International Conference on Diabetes and Cholesterol Metabolism October 15-17, 2018 Dubai, UAE

Gestational diabetes is a type of diabetes in which a woman develops high blood sugar levels during pregnancy. Pregnancy hormones and increased fat deposits during pregnancy mediate insulin resistance during pregnancy. Pregnancy hormones compete with the insulin for the insulin receptor. Insulin resistance prevents glucose from entering the cells properly. As a result, glucose remains in the bloodstream, where glucose levels rise. It can be managed by exercise and a healthy diet. Insulin injections are the most common medical treatment for gestational diabetes. If gestational diabetes is not detected and controlled, it may increase the risk of birth complications, such as shoulder dystocia (when the baby's shoulder gets stuck during the birth). Babies of mothers with gestational diabetes may experience respiratory distress syndrome, hypoglycaemia and can also be large for their gestational age. Women with gestational diabetes are at high risk of developing diabetes mellitus later in life.

Several types of complications are seen due to uncontrollable diabetes. Long-term complications of diabetes develop gradually. They are divided into microvascular (due to damage to small blood vessels) and macrovascular (due to damage to larger blood vessels). Microvascular complications include damage to eyes, kidney failure and impotence. Macrovascular complications include cardiovascular diseases such as heart attacks, strokes and insufficiency in blood flow to legs. The other factors that quicken the complications of diabetes include smoking, high cholesterol levels, obesity, high blood pressure, and lack of exercise. By controlling the blood sugar level and regular diabetes check-ups, risk of complications can be lowered. Early recognition and prevention of the diabetic complications are mandatory for the improvement of the quality of life and psychological outcome of these patients.

Endocrinology is the study of endocrine system, its diseases, and its specific secretions known as hormones. Examples of hormones include thyroid hormone, growth hormone, and insulin. These hormones influences major body functions, including the body's ability to change calories into energy, also regulate processes, such as appetite, breathing, fluid balance, feminization, and weight control.  The endocrine system also influences heart beats, bones and tissues growth. It plays a vital role in whether or not you develop diabetes, thyroid disease, growth disorders, sexual dysfunction, and a host of other hormone-related disorders.

Endocrinology diseases may relate to too much or too little secretion of a hormone, too much or too little action of a hormone, or problems with receiving the hormone. Common endocrine disorders include diabetes mellitus, Addison’s disease, Cushing’s syndrome, Graves’ disease, acromegaly, Hashimoto’s thyroiditis, hypothyroidism, and hyperthyroidism. These disorders often have widespread symptoms, affect multiple parts of the body, and can range in severity from mild to very severe. Treatments often relays on adjusting hormone balance using synthetic hormones. Untreated endocrine disorders can have widespread complications throughout the body.

Obesity is a medical condition which results from the accumulation of excess fat on the body. Obesity is thought to trigger changes to the body's metabolism. It also adds pressure on body's ability to use insulin, to properly control blood sugar levels, and are therefore more likely to develop diabetes. The abdominal fat influences fat cells to release ‘pro-inflammatory’ chemicals, which can reduce insulin sensitivity by disrupting the function of insulin responsive cells and their ability to respond to insulin. Obesity also causes prediabetes, a metabolic condition that almost always develops into type 2 diabetes.

Obesity has many causes such as age, gender, genes, psychological makeup, socioeconomic, and environmental factors. Certain medical conditions and medications can cause or promote obesity, although these are much less common causes of obesity than overeating and inactivity. Some examples of these are depression, certain medications (examples are steroids, antidepressants, control pills), Polycystic ovarian syndrome, Prader-Willi syndrome. The goal of obesity treatment is to reach and stay at a healthy weight. All weight-loss programs focus on eating habits and physical activity.

