OP. 1 The rapid rise in the prevalence of diabetes mellitusin Tunisia.

Radhia Bouguerra*, Leila Ben Salem*, Hugh Alberti, Chiheb BenRayana*, Jalila El Atti*, Béchir Zouari***,

(1) Institut National de Nutrition, Tunis, Tunisia(3) Department of Preventive Medicine, Faculty of Medicine, Tunis,

Tunisia

Aims: The prevalence of diabetes mellitus is known to be increasing worldwide but few population-based surveys have been undertaken in Africa or the Middle East. The aims of this study are to report the prevalence of diabetes mellitus and impaired fasting glucose in Tunisia, to compare the prevalence to previous studies undertaken in Tunisia in the early 1980s and to analyze the relationship between diabetes and age, sex, area of residency and body mass index .

Methods: We have used data from the Tunisian National Nutrition Survey, a cross sectional health study providing a large nationally representative sample of the Tunisian population including 3729 adults and was conducted in 1996 and 1997.We used the American Diabetes Association diagnostic criteria to determine the prevalence of diabetes mellitus(FPG) ³ 7mmol/l) and impaired fasting glucose as (an FPG ³ 6,1 mmol/l but < 7 mmol/l).

To compare the prevalence rates of diabetes between our survey and the study of Dr Ben Khelifa , we have used the same diagnostic criteria of fasting plasma glucose &#8805; 7.8mmol/l and we have adjusted both Populations to the 1995 world population .

Results: The crude overall diabetes prevalence was 9.9% (9.5% in men and 10.1 in women). 75% of those identified as having diabetes were undiagnosed. Higher crude prevalence rates of diabetes mellitus were observed in the urban(12.5%) compared to the rural population(5.6%) (p<0.0001). The prevalence of impaired fasting glucose was 5.3% (5.3% in men and 5.1% in women. Step wise logistic regression showed age of more than forty years, urban residency and high body mass index to each be significantly and independently related to diabetes prevalence. Using the same diagnostic criteria a marked increase of diabetes prevalence was observed when comparing our study with the previoussurvey by DrBen Khelifa and revealed a significant increase in all groups except for men in rural areas The increase was particularly striking among women living in rural areas where the prevalence increased from 0.74 in 1981 to 3.83 in 1996 (p<0.001).In urban areas, the prevalence increased from 4.03 to 8.73 in men (p<0.001) and from 3.77 to 9.97 in women (p<0.001). The mean body mass index of rural and urban women significantly increased between the two surveys. However rural men did not observe a significant increase of the mean body mass index during the time period.

Conclusions: Our study has demonstrated a high prevalence of diabetes in the adult population with a wide difference among the rural and urban areas. There has been a significant increase in diabetes prevalence in both men and women during the 15-year period between the two surveys. The prevalence of

1

diabetes mellitus has more than doubled in Tunisia over a 15-year period. The cause of the rising prevalence of diabetes is in part related to obesity.

OP. 2 Renoprotective effect of ACE inhibitors and Calcium Channel Blockers in

Hypertensive Nephropathy in Rats

Wael M.Yousef 1 ; Adel H. Omar1; Mohamed. D. Morsy2; Moshira M. Abd El-Wahed3; Naglaa M. Ghanayem4

1Department of Clinical Pharmacology, Faculty of Medicine, Menoufiya University, Egypt.2Department Physiology, Faculty of Medicine, Menoufiya University, Egypt.

3Department of Pathology, Faculty of Medicine, Menoufiya University, Egypt.4Department of Biochemistry, Faculty of Medicine, Menoufiya University, Egypt.

1Corresponding author address: Wael Mohamed Yousef, Department of Clinical Pharmacology, Faculty of Medicine, Menoufiya University, Egypt. E-mail address:

waelpharma@yahoo.co.uk.

Introduction & Aim: Diabetic hypertensive nephropathy (DHNP) is considered a major cause of illness and premature death in people with DM largely through accompanying cardiovascular diseases and end stage renal failure. Approximately 40% of the patient with type II diabetes will develop diabetic kidney disease while 30% insulin dependent diabetic patients are prone to DHNP after 25 years of the disease. The present study was designed to illustrate the role of ACE-I (Captopril) and CCBs (amlodipine and diltiazem) in prevention and treatment of DHNP in rats.

Materials & Methods: Sixty male albino rats weighing (130-180gm) were used in this study. These animals were subdivided into four equal groups. Insulinopenic diabetes was induced by STZ, three weeks later, animals with systolic blood pressure of 140 mmHg or more were considered hypertensive. Nephropathy was confirmed by elevation of serum creatinine above 1.2mg% and reduction of creatinine clearance below 1ml/min then treatment was started for 12 weeks. At the end of experiment urine samples and blood samples were taken for biochemical analysis and kidneys were taken after scarification for histopathological evaluation.

Results: DHNP produced a significant increase in rat weight, rat kidney weight, SBP, BUN (Blood Urea Nitrogen) level, K/B (Kidney/Body weight) ratio, random blood glucose, 24 hrs urine proteins, and 24 hrs urine volumes and creatinine clearance. Treatment by either ACE-I or CCBs significantly lowered elevated SBP and elevated 24 hrs urine volumes. Furthermore, treatment with captopril produced a highly significant lowering of elevated SBP and elevated serum creatinine; and a significant reduction in elevated K/B ratio and proteinuria. Light microscopic examination of diabetic kidneys revealed glomerulopathy characterized by thickening of the glomerular basement membrane, mesangial matrix expansion, arteriolar hyalinosis and large proteinaceous deposits occluding some capillary loops and hyaline droplets within the glomeruli. Moreover, examination of kidneys of DHNP animals by

2

light microscope revealed focal tubular necrosis at multiple points along the nephron, interstitial edema and accumulation of leucocytes within dilated vasa recta.

Conclusion: It can be concluded that, hypertension together with nephropathy that occur in DM could be controlled by using of ACE-I (Captopril) and CCBs (Amlodipine and Diltiazem) as they had a nephroprotective values that preserve or at least slow down the progression of DHNP. Recommendations: Based on the obtained results from the present study, one can recommend that; ACE-I might be considered the first line therapy for DHNP as its therapeutic and nephroprotective effects is still more obvious than calcium channel blockers

Key words: Diabetic Hypertensive Nephropathy, ACE-I, Calcium Channel Blockers, Diabetes Mellitus

3

OP. 3 Metabolic Syndrome and Cardiovascular Risk:

Treating the Clinical Spectrum

Mesbah Sayed Kamel . MD

We are in the midst of an epidemic of the metabolic syndrome and resulting vascular disease. Heralded by obesity and less vigorous lifestyles, this generation has the potential to be significantly impacted by vascular disease and its clinical sequelae.

Fortunately, this potential threat to health and well-being has been recognized. Efforts to make societal lifestyle changes are under way, which should help, particularly for the next generations. However, the present risk, conferred by genetics and magnified by lifestyle, is real and is growing as we all age. It is essential that we act now with effective means to blunt the impact of these metabolic derangements.

The growth in our understanding of the interrelationships of the many macrovascular risk factors has led to more effective means to slow the development of macrovascular disease. The role of insulin resistance at the core of this process has provided a clinical target for preventive interventions. Further, the recognition that the inflammatory process may underlie the development of vascular dysfunction has provided a mechanistic construct for the benefits of many of these treatments.

4

OP. 4 Effect of Co-Administration of Progesterone and B-Cell KATP Channels Blocker or Opener on Insulin

Esmaeel Barazandeh , Islamic Azad University, Karaj Branch, Iran.Rahim Ahmadi, Islamic Azad University, Hamedan Branch, Iran.

Background and Aims: Of clinical point of view study on the effects of sex steroid hormones on insulin resistance is important in treatment of related disorders. Therefore, the main purpose of the present study was to clarify the effects of progesterone on insulin resistance in rats. According the roles of pancreatic B-cells ATP-sensitive K+ (KATP) channels in insulin resistance, the effects of progesterone on pancreatic KATP channels were also studied.

Materials and Methods: Diazoxide (30mg/kg/day) or verapamil (100mg/kg/day) were used as pancreatic B-cell opener or blocker, respectively. Progesterone (20 mg/kg/day) was also used in female rats. The period of 4 weeks was considered for each experiment. After 4 weeks, serum glucose and insulin were measured and insulin resistance was compared statistically between the groups (ANOVA).

Results: Administration of progesterone, diazoxide or "progesterone+diazoxide" caused to decreasing but of verapamil resulted in increasing of insulin resistance (P<0.01). On the other hand, "progesterone + verapamil" treatment also caused to decreasing of insulin resistance (P<0.001).

Conclusion: Progesterone was an "insulin resistance reducer" hormone. Since progesterone prohibited the verapamil effect on insulin resistance, it seems that progesterone is a hormone which influences insulin resistance by its inhibitory acting on pancreatic KATP channels.

Key words: Insulin Resistance, Progesterone, KATP Channels, Diazoxide, Verapami.

5

OP. 5 The Utilisation of Cobalt Chloride As Agent ofGlycaemia Lowering in Experimental Diabetes

Zine Kechrid, , Noureddine BOUZERNALaboratory of Biochemistry and Microbiology application, Department of Biochemistry,

Faculty of Sciences, University of Annaba

To investigate the benefit effect of cobalt chloride for reducing blood glucose in experimental diabetes. Forty male wealing normal albino (Wistar) rats of 8 weeks of age were fed with a basal diet. Twenty rats (n = 20) were then intraperitoneally injected with alloxan to induce diabetes. Then after one week ten rats from each group (n = 20) were given 2 mM of CoCl2 in the drinking water for further two weeks. Body weight gain was recorded regularly. On day 21 after an over night fasting, animals were killed and concentrations of blood glucose, serum cholesterol, serum triglycerides, serum creatinine, serum urea, were estimated. Activities of serum glutamic oxalic transaminase (GOT), serum glutamic pyruvic transaminase (GPT) and serum alkaline phosphatase were also estimated.

The diabetic state had an effect on growth rate. However treatment with CoCl2 resulted no change in body weight gain. The administration of CoCl2 significantly reduced blood glucose, serum creatinine, serum urea concentrations and GOT, GPT. Whereas the activity of alkaline phosphatase was increased of diabetic rats compared to their control counterparts. We conclude that these results suggest that cobalt resulted in reduction of blood glucose (glycaemia), which is mediated, by reduction in the rate of systematic appearance of glucose and hepatic gluconeogenesis.

Key words: Diabetic rats, Glucose, GOT, GPT, CoCl2, gluconeogenesis

6

OP. 6 Hyperuricemia : A Diabetic Cardiovascular Risk Factors

Y. Benabbas, N. Kerrouaz; Y. Kitouni; N.Chorfa, L. Nezzal, D.RoulaService de médecine interne- CHU Constantine(Ageria)

The purpose of our study is to screen the possible relations between the frequency of cardio-vascular complications and the uricemia level in the diabetic patients, as well as to compare a control group of non diabetics

Material: The population included 256 patients which were recorded from the consultation of internal medicine and divided in two groups: the first group is made up of 152 diabetics (type 1: 66, type 2: 86) and the second group contained 104 non diabetic subjects (M: 43, F: 61). The subjects that were excluded from the study, were patients with renal failure, non diabetics treated

for a hyperuricemia and patients receiving drugs inducing hyperuricemia . Method: The method used for each diabetic patient was a list

sorted according to: age, type and duration of diabetes. Uricemia has been measured for all patients as well as checking renal function and lipids. We recorded the following complications: hypertension, coronary failure, myocardial infarction, stroke, limb arteriopathy and gangrene.Frequency of hyperuricemia was studied according to the complications, age, sex and duration

of diabetes .

Results: Hyperuricemia is occurred in 56% of diabetic patients and 41% of non diabetics (p<0.004), it appeared to be more frequent in type 2 (54%) than in type 1 (46%). It predominates in diabetic males (59%) which are type 2 in particular (67% vs 48%). At the same time it is more frequent in women in the control group (58%). Hyperuricemia is more frequent before 50 in type 1 diabetes (71%) compared to type 2 diabetes where this frequency is highest over the above period (92%, p< 0.001).

