Biography:

Rajashree Khot did her MD from govt. Medical college, nagpur, India and diploma in management for diabetes from CMC, vellore. She is an associate professor in dept. of medicine at aiims, nagpur. She is incharge of Covid-19 ward, currently. She has a great academic career and over 100 publications in various journals. She has presented papers in many national conferences and also won awards. She is on the advisory board of vidarbha journal of internal medicine. She is an active member of diabetes association of India, nagpur branch.

Abstract:

Recent Covid 19 pandemic has posed the biggest challenge to global healthcare systems. Diabetes and Covid 19 share a bidirectional relationship. India initially imposed strict lockdown measures. Post lockdown, the infection spread like fire and Diabetes became an important association.

In a cross-sectional observational study, we enrolled 150 consecutive patients to study the impact of lockdown on Chronic illnesses. Of these 63(42%) patients were diabetics.Subset analysis of these patients revealed that Glycemic control improved in 15(23.8%), worsened in 26(41.1%) and steady in 22(34.9%). The factors responsible for improved control were improved self-management of diabetes, eating home cooked food and use of telemedicine and for worsened control were lack of exercise, non-availability of drugs and financial problems. Weight was unchanged in 43(68.2%). On statistical analysis glycemic control worsened significantly during lockdown period.

In an ongoing longitudinal cohort study of clinical profile of hospitalized COVID 19 confirmed cases, prevalence of Diabetes was 9.15% i.e.42/459 patients. On interim analysis of subset of Diabetic patients 39.47% were asymptomatic,50.9% had mild infection,36% had moderate and 1.74% had severe illness. Mortality was 1.7%. Mean Admission blood glucose was 168.9 + 12.5 mg/dl in mild and 228 + 14.8 mg/dl in severe cases.

To conclude, lockdown period affected the glycemic control in both positive and negative manner, with lack of exercise being the most common factor for worsening. Diabetes is an important risk factor for COVID 19 infection. Admission blood glucose is significantly associated with severity of infection and mortality in T2DM patients with COVID19 infection.

Biography:

Shaibal Guha did his MD in internal medicine from PMCH, India, and later joined as senior resident (Internal Medicine & Critical Care) at escorts hospital, faridabad. He thereafter joined bihar's premier healthcare institution - the indira gandhi institute of medical sciences in patna, as registrar (Internal Medicine), where he worked for four years. Subsequently, in the year 2003, shaibal guha set up his own consultancy, positive health centre, which now has two branches in patna, India

Abstract:

Aim: To evaluate the efficacy of hydroxychloroquine 400mg as a fourth therapeutic agent in type 2 diabetes mellitus (T2DM) patients with poorly controlled blood glucose despite receiving an optimum dose of three oral antidiabetic drugs (OAD).

Methods: Patients treated with hydroxychloroquine 400 mg as an add-on drug, on those patients who were poorly controlled despite optimum doses of three OADs, metformin, sulfonylureas, pioglitazone or alpha-glucosidase inhibitors were included in this analysis. Total 131 patients with ≥ 3 regular follow-ups visiting a Diabetes Specialty Clinic in Patna Bihar India were considered for this retrospective analysis. All patients were tested to exclude any degree of retinal abnormality or retinopathy or any type of cardiovascular complication before addition of hydroxychloroquine.

Results: Mean age of the patients included was 55.2 ± 9.58 years, with 71 (54.2%) were males. Patients were having ≥60 Kg body weight and 80 (61%) had T2DM for ≥5 yrs. Patients achieving glycemic control (HbA1c≤ 7%) with the addition of hydroxychloroquine were 120 (91.6%)% (P<0.05). The mean duration required to achieve glycemic control after adding hydroxychloroquine was 2.8 months. The mean HbA1c reduced significantly by 1.31 ± 0.5% from the baseline of 7.96 ± 0.5 to 6.65 ± 0.5% (P= 0.001). The fasting blood glucose was reduced from 158.3 ± 27.4 to 114.8 ± 11.2 mg/dl (mean difference: -43.5 ± 14.6 mg/ dl; P=0.001). Whereas the post prandial blood glucose was reduced from 226.9 ± 23.8 to 158.6 ± 22.6 mg/dl (mean difference: -68.3 ± 21.4 mg/dl; P=0.001). The response in age group <55 years was 90.6%, whereas in ≥55 years group, it was 82.1%. Patients with <5 years duration of diabetes responded more (91.8%) compared to patients with a longer duration (≥ 5 years) of diabetes (83.4%).

