Irina Kurnikova is a Professor of Medicine at RUDN University (Peoples Friendship University of Russia), Moscow, Russia. She has extensive experience in the field of scientific and practical Endocrinology. The main areas of her research are the optimization of the system approach to the treatment and rehabilitation of patients with diabetes mellitus, diseases of the thyroid gland. The main directions of scientific research are the influence of disturbances in the system of regulation of the organism and other endogenous factors (comorbidity, disruption of the mechanisms of interstitial humoral transport) on the effectiveness of treatment and the quality of compensation for diabetes and other endocrine diseases.

Statement of the Problem: Known factors of cardiovascular risk - modifi able and non-modifi able have been published. The main known endogenous risk factors for the development of cardiovascular diseases in patients with diabetes type 2 (DT2) are: macroangiopathy (endothelial dysfunction), obesity and dyslipidemia, disorders in the blood coagulation system due to diabetes. However, autonomic dysfunction attention is not enough. Th e purpose of this study: to assess the infl uence of disturbances in the system of vegetative regulation caused by diabetic autonomic neuropathy on the risk of formation and rate of progression of diseases of the cardiovascular system in patients with DT2. Methodology & Th eoretical Orientation: 28 patients with DT2 associated with HTN were evaluated autonomic regulation by the method of spectral analysis of daily variability of the heart rhythm power spectrum of oscillation in three frequency bands: 0.004-0.08 Hz (very low frequency-VLF), 0.09-0.16 Hz (low frequency-LF), 0.17- 0.5 Hz (high frequency-HF). Were studied parameters of daily monitoring of blood pressure as criteria for clinical and functional diagnosis and forecasting factor. IC-index of centralization (LF+VLF)/HF.

Findings: In the "DT2+HTN" group, an increase in LF (38.5±12.7%) was observed, which is characteristic of chronic stress, which is signifi cantly higher than in the comparison group (p=0.001; r=0.31). Reduction of HF (15.4±5.5%) is oft en observed in patients with cardiovascular pathology and indicates a state of chronic stress. Th e level of ULF (%), which was already above the normal values in DT2 patients, was even higher in patients with arterial hypertension (p=0.0002, r=0.48), which is characteristic for the failure of vegetative regulation. In two patients from this group, the values of ULF (%) occupied almost the entire spectrum (76% and 91%). In both cases, patients died of heart failure for half a year despite active antihypertensive therapy. In the group of patients with arterial hypertension, activation of central ergotropic and humoral metabolic processes (VLF 31.5±7.3%) was observed, exceeding the value not only in the comparison group (p=0.001; r=0.37), but also standard

indices healthy individuals (28.6±11.2%).

Conclusion & Significance: The effect of HTN on metabolic homeostasis in patients with diabetes explains the reasons why it is difficult to achieve satisfactory compensation in patients with concomitant HTN and one of the mechanisms of progression of complications. The increase in IC (4.1±0.9) in the "DT2+HTN" group confirmed the high activity of the central contour of regulation in relation to the autonomic regulation. What, as a forecast factor, indicated depletion of regulatory mechanisms and a high risk of developing "vascular accidents" (OR=2.7, p=0.001).

Alyson Evans is currently working in Alimera Sciences MSL team, expanding her involvement in the Pharmaceutical industry having been in the nursing field for the past 10 years. Since she received her Undergraduate and Graduate degrees from Mount Carmel College of Nursing, she has practiced as an Adult Clinical Nurse Specialist for nearly 7 years. She has received a Doctorate of Nursing Practice Degree from the University of Cincinnati in 2014, conducting her own research project including the IRB process. She is fluent in research, evidence-based practice and interdisciplinary collaboration. Her unique background on patient care brings a new perspective to the MSL position with Alimera Sciences

Diabetes mellitus is an epidemic worldwide. Primary care providers, including advanced practice registered nurses, can play a vital role in both the treatment of the disease and prevention of complications, particularly diabetic macular edema. A working understanding of the disease process and early referral is of exceptional importance as well as long term treatment options their patients may receive from their Ophthalmologist. ILUVIEN® (fl uocinolone acetonide intravitreal implant) 0.19mg is an implant injected into the eye (vitreous) and used for the treatment of diabetic macular edema in patients who have been treated with corticosteroids before and did not have a significant increase in eye pressure. The implant can work for up to 36 months. To understand how the drug can improve vision and decrease edema, one must understand the pharmacokinetics of the drug as well as its lipophilic nature. Lipophilicity is the reason so little of the drug is required to achieve these results. Not all corticosteroids have the same lipophilicity, water solubility and tissue penetration. It is important for the primary care provider to appreciate the features of the drug and understand the implications of diabetic macular edema. Assertive, collaborative treatment imperative for this patient population to maintain vision through their life time.

Nihal M Elguindy has completed her PhD from Duke University, USA and continued her work in faculty of science in Alexandria University, Egypt. She has more than 10 years experience in the feild of treating or preventing diseases like, liver cancer, diabetes and obesity using natural products.

Curcumin, from the rhizomes of Curcuma longa, is characterized by its anti-diabetic and insulin -sensitizing activities. Curcumin has poor bioavailability that has been overcome in our research by using liposomes. Th is study aimed to measure the hepatic expression of glucose transporter-2 (GLUT-2) in high fat diet (HFD) induced type 2 diabetic rats, and to investigate the roles of liposomal curcumin in improving hepatic insulin resistance and glucose intolerance. In this study, we randomly divided Sprague-Dawley male rats into 6 groups: Control, high fat diet (HFD), treated HFD with oral curcumin (0.8 g/kg/3times/week), treated HFD with oral liposomal curcumin (0.03 g/kg/3times/week), treated HFD with subcutaneous liposomal curcumin (0.03 g/kg/3times/week) and treated HFD with interperitoneal liposomal curcumin (0.03g/kg/3times/week). Level of gene expression of GLUT-2, diabetic profi le parameters (fasting blood glucose level, serum insulin,HOMA-IR), rat weight, total cholesterol, triglyceride, HDL-C, LDL-C, liver function, kidney function, liver malondialdehyde, glutathione and catalase activity were measured in all groups. Feeding rats HFD for 8 weeks developed features of insulin resistance and type 2 diabetes. These features presented in decreased expression of GLUT-2 gene, increased body weight, hyperglycemia, hyperinsulinemia, hypercholesterolemia (with increased LDL-Cholesterol and decreased HDL-Cholesterol) and hypertriglyceridemia and decreased glutathione and activity of catalase. Curcumin (free and liposomal) treatment increased gene expression of GLUT-2, improved levels of diabetic profile parameters, lipid profile, liver and kidney function

and decreased oxidative stress. Our results suggested that curcumin (especially liposomal) is a unique natural medicine against insulin resistance in type 2 diabetes mellitus in rats.