International Conference on Diabetes and Diabetic Nursing Care September 20-21, 2017 Charlotte, North Carolina, USA

Daniele Hargenrader is the founder of Diabetes Dominator Coaching and bestselling Author of Unleash Your Inner Diabetes Dominator. She was diagnosed with type 1 diabetes at the age of 9, and lost her father to heart disease 3 years later. After battling for over 6 years with a binge eating addiction, obesity, clinical depression, and out of control blood sugars, she has taken herself from obese and suffering with diabetes, to joyful, grateful and healthy with diabetes. She is an International Speaker, has presented at Fortune 500 companies, top ranked hospitals, diabetes camps and retreats, and has dedicated herself to teaching people how to think, eat, and move to ultimately live the happy, healthy life they desire through the powers of choice, self-love, and community.

As the mindset of the patient with diabetes evolves, so too must the approach of the doctor, educator, and caregiver, if they want to achieve and maintain high levels of eff ectiveness in their patient’s treatment outcomes, and have a positive impact on the population that has diabetes. This keynote presentation will give real world examples and immediately actionable takeaways focusing on the patient with diabetes in these areas: Th e role of peer support, the role of community, the power of language, the team building mindset, the goals of the patient with diabetes, and the powerful role of the doctor. There are many factors that go into the diagnosis of a patient with diabetes such as age at diagnosis, family support, type of diabetes, and current treatment options. This presentation provides a framework, the 6 Pillars of Total Health, to make it simpler for the caregiver to make recommendations on improvement beyond the doctor’s office, as well as give researchers and educators a holistic lens to view the influence of their work and teachings.

Stephanie Frilling, MBA, MPH, is currenlty the Program Lead for the Skilled Nursing Facility Value-based Purchaing Program and the Monitoring and Valuation Lead for CMS’s Value Incentives Quality Reporting Programs. As a program lead, she is responsible for overseeing all aspects of regulatory and health policy issuse for these programs, which are opertated by the Centers for Quality Standards and Quality. During her tenure at CMS she has also served as the Program Lead for the End-stage Renal Disease Quality Incentive Program, and as a subject matter expert for the Physican Fee Scheudle and the End-stage renal Disease Prospective Payment System, and has extensive payment experience with Medicare payment and quality programs. Stephanie holds an MBA, MPH and is currently pursuing a Doctrate in Bioethics from Loyola of Chicago.

There are just over 80 professional physician or practitioner services that may be furnished via telehealth, defined by Medicare as interactive audio and video telecommunications systems that permit real-time communication between a beneficiary at the originating site and the provider at the distant site. These services include 16 nephrology billing codes for furnishing end-stage renal disease services for monthly monitoring and assessment, and two billing codes for chronic kidney disease education. In recent years, many mobile health devices and other web based tools have been developed in support of monitoring, observation and collaboration for people living with chronic disease. However, digital health devices often do not meet telehealth conditions for coverage as currently required under Medicare. The criteria for furnishing telehealth nephrology services, as well as, all other medicare telehealth services are set forth in section 1834(m) of the Social Security Act. Telehealth services are paid under Medicare Part B, when furnished via a telecommunications system that substitutes for an in-person encounter. The presentation will review the statutory and program guidance that govern Medicare telehealth services, defines payment policy terms, (such as originating site and distance site) and clarifies payment policies when telehealth services are furnished, discuss innovation and other technological advancements in telehealth and neprology, and Medicare’s program authority and other statutory inciatives for enhancing the telehealth benefit.

Naglaa E L Mokadem has completed her PhD from Case Western Reserve University, Frances Payn Bollten School of Nursing. She is currently working as an Associate Professor at Menoufi a University, Faculty of Nursing, Egypt . She has published 20 papers in reputed journals and she is serving as an Editorial Board Member of repute journals (American Journal of Nursing Science, International Journal of Novel Research in Healthcare and Nursing)

