GlobalDiabetes

S u m m i t 2 0 2 0

A WORLDDIABETES DAY

SPECIALThe event hosted a distinguished panel of expertsfrom Latin America and Asia covering a range oftrending topics in diabetes management, especiallyrelevant in the COVID-19 pandemic.

November 14, 2020

A Clinical Synopsis

• Marked reduction in COVID-19 mortality with controlled glucose level and lesser variability.• Keeping HbA1C below 7% reduces the incidence of clinical inertia.• Digital era has made glucose monitoring possible for 24*7. • Use of sensor augmented pump (SAP) and automated insulin delivery is on the rise.• Digital diabetes is likely to help millions of diabetics in the near future.• Importance of realistic nutrition plan.• Ensuring immunological prevention to reduce COVID-19 incidence. • Chronic vascular diseases of atherosclerotic origin are a major cause of mortality in diabetics.

LEARNING : HIGHLIGHTS

GLOBAL DIABETES SUMMITA CLINICAL SYNOPSIS

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GLOBAL DIABETES SUMMIT

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Dr. Anoop Mishra

Blood glucose & its variability- a key metabolic investigationwith & without diabetes : Importance in the pandemic era.

Dr. V. Mohan

Preventing clinical inertia: The way forward to preventingdiabetes complications.

Dr. Shashank Joshi

New frontiers in the treatment of type 1 diabetes.

Dr. A.G Unnikrishnan

Clinical perspectives in digital diabetology.

Dr. Jorge Victor Yamamoto Cuevas

Diabetes, obesity and COVID-19.

Dr. Evelyn Hernández

Gene therapy for diabetes.

Dr. Jesús Quintero

Diabetic nephropathy.

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A CLINICAL SYNOPSIS

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GLOBAL DIABETES SUMMIT

• A key metabolic investigation for both diabetics and non-diabetics • When blood glucose level is tightly managed, studies have shown reduced incidence of micro- and macrovascular complications.• Studies have shown that non-diabetics with increased blood sugar level at admission have 2.5 times higher risk of death and 2 times higher risk of complications. • Fasting blood glucose (FBG) is an independent predictor of 28-day mortality in COVID-19 in patients without previous diagnosis of diabetes.• A subsequent study showed that an incremental increase in the normal range of FBG is associated with substantial increase in the risk of ICU admissions for COVID-19 patients. • Controlled glucose and lesser variability in non-diabetics lead to marked reduction in the mortality rate and complications in COVID-19 cases as well as other conditions.

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- DR. ANOOP MISHRA Chairman of Fortis Centre for Diabetes, Obesity & Cholesterol, New Delhi

Blood glucoseand its variability -a key metabolicinvestigation with& without diabetes:Importance in thepandemic era

4A CLINICAL SYNOPSIS

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GLOBAL DIABETES SUMMIT

• Around 80 million people are diagnosed with diabetes around the world, and 20 million among them tend to have one or more micro- or macrovascular complications.• A study carried out in South Asia showed that only 7% of the diabetic population had the ABCD parameters controlled, where: A: HbA1C B: Blood pressure C: Cholesterol D: Diet and personal habits• Higher HbA1C correlates with drastic increase in the incidence of all complications. It is therefore important to keep it below 7%.• Delayed follow ups (after six or more months) may lead to an increase in glycemic burden and higher incidence of clinical inertia. • Patients with higher blood sugar levels need to be treated with anti-diabetic drugs instead of making life-style changes. • Short-term insulin therapy improves C-peptide and results in better beta cell function even after one or two years. • Clinical inertia has to be prevented in order to reduce complications and improve the health as well as life span of diabetic patients.

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- DR. V.MOHAN The chairman of Diabetology at Dr. Mohan’s Diabetes Specialities Centre

Preventing clinicalinertia :The way forwardto preventingdiabetescomplications

A CLINICAL SYNOPSIS

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GLOBAL DIABETES SUMMIT

• Insulin as a treatment for diabetes is nearing around 100 years. • To stay alive a type 1 diabetic takes around 1460 shots every year, which is the biggest challenge. • In the last two decades, there has been a graduation from insulin syringes to insulin pumps. • In this digital era, there has been an advancement wherein blood glucose level can be monitored 24 x 7 and use of sensor augmented pump (SAP) and automated insulin delivery. • The biggest advantage of SAP is that it prevents hypoglycemia and lowers the incidence of diabetic ketoacidosis. • HbA1C is a limited yardstick; hence newer technology with model sensors with real time and retrospective monitoring help detect hypoglycemia. • Artificial pancreas is an automated insulin delivery device attached to a sensor, it is a micro- electromechanical system with cutting edge technology.• Hybrid closed loop systems use an algorithm based on insulin requirements and bolus as per the choice of food of patients.