Metabolic syndrome is a combination of risk factors which includes high blood pressure, hyperglycemia, abnormal cholesterol levels and excess body fat around the waist that occur together, doubling your risk of heart disease, stroke, and diabetes.  This condition is also known by other names including Syndrome X, insulin resistance syndrome, and dysmetabolic syndrome. Insulin resistance, metabolic syndrome and prediabetes have overlapping aspects and are closely linked to one another. Most of the disorders associated with metabolic syndrome have no symptoms, although it is closely linked to insulin resistance, overweight or obesity and inactivity. Metabolic syndrome can be prevented or reversed by adopting few number of lifestyle changes, including losing weight, regular exercise, healthy diet, stopping smoking, cutting down on alcohol. Elevated liver enzymes, an indicator of non-alcoholic fatty liver disease, may comprise an additional component of the metabolic syndrome and may serve as a surrogate marker for type 2 diabetes.

Epidemiology is the study and analysis of incidence, distribution, and possible control of diseases and other factors relating to health. As per the statistics in 2017, an estimated 8.8 % of the global adult population were living with diabetes. The prevalence of diabetes has nearly doubled since 1980, rising from 4.7% to 8.8% in the global adult population. This reflects an increase in associated risk factors such as overweight or obese. Over the past decade, diabetes prevalence has risen faster in developing countries than in developed countries. Type 2 diabetes mellitus occurs throughout the world, but is more common in the more developed countries. The disease burden related to diabetes is high and rises in every country. The premature morbidity, mortality, reduced life expectancy and financial and other costs of diabetes make it an important public health condition.

Diabetes education is an integral component of the diabetes management and care, because diabetes requires day-to-day knowledge of nutrition, exercise, monitoring, and medication. A healthy diet is central to the management of diabetes. The aim of patient education is for people with diabetes to improve their knowledge, skills and confidence, enabling them to take increasing control of their own condition and integrate effective self-management into their daily lives. High-quality structured education can have an effect on health outcomes and can significantly improve quality of life. The potential benefits of an effective patient education programme for people with diabetes should include improving knowledge, health beliefs and lifestyle changes, improving patient outcomes - eg, weight, haemoglobin A1c (HbA1c), lipid levels, smoking and psychosocial changes, improving levels of physical activity, reducing the need for - and potentially better targeting of - medication and other items such as blood testing strips.

Cholesterol is an organic substance that body uses to produce vitamin D, make certain hormones and build healthy cells. High cholesterol and diabetes are linked to each other. Diabetes can disturb the balance between HDL and LDL cholesterol levels. LDL particles of the people with diabetes tend to stick to arteries and can easily damage blood vessel walls. Glucose coated LDL remains in the bloodstream longer and may lead to the formation of plaque. Low HDL levels are seen in the people with diabetes. Both of these increase the risk of heart and artery disease. There is a link between high blood pressure (also called hypertension) and high cholesterol. When the arteries become narrowed and hardened with cholesterol plaque, the heart has to force much harder to pump blood through them. As a result, blood pressure becomes abruptly high.

All the tissues synthesize cholesterol from acetyl-CoA. In adult the most actively synthesizing organs are liver and intestinal wall. The capacity of hydroxymethylglutarylCoA (HMG-CoA) reductase determines the rate of synthesis of cholesterol in most of the tissues. Cholesterol is absorbed in the presence of bile salts. After entering the cells of the intestinal mucosa, cholesterol is incorporated into chylomicrons, which enter the blood circulation via the lymphatic system. The proportion of the cholesterol in the food that is absorbed depends upon the intake of cholesterol and the amount of triglyceride in the diet; triglyceride tends to promote cholesterol absorption. It is then oxidized by the liver into a variety of bile acids. Bile acids, along with cholesterol itself, are excreted from the liver into the bile. Almost 95% of the bile acids are reabsorbed from the intestines, and the remainder are lost in the faeces. The excretion and reabsorption of bile acids forms the basis of the enterohepatic circulation. 