Type II diabetes mellitus (DM) is a growing public-health burden worldwide, particularly in developing countries. Lifestyle modifi cation can prevent or delay the onset of type II DM at high-risk adults. Most lifestyle intervention fi ndings are driven from western studies which might not be appropriate for diff erent cultures. Culturally sensitive interventions tailored to meet the specific needs of people in a rural area will facilitate the implementation and sustainability of behavior changes. The purpose of this study was to examine the effects of risk reduction intervention to reduce type II diabetes mellitus at high risk people in a rural area. A quasi experimental (Pre/post test) design was used. A convenience sample of 70 patients with one or more risk factors of type II DM was recruted. Th is study was conducted at the outpatient clinics of Menoufi a University Hospital at Shebein El- Kom City, Menofi a Governrate, Egypt. Tools including: semi-structured demographic data sheet, The Australian Type II Diabetes Risk Assessment Tool and 24 Hours Dietary Recall Sheet. Culturally sensitive risk reduction intervention was tailored to meet the specifi c needs of at high risk people in the designated rural area. There was a statically significant difference in type II diabetes risk score pre and post intervention in the study group with a p value <0.001. Th e lifestyle of people in developing country is different from industrialized developed countries, thus, developing preventive strategies to promote healthy lifestyles that are culturally appropriate and tailored for illiterate people with low socioeconomic status is crucial.

Adel T Abu-Heija has joined Benghazi Medical School as a Medical student in 1974. He has obtained his MBBS degree in 1980 and MRCOG diploma in 1987, worked in the United Kingdom for 3 years. He has returned to Jordan and worked as Assistant Professor at Jordan University of Science and technology. He was promoted to Associate and Full Professor. Between the years 2000-2005, he has worked as a Professor of Obstetrics and Gynecology at King Faisal University, Saudi Arabia. He has served as a Dean of Mutah University Medical College in Jordan between 2007-2011. He has been working in Oman as a Professor and the Head of department of Obstetrics and Gynecology at Sultan Qaboos University and Hospital between 15th September 2013 and 17th September 2016. He has joined back Mutah University, college of medicine as a Professor of Obstetrics and Gynecology since 18 September 2016. He has published more than 60 articles in various topics of Obstetrics and gynecology.

Objective: The objective of this work is to study the effect of age, parity and body mass index (BMI) on the incidences of positive 50g glucose challenge test (OGCT) and gestational diabetes mellitus (GDM) in healthy pregnant Omani women.

Method: In this prospective study, a 50 g OGCT was performed to307 health pregnant Omani women at 24-28 weeks of gestation. When venous plasma glucose concentration (VPG) aft er 1 hour was >7.8 mmol/l, OGCT was considered positive. Women with a positive OGCT had a confi rmatory diagnosis of GDM made by performing 2-h 75 g oral glucose tolerance test (OGTT). When either fasting or 2-h post 75 g OGTT values were >5.5 mmol/I and >8 mmol/l respectively, women were considered diabetic.

Results: We screened 307 women, total number of women with positive OGCT was 83 (27.03%) and GDM 23 (7.5%). The incidences of positive OGCT and GDM increased significantly with increasing maternal age, from 20.0% and 2.2%, respectively in women aged <25 years to 37.8% and 14.7%, respectively in women aged >35 years, (P=0.02 and P=0.009, respectively). The incidences of positive OGCT and GDM increased markedly with increasing pre-pregnancy BMI, from 19.8% and 3.8%, respectively in women with BMI <25 kg/m2 to 37.8% and 9.9%, respectively in women with BMI >25 kg/m2, (P=0.02 and P=0.04, respectively). Th ere is steady increase in the incidences of positive OGCT and GDM with increasing parity. Conclusions: Maternal age and pre-pregnancy BMI have a profound impact on the incidences of positive of OGCT and GDM.

Deborah Paschal began her career as a Clinical Nurse practitioner with the cardiothoracic surgery division at Presbyterian Medical Center and is currently working at Jefferson Aria Health in the endocrine division as Co-Director for Clinical Updates for Nurse Practitioners and Physician Assistants program with the National Association for Continuing Education. She has attended Germantown School of Nursing, where she Graduated with her Diploma in 1988. At LaSalle University, she has completed her Bachelor of Science in Nursing, Masters of Science in Nursing and Adult Nurse Practitioner program in 1997 and UPENN Streamlined Post-Master’s Adult Gerontology Acute Care NP in 2016.