An increased level of uricemia occurred from the third year of the evolution of diabetes, 23% (p<10-4) of diabetics had this anomaly during this period. From the tenth year, it occurred approximately in 27% of the time. In the diabetic’s population, hyperuricemia is found in this order of frequency: arteriopathy (56%), hypertension (33%) and coronary failure (25%), compared to diabetics whom uricemia is normal and in the control group where such complications occurred at the following levels: 34% -16%, 20%-23%, and 14%-2% (P<0.004) . Moreover, type 2 diabetics are more affected than patients with type 1 diabetes.As well as whom uricemia is normal: (Arteriopathy: 69% 45% 34% ,

Hypertension: 38% 27% 20%, coronary failure: 31% 18% 14%).Ischemic cardiomyopathy is four times more frequent in the diabetic patients with hyperuricemia (8%) compared to diabetics with a normal uricemia (2%, p<0.004).

7

In any control group patient, hyperuricemia generally is not found. During stroke and gangrene, hyperuricemia is not significantly more frequent in the diabetic than in non diabetic .

Conclusion :Among cardiovascular risk factors, Hyperuricemia seems to be specific for the arteriopathy, particularly in type 2 diabetics.

Key words: diabetes, hyperuricemia, cardiovascular risk factors

8

OP. 7 Structural & biochemical effect of two antihypertensive drugs (captopril& nifidipine) & garlig on the progression of

experimentally induced diabetic nephropathy

mohamad sh abdulla MB,Ch,B.mrcp(uk) assistan dean medicalcollege .tikrit university iraq

abdullkareem salm assistant prof anatomy departement medicalcollege tikrit university tikrit iraq

The aim of this study is to investigate structural & biochemical effect of two antihypertensive drugs (captopril& nifidipine) & garlig on the progression of experimentally induced diabetic nephropathy by:

1:Studying the structural & morphological changes that accompanied DM

nephropathy.

2:Studiyng the biochemical changes that accompanied DM nephropathy.

3:Studying the therapeutic effect of antihypertensive used in this work.

4:Studying the morphological & biochemical relationships during DM

nephropathy with & without treatment.

5 :Studying the effect of garlic on the expected deterioration which occur in the

diabetic kidney.

A total of (360) male Sprague Dawly rats were used. They were classified into 3 main groups according to the type of hypoglycemic drug used (insulin, glibenglmide & Garlic).

Each group then is subdivided into 3 subgroups, 1 as positive control , it was given hypoglycemicwithout any other treatment.2 given hypoglycemic +

nifidipine 3 given hypoglycemic + captopril , another group was considered as a negative control these are DM animals without treatment.

It has been found that both captopril & nifidipine showed a good preservation of s.albumin.Captopril has the best preservative effect in

maintaining normal Burea.Insulin was shown to be better than glibenglamide & garlic regarding therapeutic effects. In this study we found that there are certain structural & functional altrations that result from DM .these can be suppressed

by using antihypertensves, the two drugs used showed an equal effect on slowing interstitial fibrosis,lowring the rate of glomrular hypertrophy& mesangial

matrix expantion.The most important finding is the prevention of basement mambrane thickening & hyalanosis of glomeruli.Also garlic in combination with

antihypertensves could have a synergistic action in preventing lesions of DM nephropathy .

9

OP. 8 The Effect of Estradiol on Insulin Sensitivity and Diabetes

Mehrdad Kassaee, Islamic Azad University, Hamedan Branch, Iran.Rahim Ahmadi, Islamic Azad University, Hamedan Branch, Iran.

Background and Aims: Various clinical observations and experimental data from in-vitro studies suggest that insulin and sex hormones interact. Steroid sex hormones significantly contribute to endocrine modulation of insulin secretion and sensitivity, however, whether sex steroids have a physiological role in regulating insulin sensitivity remains an intriguing question. The aim of this study was to study the effects of estradiol administration on insulin sensitivity in rats.

Materials and Methods: Estradiol valerate (200 g/kg/day) was injected subcutaneously. Bi-ovariectomy was performed by using standard methods. After 4 weeks, blood samples were collected by cardiac puncture technique, 24h after the last treatment. Insulin sensitivity (glucose/ insulin ratio) was compared statistically between the groups (ANOVA ).

Results: Bi-ovariectomy caused to increasing of insulin sensitivity (P<0.01) but estradiol replacement resulted in decreasing of insulin sensitivity compared with bi-orariectomised rats (P<0.05). Estradiol administration also resulted in decreasing of insulin sensitivity in non-ovariectomised rats (P<0.01).

Conclusion: Based on our findings, estradiol was insulin sensitivity reducer in, and this is why that ovariectomy caused to increasing of insulin sensitivity estradiol replacement prohibited the increasing of insulin sensitivity in gonadectomized rats. Conclusively, estradiol plays an important role in insulin sensitivity and thus, diabetes.

Key words: Insulin sensitivity, Estradiol, Ovariectomy

10

OP.9 Reduce Risk of Cardiovascular Disease in Diabetic Patient's

Hanan Sobah Sobah, Ph,D

Lecturer of Medical Surgical NursingFaculty of Nursing, Ain Shams University

Exercise is extremely important in the management of

diabetes because of its effects on lowing blood glucose and reducing

cardiovascular risk factors. Exercise lowers blood glucose by increasing

the uptake of glucose by body muscles and by improving insulin

utilization. It also improves circulation and muscle tone. Resistance

training can increase lean muscle mass there by increasing the resting

metabolic rate. These effects are useful in diabetes in relation to losing

weight, easing stress, and maintaining a feeling of well-being .

Exercise also alters blood lipids, increasing level of high-

density lipoproteins and decreasing total cholesterol and triglyceride

levels. This is especially important to the person with diabetes because of

the increased risk of cardiovascular disease .

11

OP.10 Effects of Maternal Diabetes on Brain Development and Cognitive Functions

Giyasettin Baydas 1 , Nusret Sırma2, Ramis Çolak2, Yusuf Ozkan2, Emir Dönder2,Mehmet Tuzcu3, Sema T.Koz1

Departments of 1Physiolology, 2Internal Medicine and 3Biology, Faculty of Medicine, Firat University, 23119 Elazig, TUEKEY

Gestational diabetes has been associated with an increased risk of

congenital malformation in the offspring. However, little is known about the

effects of maternal diabetes on the brain maturation. We have therefore

compared the levels of brain cytoskeletal protein (glial fibrillary acidic protein:

GFAP) and learning performance in offspring of diabetic dams. Diabetes was

induced in adult female Albino rats by injection with streptozotocin (STZ; 40

mg/kg body weight). Blood glucose levels were measured two days after the

injection of STZ. Only rats with glucose levels greater than 200 mg/dl were used

in the diabetic groups. Females of diabetic and control groups were then mated

to untreated male rats. Pups from control and diabetic mothers were divided into

two groups. One group was decapitated after birth to determine brain GFAP

levels using immunoblotting test and other pups were tested in Morris water

maze to assess differences in learning and memory performance at the 75 days of

age. GFAP levels significantly reduced in pups from diabetic dams compared to

the control values, suggesting delayed astrocytic differentiation. Furthermore,

pups from diabetic mothers showed poorer performance in water maze test. In

conclusion, present findings suggest that uncontroled diabetes lead to delayed

brain development and cognutive deficits.

*This work was supported by the Firat University Research Foundation (FUBAP-1135)

12

OP.11 Technological Advanced in Caring of diabetic Patient

Susan Mohamed Dessowky Ph,D and Jackleen Fahim Gendy, Ph,D

Diabetes Mellitus is multisystem disease related to abnormal insulin

production, or impaired insulin utilization. So, it considered a serious health

problem throughout the world, because technology have a strong influence on

care of diabetic patients, so technological advance have a special relevance for

those patients it integrated in all aspect of managing diabetes as nutritional, drug

therapy exercise, and self-monitoring of blood glucose, many new measures

researched for managing of diabetes as pancreas transplantation, pancreatic is

let cell transplantation is another potential treatment measure although it still an

experimental procedure, also many new insulin delivery systems are being

researched but not approved yet these includes: inhaled insulin, skin patch

containing reservoir of insulin, oral spray and insulin pills.

13

OP.12 Glucose Uptake at The Insulin resistanceZulaykho Shamansurova

Institute of Endocrinology, Tashkent, Uzbekistan

Background and aim. Recent in vestigations suggested that tissue glucose uptake are increased at the diabetes mellitus (DM) and hyperglycemia state, such as impaired glucose tolerances (IGT), obesity (O), polycistic ovarian syndrome (PCOS), Grave disease (GD). Glucose uptake in whole body may be calculated during the oral glucose tolerance test (OGTT). But various tissues has differ glucose uptake properties and according this devised on insulin sensitive (muscle, adipose, liver) and insensitive (others) tissue. There relationship between tissue glucose uptake and insulin resistance presented the aim of investigation.

Material and methods. Glucose uptake was measured in separated and washed erythrocytes from vein blood taken from 78 subjects. 16 with DM, 17 with O, 11 with IGT, 11 with GD, 11 with PCOS and 10 healthy subjects among them. Glucose uptake was calculated as difference of glucose in media before and after incubation of erythrocytes, insulin resistance was calculated by fasting glucose, fasting insulin and they relation to 22.5 as HOMA index.

Results. Glucose uptake were increased in DM patients on 2.2 time (P<0.05), in O group on 1.7 time (P<0.05), in IGT on 1.9 time (P<0.05), in GD on 1.5 time (P<0.05), in PCOS on 1,6 time (P<0.05) than healthy subjects. HOMA index was increased at the DM group on 2.9 time (P<0.05), on IGT on 2.2 time (P<0.05), in O group on 1.8 (time), in GD on 1.6 time (P<0.05), in PCOS on 1.8 time (P<0.05) than healthy subjects and shown positive correlation with glucose uptake in all groups.

Results. Erythrocytes glucose uptake increased at the hyperglycemia states such as DM, IGT, O, GD, PCOS and correlated with HOMA index and may reflected the degree of the carbohydrate abnormalities.

14

OP.13 Type 2 Diabetes in Children and Adolescents

SOHAIR ABDEL-RAHMAN"Institution Organization" KING FAHD MEDICAL CITY,RIYADH"

WHAT IS THE CLASSIFICATION OF DIABETES IN CHILDREN?

WHAT IS THE EPIDEMIOLOGY OF TYPE2 DIABETES IN

CHILDREN?

WHAT IS THE PATHOPHISIOLOGY OF TYPE2 DIABETES IN

CHILDREN?

HOW SHOULD CHILDREN WITH TYPE2 DIABETES BE

TREATED?

CAN TYPE2 DIABETES IN CHILDREN BE PREVENTED?"

15

OP.14 A Critical Review of Patient Reported Type 2DiabetesService Quality Indicators

Jafar Sadegh Tabrizi"Authors: Jafar S. Tabrizi1, Andrew Wilson2 and Terry Coyne31,3) School of Population Health, the University of Queensland,

Brisbane, Queensland, Australia2) Faculty of Health Science, the University of Queensland, Brisbane,

Queensland, Australia

Objectives. To determine what measures of service quality for diabetes can be based on patient report and to assess the most appropriate methods for ascertaining them.

Method. A critical review of the literature from 1960 to June 2005,based on a systematic search of MEDLINE and PUBMED and references in the recently published articles. strategy identified 203 published articles (qualitative and quantitative studies) on quality of care for people with Type 2 diabetes.

Results. 203 potential articles were identified. Of which only ten articles were found to be relevant to the topic. These ten papers report results of surveys of patients.

Conclusion. The potential service quality factors from Type 2 diabetic patients’ perspective were: timeliness, confidentiality, continuity,dignity, communication, access, education, cost and autonomy. The most appropriate approach to evaluate patients’ perception was combining qualitative and quantitative methods for achieving comprehensive outcomes with high validity and reliability.

Key words. Type 2 diabetes; qualitative research; quantitative research; quality of care; service quality; patients’ perspective.

