mean age 56 ± 3, disease duration from 1 up to 15 years. Results: Patients with a history of hypoglycemia was not observed significant differences in spectral indices of heart rate variability HF (199 ± 80 ms2 vs. 170 ± 50ms2), LF (370±260ms2 vs. 356 ± 253ms2) on the background of hypoglycemia (low blood glucose levels 2,9 ± 0.4 mmol\ l). Patients without a history of hypoglycemia was observed with decrease high-frequency component of spectral parameters of HF (218 ± 181ms2 vs. 89 ± 94ms2 P = 0,03), and low-frequency component LF (534 ± 378ms2 vs. LF 329 ± 263ms2 p = 0.26). Significant prolangation of QTc interval on the background of hypoglycemia has not been achieved. Conclusions: Patients with type 2 diabetes with no prior history of hypoglycemia , has been registred with sharp decline in heart rate variability in case onset symptomatic hypoglycemia , which is dangerous for the development of life-threatening arrhythmias , but preventable medication. Patients with type 2 diabetes and frequent hypoglycemia in history have not been registred changes of heart rate variability by response to the supposed onset hypoglycemia , due to lower sympathoadrenal response , that is extremely dangerous against the forecast due to the asymptomatic and high risk of hard hypoglycemia
Tertychanaya Ekaterina Russian Medical Academy of Postdegree Education Russia
PO-28
Role of Lipotoxicity and Glucotoxicity in Newly Diagnosed Diabetes Type 2. Aim: To improve the management of type 2 diabetes by affecting the lipotoxicity and glucotoxicity on the early stage of the disease. Methods: In patients with duration of type 2 diabetes less than 6 months evaluated glycemic and lipid profile, free fatty acids, body composition by dual energy absorptiometry. They were divided into basic group and control group: 30 patients used metformin and sibutramine, others accepted only biguanide. Results: The average age of the patients was 53.6 years (± 8.44), 25% men, 75% women. They have obesity class II. All patients had visceral obesity according to waist- hips ratio -0.97 (± 0.1). The average body fat was 44.9 %, in healthy people it does not exceed 25 %. The index of the android\genoid fat was on average 1.16 (± 0.22) and positively correlated with the waist- hips ratio. After 6 months of treatment in the study group there was a decrease in body weight of 12 kg (±6,4), the waist- hip ratio decreased by 0.056 (p ≤ 0.05). The patients in the basic group have obesity class I after treatment. The index android\ genoid fat decreased by 0.014(p≤0.05), which shows decreased in the volume of visceral fat. In the study 4th Emirates Diabetes & Endocrine Congress 2014
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Author / Authors: MD, Professor Ametov AS , Ermakova Ametov AS - MD, Professor of Endocrinology and Diabetology State Budget Institution of Additional Professional Education (GBOU DPO RMAPO )
Poster Presentations group, HbA1c levels decreased significantly to 6,32% (± 0,74) (p ≤ 0.05), fasting and postprandial glycemia also achieved the target values. Furthermore, there was a significant reduction in total cholesterol from 5.3 mmol\l (± 1.3) to 4.8 mmol\l (± 1,01) (p ≤ 0.05) compared with the control group. Triglycerides were not significantly changed in the treatment group and the control group increased their level (p ≤ 0,05). This relationship was characterized for low-density lipoproteins too. In the present study free fatty acids (FFA) was assessed at the start of the study in the main group. The average of FFA level was 0.61 mgekv\l (± 0,204) (which is higher than the normal range by 0.5 mgekv\l) and after the treatment there was a decrease to 0.48 (± 0.16). This approach allowed us to achieve effective weight loss with a decrease in the volume of visceral fat, improve lipid profile and glycemic control. In this way, patients of main group had good metabolic control at the early stage of the disease, allowing them to avoid the development of microvascular and macrovascular complications. Conclusions: In our study, early intervention into pathogenetic mechanisms of glucotoxicity and lipotoxicity significantly improved glycemic and metabolic control. This approach will provide control over diabetes 2 type and its complications for a long time through the mechanism of «metabolic memory». Author / Authors: Ametov AS - MD, professor of endocrinology and diabetology Russian medical academy of postdegree education
YUSUF PARVEZ DHA
PO-29
Apparent Mineralocorticoid Excess (AME) Syndrome
Poster Presentations
Abstract: Apparent mineralocorticoid excess (AME) syndrome is a rare autosomal recessive disorder due to the deficiency of 11β hydroxysteroid dehydrogenase type 2 enzyme (11beta-HSD2). Mutations in this gene affect the enzymatic activity resulting to an excess of cortisol, which causes its inappropriate access to mineralocorticoid receptor leading to inherited hypertension.This is a potentially fatal but treatable disorder. We present clinical and molecular studies on two sisters diagnosed as AME. Key words: Hypertension,11β hydroxysteroid dehydrogenase type2 enzyme, Mutation Author / Authors: Yusuf Parvez,Ola El Sayed
Rima Tahhan Al-Zahra Hospital UAE
PO-30