Conclusion: When type 2 diabetes is uncontrolled by using three oral anti- diabetic drugs adding hydroxychloroquine as a fourth add-on therapeutic agent is effective in achieving the desired glycemic control

Biography:

Vinod C Tawar has completed his Graduate degree at Bombay University in 1964 with major in chemistry and a minor in botany with honors. He has completed his postgraduate program in technology of pharmaceuticals and fine chemicals at bombay university in 1966. In 1967, he has completed his Master’s degree programme in pharmacology at University of Manitoba, Canada in 1969. In 1970, he has commenced his work as a toxicologist and had established a province wide analytical laboratory in the field till 1981. He has completed his MD degree from Medical School in 1985. He has also completed a 2 years residency, for a licensure as a physician. After a general practice of several years and pharmacology research he was awarded a family physician status in 2008. In the due course of his practice, he has continued with his interests in clinical research (diabetes, renal dysfunction, resistant dermatitis, peripheral vascular disease and leading into innovative treatment measures).

Abstract:

Magnesium has been well recognized as an essential element for human body functions and identified as a treatment for multiple diseases. It is often described as a complementary and alternative medicine with its lack of adverse symptoms i.e. well tolerated.  In literature, magnesium has been used for the treatment of Eclampsia, Pre-eclampsia, cardiac arrhythmia, severe asthma, migraine, metabolic syndrome, glucose-insulin metabolism, dysmenorrhea, leg cramps for pregnant women and kidney disease. Among the dietary sources of magnesium are leafy green vegetables, nuts, legumes and whole grain.

A literature search on clinical trial studies on Magnesium hydroxide has been almost impossible likely due to its most economical nature and inspite of it being well tolerated. It’s most common use being a gentle laxative. My study design included a trial consisting of 15 patients. 12 patients were diabetics with gastric paresis and others with irritable bowel disease.  These patients were observed for a 12 weeks period weight monitored.

Each patient was advised to take 2 table spoon full magnesium hydroxide   every morning and titrating to four tablespoons.  The laxative effect was seen on late afternoon or next morning.  The evacuation had some extent resulted in dehydration to variable extent and intermittent hunger. The patients were instructed to take fruit juices or nuts or digestive cookies.  The caloric control and active life style was emphasized. After 12 weeks, body weights, waist length, blood pressure and routine diabetes parameters were studied.

Results:

 Normal blood pressures were observed.  The weight loss of 15 to 20 pounds was seen. a decrease in HbA1C ranged from 0.4 to 0.6 inspite of  COVID related limitations  in activates. Renal function studies showed   a normal creatinine and an increase in GFR   thus preventing a kidney dysfunction risk. A  Lipid study demonstrated   decrease in total cholesterol, decreased LDL and increased HDL.

Conclusion:

 The administration of magnesium hydroxide had shown multiple benefits in the management of weight, diabetes and prevention of kidney and heart diseases. Studies on a large scale are needed for further evidences.

Biography:

Xiangbing Wang, MD is a internal medicine specialist in new brunswick, NJ and has over 37 years of experience in the medical field. He graduated from human normal university, college Of medicine medical school in 1983. He is affiliated with robert wood johnson university hospital. 