Cholesterol metabolism is altered in diabetes. Cholesterol absorption is decreased and the cholesterol biosynthesis is increased in diabetes. The increased cholesterol synthesis can be reduced by insulin. Low cholesterol absorption efficiency has been reported earlier in a limited number of diabetic subjects with mild hyperlipidemia and in moderately overweight. In type 2 diabetes, in obesity and in conditions such as cortisol excess (Cushing’s Syndrome), raised insulin levels are frequently found. Insulin resistance is often associated. Lack of insulin can lower the level of "good" cholesterol (HDL, or high density lipoprotein). When insulin is given and well controlled, HDL numbers typically go back to normal. Cholesterol problems in people who have type 1 diabetes are usually related to the lack of insulin. Gestation diabetes mellitus is associated with higher cholesterol synthesis in the first trimester, and elevated serum squalene levels in the second and third trimester of pregnancy, and that maternal serum squalene and cholesterol synthesis correlates with birth weight.

Patients with diabetes often show abnormal lipid profiles because insulin regulates several of the steps of lipid metabolism. Patients with type 1 diabetes that exhibit effective glycaemic control may exhibit qualitative abnormalities. Dyslipidaemia in type2 diabetes is characterised by several strictly linked abnormalities: elevated fasting and postprandial triglycerides, a significant decrease in high‐density lipoprotein (HDL) cholesterol and an increase in smaller low‐density lipoprotein (LDL) and HDL particles. Also, the elevated postprandial triglycerides that are often present in patients with type2 diabetes may be linked to insulin resistance. Therefore, the abatement of hyperglycaemia and insulin resistance should be one of the main treatment objectives to address dyslipidaemia in patients with diabetes.

Presence of high level of cholesterol in the blood may increase risk of cardiovascular disease, heart attack and stroke. If the cholesterol is high, the excess oily substance will stick to the walls of the arteries, and eventually hardens, forming a type of plaque that damages the arteries. They become narrowed and lose their elasticity. This can contribute to the development of high blood pressure or hypertension, which can cause more damage to the blood vessels. The ultimate danger is that the arteries will become so narrowed that a blood clot will block blood flow, causing a severe cardiovascular event. Obesity, along with the high waist circumference and high body mass index, is an independent risk factor for coronary heart disease (CHD) and diabetes.

Hyperlipidemia is the presence of high levels of fats (lipids) in the blood. The two major types of lipids found in the blood are cholesterol and triglycerides. Hypercholesterolemia, also called high cholesterol, is a medical term for abnormally high levels of cholesterol in the blood.  Elevated levels of cholesterol in the blood may be an outcome of an unhealthy diet, obesity, inherited or the presence of other diseases such as type 2 diabetes. Hyperlipidemia has no symptoms, so the only way to detect it is to have your doctor perform a blood test called a lipid panel or a lipid profile. Lifestyle changes are the important aspect for managing hyperlipidemia. These changes alone may be enough to reduce the risk of complications like heart disease and stroke. Whereas hypercholesterolemia is typically due to a combination of environmental and genetic factors. Environmental factors include weight, diet, and stress. Familial hypercholesterolemia is a disorder that is passed down through families and caused by a defect on chromosome 19. It causes LDL (bad) cholesterol level to be very high. The condition begins at birth and can cause heart attacks at an early age.

Research activity in the field of diabetes has increased greatly in recent years and current standard of care for type 2 diabetes consists of screening for elevated HbA1c levels or, in some cases, fasting plasma glucose, with diagnosis followed by management with lifestyle modifications. People with type 2 diabetes can achieve their target blood sugar levels with diet, exercise and proper medications or insulin therapy. Insulin, along with diet, is crucial to the survival of individuals with type 1 diabetes. Pancreatic islet allo-transplantation is a procedure in which islets from the donor pancreas are transferred into another person to treat type 1 diabetes and have been a promising cellular-based therapy.

The artificial pancreas is a machine which would monitor blood glucose levels using an array of sensors, and release insulin from a reservoir into the bloodstream, using an infusion pump, whenever it is required. Current gene therapy study highlights the transfer of insulin gene into other cells such as the liver, stomach, or intestines. Bariatric surgery (weight loss surgery) is performed by reducing the size of the stomach with a gastric band or through removal of a portion of the stomach. The recent advances in nanomedicine include smart drugs which only activate when needed, nanoformulations for efficient drug delivery, engineered microbes which produce human hormones, and even nanorobots, which would move autonomously around the body acting as a boost, for our immune system, red blood cells, or many other biological systems.