Discharge of the hyperglycemic patient from inpatient care is associated with increased risk for all patients and particularly for those with a history of diabetes or new-onset hyperglycemia. Continuity of care is considered essential at the time of discharge by the American Association of Clinical Endocrinologists (AACE) and the ADA. Current recommendations suggest that

planning for discharge to outpatient settings should begin at the time of hospital admission, with plans updated to refl ect changes in anticipated patient needs, patient home environment and support. At the time of discharge, there may be risk of continuation of anti-hyperglycemic therapy, initiated to cover medical stress, in doses that will subsequently be unsafe. In the face of this complexity,

educational programs alone will not suffice to improve care. Institutional commitment and systems changes are essential. As they are readied for hospital release, discharge planning should prepare patients for self-monitoring and self-care at home and give them the survival skills necessary to maintain glycemic control. A treatment plan devised by a multidisciplinary team is the best means to ensure that patients receive a practical and successful treatment regimen that can be readily overseen by themselves, their families, and their post discharge medical team.

Sadeq Rahimi has completed his PhD in McGill University in 2005; and Postdoctoral studies at the Department of Global Health and Social Medicine, Harvard Medical School. He is a Visiting Assistant Professor of Global Health and Social Medicine at Harvard Medical School, and Senior Social Scientist with in-sync, a health research and insight strategy organization. He has published numerous papers in reputed journals and has been serving as an Editorial Board Member on three journals. His latest book, Meaning, Madness and Political Subjectivity concerning social and cultural aspects of schizophrenia is taought in many universities.

Evidence-based approaches to the care of patients with type 2 diabetes (T2D) are based largely on clinical trials and routinely bypass practical impediments such as patient preferences, awareness, and motivational barriers. Although uncovering factors that infl uence adherence in T2D patients is well explored in the literature, the systematic overlap of quantitative electronic health record (EHR) and payer data with qualitative data is lacking. We conducted a prospective mixed-method study of 500 patients with varying levels of glycemic control and oral antidiabetic adherence, identified through EHR and payer information. We developed a conceptual model using two online methods overlaid with EHR and prescription claims information. Qualitative insights were collected using two online methods: daily snapshots over a 12-day period that included anecdotes, uploaded pictures, videos and comments about daily postings; and an online panel where patients shared their own views on T2D and adherence and commented on views from other patients. We consented 44 patients with 23 completing the study. Built around adherence measures as the

fi rst tier of segmentation and considering glycemic control, disease and attitudinal orientation, the model partitions patients into 8 distinct segments each portraying unique phenotypic characteristics. Although preliminary, these groupings may assist providers, healthcare systems and payers identify patient types and incorporate more eff ective ways of engaging specific patient groups, thus facilitating greater adherence, better illness management and more robust treatment outcomes.

Rono kimutai Stephen is a Clinical officer. He has completed his Graduation with Diploma in Clinical Medicine and surgery from Kenya Medical Training College. He is currently working with Academic Model Providing Access to health care (AMPATH) department of Chronic Disease management, implementing an innovative program that would make chronic diseases like diabetes accessible and affordable to patients living in rural and remote region in western Kenya. His responsibility in the program is to mentor Nurses and other health care providers on diabetes management in primary care facilities to facilitate effective task shifting. As a special added value of this event, he finds the opportunity to network with other professional from the world, which is an exceptional opportunity for horizontal exchange of experience on global challenges and solutions of diabetes management especially in rural areas. This will help me to improve the process of implementing diabetes care program in primary care facilities in rural western Kenya.

C Poojitha Reddy is a final year (part 1) Student at Kurnool Medical College, Kurnool. She has participated in National Science Congress and won 1st place for her presentation on Biodiversity. In NCC, she has been selected as “Best cadet of Andhra Pradesh 2010” and received award from Prime Minister of India

Background & Aims: Type 2 diabetes is a heterogeneous group disease with variable degree of insulin resistance and insulin deficiency. Intensified insulin therapy [IIT] with pre-prandial regular insulin and long acting insulin overnight is superior to conventional insulin therapy (CIT) with pre-mixed regular and long acting insulin twice a day for glycemic control.

