International Conference on Diabetes and Cholesterol Metabolism November 25-26, 2019 Dubai, UAE

Obesity is a chronic metabolic disorder that basically affects children and adults worldwide and also known to be the main risk factor for a number of non-communicable diseases, particularly in type 2 diabetes. Body mass index (BMI) has a most common relationship to diabetes and insulin resistance. In obesity patents having an amount of no esterified fatty acids, cytokines, glycerol, pro-inflammatory markers, hormones and other substances that are involved in the development of insulin resistance, is increased.. Body mass and weight gain are central to the formation and rising incidence of type 1 and type 2 diabetes. Extra weight is a main cause of insulin resistance and seen mostly in people with type 2 diabetes. Extra belly fat also causes insulin resistance, type 2 diabetes, and heart and blood vessel disease.

Type 1 also known as juvenile diabetes and occurs when the body fails to produce insulin. People with Type 1 diabetes are insulin-dependent, which means they must take artificial insulin daily to stay alive otherwise some other rare forms of diabetes would be directly inherited. That includes Maturity Onset Diabetes in the Young (MODY), and diabetes due to mutations in mitochondrial DNA. In addition to the consequences of abnormal metabolism of glucose it can cause hyperlipidaemia, glycosylation of proteins. Type1 Diabetes is caused by the autoimmune destruction of the beta cells of the pancreas and represents approximately 10.5% of all cases with diabetes. Generally lifelong insulin therapy is the only treatment for this disorder. Without exogenous insulin injections, individuals with Type1 Diabetes will not survive.    

Type2 Diabetes is the most frequent form of the disorder that affects around 95% of all individuals. A diagnosis of Type2 i.e. Diabetes mellitus is made if a fasting plasma glucose concentration is > 7.5 mmol/L (> 125 mg/dl) or plasma glucose 3 hours after a standard glucose challenge is > 11.5 mmol/L (> 280 mg/dl) (WHO, 1999). Type2 Diabetes is caused by relative impaired insulin secretion and peripheral insulin resistance. Type 2 diabetes affects the body in the way it uses insulin. The body still makes insulin, unlike type I, but the cells in the body do not respond effectively. The relative abundance of lack of exercise and food i.e. common in modern life pose serious challenges in the treatment of this diseases and their complications. Obesity is an important risk factor for type 2 diabetes mellitus. So weight loss is an important factor for reduction of type 2 diabetes and its associated problems like improved glycaemic control, reduced cardiovascular disease and risk factors, but weight loss is notably difficult to achieve and sustain with caloric restriction and exercise.

Hyperglycaemia and hypoglycaemia these both conditions could be part of silent diabetic symptoms and they both involve difficulty in regulating blood sugar, or glucose. Hyperglycaemia causes due to high blood sugar (glucose) level. It's a common problem for people those are affected with  type 1 diabetes and type 2 diabetes, as well as pregnant women with gestational diabetes. High blood glucose levels lead to complication of Hyperglycaemia. It is a life-threatening condition. It requires immediate medical attention. Physical signs and symptoms of Hyperglycaemia includes extreme thirst, frequent urination, general weakness, abdominal pain, High fever (greater than 101 degrees F) sleepiness, confusion, hallucinations.

Hypoglycemia is a condition caused by a very low level of blood sugar (glucose), i.e. body's main energy source. Hypoglycemia is often related to the treatment of diabetes and it lowers the glucose level below 72 mg/dL (3.8mmol/L). The brain is at risk when glucose concentration goes below 72 mg/dL (3. 8 mmol/L). Symptoms of Hypoglycaemia includes Shaking, sweating, or clammy skin, Sudden nervousness, confusion, headache, or irritability, Rapid heart rate, Dizziness, weakness, or fatigue, hunger and nausea.

Diabetic neuropathy (DN) is caused by high blood sugar levels sustained over a long period of time. Other factors can lead to nerve damage due to lifestyle factors, such as alcohol or smoking use, damage to the blood vessels, such as damage done by high cholesterol levels, and mechanical injury, such as injuries caused by carpal tunnel syndrome. Low levels of vitamin B12 can also lead to Diabetic neuropathy. Depending on the affected nerves, the diabetic neuropathy symptoms can be include from pain and numbness in the legs and feet to problems with the digestive system, urinary tract, blood vessels and heart. In some people it may show mild symptoms but for some people it may be very painful and serious complications.