16

OP.15 Purpose Diabetes mellitus is a global health problem;retinopathy and neuropathy are two common complications of

diabetes

Abdollahi Ali (Iran)

The aim of this study was to evaluate correlation between diabeticretinopathy (DR) and diabetic neuropathy (DN) in type 2 diabetesmellitus

Patients and method:In a cross sectional single blind study 100 patients with type 2

diabetes (49 males, 51 females) were studied. Evaluation of peripheral neuropathy was based on clinical symptoms (neuropathic symptom score).Retinopathy was evaluated by indirect ophthalmoscopy.

Results:Prevalence of neuropathy in patients were72 % and retinopathy

was diagnosed in 72% of patients (69.9% NPDR, 30.1% PDR)

In total 72 patients had retinopathy, of whom 58 patient had neuropathy (P=0.019)

ConclusionNeuropathy are coexist with retinopathy in diabetes mellitus type 2

but dose not coexist with type of retinopathy

17

OP.16 Diabetic retinopathy; the conjoint responsibility of physician and ophthalmologist

Dr. Tarek Ahmed El-Mamoun; MD., FRCS.Assistant professor of ophthalmology, Ain Shams University

Diabetes is the commonest cause of blindness in the working age group (25 – 75 years). Diabetic people suffer from permanent irreversible visual disability 20

times the non diabetic people. Very important questions should be answered: Does diabetic control help to reduce the risk of blindness? Does the physician have a role in prevention of diabetic retinopathy? When the physician has to refer the patient to the ophthalmologist? What is the laser treatment of diabetic retinopathy and what else the

ophthalmologist have to do? Does the non experienced ophthalmologist help or add to the problem?

18

OP.17 Diabetic Cataract, Can We Do Better?

Dr. Tarek Ahmed El-Mamoun; MD., FRCS.Assistant professor of ophthalmology, Ain Shams University

Diabetic people suffer from cataract much more than the non diabetic people. Also cataract occurs in younger age. Also serious complications can occur after

cataract extraction, such as infection and rapid deterioration of diabetic retinopathy. How can we adopt the modern modalities of treatment in order to

reduce the rate of complications, and maintain a normal life style to our patients without any form of disability .

19

OP.18 The prevalence of type 2 diabetes mellitus in children and adolescent in Tunisia: a population based study.

Radhia Bouguerra*,Hayet Ben Amara, Leila Ben Salem*, Chiheb Ben Rayana*, Jalila El Atti*, Béchir Zouari,***

)1 (Institut National de Nutrition, Tunis, Tunisia)3 (Department of Preventive Medicine, Faculty of Medicine, Tunis, Tunisia

Aims: The prevalence and magnitude of childhood obesity are increasing in the world. We examined the prevalence of type 2 diabetes and the effect of

varying degree of obesity on the prevalence of type 2 diabetes mellitus in a large nationally representative sample of children and adolescents in Tunisia .

Methods:. We have used data from the Tunisian National Nutrition Survey, a cross sectional health study providing a large nationally representative sample

of the Tunisian population and was conducted in 1996 and 1997 including a total of 3543 children The T.N.N.S included 1792 children (988 girls and 804

boys) from 10 years to 19 years at the time of T.N.N.S for whom anthropometrics measurements (body weight, height,) blood measurements

(fasting plasma glucose, total cholesterol, triglycerides) were recorded. In children and adolescent we used the American Diabetes Association diagnostic

criteria to determine the prevalence of diabetes mellitus and impaired fasting glucose. In children and adolescent the definition of obesity were based on sex and age specific 95th body mass index percentile respectively derived from the

U.S.A first National Health and Nutrition Survey .

Results: A total of 20 children or adolescent in the sample were considered to have diabetes. There were two children with already known type 1 diabetes mellitus( reported using insulin). The crude overall type 2 diabetes prevalence

was1.1% . The prevalence was 0.5% in urban and 1.9% in rural boys and was 0.9% in urban and 1.4% in rural girls. The prevalence of impaired fasting

glucose were found in (3.3% urban, 4.1% rural) boys and in (4% urban, 2.8% rural) girls. The prevalence of obesity was higher in girls(2.6%) than in boys

(1.7%)particularly among those 10 years old (p<0.0001). The prevalence of obesity is significantly higher in urban communities (2.2% in boys, 3.1% in girls)

than in the rural ones (0.7% in boys, 1.5% in girls) (p<0.0001). We did not observe an increase of the prevalence of type 2 diabetes with the body mass index

in the 95th percentile or higher .

Conclusions: Our study has demonstrated a low prevalence of type 2 diabetes and obesity in the children and adolescent population but a high

prevalence of. impaired fasting glucose. The sample size was not large enough to obtain precise prevalence estimates because of the relatively low prevalence .

20

OP.19 Study of The Effect of Cooked Beans As A Popular Egyptian Meal on Blood Glucose and Insulin

Levels in Diabetics :The Value of Addition of Oil

HANI NAGUIB SULTANATE OF OMAN"

Since several years, the hypothesis of Burkitt and Trowell have stimulated a great deal of interest in dietary fibre , its physiological effects and its possible role in prevention and management of diabetes mellitus. Moreover, Karlstrom et al , 1987 reported that a moderate amount of leguminous seeds in the diabetic diet resulted in improved diabetic control in D.M.type 2 patients compared with a control diet with the same contents of energy, protein ,fat and carbohydrate .

The objective of this study: was to determine the effect of cooked beans as a popular Egyptian breakfast on the blood glucose and insulin level in D.M. type 2 patients before and after addition of corn oil . Also the effect of addition of proctofibe to that Egyptian meal .This work was carried on 3 groups each of 10,

First group of D.M. type 2 patients was given cooked beans and cooked beans with oil.

Second group of D.M. type 2 was given cooked beans and cooked beans with fiber .

Third group control subjects was given cooked beans and cooked beans with oil .

Each patient was subjected to full history taking , clinical examination and routinelaboratory investigations .

An oral carbohydrate tolerance curve was performed After an overnight fast , the test was performed with 480 gm of cooked beans equivalent to 75 gm carbohydrates on one occasion and on the next day the same procedure was repeated after addition of three table spoonfuls of oil . Beans will be eaten with 159 gm of whole meal bread i.e. mixed flour .

Each time venous blood was withdrawn from previously fixed cannula , before eating (0 time ) and after 30 , 60 , 90 , 120 and 180 minutes . Plasma will be stocked at-20 & ordm; C to perform insulin level by radioimmunoassay .

Also effect of addition of 6 tablets of high fibre preparation . Each tabletcontains 375 mg of cereal bran fibre and 94 mg of citrus fruit fibre . In group &#1030; : ( D. M. type 2 patients receiving cooked beans and effect of addition of corn oil ) . Non significant change in the percent increment rise of blood glucose and plasma insulin before and after addition of corn oil denoting that oil has no effect on the blood glucose nor plasma insulin , in contrast improves the plasma cholesterol level in these diabetic patients .

In group II : (D.M.. type 2 patients receiving cooked beans and effect of addition of proctofibre ) . Significant reduction in the percent increment rise of blood glucose and insulin level at 2 points (60, 90 minutes )

The observed reduction in the mean increment rise of blood glucose after addition of fiber to carbohydrate loading , could not be explained by a proportional increase in serum insulin levels , as the serum insulin level was also

21

reduced by the addition of fibre . The effect of fibre in improving the carbohydrate tolerance is uncertain, but it is most likely due to slower carbohydrate digestion and /or absorption , or directly through its effect on glucose metabolism .

In group III : ( Control subjects receiving cooked beans and effect of addition of corn oil ). Significant rise in the percent increment changes of blood glucose and insulin level at 120 , 180 minutes after addition of corn oil . This elevation in the incremental change which occurred late in the curve is still uncertain and needs further studies

CONCLUSION 1- Addition of corn oil which is formed of poly-unsaturated fatty acids to a

meal of a non insulin dependent diabetic patient is not harmful and did not alter the plasma glucose and insulin level , in contrast it is very beneficial since it decreases the plasma cholesterol level , delaying atherosclerosis which is one of the major complication of diabetes .

2- Acute addition of high fiber diet ( proctofibe ) to the complex carbohydrate diet resulted in a significant decrease in the mean increment rise of blood glucose and insulin level . This is very important in the regulation of diabetic diet .

3- The use of small amount of supplemented fibre in the present study , has resulted in significant improvement in glucose tolerance in diabetic patients . The amount used is convenient to take and could be mixed with other foods .

4- It may be beneficial to induce complex carbohydrates to be used in the diet in order to control the post prandial plasma glucose and insulin level .

5- As there is a spectrum of post prandial blood glucose responses to different complex carbohydrate , so it is clear that we need a system that allow us to make

1. dietary recommendations on the basis of the expected biological responses to a food . So , it is wise to use the glycemic index to characterize foods , which is based on the blood glucose response to a food in comparison with the response to an equivalent amount of glucose .

6- In order to be of clinical help , our results must be observed after chronic ingestion.

22

OP.20 Patterns of Cardiovascular metabolic

Syndrome in Ismailia, Egypt.

Gamela M.A.Nasr ,Hussein Garmouzy , Ahmed El Hawary and Fathi Maklady.

Department of Cardiology, Faculty of Medicine, Suez Canal University.

Background and aim: Cardiovascular dysmetabolic syndrome (CDS), dysmetabolic syndrome, syndrome X, DROP syndrome (dyslipidemia, insulin resistance (IR), obesity, and high blood pressure) and IR syndrome are all synonymies for the syndrome characterized by four critical elements: atherogenic dyslipidemia, IR, central obesity, and high blood pressure. The aim of the study was to describe the prevalence and demographical, clinical and laboratory characteristics of patients of cardiovascular dysmetabolic syndrome in Ismailia.

Methods: A descriptive, cross-sectional, hospital based study in which, 1250 patients, mean age (52 years + 7), (688 men and 562 women) who attended Suez Canal university (SCU) outpatient clinic of cardiology and diabetes were screened for CDS criteria. Those who met the dysmetabolic syndrome criteria were subjected to careful history taking, blood pressure measurement anthropometric measures (Height and weight, body mass index, waist circumference). ECG and Blood samples: (Na and K, Fasting blood sugar (FBS), random blood sugar (RBS), 2 hours post prandial blood sugar (PPBS), fasting plasma insulin (FPI), serum creatinine (S.Cr.) and Lipids were measured . HOMA-IR was assessed according to the level of FBS and FPI (normal values from 5-15 um/ml), which was measured with a dextran-charcoal

radioimmunoassay. Serum intact pro-insulin was measured by using a highly specific, 2-site monoclonal antibody-based method.

Results: Two-hundred fifty patients (20%) from (1250) had fulfilled the criteria of CDS: (120 men, 18% from the screened 688 men) and (130 women, 23% from the screened 562 women). This means that the overall prevalence of CDS is (20%) among patients attended SCU hospital. One hundred forty five patients (58%) had the four criteria of CDS (central obesity, hypertension, DM or IGT and dyslipidemia). While (105) patients (42%) had three criteria in the form of (central obesity, hypertension and DM or IGT in 30% of patients) and (central obesity, hypertension and dyslipidemia in 12% of patients). Most of parameters of insulin resistance (IR) were higher in females than males, fasting plasma insulin, PPBS and HOMA-IR :( 26 vs. 21 uU/mL), (160.8 vs. 151 mg/dl), and (10 vs. 8.5) respectively, (P value less than 0.05). In addition, waist circumference and BMI were higher in females than males, (125 vs 122 cm) and (42.7 vs 38.8 kg/m2) respectively, (P value less than 0.05).HDL were higher in females than males (43 vs. 39 mg/dl) respectively, with statistical significant difference (P value more than 0.05).Total body obesity (BMI) and central obesity (waist circumference) had a statistically significant direct correlation relation

23

with fasting plasma insulin, HOMA-IR, HDL, TG, FBS and PPBS (P value less than 0.05).Central obesity alone had a statistically significant direct correlation relation with serum uric acid, (P value less than 0.01).Total body obesity (BMI) had a statistically significant direct correlation relation with systolic and diastolic blood pressure (P value less than 0.05).Central obesity (waist circumference) had a statistically significant direct correlation relation with diastolic blood pressure (P value less than 0.05).Patients with family history of DM had higher BMI, waist circumference, FBS, PPBS, fasting plasma insulin, TG and a lower HDL than patients without family history of DM (P value less than 0.05). Also, CDS started at early age in those patients (mean age 47.6 years old + 5.4) versus (mean age 52 years old + 7) in patients without family history of DM, (P value less than 0.05). Patients with CDS and family history of hypertension had higher BP, BMI, waist circumference, TG and lower HDL than patients without family history of hypertension, (P value les than 0.05).

