Day 2 :
Keynote Forum
Nicolas F Wiernsperger
University of Lyon, France
Keynote: Evidences that insulin resistance, core of cardiometabolic diseases, is the primary therapeutic target
Time : 09:30-10:15
Biography:
Dr Nicolas Wiernsperger is a french physiologist and pharmacologist. He has been head of research department on cerebrovascular accidents at Novartis (Switzerland) until 1984. He established as a world recognized specialist of microcirculation. From 1985 to 2005 he was appointed Head of International Pharmacological Development and Senior Pharmacologist at Merck KgA in Lyon. He was also head of a private/public research unit on diabetes microvascular complications at Lyon University. He is an international recognized expert of cardiometabolic diseases and aging. He has published close to 150 papers as well as 2 books. He has been teaching as Invited Professor at several universities. Since 2005 he deals with the development of new drugs as well as,more recently, nutraceuticals
Abstract:
Cardiometabolic diseases affect about one third of the worldwide population. Recent years revealed that the core of these different pathologies is insulin resistance. Diminished sensitivity to insulin leads to various metabolic and vascular (both macro- and microvascular) disturbances. Epidemiology and clinical observations show that resistance to this hormone can be seen very early, possibly already in early childhood. It has clearcut impacts on adult health and worsens with aging. However also aging-related diseases such as cognitive dysfunction and related dementias are also associated with resistance to insulin.
The presentation will show the poorly recognized importance of microvascular insulin resistance as well as many aspects of this defect in various tissues. It will also be shown how to detect this parameter easily and early in human beings. Finally suggestions will be made about possible new treatment strategies.
Keynote Forum
Shigehiro Katayama
Saitama Medical University, Japan
Keynote: Recent Progress for the Treatment of Diabetic Nephropathy
Time : 10:15
Biography:
Shigehiro Katayama, M.D., Ph.D. has been Director of Saitama Medical University Hospital since 2008 and the Deputy Head from 2002 to 2008. He is currently Director Saitama Medical University Kawagoe Clinic since 2014. He also has been the Professor and the Head of Endocrinology and Diabetes Division at Faculty of Medicine, Saitama Medical University since 1995 and retired to be Emeritus Professor in 2015.
He graduated from Faculty of Medicine, The University of Tokyo and received M.D. degree in 1973 and Ph.D. degree in 1980 from The University of Tokyo. He was Postdoctoral Research Fellow at the Rockfeller University in 1980 and Assitant Professor at the State University of New York at Buffalo from 1981-1983. He moved to Saitama Medical University in 1983.
His research interests are in hypertension in diabetics in relation to effects of hypoglycemic and/or hypotensive agents on insulin resistance and in relation to diabetic nephropathy.　 He has been the Member of New Drug Approval Advisory Committee at The Department of Health and Welfare since 1993. He was a member of the committee to decide the drug price and the committee to approve a new drug, PMDA. He is now serving as one of the Program Officers in the field of Circulatory Disease and Diabetes Mellitus, Japan Agency fpr Medical Research and Development (AMED). He is a Board Certified Member of Japanese Society of Internal Medicine, Japan Endocrine Society, Japanese Society of Nephrology, Japanese Society of Hypertension, Japanese Society of Diabetes and a Fellow of American Diabetes Association, American Heart Association (High Blood Pressure Council).
He recieved Expert Investigator Award from the Japanese Society of Diabetic Complications in 2012, and Society Award from the Japanese Society of Hypertension in 2013.
Abstract:
In Japan, diabetic nephropathy is the leading cause requiring dialysis since 1998. The number of patients under dialysis is about 320,000, 40% of which are diabetics. Since dialysis costs expensive, prevention of the progression of diabetic nephropathy is an urgent target. We evaluated the incidence of diabetic nephropathy (macroalbuminuria of more than 300 mg/g・Cre) from normo- and low-microalbuminuria (<150 mg/g・Cre) in 1550 type 2 diabetics during 8 years (JDCS; Japan Diabetes Complications Study). The onset of macroalbuminuria was observed in 0.67% of the patients, which was one third of the incidence reported in UKPDS. Moreover, 30% of patients with low-microalbunminuria returned to normoalbuminuria (remission/regression). The higher the initial albuminuria, HbA1c, or systolic blood pressure was, the progression risk to macroalbuminuria was higher. Smoking was also the risk for diabetic nephropathy.