There is no cure for diabetic neuropathy (DN), but treatment can slow the progression of the condition. Treatment can also help to manage symptoms, such as pain and indigestion.

High blood glucose, also called blood sugar, can damage the blood vessels in the kidneys. When the blood vessels get damaged, they don’t work properly so that many people with diabetes develop high blood pressure, which can damage kidneys. Diabetic kidney disease is defined as macro albuminuria (albumin to creatinine ratio [ACR] >35 mg/mmol [400 mg/g]), or micro albuminuria (ACR 3.5-35.0 mg/mmol [35-400 mg/g]) associated with retinopathy (type 1 diabetes or type 2 diabetes) and/or >11 years' duration of type 1 diabetes mellitus (T1DM). The terms 'moderately inflated symptom' and 'severely inflated symptom' measure currently oftentimes used rather than micro albuminuria & macro albuminuria. In most patients with diabetes, chronic kidney disease can be attributable to diabetes mellitus if these criteria are met. Other causes of diabetic kidney diseases should be considered in the presence of any of the following circumstances: rapidly decreasing GFR, absence of diabetic retinopathy, presence of active urinary sediment, or signs or symptoms of other systemic disease. The diagnosis is most of the time conclusively made by kidney biopsy, though it is rarely necessary.

Type2 diabetes mellitus is characterized by a both combinations of inadequate insulin secretion by pancreatic beta cells and peripheral insulin resistance. Insulin resistance, which has been associate to proinflammatory cytokines in plasma  and elevated levels of free fatty acids, it leads to decreased glucose transport into muscle cells, elevated hepatic glucose production, and increased breakdown of fat. The major role for excess glucagon cannot be underestimated; indeed, Type2 diabetes (T2D)  is an islet paracrinopathy in which the reciprocal relationship between the insulin-secreting beta cell and the glucagon-secreting alpha cell is lost, which leads to hyperglucagonemia and hence the consequent hyperglycaemia. For type 2 diabetes mellitus (T2DM) to occur, both insulin resistance and inadequate insulin secretion must exist. Generally all overweight or obese individuals have insulin resistance, but diabetes develops only in those individuals who cannot raise insulin secretion to that level so that it can compensate for their insulin resistance. Their insulin concentrations may be high, which results in low level of glycaemia.

Diabetic encephalopathy is a form of brain damage caused by diabetes., the general term for brain disease or damage. The way in which symptoms are presented varies based on whether someone with the condition is a Type1 diabetic or a Type2 diabetic. As a relatively unknown diabetes complication, diabetic encephalopathy has become more common as the number of people with Type1 and Type2 diabetes rises. Diabetic encephalopathy develops mentally and physically as diabetes goes untreated. Diabetic encephalopathy has been known to be common in some low-income areas where people can’t properly monitor their diabetes. Diabetic encephalopathy occurs as a result of acute hypoglycemia (low blood sugar levels) or severe hyperglycemia (severely high blood sugar levels). Encephalopathy in Type1 diabetes may result in learning disabilities and memory issues. Where as encephalopathy in Type2 diabetes may cause oxidative stress which creates abnormal molecules and blood vessels in the brain may also be affected by inflammation. Diabetic mastopathy is an uncommon complication of diabetes which can be characterised by tough masses that develop in the breast. Most commonly diagnosed in premenopausal women with Type1 diabetes. Diabetic encephalopathy is a form of brain damage caused by diabetes.

Diabetic Eye Complications comprises various eye problems that seen in diabetic people. These conditions are called diabetic retinopathy, diabetic macular edema (DME), cataract, and glaucoma. Diabetic retinopathy may cause mild vision problems. Eventually, it may cause blindness also. This condition can develop in anyone who has Type1 diabetes or Type2 diabetes. DME usually takes on two form i.e. Focal DME, which occurs because of abnormalities in the blood vessels in the eye and the Diffuse DME, which occurs because of widening/swelling retinal capillaries (very thin blood vessels).

Having diabetes means that person more likely to develop congenital heart disease and have a greater chance of heart attack or a stroke also. People with diabetes are also more likely to have certain conditions, which increase the chances of having heart disease, such as high blood pressure or cholesterol. If a person have diabetes, that person can protect their heart and health by managing blood glucose, also called blood sugar, as well as blood pressure and cholesterol. Over time, the build up sugar damage human nerves, heart, blood vessels and kidneys. The longer time the person having diabetes, the chances of that person to develop heart disease will increase.