Conclusion: Cardiovascular dysmetabolic syndrome(CDS) is a serious problem affecting(20-24%) worldwide and (19-23%)in Egypt .In our study it was estimated to be 20%..There is a pressing need for a national preventive program to combat obesity, diabetes and related comorbidities by general practitioners and diabetologists

Key words: CDS, atherogenic dyslipidemia, IR, central obesity, and hypertension and insulin resistance

24

OP.21 Dietary Changes for People with Diabetes Fasting Ramadan

Suhail S. Kishawi, MoH Advisor in Endocrinology & Diabetes, Head of Medical Department, Shifa Hospital, Gaza Palestine

Fasting during Ramadan constitutes one of the five pillars of Islam. Religious counselling, most of the time, is based on the health status of the person who wishes to fast and the main issue is not to inflict harm to our own body. Despite being exempt, people with diabetes often have irresistible desire to fast Ramadan. Therefore for those who insist to fast, they should be provided with all necessary instructions including dietary advice. It is important that healthcare professionals should have evidence-based practice and closely liaise with their patients to ensure Muslims who have diabetes and are fasting do so as safely as possible.

During Ramadan there is a major change in the dietary pattern and meal pattern compared with other times of the year. There are only two meals a day –Suhur (early morning meal before dawn) and Iftar (break of fast after sunset). As well as fasting between dawn and sunset, large quantities of sugary fluids, such as canned juices and carbonated drinks, together with fried foods and carbohydrate-rich meals are taken during the non-fasting hours.

Most health problems are likely to arise from inappropriate diet or as a consequence of over-eating and insufficient sleep. Longer gaps between meals and greater amounts of foods – in particular a higher intake of carbohydrate – mean people with diabetes may experience large swings in blood glucose levels during Ramadan. Therefore the nutritional advice for the people with diabetes should be tailored and accommodated accordingly putting into consideration their special needs and medical problems.

For healthy individuals there is no need to consume excess food at iftar or suhur. The reasons for this are two-fold. First, such a lifestyle contradicts the principal aims and spirit of Ramadan. Secondly, the body has regulatory mechanisms that reduce the metabolic rate and ensure efficient utilization of body fat. Furthermore, most people assume a more sedentary lifestyle while fasting. The net result is that a balanced diet, which consists of less than the normal amount of food intake, is sufficient to keep a person healthy and active during the month of Ramadan. Therefore people with diabetes should follow these rules more than other individuals and definitely will benefit them especially Type 2 patients.

To remain healthy during Ramadan, one should consume food from the major food groups: bread and cereal, milk and dairy products, fish, meat and poultry, beans, vegetables and fruits. Intake of fruits after a meal is strongly suggested. Diet in Ramadan should not differ much from the normal diet and should be as simple as possible. The diet should be such that normal weight is maintained, neither losing nor gaining. However, if one is overweight, Ramadan is an ideal time to try to normalize one's weight. Underweight or marginally normal weight people are discouraged from loosing weight. Dietary indiscretion during the non-fasting periods with excessive gorging or compensatory eating of fatty foods and

25

carbohydrate contributes to the tendency of towards hyperglycemia and weight gain.

In view of the long hours of fasting, the so-called "complex carbohydrates" or slow digesting foods (slow energy release foods) should be consumed at Suhur so that the food lasts longer (about eight hours) resulting in less hunger during the day. These complex carbohydrates are found in foods that contain grains and seeds like barley, wheat, oats, millet, semolina, beans, lentils, whole wheat flour and unpolished rice. In contrast, refined carbohydrates or fast-digesting foods (quick energy release foods) last for only three to four hours and may be better taken at Iftar to restore blood glucose levels rapidly. Dates are an excellent source of sugar, fiber, carbohydrates, potassium and magnesium and have been recommended since the days of the Prophet Mohammed (PBUH) as a good way of breaking the fast.

Relevant details will be presented and be available in a full paper.

26

OP.22 Prevalence of Diabetes Mellitus in Adult in Rafsanjan .2002

Salem Zinat (MS), Neshat Ali (MD), Bagherian keivan (MD),Sheikh Fathollahi Mahmood (MS), Sajjadi Mohammad Ali(MD)

Department of social Medicine, medical faculty.

Background: Diabetes mellitus (DM) is the most widespread metabolic disease and a major risk factor of coronary heart diseases. Life expectancy is reduced up to 25% in type II diabetic patients. The present study was planned to determine the prevalence of DM in Rafsanjan in the year 2001

Materials and Methods: This survey was a cross sectional study that carried out on 30 year-old people and above who reside in Rafsnajan. By the stratified random sampling technique the number of 756 people were selected and entered into the study. A questionnaire which has been already designed was completed by interviewing the subjects. Anthropometric indices were also measured. A fasting blood sample was drawn and criteria of ADA was used for diagnosis of diabetes mellitus . Obesity was determined by body mass index ( BMI ).Data analyzed by SPSS(12) software .Variables were showed as mean +_ standard deviation . In order to investigation the association between variables x2 test was used

Results: The findings showed that the point prevalence of diabetes mellitus was 19.1 %ADA Criteria in Rafsanjan city. It should be also noted that the DM prevalence was higher in women then mem. Moreover, 18.4% of obese and 13.5% of overweight people had DM. The prevalence of the DM increased by increasing the age of the subjects. However, this association was not significant. There was a significant association between diabetes mellitus and women’s job (P=0.005).

Conclusion: This study indicated that prevalence of diabetes could be considered as a health problem in this city. The extent of this problem justifies implementation of an interventional approach on the people’s lifestyle.

Keywords: Diabetes Mellitus, Rafsanjan, Prevalence.

27

OP.23 Clients’ perspective on service quality measure forType 2 diabetes

Authors: Jafar S. Tabrizi1, Andrew Wilson2 and Terry Coyne31,3) School of Population Health, the University of Queensland,

Brisbane, Queensland, Australia2) Faculty of Health Science, the University of Queensland, Brisbane,

Queensland, Australia

Objectives: To explore the needs, expectations, feelings and experiences with the health care system of people with type 2 diabetes.

Methods: A qualitative method of Focus Group Discussion (FGD) was used to find the service quality indicators from the perspective of people with Type 2 diabetes. Two FGs have been carried out with 33 people with Type 2 diabetes with collaboration of Diabetes Australia – Queensland branch (DA-Q). Participants have been recruited from the membership file of DA-Q.

Results and Conclusion: The results of this study identified fourteen potential factors as the most important service quality indicators from the perspective of people with Type 2 diabetes in Australia situation. These factors included availability and access; choice of health care providers; continuity; prevention and early detection; dignity, respect and caring; timeliness and prompt attention; safety; autonomy; communication; confidentiality; quality of basic amenities; education; support groups and diet.

Key words: Type 2 diabetes, service quality measure, quality indicators, focus group discussion and qualitative study.

28

OP.24 Correlation of HbA1c and outcome of pregancy inInsulin dependent diabetic women

Farideh Akhlaghi MD, Reza Rajabian MD, Fatemeh Talebi

OBJECTIVE: To investigate correlation of maternal, perinatal, and neonatal outcomes of pregnancy with mean of HbA1c in insulin dependent diabetic women.

METHODS: This prospective study was performed in thirty one of insulin dependent diabetic women who cared in Khorasan diabetic research center between October 2003 to October 2004 . Age, parity, duration of diabetes, mean blood glucose, mean HbA1c and type of delivery in this women were assessed. Maternal , perinatal and neonatal outcome were studied and analyzed.

RESULTS: Mean age of women was 24.5 years. 41.9% women were primigravid. Obstetrical history including abortion, preterm labor, still birth, macrosomia and live born were studied. The mean of HbA1C determined ( Once in each trimester) and Patients were divided to 4 groups. In 41.9% of cases HbA1c was equal or above 10%, and 12.9% were in normal range between 4.6-7.6%. The correlation between HbA1C and abortion, anomalies, macrosomia, still birth, hypocalcemia, hypoglycemia, respiratory distress syndrom and maternal complications including pre-eclampsia, polyhdroamnious, preterm labor, diabetic retinopathy and type of delivery were studied. In most complicated cases HbA1c was above normal ( statistically not significant) and correlation between HbA1c and preterm labor was significant (P < 0.001).

Conclusion: Correlation between HbA1c and fetal/neonatal and maternal complications is important. Probability of abortion, congenital malformations, macrosomia, fetal death, neonatal hypoglycemia, pre-eclampsia, polyhydroamnius, preterm labor and diabetic retinopathy increased in HbA1c greater than normal.

Key words: Insulin dependent diabetes , HbA1c, fetal complications, neonatal complications, maternal complications.

29

OP.25 Diabetes mellitus :the value of preconception counseling

Amal Talaat, Obstetric ,Ph,D, Ain Shams University

Diabetes mellitus is an excellent example of how preconception counseling can influence the out come of pregnancy. Blood glucose control in the first few weeks of pregnancy can reduce the risks of congenital anomalies and miscarriage to that of the non diabetic pregnant women, blood glucose control late in pregnancy can reduce he risks of macrosomia. preconception counseling also allows the care providers to address complications of diabetes mellitus and review medications being taken for those condition. finally, preconception counseling provides an a venue for education on this important disease as it impacts one's life .

30

OP.26 Diabetes and SexualityNevien Samier, Obstetric ,Ph,D, Ain Shams University

NO-----------Abstract

31

OP.27 Gender Effect on Insulin ResistanceSamaneh Soltani, Tehran University of Medical Sciences, School of

Allied Medical Science, Iran .Rahim Ahmadi, Islamic Azad University, Hamedan Branch, Iran.

Background and Aims: Sex steroid hormones significantly contribute to endocrine modulation of insulin resistance. Study on the gender effects on insulin resistance is important from clinical point of view, since the results can be applied as therapeutic considerations. The main aim of this research was to study the gender effects on insulin resistance in rats.

Materials and Methods: Female rats were divided into control, uni- and bi-ovariectomised and estradiol receiving bi-ovariectomised animals. Male rats are also divided into control, uni-orchidectomised, bi-orchidectomised and testosterone receiving bi-orchidectomised animals. The period of 4 weeks was considered for each experiment.Estradiol valerate (200 g/kg/day) was injected subcutaneously and testosterone (50mg/kg/day) was injected intraperitoneally After 4 weeks, blood samples were collected by cardiac puncture technique, 24h after the last treatment. At last, serum glucose and insulin were measured and insulin resistance was compared statistically between the groups (ANOVA ).

Results: Insulin resistance was significantly more in female animals compared with males (P<0.01).Gonadectomy caused to decreasing of insulin resistance (P<0.001),however, there was no significant difference between insulin resistance of uni- or bi-ovariectomised female rats and uni- or bi-orchidectomised male animals. Testosterone replacement in male and estradiol replacement in female rats both resulted in increasing of insulin resistance (P<0.01) but there was no significant difference between these groups.

Conclusion: Based on our findings, sex steroid hormones play a pivotal role in insulin resistance of male and female animals and there are gender effects on insulin resistance. Since there was no significant difference between insulin resistance in male and female gonadectomised animals, gender effects on insulin resistance are basically caused by gonadal hormones

Key words: Insulin resistance, Gender effect, Estradiol ,Testosterone

32

OP.28 Type 2 DM :Stop the Progression: New Approaches to Early Aggressive Combination Therapy

Mesbah Sayed Kamel . MD

There is a rational to combat the multifactorial aspects of type2 DM TO STOP THE progression of the disease and its hazardus complications

and negative impacts on life.