Abstract:

Primary hyperparathyroidism (PHPT) and vitamin D deficiency are common disorders which are interrelated. The epidemiology of PHPT has changed over the years and differs in the developing vs the developed world.  Over the past 50 years, the presentation of PHPT has shifted in the Western world to a more asymptomatic disease form but classical symptomatic presentation with severe vitamin D deficiency remains a majority in developing countries.  Increased rates of screening of 25(OH) D levels and supplementation of vitamin D have changed the prevalence of PHPT and have added norm calcemic PHPT (NPHPT) to the spectrum.  A disturbed vitamin D metabolism seems to play a role in the pathogenesis which is thought to exacerbate the severity of PHPT. The mechanisms behind low total 25OHD levels in PHPT patients are likely multifactorial including1). In developing countries, the traditional dressing limits sun exposure and the prevalent vegetarian diet leads to nutritional deficiency of vitamin D; 2) Enhancing conversion of 25(OH)D to 1,25(OH)₂ D and 24,25(OH)₂ D; 3).  Elevated IPTH decreases vitamin D binding protein (DBP) production in the liver which in turn leads to decreased total 25(OH) D levels.  Although, standard measurements and guidelines only include total 25OHD levels, a few studies show that total 25(OH) D levels may not be a reliable indicator of vitamin D status in PHPT patients. The levels of 25(OH) D to rule out vitamin D deficiency in PHPT and the role of free 25(OH) D levels in PHPT are not fully defined.   Although it has been validated that supplementation of vitamin D should be done in PHPT patients with lower total 25(OH) D levels, the threshold to supplement to, in relation with the severity of PHPT and degree of vitamin D deficiency is still unknown. Nutritional replacement of vitamin D although recommended in all forms of PHPT especially before parathyroidectomy, the threshold to replace to is currently not well defined and should be based off the severity of PHPT. Further research is needed to study the pathogenesis of hypovitaminosis D, DBP and the optimal total 25(OH) D levels in PHPT patients.

Abbreviations:

25(OH) D = 25-hydroxyvitamin D; DBP = vitamin D binding protein; iPTH = intact parathyroid hormone; 1, 25(OH)₂ D = 1,25 dihydroxyvitamin D; 24,25(OH)₂ D = 24,25 dihydroxyvitamin D; PHPT = primary hyperparathyroidism; NPHPT = norm calcemic primary hyperparathyroidism

Biography:

Audesh Bhat is currently working as an assistant professor in the central university of jammu, India. Bhat completed his M.Phil/Ph.D from the university of Jammu, India in collaboration with jawaharlal nehru university, new delhi, India. He did his postdoctoral training from washington university, saint louis, USA and university of saskatchewan, Canada. Bhat briefly worked at novart is healthcare Pvt. Ltd before joining the current work place. His research work encompasses diverse areas such as diabetes, cardiovascular disorders, cancer biology, cell and molecular biology. He has published more than 40 research articles in peer-reviewed journals and has been serving as an editorial board of current pharmaceutical biotechnology journal

Abstract:

Diabetic cardiomyopathy (DCM) is clinically defined as diastolic or systolic cardiac dysfunction occurring in diabetic patients independent of cardiomyopathy due to coronary artery disease, hypertension, or other vascular disease. Even though cardiovascular disorder (CVD) is the principal cause of death in patients with type 2 diabetes mellitus (T2DM), reducing plasma glucose level has little effect on CVD risk and alternative studies focused on reducing plasma glucose in T2DM patients have only a minor effect in reducing CVD risk. In view of the multiple CVD risk factors beyond hyperglycemia that exist in most T2DM patients, a multifactorial approach to address the CVD risk needs to be adopted. Thus, there is an urgent need to identify novel targets or pathways which regulate multiple mechanisms involved in the pathogenesis of DCM. Understanding the functional role of sodium dependent glucose co-transporters (SGLTs) in these multiple mechanisms can be an answer to this pathological condition. We looked into the potential impact of SGLT1 inhibition on the improvement of cardiovascular dysfunction using in-vitro model of DCM, created by treating cultured cardiomyocytes with high glucose and palmitic acid. Significant increase in SGLT1 expression was observed in high glucose+palmitic acid treated cardiomyocytes accompanied with increase in the markers of inflammation, hypertrophy, oxidative stress and decrease in glucose uptake. All these effects of high glucose+palmitic acid were attenuated by co-treatment with SGLT inhibitors Canagliflozin and Dapagliflozin. These results support the hypothesis that safe and specific SGLT1 inhibitors will be very effective in preventing diabetes associated cardiomyopathy and associated CVDs.