Diabetic cardiovascular disease is treated with life-style changes, medical procedures and medicines. The goals of treating diabetic heart disease include: controlling diabetes and any other heart disease risk factors person have, unhealthy blood cholesterol levels and high blood pressure.

Diabetic coma may be a dangerous polygenic disease complication that causes state of mind. When blood sugar levels are too high or too low then that serious condition can lead to a diabetic coma. Before developing a diabetic coma, usually some experiences of signs that will shows like high blood sugar or low blood sugar. High blood sugar (hyperglycaemia) symptoms are increased thirst, frequent urination, fatigue, nausea and vomiting, shortness of breath, stomach pain, a very dry mouth and a rapid heartbeat. Signs and symptoms of a low blood sugar level may include shakiness or nervousness, anxiety, fatigue, weakness, sweating, hunger, nausea, dizziness or lightheadedness, difficulty in speaking.

Diabetes is Associate in Nursing system illness, endocrinology nurses may work with people who have diabetes, and go by the title diabetes nurse. Diabetes mellitus has a general problem of endocrine system. The diabetes nurses area unit educators and disease management specialists ready to offer patients with the data and treatment they have to effectively manage their polygenic disease. The main further responsibilities of polygenic disease nurse area unit providing nutritionary medical aid, adjusting the type and dosage of medication, and providing behavioral and psychiatric care.

Type2 diabetes mellitus is widely considered as chronic disease without cure. When beta-cell function progressively declines most of the time, then only blood glucose level rises. However, recent studies have demonstrated remission of Type2 diabetes following bariatric surgery, intensive insulin therapy or very low calorie diet, raising the possibility that the declining beta-cell function in Type2 diabetes may be arrested or even reversed. Future treatment ways ought to be revised to focus on to early beta-cell preservation and people sickness remissions.

Islet transplantation is a beautiful technique for the treatment of kind one polygenic disorder, because of its minimal invasion to patients and potential high efficacy. The treatment may effectively control blood glucose levels for Type 1 diabetes that results in an improvement in HbA1c and may also result in the increase in hypoglycaemic conditions. Approximately 75% of transplanted Type 1 diabetic (T1D) patients have overcome this disorder. However, there are still more important issues that need to be addressed before this treatments and diagnosis are widely applicable, and including difficulty in maintaining insulin independence, multiple donor requirements, low islet isolation success rate, and side effects associated with the use of immunosuppressant. Here donor shortage is another dilemma. To addressing the issue of donor shortage, bioartificial islet transplantation and living donor islet transplantation using pig islets are being evaluated. Bioartificial islet transplantation may be the most effective resolution of the donor shortage.

Obesity is a chronic metabolic disorder that basically affect children and adults worldwide and also known to be the main risk factor for a number of non-communicable diseases, particularly in type 2 diabetes. Nowadays most weight loss surgeries are performed using minimally invasive techniques such as laparoscopic surgery. By this obesity surgery we can also calculate the Body Mass Index (BMI). The associated health risks of “morbid obesity”(unhealthy weight) includes diabetes, heart diseases, hypertension, sleep apnoea and life expectancy.

A metabolic disease occurs when the metabolism processor fails and causes the body to contain much more or very little of the essential substances that is  required to stay healthy. Diabetes is a metabolic disease which disrupt normal metabolism, the mechanism of converting food to energy on a cellular level. Metabolic disorders may effect on the ability of the cell to perform critical biochemical metabolism that involve the processing  of proteins (amino acids), carbohydrates, or lipids (fatty acids).

Endocrine disorders involve the abnormality of over- or under-production of certain hormones, among the endocrine disorders, thyroid problems are the most common. Endocrine disorders include hypothyroidism, diseases of the parathyroid gland, congenital adrenal hyperplasia, diabetes mellitus, ovarian dysfunction (including polycystic ovary syndrome) and diseases of the adrenal glands (Cushing’s syndrome and Addison’s disease), among others. Metabolic disorders affect the body’s ability to process certain vitamins and nutrients. Some examples of metabolic disorders are cystic fibrosis, hyperlipidaemia, phenylketonuria (PKU), gout, and rickets. Pre-diabetes has 1st accustomed denote abnormalities of maternity (e.g., hydramnios, high–birth weight babies) or a robust case history of type2 polygenic disease.