Materials & Methods: 606 type 2 diabetes patients with insulin resistance, aged 40-50 years, duration of diabetes 5-6 years and taking insulin are taken up for the study from the daily O.P. of Diabetes research center, Sainagar, Anantapur, AP, India, from March 2016 to June 2017. Patients with two or less injections per day are regarded as CIT and more than 2 insulin injections per day as IIT. BP, body weight, BMI, HbA1c are studied at the beginning of the study and 6 months later.

Results: CIT- n=167, IIT- n=439 patients receiving CIT at baseline had lower weight (p<0.05), BMI (<0.05) and BP (P<0.05). At reexamination after 6 months both groups had significantly lower HbA1c (p<0.001) body weight (p<0.001) and BMI(p<0.001), BP control was significant in patients with IIT (p<0.001)

Conclusion: Metabolic control in terms of HbA1c does not differ between IIT and CIT but BP control and quality of life was significantly better in patients receiving IIT.

Ranga Raj Dhungana has implemented HIV/STI related projects for more than 15 years. He has continued his expertise through academic institutions and health projects after completion of PhD in public health from Sri Lanka. He established an Integrated School Health Program (ISHP) for Disaster Emergency Preparedness(DEP), Mobile Health Camp(MHC), First Aid Management and Referrals(FAMR), and Child Mental Health Support(CMHS) in Nepal in 2015. Beside these, he provided technical support in implementation of research project/s related to Reproductive Health and Rights (RHR) and Nutrition. He has also initiated to establish an international partnership program related to Management of Communicable and Non-Communicable Diseases like Diabetes.

Statement of Problem: Nutritional status of children under five in Nepal is very poor. The 2011 NDHS found 29% underweight and 11% wasted. USAID reported 40% stunting and 60% stunting with deficiencies of diarrheal disease with effects of nutritional status, 49% households have access to food year-round. However, 12% households are mildly food insecure, 23% moderately, and 16% severely. Rural households insecure 46% as compared to urban 67%. Th e purpose of this cross-sectional study was to identify assess of household food security and nutritional status of children aged essential dietary components, and 44% population does not access to toilets that contribute to morbidity of 1-5 years in Dhading.

Methodology: Data among 172 paired caregivers and children collected. Anthropometric measurements of children, face-to-face interviews of caretakers and household food security using HFIAS module questionnaire were measured. Data were analysed by using Pearson’s chi square test and Fisher’s exact test.

Finding: Th e prevalence was 30.2% underweight, 20.3% stunting and 8.1% wasting determined by applying 2006’s WHO growth chart in Dhading. Moderate food insecurity was 45.9% and 15.2% severe food insecurity, where normal and healthy food-plan for under 5 children with diabetes were not available.

Conclusion & Significance: Mother’s education and family income had a significant association with underweight of a child. Many predominant factors that attribute leading to the vicious cycle for the prevalence of under nutrition, which are the socio-economic and educational status. If these conditions are taken meticulously with healthy food-plan, the consequences of nutrients’ defi ciencies and risk of diabetes can be well-prevented. Thus, household food security, well nutritional status, and appropriate nursing care can be strengthening by adopting “Integrated School Health Program (ISHP)” that can facilitate to create awareness for establishment of regular eating patterns, food-plan among under 5 children with diabetes, and nursing care interlinkage.

Uneeba Syed has done her MBBS from National University Of Science and Technology (NUST) Pakistan. She has done her FCPS in Medicine and FCPS endocrinology. She is also a CRCP qualifi ed. She is presently working as a Consultant Medical Specialist and Endocrinologist in a renowned government hospital of Pakistan.

Background: The use of syringes, needles and lancets is common in every diabetic patient whether for blood glucose monitoring or for insulin treatment. Most hospitals follow well-established guidelines regarding sharps disposal. However, in the community, improper disposal of needles and syringes is common leading to needle stick injuries and predisposing domestic waste handlers, ragpickers and the general community at high risk of communicable diseases like hepatitis B, C and HIV.