Questionnaire Survey on Hypoglycemia and Driving for Individuals with Diabetes in U.A.E The purpose is to examine the behavior and the knowledge of individuals with diabetes while driving in U.A.E as anti-hyperglycemic medications could lead to hypoglycemia resulting in motor and cognitive dysfunction promoting road accidents. A limited data is available about the subject. Method: this is a cross sectional study survey performed on patients with diabetes attending outpatient specialty clinics in one center. Patients were requested to answers three questions related to driving (do you check blood glucose before driving, how low B.G need to go before stop driving, frequency of hypogly58
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Poster Presentations cemia on the road in the last 3 and 6 months).The answer to question one was stratified to ;yes always, yes sometimes or no. A self-reported hypoglycemia episodes classified to mild, moderate and severe as per ADA recommendation complemented the survey. Results: 104 patients completed the survey after giving verbal consent.92.3%(96) have type 2 diabetes and 7.7%(8) type1. Male 59.6% (62/104) and female 40.4%(42/104). Mean(SD) age, BMI, diabetes duration and HbA1c ; 45.88±9.6, 30.88±6.04, 7.68±5.89, and 7.60±1.33 respectively. 86 patients reported driving .31.7% and 6.1%of questionnaire responders are checking their B.G sometimes and always before going on the road. In the sample 50% of insulin users are not doing so at all and 44.4% and 5.6% reported performing B.G checking sometimes and always before their journey. 44.1% (41) did not know the safe B.G level for driving. But when stratified to subgroups according to self-report of hypo in the last one year the experience of hypoglycemia increase the percentage of knowing the safe B.G level ;55.6% and 44.4%(18) in severe hypo group reporting knowing and not knowing compared to 35% and 64.7% in no hypo group p=0.012 respectively, Mean (SD) of B.G level at which should not drive is 71.92±11.76 .Mean (SD) hypoglycemia episodes while driving is 0.64±2.41 in the last one year .15.1% reported at least one hypoglycemia event. The frequency of hypoglycemia varied ;5.8% one,3.5% two,2.3% three ,1.2% ten and 2.3 14 hypoglycemia events . Conclusion: Driving and diabetes need to be highlighted by medical professional for avoidance of road misshape in U.A.E
Shadin Ghabra Sheikh Khalifa Medical City UAE
PO-31
Background: The prevalence of Obesity & Type II Diabetes Mellitus (DM) is among the highest in the world (1). Bariatric surgery is the most effective long term option to treat morbid obesity. In addition, bariatric surgery has been shown to be more effective than intensive medical therapy for morbidly obese patients. (2-5). We sought to examine the effects of bariatric surgery in morbidly obese patients undergoing surgery at BMI Abu Dhabi and its effect on diabetes management. Method: We reviewed our prospectively maintained database for morbidly obese patients who had laparoscopic Roux en Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG), and laparoscopic adjustable gastric banding (LAGB) at BMI Abu Dhabi from January 2010 to December 2011. Patients with more than 2 year follow were included in our study. We defined complete resolution of type II DM as Hemoglobin A1c of less than 6.0% and partial resolution as less than 6.5% without the use of anti-diabetic medications. Results: A total of 182 patients had bariatric surgery during the study period. Patients with type II DM represented 29.7% of our patients (54 patients). 11 patients were excluded from this result; 9 due to lack of follow up from the patient and 2 due to pregnancy. The mean excess weight loss % (EWL%) for patients who had type II DM at 2 years was 64.3% while the EWL% for non-diabetic patients was 70%. Resolution of Type II DM at 2 years was 31.8%, partial resolution of type II DM was 18.1%, and only 6.8% of our patients did not show any improvement in type II DM. Loss of follow up was 43.3%. Conclusion: Bariatric surgery at BMI Abu Dhabi has led to a significant weight loss and improvement in type II Diabetes two years after surgery. References: Hajat C, Harrison O. Progress in Cardiovascular Diseases 53 (2010) 28–38 The Abu Dhabi Cardiovascular Program: The Continuation of Framingham 4th Emirates Diabetes & Endocrine Congress 2014
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Two Year Resolution of Type 2 Diabetes Mellitus in Patients Undergoing Bariatric Surgeries at BMI Abu Dhabi
Poster Presentations Schauer PR Kashyap SR Wolski K N Engl J Med. 2012 Apr 26;366(17):1567-76. doi: 10.1056/NEJMoa1200225. Epub 2012 Mar 26. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. BMJ. 2013 Oct 22;347 Gloy VL, Briel M, Bhatt DL, Kashyap SR, Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. Dixon JB O’Brien PE Playfair J JAMA. 2008 Jan 23;299(3):316-23. doi: 10.1001/jama.299.3.316. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. Ikramuddin S Korner J Lee WJ JAMA. 2013 Jun 5;309(21):2240-9. doi: 10.1001/jama.2013.5835. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and Hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. Author / Authors: Shadin Ghabra, Maha Ibrahim, Mohamed Al Haddad, Ahmed Maasher, Abdelrahman Nimeri.