33

OP.29 Effect of Some Calcium Channels Blockers in Experimentally induced Diabetic Nephropathy in

rats

Wael M.Yousef 1 ; Adel H. Omar1; Mohamed. D. Morsy2; Moshira M. Abd El-Wahed3; Naglaa

M. Ghanayem4

1Department of Clinical Pharmacology, Faculty of Medicine, Menoufiya University, Egypt.2Department Physiology, Faculty of Medicine, Menoufiya University, Egypt.

3Department of Pathology, Faculty of Medicine, Menoufiya University, Egypt.4Department of Biochemistry, Faculty of Medicine, Menoufiya University, Egypt.

1Corresponding author address: Wael Mohamed Yousef, Department of Clinical Pharmacology, Faculty of Medicine, Menoufiya University, Egypt. E-mail address:

waelpharma@yahoo.co.uk.

Introduction & Aim: Diabetic nephropathy (DNP) is considered a CRD

(Chronic Renal Disease); it is a major cause of illness and premature death in

people with DM. Furthermore, it is considered the single most important cause

of end stage renal disease in the western world and accounts for more than a

quarter of all end stage renal diseases. The present study was designed to

illustrate the role of CCBs (amlodipine and diltiazem) in prevention and

treatment of DNP in rats.

Materials & Methods: Eighty male albino rats weighing (130-180gm)

were used in this study. These animals were subdivided into five equal groups.

Insulinopenic diabetes was induced by STZ, two weeks later, 30 minutes of

complete ischaemia was induced in the left kidney to induce diabetic

nephropathy then treatment was started for 12 weeks. At the end of experiment

urine samples and blood samples were taken for biochemical analysis and

kidneys were taken after scarification for histopathological evaluation.

Results: Combination of renal ischaemia with DM produced a significant

increase in rat weight, rat kidney weight, BUN (Blood Urea Nitrogen) level, K/B

(Kidney/Body weight) ratio, random blood glucose, 24 hrs urine proteins, and 24

hrs urine volumes and creatinine clearance. Treatment with diltiazem or

amlodipine significantly lowered elevated SBP and elevated 24 hrs urine

volumes. Furthermore, treatment with captopril produced a highly significant

lowering of elevated SBP and elevated serum creatinine; and a significant

34

reduction in elevated K/B ratio and proteinuria. Light microscopic examination

of diabetic kidneys revealed glomerulopathy characterized by thickening of the

glomerular basement membrane, mesangial matrix expansion, arteriolar

hyalinosis and large proteinaceous deposits occluding some capillary loops and

hyaline droplets within the glomeruli. Moreover, examination of kidneys of

ischaemic animals by light microscope revealed focal tubular necrosis at multiple

points along the nephron, interstitial edema and accumulation of leucocytes

within dilated vasa recta.

Conclusion: It can be concluded that, renal ischaemia hasten the

progression of DNP, diltiazem and amlodipine have a tendency to reverse of

changed parameters toward normal values except biochemical parameters,

generally speaking, diltiazem is better than amlodipine in reversing biochemical

and histopathological changes produced by DNP, and captopril reversed most of

changed parameters except histopathological changes.

Recommendations: Based on the obtained results from the present study, one

can recommend that; 1) Diltiazem and amlodipine have a nephroprotective effect

in DNP, therefore, they should be used in diabetic patients to protect and/or slow

progression of DNP. 2) Captopril might be considered the first therapy for DNP.

Moreover, combination of captopril with CCBs could be a more effective tool got

protection and/or slow progression of DNP.

Key words: Diabetic Nephropathy, Diltiazem, Amlodipine, Calcium

Channel Blockers, Diabetes Mellitus, Ischaemia

35

OP.30 Prevalence of Overweight and Obesity among Children

And Adolescence in Gurayat region K.S.A

Abubakr yagoub ibrahim(K.S.A)

The aim of this Study is to identify prevalence of overweight and Obesity among Saudi children and adolescence (1- 19) years old in Gurayat - K.S.A

Subjects and Methods: The Study is conducted by cross-sectional household survey; the sample is undertaken by Stratified cluster random method. Total No. of the study subjects are (1530) children and adolescence, which (782) boys (51.1%) and (748) girls (48. 9%), and their ages ranging from (1- 19) years. Weight and height taken from the targets, body mass index (BMI) calculated as a proxy to identify overweight and obesity. Study subjects are identified as overweight, obese by using age and Sex- specific cut-off point for BMI, which adopted by (WHO/CDC) Reference data base for BMI.

Results : The overall prevalence of overweight is (5.2%) (9.2%) among boys and girls respectively, and the Overall prevalence of obesity is (4.9%) (6.4%) among boys and girls respectively. Overweight and Obesity tends to be more prevalent among girls more than boys Children were grouped according to their age into five groups (1-2), (3-5), (6-12), (13-15), (16-19), for each group prevalence of overweight and obesity were calculated. The prevalence tend to increase with age in both sex, with higher prevalence of overweight among boys at the age group of (13-15) years old ,and among girls at the age group of (16-19) years old . Higher prevalence of obesity observed among boys at the age group of (6- 12) years old, and among girls at the age group of (16-19) years old. Lowest prevalence of obesity observed among boys at the age group of (3-5) years old, among girls at the age group of (1-2) years old. Family size has an inverse action on the prevalence of overweight and obesity for it increases when the family size decreases. In relation to other factors higher prevalence of Overweight and obesity observed among secondary/ high school girls, though high prevalence of obesity and overweight seen among those fathers with high income. Educational status of parents has an influence in the prevalence of overweight and obesity , for it is high between illiterate father and mother , with more prevalence rate between illiterate mothers .

Conclusion :The survey show that there is prevalence of overweight and obesity among children and adolescents in Gurayat area , with variable prevalence according to age and sex , educational status , with influence of Scio economical, educational status of fathers , and family size in the prevalence.

Suggestions are made for preventive measures which should be undertaken.

36

OP.31 Prevalence of Diabetes-Associated Antibodies and Impaired

Insulin Response to Glucose in First DegreeRelatives of Diabetic Patients

Ebtissam M. Salah*, Hesham El-Hafnawy**, Mona Anwar*, Samar M. E. Salem*, Mai M.

Youssef*, Atef Bassyoni** and Marry Aziz*** National Research Center

** National Institute of Diabetes and Endocrinology

Type 1 diabetes is a chronic autoimmune disease with a subclinical

prodromal period characterized by the presence of circulating antibodies to

various islet cell proteins. Our main objective is to estimate the prevalence of

diabetes-associated autoantibodies in a group of 1st degree relatives, compared to

healthy control subjects. Also, we tried to assess the insulin secretory capacity in

subjects having multiple antibodies using First Phase Insulin Response (FPIR) to

intravenous glucose.

Eighty children and adolescents of the first degree relatives of diabetic

patients attending the out patient clinic in the diabetic institute participated in

our study. They were (34 boys and 46 girls, 50 siblings and 30 offspring of

diabetic parents, aged 8 – 20 years with mean age 13.23 + 3.6). 20 age and sex

matched control subjects with negative family history of diabetes were enrolled

from the child health clinic in the NRC. Sera of all subjects and controls were

monitored for: islet cell antibodies (ICA), anti-insulin autoantibodies (IAA) and

glutamic acid decarboxylase antibodies (GAD) using ELIZA technique, and (IA-

2) antibodies using radioligand binding assay. It was found that: according to the

considered cut off point for positivity, 23 out of the 80 relatives (28.75%) showed

positive ICA. 21 out of 80 relatives (26.25%) showed positive IAA. 17 out of 80

relatives (21.25%) showed positive GAD antibodies. 5/80 relatives (6.25%)

showed positive IA-2 antibodies. As regard the control group only one subject

tested positive for ICA and another one tested positive for IAA. None of the

control group tested positive for GAD or IA-2 antibodies.

On studying different combinations of positive antibodies, it was found

that only two subjects of the study group (2.5%) had three positive antibodies,

37

10% had positive ICA and IAA, 3.75% had positive ICA and anti-GAD. The

same percent of the study group had positive IAA and anti-GAD. Those subjects

showing more than one positive antibody underwent IVGTT to determine FPIR

to predict subjects at high risk for developing type 1 diabetes. One subject was

found to be at risk and four subjects were found to be at high risk for developing

type 1 diabetes.

38

OP.32 The Effect of Testosterone on insulin sensitivity and Diabetes

Rahim Ahmadi, Islamic Azad University, Hamedan Branch, Iran.Laszlo Rosival, Semelweis International University,Hungary .Shahrbanoo Oryan,Tarbiat Moallem University ,Tehran,Iran.Kazem Parivar,Tarbiat Moallem University, Tehran, Iran.

Background and Aims: Androgens exert major effects on glucose homeostasis and insulin secretion. The idea of insulin-androgens interrelationship primarily was emerged from the report of diabetes of the bearded women in 1921. Insulin resistance, glucose intolerance and hyperinsulinemia have been reported to follow administration of anabolic steroids. The aim of this study was to determine the effects of testosterone on insulin sensitivity, and thus, diabetes in rats.

Materials and Methods: Testosterone enantate (10 or 50 mg/kg/day) was injected intraperiotenally. Bi-orchidectomy was performed by using standard methods. After 4 weeks, blood samples were collected by cardiac puncture technique,24h after the last treatment. Insulin sensitivity (glucose/ insulin ratio) was compared statistically between the groups (ANOVA).

Results: Bi-orchidectomy resulted in increasing of insulin sensitivity (P<0.05) but testosterone replacement (50mg/kg/day) caused to decreasing of insulin sensitivity compared with bi-orchidectomised animals (P<0.001). Testosterone administration (10 mg/kg/day) also resulted in decreasing of insulin sensitivity in non-orchidectomised animals(P<0.05).

Conclusion: Based on our findings, testosterone was insulin sensitivity reducer in male animals and this is why that orchidectomy caused to increasing of insulin sensitivity but testosterone administration prohibited the increasing of insulin sensitivity in gonadectomized rats. Conclusively, testosterone plays an important role in insulin sensitivity and thus, diabetes.

Key words: Insulin sensitivity, Testosterone, Orchidectomy.

39

OP.33 Dose Testosterone or Progesterone Prohibit or Potentiate the Effect o Diazoxide on Insulin secretion and Sensitivity

Suma Arab-Zadeh Moghaddam, Islamic Azad University, Hamedan Branch , Iran.Rahim Ahmadi , Islamic Azad University, Hamedan Branch, Iran.

Background and Aims: Diazoxide is used clinically in the treatment of hyperinsulinism, insulinoma and hypoglycemia. This drug can suppress insulin release. Progestins and androgens also have effects on insulin secretion. The aim of this study was to determine the effects of co-administration of progesterone or testosterone and diazoxide on insulin sensitivity in rats.

Materials and Methods: Diazoxide (30 mg/kg/day) was administered in drinking water. Testosterone enantate (10 mg/kg/day) or ogesterone (20mg/kg/day) were injected intraperiotenally or subcutaneously, respectively. After 4 weeks, blood samples were collected and serum insulin and glucose were measured. Insulin sensitivity (glucose/ insulin ratio) was compared statistically between the groups (ANOVA).

Results: In male rats, diazoxide administration caused to increasing of insulin sensitivity (P<0.01). However, testosterone administration resulted in decreasing of insulin sensitivity (P<0.05). Co-administration of testosterone and diazoxide had the same effects as diazoxide. In female rats, diazoxide or progesterone caused to increasing of insulin sensitivity (P<0.01). Co-administration of diazoxide and progesterone also resulted in increasing of insulin sensitivity (P<0.01).In addition, there was no significant difference between insulin sensitivity of diazoxide and "diazoxide + progesterone" receiving animals.

Conclusion: The results of our study show that testosterone can not prohibit the increasing effects of diazoxide on insulin sensitivity in male rats. Progestrone also does not potentiate the increasing effects of diazoxide on insulin sensitivity in female animals.

Key words: Insulin sensitivity, Diazoxide, Testosterone, Progesterone.