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- DR. SHASHANK JOSHI An Indian endocrinologist, diabetologist and medical researcher in Mumbai

New frontiries inthe treatment oftype 1 diabetes

A CLINICAL SYNOPSIS

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GLOBAL DIABETES SUMMIT

• Improving self-monitoring of blood glucose level is important but maintaining it physically is challenging. • For gestational diabetes it is important to adopt to the technology to ensure continuous monitoring of blood glucose levels and the adjustment of insulin doses. • Time and range is a good alternative for HbA1C. A time and range of 70% in continuous glucose monitoring is correlated with a HbA1C of 6.7%.• The value of continuous glucose-monitoring through one’s watch or phone sensors also helps controlling blood glucose levels in non-diabetic patients.• Digital diabetes is likely to help millions of diabetics in the near future.

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- DR. A.G UNNIKRISHNAN CEO of Endocrinology at the Chellaram Diabetes Institute, Pune

Clinical perspectivesin digital diabetology

A CLINICAL SYNOPSIS

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GLOBAL DIABETES SUMMIT

• Patients with a higher body mass index or obesity along with diabetes were seen to have worsened outcomes due to COVID-19 infection.• There has been a strong reflection of diabetes-prevalence worldwide, on COVID-19 mortality.• COVID-19 being a severe acute inflammatory disease, if combined with diabetes or obesity, which are both inflammatory conditions, leads to higher complications due to reduced focus on inflammatory risk distribution.• Drugs like DPP4 inhibitors or GLP1 agonists can be prescribed to reduce inflammatory cascade in diabetics.

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- DR. JORGE VICTOR YAMAMOTO CUEVAS Endocrinologist at San Angel Inn University Hospital, Mexico

Diabetes, obesityand COVID-19

A CLINICAL SYNOPSIS

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• Novel gene therapy offers the correction of defective genes that are associated with pathophysiology of various diseases including diabetes. • Studies have shown that overexpression of insulin like growth factor type 1 gene in the beta cells of transgenic non-obese diabetic mice, because this factor is associated with the positive regulation of the immune response. • The transfer and expression of the gene sequence that encodes IGF-1 of the beta cells in murine models resulted in the reduction of glycemia by 80%, proving that IGF-1 might be a factor in the delay of the progression of the disease. • Currently, several tissues like the stomach, liver, pancreas and cardiovascular tissue are being worked on through trans-differentiation techniques to obtain cells that can generate insulin effectively.

GLOBAL DIABETES SUMMIT9

- DR. EVELYN HERNÁNDEZ Endocrinologist at Caracas University Hospital, Venezuela

Gene therapyfor diabetes

A CLINICAL SYNOPSIS

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• Different epidemiological studies have shown a prevalence of chronic kidney disease (CKD) in 30%-40% of the diabetic population.• The number of diabetics has tripled in the last 20 years worldwide and hence remains a global concern. • Diabetes mellitus increases the rate of mortality and loss of potential years of life in such patients. • The combination of diabetes mellitus and hypertension causes 80% of terminal kidney diseases worldwide. • Pathophysiological relation between micro- and macrovascular angiopathic alterations lead to both renal and cardiovascular complications which are accelerated by diabetes mellitus.• All the complications have a long clinical latency period, thus making their early diagnosis difficult. • To effectively manage diabetic nephropathy, it is important to maintain blood glucose levels.

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- DR. JESÚS QUINTERO Internist at La Raza National Medical Center Specialty Hospital, Mexico

Diabetesnepropathy

A CLINICAL SYNOPSIS

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GLOBAL DIABETES SUMMIT11

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GlobalDiabetes

S u m m i t 2 0 2 0

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A CLINICAL SYNOPSIS