Marina A. Prudnikova GBOU SPE Russian Medical Academy of Postgraduate Education Russia
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Role of Low-Grade Inflammation in Diabetic Neuropathy. Aims: The aim of the present study was to investigate role of chronic low-grade inflammation in the development of the diabetic neuropathy.
Poster Presentations
Methods: patients with type 2 diabetes mellitus evaluated glycemic and lipid profile, inflammatory cytocines, state of the peripheral nerves(electromyography). They were divided into basic group and control group: 17 patients used fenofibrate and oral hypoglycemic agents, others accepted only oral diabetes drugs. Results: we examined 34 patients with type 2 diabetes mellitus (15 mn, 19 women). Mean age of 60,45±6,88 years, mean duration of diabetes 5,24±3,58 years, mean BMI - 33,09±7,17 kg/m2, smoking history 12,43±14,54 years. After 6 months of treatment in the study group there was a decrease average level IL-6 from 2,6±1,710 pg/ml to 2,00±1,146 pg/ml, tumor necrosis factor alpha from 7,4±3,453 pg/ml to 7,0 ±1,355 pg/ml , CRP from 2,850±5,414 mg/l to 1,060±3,036 mg/l , HbA1c from 6,6±0,4964 % to 6,2 ±0,6945 %, triglycerides from 1,755±0,6363 to 1,260±0,5664 mmol/l, M-wave extensor digitorum brevis ( EMG) increase from 5,915 ± 2,2625 to 6,550±2,489 m/s, M-wave abductor halluces (EMG) increase from 11,25 ±4,811 to12,30±4,506 m/s. After 6 months in the basic group there was increase average level IL-6 from 2,2 ±1,297 pg/ml to 2,65 ±2,229 pg/ml, tumor necrosis factor alpha from 7,650 ±2,063 pg/ ml to 7,900 ±2,390 pg/ml , CRP from 1,635 ±3,431 mg/l to 2,950 ±3,556 mg/l, HbA1c decrease from 6,850±1,050 % to 6,6 ±1,084%, triglycerides from 2,050 ±2,511 to 2,155 ±0,9086 mmol/l, M-wave extensor digitorum brevis ( EMG) increase from 4,900 ± 2,473 to 6,425 ±2,821 m/s, M-wave abductor halluces (EMG) increase from 8,2475 ±4,811 to12,675 ±5,260 m/s. Conclusions: levels of inflammatory markers and triglycerides significantly decreased in patients receiving fenofibrate. Electromyography results and glycemic profile did not differ between the groups at the end of the study. Author / Authors: A.S.Ametov, M.A.Prudnikova
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Poster Presentations Noor Al Busaidi National Diabetes and Endocrine Centre, Muscat Oman
PO-33
Glycemic Control And Co Morbidities of Patients Referred to National Diabetes and Endocrine Centre In Muscat Background: Diabetes is a significant health problem worldwide including Oman .Diabetes is a disabling disease with decreasing productivity and quality of life of patients with diabetes and its complications cause huge burden on health system due to increase cost of management. Aiming at understanding of the disease burden in Oman and working better for good control including improving quality of life for patients with diabetes ,Oman has established a highly specialized National Diabetes and endocrine center (NDEC) in 2013. This center receiving complicated patients with diabetes from primary , secondary and tertiary care facilities on referral base. Relevance: High hemoglobin A1c is associated with increased morbidity and mortality among diabetic patients . Objectives: To determine the glycaemic control and co morbidities of patients referred from primary health care facilities to the NDEC. To assess the use of glycosylated hemoglobin (HbA1C) level test as an indicator of diabetes control in the patients attending the NDEC.
Results: During the study period, 616 patients were referred with poor glycemic control. Among them 138 were of Type 1 diabetes patients and 478 were Type 2 diabetes patients. Out of referred patients 98.5% Type 1 and 98.7% Type 2 diabetes patients had their initial HbA1C test done at NDEC. The mean value of HbA1C in Type 1 diabetes patients was 10.3%, while it was 9.6% in patients with type 2 diabetes, with mean diabetes duration of 9 years in both types of diabetes. Nephropathy was found in 40% of patients with type2 diabetes and 24% of type 1 diabetes . Retinopathy was reported in 14% of type 2 diabetes while it was 9% in patients with type 1 diabetes . Macro vascular complications were reported in 14% of type 2 diabetes patients ,while 1% was reported among type 1 diabetic patients . Conclusions: HbA1C was used as an effective tool to assess the glycemic control in almost all the patients attending NDEC. During the study period it was observed that glycemic control among the patients referred from primary health care were suboptimal with co morbidities. This could be due to late referral ; reasons related to organizational , professional or patient causes; or other reasons related to health system. Recommendations: Effective strategies are highly recommended to improve the current set up at primary care level to facilitate early detection of complications and reduce the burden of diabetes related co morbidities. Results reflect that there is a need for structured care provided by competent health care staff. Attention is needed for provision of facilities and appropriate resources . Keywords: HbA1c; Glycemic control; Diabetes; Oman ;NDEC.