Biography:

Anand Shankar has been practising as a diabetologist in patna, Bihar, since 2006. He has his own clinic at makhania kuan road, and also consults at ruban memorial hospital (patliputra colony). Anand Shankar received training in diabetology from 2004-2006 as a clinical assistant in the department of diabetology, apollo diabetes centre, Apollo hospital and at Dr.V Seshiah diabetes care and research institute, chennai. For two years prior to this training, he gained experience as a senior resident in the department of internal medicine at Dr. Ram Manohar lohia hospital, India

Abstract:

Objective: Newer AHAs for T2DM, including sodium glucose co-transporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP1RAs), have been shown to be effective for glycemic control and to promote weight loss, which may contribute to the cardiovascular benefits seen with some of these agents [1,2]. Remogliflozin is the new SGLT2i which has approved in India.

Aim: Real-world effectiveness of remogliflozin 100 mg BD versus liraglutide 0.6 mg/day was examined in obese and uncontrolled patients with Type II diabetes.

Methods: A single center, retrospective observational study conducted for 24 weeks in a real-world setting. Dose of remogliflozin was 100mg BD and liraglutide was 0.6 mg/day. All patients received remogliflozin or liraglutide in addition to their existing antidiabetic therapy except dipeptidyl peptidase-4 inhibitors and insulin. HbA1c, Weight and BMI were evaluated at baseline and after 24 weeks of therapy.

Results: A total of 60 patients with 42 (70%) females, 18 (30%) males, overweight (91.71 ± 14.19 kg), obese (35.6 ± 5.04 kg/m2) and uncontrolled (HbA1c 8.2 ± 0.8%) patients with T2DM. Mean HbA1c and rate of achieving HbA1c<7% was similar at 6 months with remogliflozin (N=45)(P < 0.05) and liraglutide (N=15)(P < 0.05). At 24 weeks, patients who continued liraglutide had a non-significant mean weight loss of 2.73 ±0.62 kg which was 2.69 ± 1.02 kg with remogliflozin and non-significant decrease in BMI was found in both the arm (-1.15 ±0.6 kg/m2 with remogliflozin and -1.21 ±0.8 kg/m2 with liraglutide). Patients were less likely to discontinue or switch with remogliflozin than liraglutide, and were more likely to add-on because of cost effectiveness.

Discussion: There is a progressive decline in β-cell function in T2DM requiring treatment adjustment. Co-morbidities such as obesity, cardiovascular diseases and patient factors like financial capabilities, compliance needs to be taken into consideration while individualizing therapy. Low dose liraglutide (0.6 mg/dl) once a day and remogliflozin 100 mg BD improved glycemic control and decrease in weight in almost similar fashion, in obese uncontrolled longstanding type 2 diabetes. Patients in the remogliflozin compare to liraglutide were more likely to be adherent to treatment and less likely to discontinue or switch treatment.

Biography:

Ameer Al-Jasim a medical student interested in surgical research. Currently working on literature reviews related to establishing new guidelines of surgical practice in the era of COVID-19 crisis for better patient care.

Abstract:

Diabetic foot disease (DFD) is a common complication of DM. It forms a huge burden on the surgical wards worldwide, yet it can be prevented extensively by patients with appropriate level of knowledge, attitudes and practices towards their diabetes.

Aim:

To assess the level of knowledge, attitudes and practices of DFD patients using a structured questionnaire specifically developed for that purpose.

Methods:

A structured questionnaire was developed to assess the knowledge, attitudes and practices towards the prevention of both DM and DFD. A pilot study was conducted to examine the effectiveness and practicality of the questionnaire and scoring method, which retained scientific desirable results. The questionnaire was approved by Department of Community and Family Medicine at College of Medicine-University of Baghdad. Questionnaire scores were compared with similar studies and with the study sample itself. A total of 77 patients were included in the study.

Results:

58% were males. Only 27% had finished secondary school education. 27% were presenting with diabetic foot complications for the first time. The mean total score of the sample was 28.4 ± 5.8 out of a possible total of 44. People with secondary school education and those who’ve had DM for more than 15 years had better questionnaire scores overall. Higher knowledge scores of DM and diabetic foot disease were weakly correlated with better attitudes & practices scores for those two diseases.