There were many trials which elucidated the effectiveness of ACE inhibitors or ARBs (angiotensin II receptor antagonists) including ours such as Japan IDDM, INNOVATION, ORIENT and ROADMAP study. However, relative risk reduction with these RAS inhibitors was about 20 - 30% in patients with macroalbuminuria and 60% in patients with microalbuminuria. We need more vigorous strategy to prevent the new onset and/or progression of diabetic nephropathy. Recent trials using SGLT2 inhibitors such as empagliflozin or canagliflozin decreased not only cardiovascular outcomes by 14% but also renal outcomes by 30 – 40%. SGLT2 inhibitors may increase sodium delivery to the macula densa and then improve tubuloglomerular (TG) feedback, which may result in constriction of afferent arteriole and hence amelioration of hyperfiltration. DPP-4 inhibitors and GLP-1 receptor antagonists may have such an action as well. These new hypoglycemic agents may have a great potential to protect renal functions, especially diabetics with hyperfiltration. Furthermore, we are waiting new renoprotective drugs such as anti-oxidant Nrf2 stimulator, bardoxolone methyl, or non-steroidal mineralocorticoid receptor antagonist (MRA), finerenone.
- Herbal medicine for Diabetes | Obesity & Metabolic Disorders | Diabetes Complications | Diabetes Management
Session Introduction
Manojkumar N
Kottakkal Ayurveda College, India
Title: Experimental evaluation of anti-diabetic property of pericarp of Myristica fragrans Houtt., on albino Wistar rat model
Biography:
Manojkumar N is a Professor in Kottakkal Ayurveda College, Kerala University of Health Sciences, India. He has 15 years of experience in evaluation, teaching, administration and research in this educational institution. He is a medical doctor who has been practicing Ayurveda for the past 22 years. He has guided 14 research works.
Abstract:
Introduction & Aim: Diabetes mellitus is a multisystem disorder affecting 387 million people in the world and among them 78.3 million from South East Asia. By 2040, this is expected to rise to 131 million. Significance of Alternative medicine is increasing day by day as there is no cure for this condition in contemporary system of medicines. Many Ayurvedic doctors are effectively using pericarp of Myristica fragrans Houtt., in diabetes mellitus. But they are not documented scientifically yet. Moreover, need of adding new drugs to the Ayurvedic pharmacopoeia are essential in this era of drug scarcity and adulteration. Hence in this study, an animal model is selected to prove the efficacy of Myristica fragrans Houtt.
Method: 30 Alloxan-induced diabetic animals were selected for the study and grouped in to four each containing 6 rats, half-dose, therapeutic dose and double-dose of the cold infusion of the drug, the standard drug Glibenclamide (0.5 mg/Kg.b.wt.) and the control group with distilled water. Blood sugar level was assessed on day 0, 1, 2, 5, 10, 15 and 20 at time interval 0, 1, 2, 4 and 6 hours by using Glucometer. Hepatic and renal function and anti-oxidant action were also assessed.
Result: Therapeutic dose and double-dose were found to be significantly effective in blood sugar level and also in the renal and hepatic parameters. Levels of antioxidant enzymes and glutathione were increased as compared to the control group.
Conclusion: Pericarp of Myristica fragrans is therapeutically effective in Alloxan-induced diabetic rat model and also possesses significant antioxidant activity.
Prakash Mangalasseri
VPSV Ayurveda College, India
Title: Management of diabetes mellitus through ayurveda by Dosha and Prakrity based assessments
Biography:
Prakash Mangalasseri has graduated from Kottakkal, India and Post-graduation from Gujarat Ayurveda University. He is presently a PhD student from Kerala University of Health Sciences. His research thesis was selected for Best Thesis Award all India level in 2002. He was an invited speaker for many National and International seminars and symposiums. He was selected for best script writer award in UGC program by National Channel. He has wide research and treatment experience on General Medicine, Male Infertility, Panchakarma Therapy and Ayurvedic psychiatry. He has many publications and contributed chapters in various book.