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Research Design and Methods: This is a Retrospective Analysis of medical records of all diabetic patients who were referred and registered in the NDEC between February 2013 to January 2014. The patientâ&#x20AC;&#x2122;s demographic and anthropometric details such as the BMI and HbA1C as well as co morbidities were recorded during their first visit .
Poster Presentations Murtada Elbagir Rashid Center for Diabetes and Research UAE
PO-34
The Role of Bariatric Surgery in the Management of Obesity and its Co Morbidities, Pros and Cons: with Special Reference to Experience from Rashid Center for Diabetes and Research (RCDR) The prevalence of obesity is increasing world-wide at an alarming rate and represents a global epidemic in both developed and developing countries. According to the data published by the International Obesity Task Force, at least 1.1 billion adults are overweight and 312 million of them are obese. Overweight and obesity are associated with increased risks of type 2 diabetes, hypertension, cardiovascular disease, dyslipidaemia, arthritis, non-alcoholic steatohepatitis, gallbladder disease, sleep-apnea syndrome and several cancers. These conditions are together responsible for more than 2.5 million deaths per year worldwide. This is in addition to billions of dollars in healthcare costs and lost productivity. There is accumulating epidemiological evidence that bariatric surgery plays an important role in the management of type 2 diabetic patients who are obese. Bariatric surgery is currently the only modality that provides a significant, sustained weight loss for the patient who is morbidly obese, with resultant improvement in obesity-related co morbidities. Bariatric procedures involve considerable manipulation of the gastrointestinal tract to induce weight loss. The metabolic consequences of these procedures can be severe if not prompted with relatively simple preand postoperative precautions on the part of the patient, surgeon and the physician. Modern bariatric procedures are much safer than their predecessors, but nutritional and metabolic changes must be anticipated and compensated to fully realize the benefits of surgery. The metabolic consequences of these procedures are presented here, along with specific considerations of patient populations.
Poster Presentations
Bariatric experience from RCDR in UAE have shown that most of our patients either stopped all diabetes medications, whether OHA and/or Insulin, or have made significant cuts on their daily doses. This includes also medications for hypertension and dyslipidaemia. Moreover, significant cuts on the total costs of diabetes care have been made, indicating cost-effectiveness of bariatric surgery in the treatment of type 2 obese subjects.
Hayder Hasan University of Sharjah UAE
PO-35
High Molecular Weight Adiponectin and Body Composition among Arab Females in the United Arab Emirates Introduction: High Molecular Weight adiponectin (HMW-adiponectin) is associated with multiple metabolic disorders and decreases with obesity. Several indices commonly measure obesity: body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR). Assessing serum levels of HMW-adiponectin for screening of obesity-related disorders might be difficult; therefore correlation of these indices with HMW-adiponectin, could be useful as surrogates in predicting HMW-adiponectin. Objective: To assess serum levels of HMW-adiponectin in Arab females and investigate its relationships to WC, BMI, WHR, WHtR, body fat mass (BFM) and percent body fat (%BF) so as to indicate the best predictor of serum HMW-adiponectin. 62
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Poster Presentations Materials and Methods: 108 Arab females living in UAE (age 23.44Âą6.84 years) participated in this crosssectional study. Heights, weights and WC were measured. WHR and WHtR were calculated, while BMI, BFM and %BFM were obtained from the body composition analyzer. Serum HMW-adiponectin levels were measured using ELISA kit. Results: Mean BMI was 27.57(6.18)kg/m2, WC 87.76(15.4)cm, BFM 29.5(11.68)kg, and %BFM 39.84% (8.79). Mean WHtR and WHR were 0.55 and 0.91 respectively. Mean serum HMW-adiponectin level was 1.03(0.47)ug/ml. HMW-adiponectin showed significant negative correlations with all studied indices, strongest with WHR (r= -0.393); poorest with %BFM (r= -0.211). Linear regression showed that only WHR was associated with HMW-adiponectin level. Conclusion: Arab females in this study had low HMW-adiponectin levels which may indicate ethnic difference in adiponectin regulation in relation to anthropometric measures/indices. HMW-adiponectin was inversely correlated with all obesity indices, but WHR could be a useful surrogate to predict HMW-adiponectin levels. Author / Authors: Dr. Hayder Hasan, Ms Veena Raigangar, University of Sharjah, UAE
Ishma Aijazi Dubai Hospital UAE
PO-36
To Measure the Impact of Inpatient Hyperglycemia on Morbidity, Mortality and Length of Hospital Stay in the General Medical Wards of Dubai Hospital
Particapants: Details of 150 patients were reviewed through the computerized data base ( SAM System). Patients less than 18 years, pregnant females, and patients with prolong hospital stay for metastatic malignancies were excluded. All patients were subjected to insulin slide scale at admission. Only 5% received slide scale and glargine. Methods: Data was collected retrospectively during a three month period by reviewing the patients discharge summaries on the computerized data base (SAM system). Patient demographics including age, sex, diagnosis, random blood sugar at admission was recorded on micro soft excel sheet. Patients were divided into five groups at admission namely: 1) Diabetics who were well controlled according to American Diabetic Association Criteria for in patient hyperglycemia. 2) Diabetics with hyperglycemia 3) Non diabetics with hyperglycemia 4) Non diabetics with normal blood sugars 5) Diabetics who presented with hypoglycemia. Morbidity (in terms of ICU transfer in), mortality and length of hospital stay was recorded. Analysis: Data was analyzed using statistical software SPSS .Spearman correlation and Chi-square tests with level of significance of 5%(p<0.05) were used. Results: A total of 150 patients were analysed.66.7% were females and the rest were males.15% of pa4th Emirates Diabetes & Endocrine Congress 2014
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Relevance: By using effective measures to control blood sugar at admission, it seen that morbidity, mortality and length of hospital stay can be significantly reduced. This can be very cost effective in a busy tertiary care hospital.