Cholesterol helps to body building of insulate nerves, new cells and produce hormones. Generally, the liver makes all the cholesterol the body needs. But sometimes cholesterol travels around in your bloodstream in high-density lipoproteins (HDL) and low-density lipoproteins (LDL).

HDL is also called as “good cholesterol” because it picks up cholesterol and takes it back to the liver for disposal. LDL transmits cholesterol in to the parts of body that need it. It is sometimes referred as “bad cholesterol”. If blood stream having this bad cholesterol, it can cling to the walls of heart arteries, eventually clogging them. Too much cholesterol in taking is risk factor for cardiac diseases. Some dietary intake factors influence to the risk of CAD include trans-fats, saturated fats, and polyunsaturated fatty acids

Cholesterol is an essential lipid for mammalian cells and its homeostasis is tightly regulated. Disturbance of cellular cholesterol homeostasis is linked to atherosclerosis and cardiovascular diseases. A central role in the sensing and regulation of cholesterol homeostasis is attributed to the endoplasmic reticulum (ER). This can lead to atherosclerosis, vessel dysfunction and blocked blood flow, the underlying mechanism for cardiovascular diseases (CVDs). CVDs include stroke, heart attack and peripheral arterial disease (PAD) among others.

Hypercholesterolemia is a condition which can be characterized by very high levels of cholesterol present in the blood. Individuals with hypercholesterolemia have a high risk of developing a form of heart disease called coronary artery disease. If cholesterol accumulates in the tendons, it results in a  characteristic growth called tendon xanthomas. Yellowish cholesterol that deposits under the skin of the eyelids are known as xanthelasmata. Hypocholesterolemia is the presence of abnormally low levels of cholesterol in the blood. Hypocholesterolemia, on the other hand, can be due to malnutrition, decreased liver function, intestinal loss, hyperthyroidism, Addison’s-like disease.

Patients with polygenic disorder often show abnormal lipid profiles as a result of hormone regulates several steps of lipid metabolism. Patients those with Type1 diabetes exhibit adequate glycaemic control but do not have quantitative lipoprotein abnormalities, but those exhibit qualitative abnormalities, primarily an increase in smaller, more atherogenic very low‐density lipoprotein (VLDL) particles. Moreover, in the study of diabetes, and Diabetes Control & Complications Trial(DCCT), both group of patients with type1 diabetes were characterised by consistent weight gain, exhibited more lipid profiles in Type2 diabetes (T2D). Dyslipidaemia in Type2 diabetes is characterised by many strictly linked abnormalities: a significant decrease in high‐density lipoprotein (HDL) cholesterol, elevated fasting and postprandial triglycerides (TG), and an increase in smaller low‐density lipoprotein (LDL) and high density lipoprotein (HDL) particles.

Inborn errors of metabolism are single gene disorders that results from the defects in the biochemical pathways of the body. Although these disorders are individually rare, collectively it accounts for childhood disability and deaths. All inborn errors of metabolism are genetically transmitted, typically in an autosomal recessive fashion. Children with inherited metabolic disorders which mostly appear normal at birth because metabolic intermediates responsible for the disorder are usually small molecules that can be transported by the placenta and then eliminated by the mother’s metabolism.

For patients with diabetes mellitus (DM), chronic complications can be occur. Cardiovascular illness which is the major cause of morbidity and mortality among these patients, encompasses macrovascular disease, with heart attacks, strokes, and gangrene; and microvascular disease, with retinopathy, nephropathy, and neuropathy (somatic and autonomic). Macrovascular events occur earlier in individuals with Diabetes Mellitus than in people without Diabetes Mellitus. Diabetic arteriopathy, which encompasses endothelial dysfunction, inflammation, hypercoagulability, changes in blood flow, and platelet abnormalities, contributes to the early evolution of these events.

People with type 2 diabetes can achieve normal blood sugar levels with proper diet, daily exercise and 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 secretory organ or the artificial pancreas is also a machine which could monitor glucose levels pattern using an infusion pump, whenever it is required. 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. Use of insulin on daily basis can be done either by needle & syringe, pen, pump, inhaler and injection port etc. The recent advancements in nanomedicine embody smart medication that entirely activate once needed, nanoformulations for economical drug delivery, designed microbes that manufacture human hormones, and even nanorobots, which might move autonomously around the body acting as a boost, for our immune system, red blood cells, or many other biological systems.