Abstract:
Diabetes mellitus was reported to be responsible for 11% of the total global adult health expenditure and 5.1 million deaths. 80% of people with diabetes live in low- and middle-income countries. India becomes top in South East Asia region with 65.1 Million diabetic people with a prevalence of 9.09%. Traditionally in India, Diabetes was controlled by indigenous Ayurvedic Health Care System. In Ayurveda, the disease is diagnosed as Prameha and effectively managed by its unique principles. Ayurveda identify various Dosha, types for Prameha with different prognostic considerations. Among the three Dosha, sub-types of Prameha, Kapha is curable, Pitta is mitigatedly manageable and Vata is incurable. The psychosomatic constitution (Prakrti) of an individual also plays an important role in progression, prognosis of disease and response to the treatment. Pitta prakrti constitutions are more prone to stress and stress itself is a cause for manifestation of hyperglycemia. A cross sectional study was carried out to find out the association of stress and hyperglycemia in Pitta predominant constitution and it was demonstrated in the particular Prakrity (p<0.001). In routine clinical practices, the famous Pitta alleviating drug Mahaatiktakam decoction was found to be effective in hyperglycemia especially when associated with stress. A clinical trial was conducted to find out the efficacy of the decoction in stress associated hyperglycemia seen in diabetic patients of Pitta predominant constitution and the outcome was highly significant (p<0.001). The paper attempts to explore the utility of Dosha and Prakrity based considerations in the management of diabetes mellitus through Ayurveda.
P T P Adithya Babu
VPSV Ayurveda College, India
Title: Ayurvedic management of diabetic retinopathy: A case report
Biography:
P T P Adithya Babu is presently working as an Associate Professor at the Department of Salakya Tantra, Ayurveda College, Kottakkal. He is a well-known practitioner in Ayurvedic Ophthalmology. He has presented papers in various national and international seminars. He also has tremendous clinical experience in treating major ophthalmic conditions through the Ayurvedic approach. His current research focuses on diabetic retinopathy, glaucoma and dry eye syndrome.
Abstract:
Diabetic retinopathy is the most common cause of legal blindness between the ages of 20 and 65 years. It is more common in type-1 diabetes. The major risk factors are duration of diabetes mellitus, poor metabolic control, pregnancy, hypertension, nephropathy and other factors such as smoking, obesity, hyperlipidemia, etc. Microangiopathy primarily affecting the pre-capillary arterioles and post capillary venules are the most prominent pathological changes. It also exhibits the features of micro-vascular occlusion and leakage. Three stages of the disease are identified. They are background retinopathy, proliferative and pre-proliferative stages. From the Ayurvedic perspective, the condition is to be discussed under the concept Timira-Kacha-Linganasa (a group of diseases, causing progressive loss of vision) involved Dosha being categorized as per the clinical presentation. The major changes being the Sroto Dushti (deterioration of vessels). Here the case of 72-year-old man is discussed, who presented with features of proliferative diabetic retinopathy and he has positively responded to the proposed Ayurvedic management.
Mukesh Edavalath
Vaidyaratnam P S Varier Ayurveda College, India
Title: Role of ayurvedic dietetics in the prevention and management of diabetes mellitus: A review
Biography:
Mukesh Edavalath currently holds the chair of Assistant Professor, Department of Roganidana, in Clinical medicine at Vaidyaratnam P S Varier Ayurveda College, Kerala, India. He has his Master’s Degree in Ayurveda from the University of Kannur and had previously served in the Department of Indian Systems of Medicine, Government of Kerala. Apart from being an active Clinician and Clinical Educator, he has been involved in many community outreach programs on health awareness and medical services. He has several research papers including PubMed listed articles to his credit. His current research focuses on the role of Diet dynamics in the pathology and management of Diabetes Mellitus, often described in classical Ayurvedic medicine but totally disregarded in modern Biomedicine.