Poster Presentations tients were in group 1, 47% in group 2 , 25% in group 3, 10% in group 4 and only 3% in group 5.All the patients in the above group were compared using Spearman correlation ,it was found that patients in group 2 and 3 had the highest morbidity, mortality and length of hospital stay. Conclusion: In summary in hospital hyperglycemia causes an increase in inpatient morbidity, mortality and prolongs hospital stay. Author / Authors: 1) Dr Ishma Aijazi, Specialist Registrar Internal Medicine Department, Dubai Hospital 2) Dr Hina Zia Mirza, Specialist Senior Registrar Internal Medicine Department, Dubai Hospital 3) Dr Beyla Jamil Zuberi, Specialist Senior Registrar, Dubai Hospital 4) Dr Fadhil .M.Abdulla, Consultant and head Internal Medicine Department, Dubai Hospital 5) Dr Fatehya Fardalla Alawadi, Consultant Endocrinologist and Head Department of Medicine, Dubai hospital
Alaa Ahmed Farajallah Ajman University of Science and Technology UAE
PO-37
The relationship between ghrelin hormone level and type 2diabetes in the UAE.
Poster Presentations
Abstract: Diabetes is currently the fastest growing debilitating disease in the world. Being a chronic disease, diabetes should be controlled and managed early to avoid its complications. Ghrelin is a peptide hormone with anabolic functions. It increases growth hormone secretion and appetite, decreases fat utilization as a metabolic fuel and increases fat storage in the adipose tissue. Moreover, ghrelin exerts effects on glucose metabolism, heart function and inflammatory processes. Due to these characteristics ghrelin has become a hot topic for research focusing on diabetes and its co-morbidities such as hypertension, obesity and atherosclerosis. High ghrelin level is associated with increased appetite. Type2 diabetes mellitus (DM) also has an association with increased appetite. However, many researchers have found low ghrelin levels in diabetic patients. To look into this controversy the present study aimed to 1) Determine if there is any possible relationship between fasting plasma ghrelin levels and type 2diabetes in Emirati population in the UAE, 2) Compare between the fasting total and acylated ghrelin levels in type 2diabetic patients and normal healthy persons and 3) Correlate its level with different parameters including lipid profile, glycated hemoglobin (HbA1c) and insulin resistance (IR) parameters calculated from Homeostasis Model Assessment Insulin Resistance (HOMA-IR). A cross sectional study was conducted at RCDR in Ajman in the UAE. 30 patients were selected from the outpatient clinic and fifteen control subjects were participating in this study. The blood sample was collected from each participant and analyzed for liver enzymes, serum creatinine, lipid profile, HbA1c, insulin, glucose and total ghrelin level. The results of this study showed that serum total ghrelin concentrations were significantly lower (p<0.0001) in IR group (n=8) as well as non-IR group (n=22) (p< 0.001) than the control group. It also showed a negative correlation between total ghrelin levels, fasting blood sugar and HbA1c in non-IR group (p<0.05). From the previous results we concluded the following: Low ghrelin level was associated with poor diabetes control (high HbA1c percentage), insulin resistance parameters (high HOMA 2 IR and low HOMA-%S) in diabetic patients. Therefore it can be concluded that low ghrelin levels are the indicator of bad consequences in diabetic patients. Author / Authors: Alaa Ahmed Hussein Farajallah
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Sponsors
Main Sponsor Lilly, a leading innovation-driven corporation is developing a growing portfolio of pharmaceutical products by applying the latest research from its own worldwide laboratories and from collaborations with eminent scientific organizations. Headquartered in Indianapolis, IN, Lilly provides answers – through medicines and information – for some of the world’s most urgent medical needs. Additional information about Lilly is available at www.lilly.com. For more than 85 years, Lilly has been a worldwide leader in pioneering industry-leading solutions to support people living with and treating diabetes. Lilly introduced the world’s first commercial insulin in 1923, and remains at the forefront of medical and delivery device innovation to manage diabetes. Lilly is also committed to providing solutions beyond therapy – practical tools, education, and support programmes to help overcome barriers to success along the diabetes journey. At Lilly, the journeys of each person living with or treating diabetes inspire ours. For more information, visit www.lillydiabetes.com. Boehringer Ingelheim and Lilly The Diabetes Alliance In January 2011 the Boehringer Ingelheim & Lilly Diabetes Alliance was announced. It will leverage the Collective scientific expertise & business capabilities of two leading research-driven pharmaceutical companies to address patient needs arising from the growing global diabetes epidemic Value through Innovation” A research-driven company dedicated to researching and developing, manufacturing and marketing