40

OP.34 The Miracle of Insulin from Banting to analogues and Beyond

Suhail S. Kishawi, MoH Advisor in Endocrinology & Diabetes, Head of Medical Department, Shifa Hospital, Gaza Palestine

Before insulin, dying from diabetes meant starving to death and eventually falling into coma. The discovery of Insulin highlights one of those incredible moments in medical history where a new treatment literally raises people from the dead. This defining event in the history of diabetes took place in a low-priority laboratory at the University of Toronto in 1921-1922. Dr. Frederick Banting was searching for a place to advance his research on pinpointing the cause of glucosuria. Banting became interested in treating glucosuria with extracts of an organ whose function was just beginning to be discovered—the pancreas.

Under the leadership of John Macleod, a highly respected professor of physiology, Banting worked with his partner Charles Best, a medical student, to perfect an extract. James Collip provided help in purifying their extract and the first clinical trials with a purer form of what was now referred to as either “isletin” or “insulin” began. The name “insulin” was coined by Jean de Meyer, a Belgian physician, even before it was isolated referring to the suspected glucose lowering substance secreted from the islets (insula) described by Langerhans. In January 1922, Banting and Best administered 15 mL-7.5 ml in each buttock-- of a slightly acidic alcohol solution described as "a thick brown muck" to a 14-year-old diabetic patient named Leonard Thompson, who was starving to death. The results were disappointing, abscesses developed at the injection sites, and Leonard became even more acutely ill. However, his blood glucose level had dropped initially. About 6 weeks later, Leonard was given Collip's refined extract, with astonishing results. The boy's blood glucose fell from 520 to 120 mg/dl in about 24 hours, and he quickly began to gain weight and regain strength. Leonard lived a relatively healthy life for 13 more years but died of pneumonia at age 27.

By 1923, the extraction process had been improved, and insulin was commercially available in North America. Banting and associates at the University of Toronto were awarded the Nobel Prize in Medicine for their achievement.

The insulin product available at that time had a short duration of action and often required administration during the middle of the night to ensure adequate insulin concentrations in the early morning. This need for multiple injections led to the development of longer-acting insulin preparations. Protamine zinc insulin (PZI), a long-acting insulin, was introduced in the 1930s and remained on the market until several years ago. Neutral Protamine Hagedorn (NPH) was introduced in the 1940s and the lente series of insulins in the 1950s.

41

Advances in chromatography led to the production of more highly purified insulins in the 1960s and 1970s. In the 1980s, recombinant DNA technology was used to commercially produce human insulin. The most recent advance is the development of insulin analogues produced by recombinant DNA, peptide synthesis, and enzyme-catalyzed semisynthesis. The pharmacokinetic profiles of the insulin analogues are able to closely imitate normal insulin secretory patterns. The first recombinant DNA human insulin analogue, insulin lispro, was approved in July 1996 FDA. Since then, three additional analogues, insulin glargine ,insulin aspart and insulin detemir, have been approved. Other insulin analogues and delivery systems are being evaluated.

All insulin delivery devices inject insulin under the skin using the classical syringe used by most patients. Others use insulin pens, jet injectors, or insulin pumps. Several new approaches for taking insulin are under development namely insulin patches ,oral formulations designed to resist insulin digestion in the gastrointestinal tract and inhaled insulin. Of all the alternative delivery routes, so far, pulmonary delivery of insulin looks the most promising.

Relevant details will be presented and be available in a full paper.

42

PP.1 Cytokines in Saudi diabetic patientsLaila Hamed Damanhouri"(K.S.A)

Objective To determine the prevalence of Tumour necrosis factor-alpha(TNFá) and interferon-gamma (INF-ã) in a group of Saudi diabetic patients living in the Jeddah area of western Saudi Arabia.

Methods A total of 100 samples were collected from Saudi patients with type 1 diabetes attending the diabetic clinic at King Abdulaziz university Hospital (KAUH). Another 100 samples were collected from healthy individuals with no history of diabetes as a control group.Both of cytokines were determined by ELISA.

Results The prevalence of INF-ã and TNFá in type 1 diabetic patients was 19% and 17% respectively and in control subjects was 2% and 4% respectively. The results was significantly higher in type 1 diabetic patients than the control group.

Conclusion our data indicate the involvement of inflammatory cytokines produced by Th1 cells and monocytes in autoimmune diabetes which, in turn, reflects the important role of cellular immuneresponses in the pathogenesis of autoimmune diabetes.

Both INF-ã and TNFá are not low amongst Saudi diabetic patients. Thus,in other population and ethnic groups, the detection of these markers can be used in the accurate classification of disease, to identify subjects who may benefit from early insulin therapy and, eventually, to identify those who may benefit from specific immunotherapy.

43

PP.2 Telecare of diabetic children

Prof., dr Wafaa El-Sayed Abdel-Gileel ,Ph,D

Ain Shams university

Recent technologic advances permit telecare to replace the usual care"

face to face visits " for diabetic children specially those of limited access to health

professional. It is helpful for the purpose of teaching, monitoring, supporting

and guiding.

Aim of this article review is to shed light on concept of telecare in treating

and nursing diabetic children

44

PP.3 Infant of diabetic mother: Risk and Nursing care

Nahed Said, Pediatric Department, Faculty of Nursing,Ain Shams University

Infant of diabetic mothers are at an increased risk of morbidity and mortality related to :macrosomal intra-uterine growth retardation (IUGR) , sudden death,

hyper viscosity secondary to poly cythemia, hypoglycemia, congenital mal formation , hypocalcaemia and hypomagnesaemia. So, the nurse must be alert and assessed the infants of diabetic mother for signs o complications, trauma,

congenital anomalies at delivery and during the early hours after birth .

45

PP.4 Complementary Therapy for Diabetes

Prof., Dr., Magda Abd El Aziz Mohamed Prof of Medical

Surgical NursingAin Shams University

Herbs for Diabetes since antiquity, diabetes has been treated with plant medicines. Recent scientific investigation has confirmed the efficacy of many of these preparations, some of which are remarkably effective. Only those herbs that appear most effective, are relatively non-toxic and have substantial documentation of efficacy are covered here. Bitter Melon (Momordica Charantia) Bitter melon, also known as balsam pear, is a tropical vegetable widely cultivated in Asia, Africa and South America, and has been used extensively in folk medicine as a remedy for diabetes. The blood sugar lowering action of the fresh juice or extract of the unripe fruit has been clearly established in both experimental and clinical studies. Onion and Garlic (Allium cepa and Allium sativum) Onion and garlic have significant blood sugar lowering action. The principal active ingredients are believed to be allyl propyl disulphide (APDS) and diallyl disulphide oxide (allicin), although other constitutents such as flavonoids may play a role as well.

Gene therapy is the treatment or prevention of a disease by introduction of, often engineered, genetic material into cells in order to

alter some sort of function of that cell. Gene therapy may hold the key to curing type 1 diabetes, gene therapy may be able to prevent diabetes, gene

therapy may provide a means of helping the millions of diabetics worldwide. For autoimmune diabetes, gene therapy promises a life free of insulin injections, with no risk of ketoacidosis or hyperglycemia or any of

the other disorders that may follow diabetes onset.

46

PP.5 Problem - Solving Skills in Diabetes Self- Management

Dr./ HANAN MOHAMMED MOHAMMEDLecturer at medical-surgical nursing

Faculty of nursing - Ain Shams University

Management of chronic illness is a significant public health concern that is made more challenging by problems of regimen adherence . Effective self-management of chronic illness such as diabetes requires not only technical skills to perform regimen behaviors but also problem-solving skills to manage daily barriers to regimen adherence and to make appropriate adjustment to the self-care regimens .Helping people with diabetes is one of the key tasks of diabetes nurses, wherever they work, problem-solving skills are an integral part of self-management . In the meantime ,diabetes nurses need to try and help those who have high blood glucose levels ,through effective questioning and communication skills ,to learn from past experiences and develop more positive problem-solving strategies. Responsibilities of diabetes nurse clinicians include providing diabetes education, assisting in the choice of insulin regimen , adjusting insulin dosages , teaching patients problem-solving skills , helping patients work through self-management problems , and developing educational and motivational strategies to promote patients independent self-management .

47

PP.6 Clinical Investigation of Silybum Marianum Seed Extract (Silymarin) Treatment in Type-2 Diabetes Patients

 H. Fallah Huseini1, B. Larijani2, Wael. M. Yousef 3 , H. Fakhrzadeh2, S. B. Radjabipour2, R.

Heshmat4, R. Heydari2

1Department of Pharmacology, Institute of Medicinal Plants, No. 97, Bozorgmehr St. Ghods St. Enghelab Ave. Tehran Iran.

2Endocrinology & Metabolism Research Center, Tehran University of Medical Sciences Tehran Iran.

3Department of Clinical Pharmacology, Faculty of Medicine, Menoufiya University, Egypt.4Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences. Tehran,

Iran.3Corresponding author address: Wael Mohamed Yousef, Departmen of Clinical

Pharmacology, Faculty of Medicine, Menoufiya University, Egypt. E-mail address: waelpharma@yahoo.co.uk.

Introduction: The free radical production and consequently metabolic oxidative stress disorder is hallmark of chronic disease particularly in uncontrolled hyperinsulinemic type II diabetic patients. Inhibition of free radical production, its neutralization or correction of oxidative metabolic abnormality in diabetic patients following antioxidant therapy may influence the glycemic control. 

Aim: The present study was designed to investigate the efficacy of silymarin treatment with known antioxidant property on glycemic control in type II diabetic patients.

Methods: A 12 month randomized double blind clinical trial was conducted in 80 non-insulin dependent diabetic patients in two well – matched groups. One group (n=48) received 200mg silymarin tablet 3 times a day plus standard therapy, while the control group (n=32) received placebo plus standard therapy. The patients were visited every two month and glycosylated hemoglobin (HbA1c), fasting blood glucose, total cholesterol, LDL and HDL, triglyceride, SGOT and SGPT levels were determined at the beginning, after four month and at the end of the study.

Results: There were significant decrease in HbA1c, fasting blood glucose, total cholesterol, LDL, SGOT and SGPT levels in silymarin treated patients as compared to placebo group.

Conclusion: In present study the silymarin treatment to hyperglycemic type II diabetic patients for twelve months improved glycemic as well as lipid profile.

Key words: Silymarin, Herbal medicine, Antioxidant, Type II diabetes.

48

PP.7 Risk Factors for Insulin Dependent Diabetes: (Nursing View)

Hanan Shehata,Ain Shams University

Insulin dependent diabetes. Formerly known as "juvenile

onset" or type 1diabetes mellitus ,most often occurs in people who are under

30 years of age ,with a peak onset between ages 11 and 13 .

The rate of type 1 diabetes is 1.5 to2 times higher in white than non

whites. Incidence among males and females typically, it is seen in people with

a lean body type , although it can occur in people who are over weight .The

individual with type 1 diabetes requires a supply of insulin from exogenous ,

such as injection , in order to sustain life . without insulin , the patient will

develop diabetic ketoacidosis (DKA), a life- threatening condition resulting in

metabolic acidosis. A great deal of patient contact take place in outpatient

and home settings .The major goal of patient care in these settings is to

enable the patient or care giver To reach an optimal level of independence in

self – care activities .

49

PP.8 Compliance of Diabetic Patients for Essential Approach to Over Come Obesity

. Eman Talaat Mohamed*, r. Salwa Abdalla Mohammed***Faculty of Nursing, Ain Shams University, **T.I.N., Armed Forces

Severe obesity is a serious health condition that can lead to an earlier death.

Aim of the study: This study aimed to assessment of diabetic patient’s compliance to the dietary regimen and exercises, and analysis of the factors influencing it.

Research Methodology: Convenient sample of 60 obese type 2 diabetic patients from national institute of diabetes were selected randomly, free from complications and their ages ranges from 40-60 years. Tools were structured interview questionnaire, pre and post test and educational program about diabetic dietary and walking exercise program. Consent form obtained then data was collected through 3 phases; pre assessment phase, implementation phase and evaluation phase. Then data was statistically analyzed and tabulated.