Objectives: Th e objective of this study is to determine the knowledge, attitude and behavior of diabetic patients related to disposal of used needles and syringes and the eff ect of counselling on these practices.

Methods: A cross-sectional, interventional study was conducted on 300 diabetic subjects attending a tertiary care hospital in Lahore by means of a structured 20-point questionnaire and standardized interview in appropriate community language. Data was analyzed using spss20inc. Study participants were counselled about safe sharps disposal and instructed to bring all used needles and syringes in puncture-resistant closed container on their next DMC visit.

Results: Out of 300 patients 131 (43.6%) were male and 169 (56.3%) were female. 107 (35.6%) were illiterate, 186 (63%) were unemployed and 111 (37%) were employed. 7 (6%) had hepatitis B, 20 (23%) had hepatitis C and 3 (1%) had HIV. 296 (99%) had no knowledge about proper disposal. Irrespective of any factor, 285 (95%) of the patients were throwing the sharps in dustbins, 3(1%) in the toilets, 7 (2%) outside and 6 (2%) elsewhere. 180 (60%) patients brought back the needles in boxes whereas 118 (39.3%) did not

and 2 (0.6%) were lost to follow-up.

Conclusion: Th is study revealed that diabetic subjects attending the tertiary care hospital in Lahore, Pakistan have little knowledge of the importance of safe sharps disposal or of the risk of transmissible diseases resulting therefrom and had also not received any instructions. Th ere was a change in the attitude and practice following counselling. Interventions to increase awareness about importance of proper sharps disposal among the diabetic population are needed. It is therefore recommended that specific health education regarding sharps disposal be routinely given to diabetic subjects.

Nyane N A has completed her BPharm Degree from University of Lesotho. She has enrolled in her studies at University of KwaZulu-Natal where she is currently doing her research under the department of Pharmacology, School of Health Sciences. She was awarded fi rst prize (30000-travel voucher) in research symposium 2016 for winning in the Masters oral category held by College of Health sciences. She has assisted the Honors students with their Laboratory Experiments. She is lecturing on third level and fourth level at University of KwaZulu-Natal in school of Pharmacy. She has two accepted manuscript in Journal of Pharmacology and the other is PLOS ONE.

Type 2 diabetes (T2D) is characterized by impaired insulin secretion and peripheral insulin resistance. Despite many classes of drugs available, T2D is still projected to increase by 55% in 2035. Citrus fruit-derived fl avonoid, naringenin has been reported to have antidyslipidemic, anti-oxidant and more recently metformin-like antidiabetic eff ects. Metformin, the most commonly used drug for T2D management acts by activating adenosine monophosphate activated protein kinase (AMPK). Naringenin’s anti-diabetic effects could be mediated by AMPK activation. Although naringenin has been shown to have anti-diabetic properties, it is less lipophilic and has poor water solubility hence chalco-naringenin analogs with enhanced pharmacological activities were synthesized. A series of 11 compounds of 4-[(cyclopropylcarbonyl) amino] chalco-naringenin analogues were synthesized using Claisen-Schmidt and characterized by IR, 1H-NMR and 13 C-NMR. An intermediate compound, N-(3-acetylphenyl) cyclopropanecarboxamide synthesized was reacted with commercially available aldehydes to yield the fi nal amino-chalco-naringenin series. Th e synthesized compounds showed characteristic peaks on IR, 1H-NMR and 13 C-NMR and fi t very well in the hydrophobic binding pockets of

AMPK. Th ey also presented good binding affi nity to the enzyme as shown by computer simulation suggesting potential metforminlike antidiabetic eff ects. Further, in vitro and in vivo antidiabetic studies are suggested to elucidate the molecular mechanisms of these compounds.

Introduction: Diabetes mellitus is a group of metabolic disorders characterized by hyperglycaemia resulting from impaired insulin secretion or defective insulin or both.

Study objective: Th e objective of this study is to investigate the consumption patterns, knowledge, barriers and benefi ts of compliance to diabetes dietary plans among black Zimbabweans receiving diabetes education from traditional and/or the western public health system.