Sponsors
pharmaceuticals that improve health and quality of life Founded in 1885 Headquartered in Ingelheim (Germany) ~ 42,000 employees worldwide (2010) “Answers that Matter” A leading innovation-driven corporation providing answers – through medicines and information – for some of the world’s most urgent medical needs Founded in 1876 Headquartered in Indianapolis, Indiana (USA) ~ 39,000 employees worldwide (2010) Our joint Alliance Mission Inspired to deliver innovative solutions That makes a difference for people affected by diabetes
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Sponsors Platinum Sponsors Novo Nordisk is a healthcare company and a world leader in diabetes care. The company has the broadest diabetes product portfolio in the industry, including the most advanced products within the area of insulin delivery systems. In addition, Novo Nordisk has a leading position within areas such as haemostasis management, growth hormone therapy and hormone replacement therapy. Novo Nordisk manufactures and markets pharmaceutical products and services that make a significant difference to patients, the medical profession and society. With headquarters in Denmark, Novo Nordisk employs approximately 30,000 employees in 79 countries, and markets its products in 179 countries. Novo Nordiskâ&#x20AC;&#x2122;s B shares are listed on the stock exchanges in Copenhagen and London. Its ADRs are listed on the New York Stock Exchange. MSD also known as Merck Sharp & Dohme Corp., (a subsidiary of Merck & Co., Inc., Whitehouse Station, NJ, USA) is a global research-driven pharmaceutical company dedicated to putting patients first. Established in 1891, MSD discovers, develops, manufactures and vaccines & medicines to address unmet medical needs. Merck Sharp & Dohme (MSD) has been present for more than 35 years in the Gulf region. MSD Gulf operates through offices based in the capitals of UAE, Kuwait, Bahrain, Qatar & Oman and ranks amongst the leading pharmaceutical companies through the Gulf region. Through its local distributors, MSD Gulf provides innovative medication in several disease entities. These include products for Cardiovascular, Asthma, Pain & Inflammation, Osteoporosis, Neurological, & Ophthalmic Pathological Disorders, in addition to several specialized hospital product & vaccines.
Sponsors
Sanofi, a global and diversified healthcare leader, discovers, develops and distributes therapeutic solutions focused on patientsâ&#x20AC;&#x2122; needs. Sanofi has core strengths in the field of healthcare with seven growth platforms: diabetes solutions, human vaccines, innovative drugs, rare diseases, consumer healthcare, emerging markets and animal health. Sanofi is listed in Paris (EURONEXT: SAN) and in New York (NYSE: SNY). Novartis provides healthcare solutions that address the evolving needs of patients and societies. Focused solely on healthcare Novartis offers a diversified portfolio to best meet these needs: innovative medicines, cost-saving generic pharmaceuticals, preventive vaccines, diagnostic tools and consumer health products. Novartis is the only company with leading positions in these areas. Headquartered in Basel, Switzerland, Novartis Group companies employ approximately 100,000 full-time-equivalent associates and operate in more than 140 countries around the world. 66
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Sponsors Gold Sponsors Servier is the leading independent French pharmaceutical company. Established in 1954, Servier is a research-based pharmaceutical company dedicated to the discovery of new ethical drugs specializing in major diseases such as hypertension, cardiac diseases, diabetes, depression, venous disease and osteoporosis. The company has one of the world’s highest ratios of investment in R&D; an average of 25% of Servier’s turnover is invested in R&D. Since its inception, Servier established and developed solid and productive partnerships that have made decisive contributions to the medical body and general community. Servier in the Gulf founded several partnerships with local and regional scientific bodies in the field of diabetes, osteoporosis, and cardiovascular diseases, contributing to their activities and supporting their initiatives in the aim of combating disease and improving quality of life of patients. As stated by Dr. Jacques Servier, founder of Les Laboratoires Servier “Trust is the cement of our partnerships, and it is based not simply on loyalty but also on long-term commitment”.