Abstract:
Diabetes mellitus (DM) is a major non-communicable disease with increasing prevalence at global level. Poorly controlled diabetes leads to several complications, including heart diseases, stroke and death. Prospective clinical trials provide evidence for the effectiveness of nutrition therapy in the prevention of DM. Contemporary studies in biomedicine indicate an unhealthy diet and gut dysfunction as major contributors to DM. Likewise, Ayurvedic texts describe improper diet and the subsequent gut dysfunction as the prime factor in formation of Ama (partially digested or toxic end products) which further leads to various diseases including DM (Prameha) and other diseases similar to metabolic syndrome in Biomedicine. To prevent formation of Ama, Ayurveda advocates eight principles of Aharavidhi (rules governing Diet dynamics). Further, it is advised to avoid improper eating patterns like irregular timings and food intake before digestion of the previous meal. The concept of Virudhahara (incompatible foods) in disease pathogenesis is also unique to Ayurvedic Dietetics. In established cases of DM, clinical trials as well as systematic reviews report a ~1%-2% lowering of HbA1c values along with other beneficial outcomes from nutrition therapy interventions. The existing medical nutrition therapy (MNT) guidelines revolve around what to eat and concentrate more on macro and micronutrients with their caloric and glycemic values. Although it emphasizes on individualization, Ayurveda has much broader principles of adapting the diet, with due emphasis on individual factors including the Prakriti (body constitution), Dosha (body humor), Agnibala (digestive power), Desa (place of living), Kala (season) and Satmya (personal compatibility) of the patient. In managing complications, Ayurvedic Dietetics recommends targeted nutrition therapy where food processed with medicinal herbs is administered for specific therapeutic outcomes. Finally, management of DM differs in obese and non-obese accordingly, the diet also varies for them.
Abhijit Shrirao
P Wadhwani College of Pharmacy, India
Title: Hypolipidemic activity of Madhuca longifolia in Triton-induced hyperlipidemic rats
Biography:
Abhijit Shrirao has completed his M Pharmacy in Pharmacology from NMIMS University, Mumbai. He has an experience of 1.5 years in Clinical R&D and 6 years of academic experience. Currently, he is working as Assistant Professor at P Wadhwani College of Pharmacy, Yavatmal, India. He has interest in developing medicines from herbal origin which are cheap and having less adverse effects and is studying herbs for their possible antidiabetic and antihyperlipidemic activity.
Abstract:
Objective: In the present study, an ethanolic extract from Madhuca longifolia bark was evaluated for its hypocholesterolemia and hypotriglyceridemic activities using Triton WR-1339 induced hyperlipemic rats as experimental model.
Material & Method: Hyperlipidemia was induced by a single injection of Triton WR 1339 (400 mg/kg i.p.) in Sprague Dawley rats. Ethanolic extract of Madhuca longifolia bark (ML) (250, 500 and 750 mg/kg/day) was administered to hyperlipidemic rats for one week. Harvested serum was analyzed for lipid profile such as cholesterol, triglyceride and lipoproteins. Oxidative stress parameters like superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx) and glutathione reductase (GRh) and activity of lipolytic enzyme such as lecithin-cholesterol-acyltransferase (LCAT) and post-heparin lipolytic activity (PHLA) were estimated in the liver tissues of hyperlipidemic rats.
Results: Result of the study suggested that treatment with ML 750 mg/kg/day significantly (p˂0.01) lowered the level of serum cholesterol, triglyceride phospholipids and increased in lecithin-cholesterol-acyltransferase activity and post-heparin lipolytic activity compared to Triton-treated rats. In addition, ML 750mg/kg/day significantly (p˂0.01) reduces oxidative stress and normalizes the activities of SOD, CAT, GPx and GRh compared to Triton-treated rats.
Conclusion: The current study provides strong evidence that intragastric administration of ML 750 mg/kg/day has a beneficial effect in treating dyslipidemia with decrease in oxidative stress.