Results: The result revealed that, there was significant difference between pre and post test scores of knowledge. No significant difference between pre and post program behavioural change as regards compliance to dietary regimen and exercise due to some social, traditional and psychological factors. There was no significant correlation between sample knowledge and behaviour with their sex and qualification. No significant difference between pre and post program blood sugar levels and body mass index.

Conclusion: there was a positive effect on patient knowledge, but there was negative compliance to dietary regimen and exercise.

Key words: Diabetic patient , obesity, dietary regimen , exercises and

Diabetes Mellitus

50

PP.9 Diabetes and StressYaser M. Ashour,*

Eman Shokry Abd-Allah**

and Mohamed Zakaria El Etreby***

Physiology Departments, Al Azhar faculty of Medicine Assuit *,

Community Health Nursing Department, Faculty of Nursing, Zagazig University**

and Physiology Departments, Al Azhar faculty of Medicine Cairo***

Stress is the response of our body to an emergency situation. This

response may be positive i.e. serves for the welfare of the individual e.g.

happiness, like passing an exam, or negative which affects the homeostasis of

individual e.g. sad event like losing someone we love (Wulsin and Jacobson

1992).

Can stress cause diabetes?

Biological processes are complicated processes, no one stimulus if

responsible for responses, but it is a matter of serial changes and variable factors

interacting to produce a response. Diabetes is a syndrome that needs an

interaction of various individual genetic and environmental factors to occur.

Stress per se is not a factor but it may be one among a series of a precipitating

factors causing diabetes (Wulsin and Jacobson 1992).

Thus, there is no evidence that stress causes diabetes alone. However,

stress may sometimes unmask diabetes, by causing blood glucose levels to rise or

cause symptoms to appear more quickly due to increases of the body needs for

insulin. This is often seen after a heart attack or stroke, where raised blood

sugar levels may be encountered for the first time.

51

PP.10 Healthy Eating and Carbohydrate Counting for Diabetic

Patients

Dr. Ola Abdel-Aty Ahmed

Assistant Professor of Medical Surgical NursingFaculty of Nursing - Ain Shams University

The most important thing you can do to balance your blood glucose is to

eat the right foods. Having diabetes does not mean you will have to give up all

the foods you now enjoy. However, mean planning must become a big part of

your diabetes treatment. All food you eat turns to glucose in your body and you

must have enough insulin, either insulin you make or give, to use this food

glucose for energy. When you are planning your meals, it will help you diabetes

if you: this food glucose for energy: When you are planning your meals, it will

help your diabetes if you: Choose healthy foods such as foods high in fiber and

low in fart, eat the right amount of food at the right times, and don’t skip meals

and use sugar and salt (sodium) in moderation. Dietary carbohydrate is the

chief determinant of meal-related insulin demand, making accurate

identification of the amount of carbohydrate contained in a meal the key in

finding the appropriate insulin dose for any meal. Carbohydrate counting can

also be used successfully with Type 2 non-insulin using patients, as they need to

work with their available endogenous insulin supply to maintain normal to near

normal postprandial blood glucose results.

52

PP.11 Nutrition and Behavioral Strategies for the Obese

Individual with Diabetes

Dr.Manal Salah Hassan

Lecturer of Medical Surgical Nursing

Faculty of Nursing - Ain Shams University

Diet and weight control constitute the foundation of diabetes management

.or patient who require insulin to help control blood glucose levels maintaining

as much as possible in he amount of calories and carbohydrates eaten at

different meal times is important for control of blood glucose. In addition,

consistency in the approximate time intervals between meals, with the addition

of snacks, if necessary, helps in the prevention of hypoglycemia reactions and in

overall blood glucose control.

For obese patients (especially those with type 2 diabetes),weigh loss is the key of

treatment of diabetes .or obese patient in general, weight loss is the major

preventive factors for development of diabetes. Obesity is associated with an

increased resistance to insulin and is one of the main etiologic factors associated

with type 2 diabetes. Some obese type 2 diabetes patient who require insulin or

oral agents for control of blood glucose may be able to significantly reduce or

completely eliminate the need for medication through weight loss .

53

PP.12 Knowledge Deficit Related to Home Care

for Diabetic Children Injury

Hanan Ibrahim Ahmed

Lecturer In Community Health Nursing Department

Faculty of Nursing – Ain Shams University

Diabetes encompasses a group of disorders characterized by glucose

intolerance resulting from insulin deficiency. Type 1 (insulin – dependent)

diabetes mellitus can occur at any age but usually manifests during adolescence,

between ages 11 and 12, and affects about 10% to 20% of the entire diabetic

population. Treatment for this type includes a diabetic diet, use of insulin,

glucose monitoring and exercise. Potential complications of integumentary

include injury and poor wound healing. This comucations can occur when

noncompliance with the prescribed diet, insulin use and exercise .

Community health nurse role as diabetes nurse educator understanding

the child / family some care instructions and demonstrate procedures related to

risk of injury.

54

PP.13 Necrotic Foot- Purulent Wound Plasty with Local Tissues in Various Forms of Purulent-Necrotic Foot Damages in

Patients with Diabetes Mellitus

Ismailov S.I., Kamalov T.T., Dosova Z.Kh., Samansurova Z.M.Scientific-Research Institute of Endocrinology, Uzbekistan Public

Health Ministry

Objective: to improve current methods of surgery in foot purulent-necrotic damages (PND) aiming at preserving supportive - motor function of the foot and wound healing acceleration.

Materials and methods. We examined 100 patients (59 men and 41 women, 59% and 41%, respectively) of mean age 61 years (from 48 to 75) with toe gangrene of various localization, foot and crus phlegmon hospitalized at the “Diabetic foot” department in 2005. All the patients received insulin therapy. In addition to clinical and laboratory investigations the patients were subjected to dopplerography of low extremities, the brachial-ankle index (BAI) being calculated.

Exarticulation of the damaged toes as well as the foot and crus phlegmon opening have been performed. Metatarsal head resection was performed by indications with the dissection of toe flexor tendon with synovial sheaths facilitating the PND proximal spread. The dissection of flexor tendon only caused long-term deformation and foot architectonics disorder due to misbalance between muscles – antagonists resulting in foot plantar trophic ulcers failing to heal for a long time. In the attempt to preserve the foot architectonics the respective extensor tendon operation was performed. Not to traumatize foot tissues and vessels the resection of the modified tendons was performed through additional incisions in the proximal compartments of foot plantar and dorsal surfaces.

In all patients due to gangrene we performed toe amputation with the foot and crus phlegmon opening. Due to inefficiency of treatment and PND spread 7 patients (7.7%) (BAI < 0.5) underwent hip amputation, the crus amputation the foot amputation by Sharp being performed in 2 people (2%) (BAI =0.5) and 13 (13%) respectively.

Postoperatively in 81% of patients (BAI 0.7-1.0) supportive function of low extremities was preserved, halving mean time of hospitalization reducing as compared with the open follow-up of the process indicating the decrease in expenditures. Postoperatively in 45 patients wound plasty was performed with course of wound process, BAI and character of granulation taken into account. In 23 patients secondary sutures with the dosed intention were performed, 20, 6 and 1 patients undergoing autodermoplasty by Parin, rotational wound plasty and Italian plasty, respectively. Would closure was achieved in 89% of patients with the complete wound healing within 32 days in the average versus 58 days in the control group.

55

Conclusions. When performing foot wound plasty the blood supply of low extremities and PND spread should be taken into account. BAI is of importance in choosing surgery volume and outcome in patients with diabetes mellitus.

56

PP.14 Plasmalogens Level at The Diabetes MellitusSaatov T.S.1, Akhrarova N 1., Shamansurova Z.M.2, Mukhamedova F.A 2.,

Tsoi A. 21- Institute of Biochemistry, Uzbekistan Academy of Sciences, Tashkent

2- Institute of Endocrinology, Uzbekistan Public Health Ministry,Tashkent, Uzbekistan

Background and aim. Plasmalogens (PL) are located on cell plasma membrane and participate in the membrane transport, reception and transfer of hormonal signal, in regulation of membrane-bound enzymes, maintain membrane antioxidant potential. Changes in their proportion as in diabetes mellitus (DM) can disturb the processes above. Material and methods. To study the content of PL in blood plasma and erythrocyte membrane in DM we examined 63 patients with DM and 16 healthy subjects of the same age. HbA1c level and blood sialic acids (BSA) and erythrocyte sialidase activity (ESA), total lipids, phospholipids, blood plasma and erythrocytes membranes PL were measured in each examinee.

Results. HbA1c level was increased in patients with DM by 44% (P<0.01) then healthy subjects. Blood plasma and Erythrocytes membranes PL were 1.2 and 3.6 times lower, respectively, Blood plasma and Erythrocytes membranes phospholipids were 1.2 and 1.26 times being lower, respectively, in the DM patients. The level BSA was increased by 2.21 times (P<0.05), ESA being 2.6 higher (P<0.05) in DM. The findings are the evidence for more marked loss of PL on Erythrocytes membrane in DM. Erythrocytes membrane PL were found independent of the examinees’ sex or age, but depending on the glycemia and HbA1c level as well as on presence or severity of DM. Erythrocytes membrane PL was shown to decrease in DM depending on the levels of glycemia and HbA1c as well as on the presence of complications.

Conclusion. Erythrocytes membrane PL can reflect structural-functional condition of cell membrane and be informative for the assessment of control and severity of DM

57

PP.15 Influence of The High Glucose Concentrations on CellGrowth and Apoptosis

Shamansurova ZM 1, Saatov TS21 Institute of Endocrinology, Tashkent, Uzbekistan2 Institute of Biochemistry, Tashkent, Uzbekistan

Glucose is main energy source of mammalian cells and high glucose concentration may cause adverse effect and may altered of cells function and cell growth. Cell growth was estimated after H3thymidin (HT) incorporation into rat timocytes (Thy), which taken from killed 12 nonlinear white rats in weight 100-120 mg, after washed out in Hanks buffer medium with collagenase cells suspension was cultured into RPMI-1640 medium contained glutamine and antibiotics for 72 hours at the 37C. Experiment was repeated in 4 series: without glucose (GL), with GL in concentration 5 (G5), 10 (G10) and 20 (G20) mmol/l. HT was added on 54 hours, and after 72 hours samples from medium and cells sediment fraction was taken and calculated for HT detection. In control plates without G HT incorporation was detected in cell fraction and HT level were diminished in cultivation media which suggested about growth of Thy and enough substance in culture media for cells growth. Cell growth was detected in other series too but HT incorporation level was different and was higher on 9% at the G5 than control, and less on 11% at the G10 and less on 19% at the G20. These results show that rat Thy grown at the G5 and at the G10 and G20 cells growth were suppressed. Light microscopy after trepan blue coloration show increasing of the apoptotic body counts. Conclusion. Glucose on the higher concentrations affects the cell growth and caused apoptosis in rat thymocytes.

58

PP.16 Strokes in The Elderly Diabetic Patient

Y.Benabbas, N. Kerrouaz, H. Debbache ,A. Zammouch, S. Brahami, D.RoulaService de médecine interne-CHU Benbadis – Constantine - ALGERIA

Aims: To evaluate the prevalence of strokes in patients with diabetes mellitus and to appreciate the risk and the prognosis factors related to such complication.

Material and method: We retrospectively analysed files of diabetics aged within 65 to 85 years old and hospitalised for a stroke during the year 2004. A comparative study has been done with a control group of 36 non-diabetics. We checked for all patients: first clinical manifestations, results of cerebral scanner, blood pressure (B.P.), cholesterolemia, triglyceridemia, glycemia and diabetic complications: myocardial infarction (MI), peripheral arteritis, coronary heart disease (CHD), arythmia and heart failure. Statistic test: Khi 2.