Merck Serono is the biopharmaceutical division of Merck KGaA. With headquarters in Geneva,
Switzerland, Merck Serono offers leading
brands in 150 countries to help patients with cancer, multiple sclerosis, infertility, endocrine and metabolic disorders as well as cardiovascular diseases. In the United States and Canada, EMD Serono operates as a separately incorporated subsidiary of Merck Serono. Merck Serono discovers, develops, manufactures and markets prescription We
have
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our core focus areas of
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neurodegenerative diseases, oncology and
rheumatology. For more information, please visit www.merckserono.com or www.merckgroup.com “At Janssen, we collaborate with the world for the health of everyone in it. At Janssen, what matters most to us is a healthy outcome for each patient. We’re committed to providing safe and effective medicines as well as the services and support that contribute to healthy outcomes. This calls for the best science, the most creative minds and an openness to collaborate with researchers, governments and patient organizations at every stage – from early discovery to market access and patient education. Now the fastest growing top 10 pharmaceutical company in the U.S., Europe and Japan, we’re focusing our unique model of innovation on some of the most devastating diseases and the most complex medical challenges of our time, across five therapeutic areas.”
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Sponsors
medicines of both chemical and biological origin in specialist indications.
Sponsors “Julphar Diabetes is the division of Julphar- Gulf Pharmaceutical Industries dedicated to alleviating the burden of diabetes. This division manages the manufacture and commercialization of insulin active pharmaceutical ingredient (API), oral anti-diabetics, recombinant human insulin, and medical devices. Among the key regional providers of diabetes management, Julphar Diabetes is the only company to offer a comprehensive portfolio of high quality, affordable drugs that doctors and patients continue to endorse.”
Bristol-Myers Squibb and AstraZeneca entered into collaboration in January 2007 to enable the companies to research, develop and commercialise two investigational drugs for type 2 diabetes The Bristol-Myers Squibb/AstraZeneca Diabetes collaboration is dedicated to global patient care, improving patient outcomes and creating a new vision for the treatment of type 2 diabetes.
Silver Sponsors
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BD is a leading global medical technology company that develops, manufacturers, and sells medicals devices, instrument system and reagent. The company is dedicated to improving people’s health throughout the world. BD – Diabetes Care, BD Diabetes Care plays a unique and vital role in the care of people with diabetes by providing insulin delivery products and training programs on a global basis. Products are mainly Insulin delivery devices (Pen needles, Syringes) and capillary sampling (Lancets and lancer devices). • BD serves the needs of people with diabetes by spreading best practices globally through partnerships with government and non-governmental agencies and other companies. • The Company’s education and training programs help people with diabetes manage their disease. • Support health care professionals and patients by developing educational programs and training sessions to share with them the latest studies that enhance the appropriate injection technique. • Offer comfort to all patients through the compatible and technologically advanced features of our products - BD micro Fine • BD is committed to helping improve the injection experience for the millions of people who live with diabetes, as demonstrated by our long history of innovative firsts—the first insulin syringe in 1924, the first 5 mm pen needle in 1999 and the now the world’s first 4 mm pen needle Our Vision • Great performance • Great contribution to society • Great place to work.
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Sponsors MPC Modern Pharmaceutical Company (www.modernpharma.ae) is an active partner in the advancement of healthcare in the UAE. It has remained the distributor of choice by having a single objective: Excellence in the products and services we provide:
Medtronic The Diabetes business at Medtronic (www.pumpersclub.com) is the world leader in advanced diabetes management solutions, including insulin pump therapy, continuous glucose monitoring systems and therapy management software, as well as world-class, 24/7 expert consumer and professional service and support. Medtronic is the global leader in medical technology - alleviating pain, restoring health, and extending life for millions of people around the world.
“ Amgen strives to serve patients by transforming the promise of science and biotechnology into therapies that have the power to restore health and save lives. In everything we do, we aim to fulfill our mission to serve patients. And every step of the way we are guided by the values that define us. “ Bayer is a global enterprise with core competencies in the fields of health care, nutrition and high-tech materials. As an inventor company, it sets trends in research-intensive areas. Bayer’s products and services are designed to benefit people and improve the quality of life. At the same time, the Group aims to create value through innovation, growth and high earning power. Bayer is committed to the principles of sustainable development and acts as a socially and ethically responsible corporate citizen. In fiscal 2011, the Group employed about 112,000 people and had sales of €36.5 billion. Capital expenditures amounted to €1.7 billion, R&D expenses to €2.9 billion. For more information,
Cleveland Clinic, a not-for-profit multispecialty academic medical center based in Cleveland, Ohio, USA, was founded in 1921 by four renowned physicians who envisioned an ideal medical practice involving collaboration among specialists from many fields. Through this group practice, they sought to provide exceptional patient care while pursuing research and educating healthcare providers. Today, the nearly 3,000 staff physicians and scientists in 120 specialties and subspecialties collaborate to give every patient the best outcome and experience. Cleveland Clinic is ranked among America’s top hospitals overall, and among the nation’s leaders in every major medical specialty according to U.S. News & World Report. Cleveland Clinic physicians’ commitment to collaboration extends to colleagues across the global medical community. Our presence in facilities ranging from Nevada to Florida in the United States, and from Canada to Abu Dhabi in the United Arab Emirates internationally makes that easier than ever before. Link the logo to: www.clevelandclinic.org 4th Emirates Diabetes & Endocrine Congress 2014
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go to www.bayer.com.