Design: A multiple case study research design was used. Data on frequency and quality of food consumption, beverage use was collected using three 24-hour diet recalls and a food frequency questionnaire while knowledge of diabetes prevention and self care seeking behaviours was sought using the Simplifi ed Diabetes Knowledge Scale (n=10 women and 14 men). In-depth interviews were used to gain insights regarding participant feelings and beliefs about the disease. Weight, height and blood pressure were collected by trained specialists.

Study setting: An urban suburb of Mucheke in Masvingo and a rural area of Bikita.

Results: Reported dietary data on frequency of consumption showed that urban patients had at least three to four meals per day. A grazing eating pattern was observed in terms of the snacking habits among urban participants with fruit juice, whole wheat bread, roast corn, and fruits (apples and bananas) among the most frequently used snacks. In terms of calorie intakes, consumption of dietary fat was higher than recommended for the urban group. Use of ultra processed and animal protein was higher in urban areas while carbohydrate intakes were higher in rural than urban areas. Obesity was prevalent among 13-16% of men compared to 34% for women. In relation to T2D treatment, majority of the patients used both traditional medicine and western biomedicine. Dietary advice varied from one professional to the other.

Conclusion: Glucose control was poor among the participants. Th e level of diabetes knowledge of complications, risk factors and preventive self care management practices was low. Patient levels of self effi cacy related to patient confi dence regarding eff ectiveness of health seeking behaviours was poor. To that end, the study recommended for more empowering diabetes education protocols.

Adegbenga B Ademolu is an Associate Fellow of the National Postgraduate Medical College of Nigeria. He works in the department of Medicine of Lagos State University Teaching Hospital Ikeja, Lagos Nigeria. He is a Member of the Endocrine Society, where he functions as a Reviewer for both the Journal of Clinical Endocrinology and Metabolism (JCEM) and Journal of the Endocrine Society (JES). He is also a Fellow-in-Training of the American Association of Clinical Endocrinologist. He is in the Editorial Board of the journal Gastroenterology and Liver: Clinical and Medicals (GLCM). His work on hypoglycemia amongst others is opening new path of scientifi c knowledge and research in Endocrinology and related fi eld. He has presented papers locally in Nigeria and internationally at conferences and has published papers locally in Nigeria and internationally in American, European and Asian journals. He is an Active Member of the Endocrine and Metabolism Society of Nigeria.

Hypoglycemia as a management complication of diabetes mellitus (DM) is a worldwide experience. In Africa, hypoglycemia is an uncharted territory in literature. Th erefore, the following questions will be addressed using Ademolu’s Classifi cation of Hypoglycemia (ACH). Which is the commonest and the least common grade of hypoglycemia in D M African patients? Which grade of hypoglycemia is seen commonly in type 1 and in type 2 diabetics? Th is is a retrospective study that analyses 203 (two hundred and three) documented hypoglycemic episodes in Africans with DM admitted between July 2007 and October 2016 in Lagos State University Teaching Hospital, Lagos Nigeria using a questionnaire on 50 case fi les studied. Hypoglycemia was defi ned as a blood sugar of 70 mg/dl or less. Th e age range of the patients was 18 to 95 years. Now, by using ACH to analyze the 203 hypoglycemic episodes in all type 2 diabetics studied, 48.50% had grade l hypoglycemia, 35.93% had grade 2 hypoglycemia while 15.57% had grade 3 hypoglycemia. In all type 1 DM studied, 30.50% had grade 1, 33.33% had grade 2 while 36.11% had grade 3 hypoglycemia. The lowest documented hypoglycemia amongst type 2 DM was an asymptomatic fasting blood sugar of 20 mg/dl (grade 3 hypoglycemia). By using ACH, there was no record of grade 4 hypoglycemia in both type 1 and type 2 DM patients in this African study. The commonest grade is grade 1 (mild) in type 2 DM, whereas grade 3 (severe) is the commonest in type 1 DM. Th e least common grade of hypoglycemia in type 2 DM is grade 3 while in type 1 DM, it is grade 1. Asymtomatic hypoglycemia can occur in grade 3 among African diabetics. A similar study is recommended in Americans, Europeans, Asians and all ethnic groups for possible racial diff erences or disparity in the fi ndings of this research.