Experience Dubai
Experience Dubai
About Dubai
Dubai - the exotic j jewel of the United Arab Emirates; Bordered by deserts and beaches, Dubai provides stark contrasts, from intriguing Islamic culture to the ultra-modern, high-tech metropolis of the 21st century. The city is a magnificent expression of an incredible vision and an uncompromising statement of success and opportunity. Dubai has something for everyone, from vacationers seeking a relaxing break away from the pressures of work, to business travellers looking for a new exciting experience. The emirate is an international conference, exhibition and leisure destination. Lying on the calm, blue waters of the southern Gulf and flanked by the majestic desert, Dubai offers year-round sunshine and five-star luxury along with the adventure of a unique Arabian experience. Dubai is a class destination with all the modern amenities of the western world. It is a fascinating emirate with beautiful buildings, excellent restaurants and nightlife as well as white sandy beaches, culture and history that you can feel as you visit the souks, shopping malls, museums and historic buildings and sites.
Climate Dubai has a sub-tropical, arid climate. Sunny, blue skies can be expected most of the year. Rainfall is infrequent and irregular, falling mainly in winter. Temperatures range from a low of about 10.5°C /50 °F to a high of 48°C/118.4°F. The mean daily maximum is 24 °C/75.2 °F in January rising to 41°C/105.8 °F in July.
Clothing Lightweight summer clothing is suitable for most of
the year, but
sweaters or jackets may be needed for the winter months, especially in the evenings. Compared with certain parts of the Middle East, Dubai has a very relaxed dress code. However, care should be taken not to give offence by wearing clothing which may be considered revealing, for example low-cut dresses, very short skirts, or tight shirt or top in public. At the pool or on the beaches, trunks, swimsuits and bikinis are quite acceptable. Good quality sunglasses are advised, and photo chromatic lenses for those who wear spectacles. Hats, or some protection for the head, are advisable when in direct sunlight.
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4th Emirates Diabetes & Endocrine Congress 2014
Experience Dubai
Culture & Lifestyle Dubaiâ&#x20AC;&#x2122;s culture is firmly rooted in the Islamic traditions of Arabia. Courtesy and hospitality are among the most highly prized of virtues, and the visitor is sure to be charmed by the genuine warmth and friendliness of the people. Dubai society is marked by a high degree of tolerance for different lifestyles. Foreigners are free to practice their own religion, alcohol is served in hotels and, provided reasonable discretion is shown, the dress code is liberal. Women face no discrimination and may drive and walk around unescorted. Despite rapid economic development in recent years, Dubai remains close to its heritage. Local citizens dress in traditional robes and headdress. Arab culture and folklore find expression in poetry, dancing, songs and traditional art. Weddings and other celebrations are colourful occasions of feasting and music. Traditional sports such as falconry, camel racing and dhow racing at sea continue to thrive.
Language & Religion The official language is Arabic but English is widely spoken and understood. Both languages are commonly used in business and commerce. Islam is the official religion of the UAE and there are a large number of mosques throughout the city. Other religions are respected and Dubai has two Christian churches, St Maryâ&#x20AC;&#x2122;s (Roman Catholic) and Holy Trinity (inter-denominational).
Experience Dubai
Photography Normal tourist photography is allowed, however it is considered offensive to photograph Muslim women. It is also courteous to request permission before photographing men.
Currency The monetary unit is the dirham which is divided into 100 fils. The dirham is linked to the Special Drawing Right of the International Monetary Fund. It has been held constant against the US dollar since the end of 1980 at a mid-rate of approximately US$1= Dh3.67.
4th Emirates Diabetes & Endocrine Congress 2014
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Thank you to all our Sponsors & Exhibitors for their support Main Sponsors
Platinum Sponsors
Gold Sponsors
Silver Sponsors
Support Sponsors
Exhibitors
Algorithm
Abbot Diabetes Care
National Trading & Pharmaceutical Est. Media Partner
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Roche Diagnostics Middle East
OfďŹ cial News Distributor
4th Emirates Diabetes & Endocrine Congress 2014
Al Ittihad Drug Store
Supporting
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Save The Dates 19-21 Feb 2015 Dubai, UAE
www.edec-uae.com
Stay Connected: Congress Secretariat: MCI Middle East, Tel: +971 4 311 6300, Fax: +971 4 311 6301, E-mail: edec@mci-group.com th 73 4 Emirates Diabetes & Endocrine Congress 2014
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