Results: Among 492 diabetics hospitalised during 2004, 57 (12%) had a stroke, the majority of them (86%) were of type 2. Strokes in diabetic patients have been observed at a precocious age (mean age: 69) with a high frequency in women (w: 60% vs m: 40%) in comparison to non-diabetics (w: 46% vs m: 54%). In one fourth of the cases, this complication occured at the same time as diabetes. The main clinical expression was a coma in 51% of the diabetics and only 31% with non-diabetics. The types of strokes observed in diabetic group were in order of frequency: cerebral infarction: 72%, cerebral hemorrhage: 16% and transient stroke: 12%. These values occured respectively in the non-diabetic group: 50%, 17% and 33%. One third of the diabetic patients have had an antecedent of stroke and the frequency of cardiovascular complications were significantly (p<0.02) more frequent in this group than in patients without diabetes: MI: 40%vs31%, peripheral arteritis: 33%vs19%, arythmia: 25%vs23%, heart failure: 11%vs4%. There were no significant differences in the prevalence of CHD in patients with and without diabetes (28%vs27%).The risk factors were highly predominant with diabetics: hypertension (>130/85 mmHg): 81%vs62%, hypercholesterolemia (>2g/l): 53%vs12%, hypertriglyceridemia (>1,50g/l): 44%vs 0%, hyperglycemia (>1,40g/l): 81%vs12%. 21% among diabetics died in hospital compared to 8% of non-diabetics. 61% of the first group and 13% of the second had a hyperglycemia.

Conclusion: Prevention of cerebro-vascular disease in diabetes should require an improvement of the different risk factors and particulary a B.P.< 130/85 mmHg. During the stroke, hyperglycemia could be a bad factor for the prognosis.

59

PP.17 Self Management Education for people with type 2 diabetes:What do patients want?

.Hanan Said Ali , Assisst .Prof of Medical Surgical NursingAin Shams University

National Health Service policy has aimed to improve the self-

management abilities of people living with chronic disease. Self-management education, in which people engage in active partnership and decision-making in

relation to disease management, People engaged in self-management programmers have been shown to have improve physical and physiological health. Diabetes health policy has focused on encouraging people to become

more knowledgeable about their condition and treatment regimen on improving the self-management abilities of people with diabetes. For key component to

educational programmes designed to facilitate confident of self-management of diabetes which include 1)Knowledge requirement.2)personal data

monitoring.3)specific behavioral applications.4)General behavioral application.

60

PP.18 Psychoeducational Hardships OF Children with Insulin Dependent Diabetes Mellitus Type I

Iman AminAssistant Professor,

Pediatric Nursing, Faculty of Nursing, Ain Shams University

Diabetes mellitus is a common health problem among children in Egypt,

it is a group of metabolic diseases characterized by elevated levels of glucose in

the blood. Diabetes mellitus affects about 15 million people, 5 million of whom

are undiagnosed. However, severe metabolic control in children which might be

responsible for impaired their intellectual performance later in their life. These

article investigate psycho-educational hardships of diabetic children type I, and

revealed to general and specific neurocognitive deficits as well as the impact of

these deficits on scholastic achievement and learning disabilities. Added to the

life threatening complications often contribute to increased rate of diabetic child

hospitalization that interfere of their cognitive maturity and academic progress.

From here, the pediatric nurse permit a time for diabetic child to discuss and

vent their psychoeducational problems as part of her routine diabetic care which

has a favourable results.

61

PP.19 A Guide to Getting started: A Special issues in

Diabetic Foot CareJackleen Fahim Gendy,Ph,D & Susan Mohamed Dessowky Ph,D

Diabetes mellitus is a chronic systemic disease characterized by either a

deficiency of insulin or a decreased ability of the body to use insulin. Patients

with diabetes are living longer, with an increased risk for development of chronic

complications which considered the major cause of morbidity and mortality in

patient with diabetes. These complications are classified as one of three types:

1. Macro vascular.

2. Micro vascular.

3. Naturopathic

Patients with diabetes are susceptible to infections of many types, diabetic

foot infections are very common, their occurrence is directly related to three

factors that may contribute to the development of an infection which are;

impaired polymorphonuclear leukocyte function, diabetic neuropathies, and

vascular insufficiency, poor glycemic control augments is the importance of these

factors. Up to 40% of diabetic patients with foot infection many required

amputation, and 5% to 10% will die despite amputation of the affected area.

With proper education and early intervention, foot infections are usually

eliminated in a timely manner.

62

PP.20 Time management for daily self care of Diabetic Children

Nehal .A.Allam, Pediatric Department, Faculty of Nursing,Ain Shams University

The study aimed to estimate the time management for daily self care among diabetic children, and help children to set priorities to maximize

health .An experimental design was used to conduct the study. Sample of 132 children was recruited from inpatient/ outpatient Diabetic units in Ain Shams

Children Hospital. The tools used for assessing the children knowledge and skills were a pre/ post interviewing questionnaire,4 observation checklists, children

medical record, parents and children guidance booklet. Both mothers and children participated in 14 groups. The study recommended that diabetes self

management is an essential components of good care and the time children to self care deserves serious attention in efforts to improve the quality of care .

63

PP.21 Role of Diabetes Educators in Advanced Diabetes Management

Nessrien Osman ELsayedLecturer of Medical Surgical Nursing ;Faculty of Nursing ,Ain Shams University

The evolution of advanced practice in diabetes management has emulated the advanced practice efforts of nursing groups . However, many disciplines are involved in the care and education of people with diabetes. This article reviews the expanded role of health professionals in diabetes and describes the development of a new clinical management credential for nurses, dietitians, and pharmacists with advanced degrees and advanced practice experience in diabetes.

64

PP.22 Difficulties of Diabetic Patient in Learning about Their Illness

Nadia Hamed FarahatLecturer in Community Health Nursing Department

Faculty of Nursing-Ain Shams University

What is easy and what is difficult to understand in managing diabetes?

Diabetes mellitus can be significantly influenced by daily self-care. No other

disease demands so much of the patients own self-knowledge and skills.

The diabetic patients are not always able to mobilize their knowledge in

order to put it into practice, this the professional nurse patients gain the

knowledge, skills, and attitudes necessary for self-care.

Knowledge is an essential element of disease management. Achievement

and maintenance of metabolic control requires the judicious use of medication,

diet, activity, monitoring and education.

65

PP.23 Evidence based practice in nursing diabetic patient

Salwa Samir Ahmed Kamel

Assistance, Professor

Faculty of Nursing, Ain Shams University

Evidence based nursing is an effective set of techniques to allow

working of clinicians to answer the important questions in their own clinical

practice. Evidence based nursing is one approach that may enable future

healthcare providers to mange the explosion of new literature and ultimately

may result in improved patients outcomes. Both medical and nursing

professionals have explored this change in healthcare practice, research and

knowledge development. A paradigm shift called evidence based practice

(EBP) involves an ability to access, evidence based, summarized, and apply

information from the literature day-to-day clinical problems. Evidence based

practice allows practitioners to meet a daily need for valid information about

clinical situation.

Evidence based practice allows nurses enrich their clinical training and

experience with up to date research, with the large amount of research and

information that exists in the medical field, learning the skills of evidence

based practice allows nurses to search for, assess, and apply the literature to

their clinical situations.

66

PP.24 Promoting wellness for diabetic children

Amany S. Sorour, and Dr. Wageda W. KamelLecturers of Community Health Nursing.

Zagazig University.

From the time they are born through all of their lives, individuals strive for

health and wellness. Achieving health and wellness can be difficult, especially in

the face of conditions such as disabilities. Having diabetes doesn’t make health

and wellness impossible, an individual can enjoy and promote health despite

having an illness or ailment. Promoting health and well being can help children

with diabetes to maintain or improve quality of life and reduce the risk of

secondary disabilities. According to Pender’s Model, health promotion is best

described as the behaviors a person practices that are directed towards

increasing the person’s level of well-being. The aim of this study is to design a

health education program for diabetic children to improve their health

behaviors and consequently their over all health well-being. Pre – post

assessment questionnaire sheet will be used to assess children life - style before

and after health education program.

67

PP.25Barriers to Adherence among Diabetic Patients

Hala Mohamed M. BayoumyLecturer of Medical-Surgical Nursing

The chronic nature and the many possible complications associated with diabetes, places a significant burden on patient, family and the health care system. On the other hand, the diabetic treatment regimen is complex. It may be modified over the course of the disease, is designed for life, does not guarantee recovery, depends largely on the responsibility of the patient, and requires active attention to a variety of areas such as: diet, exercise, medication, and self-monitoring of blood glucose (Jenny, 1986). Therefore, much of the recent literature in this area has changed its terminology from “compliance” to “adherence”, reflecting a change in philosophy in the practice management.

The long-term complications of diabetes and its costly hospitalizations are often precipitated by patients’ failure to adhere to the treatment regimen

required to maintain normal blood glucose levels. The outcome of diabetes treatment is thus highly dependent on the self-care behavior of the patient.

Therefore, the aim of the article review is to nonadherence to treatment protocols is of particular interest and significance in the diabetic population. Many studies have been performed to gain a better understanding of non-adherence to self-care and its determinants or its perceived barriers.

68

PP.26 Wound Management of Diabetic Foot

AMANY MOHAMED SAFWATAss.Prof. of Medical Surgical Nursing-Faculty of Nursing.

The long –term management of diabetic patient s and the prevention of

complications is challenging . It requires a co –ordinate , multidisplinary team approach and informed patient co-operation. Management of diabetic foot ulcers

requires aggressive treatment .In the short term , this involve radical local debridement, leaving only healthy tissue, systemic antibiotic therapy to combat

any infection after antibiotic sensitivity testing , diabetic control .

69

PP.27 Lifestyle Intervention in The Prevention of Type 2 Diabetes

Nahla Ahmed Abd El Aziz EasawyLecturer in community Health Nursing Department

Faculty of Nursing, Ain Shams University

Prevention of type 2 diabetes has become a great challenge for healthcare systems worldwide due to its increasing prevalence both in developed and in

developing countries. The cost of treatment of diabetes is also increasing very rapidly. This is true particularly with regard to costs incurred in the

management of the long-term complications of diabetes, among which cardiovascular disease and diabetic nephropathy are the most expensive. In addition to this economic perspective, it should be remembered that type 2

diabetes and its long- term complications are also heavy burdens on both the individual and the healthcare providers. Therefore, any attempts to prevent or

delay the development of type to diabetes are welcome.

70

PP.28 Psychosocial and BehavioralAspect of Diabetic Foot

Dr. Hanan Ebrahim Abd El-AzizLecturer of Psychiatric Nursing

Faculty of NursingCairo University

Diabetes mellitus is a chronic complex pathophysiological disease that

requires careful self management, this self management takes place in asocial

context that has apsychosocial lend behavioral ramifications, it impacts on

family life , employment , physical and social well being as well as quality of life.

Recent development in the psychobehavioral approach to self management are

increasingly recognizing the evaluation and understanding of the psychosocial

and behavioral components that need to be combined with medical aspects for

optimal management of those with diabetes in general .

There is increasing research published on the diabetic foot as a

proportion of all diabetes published research. Most of this research has focused

on pathophysiological aspects and clinical interventions and not on behavioral

and psychosocial aspects , this review will attempt to raise a awareness of these

issues among clinicians and researchers.

71

PP.29 Pre-diabetes : Global Snapshot

Dr.Mesbah Sayed Kamel . MD

The dramatic increase in the prevalence of diabetes (mainly type 2) world-wide is a matter of enormous concern to public health authorities in both

developed and developing nations and international agencies such as WHO. Perhaps of even greater concern is the simultaneous dramatic increase in

numbers with IFG and IGT (prediabetes). This is occurring not only in adults but, in so far poorly quantified number, of children and adolescents.

There are at least 300 million people worldwide with IGT. Between 10% and 25% of western populations may already have IGT. For example, in the

2000 Australian Diabetes, Obesity and Lifestyle Study the overall prevalence of diabetes was 7.4%, but the combined prevalence of IFG and IGT was more than

twice as high, at 16.4%. These glucose-intolerant, but non-diabetic, individuals represent a reservoir of potential new diabetes cases. Approximately 4-9% of

individuals with impaired glucose tolerance go on to develop type 2 diabetes each year .

IGT and IFG are not equivalent metabolically, and it is therefore not surprising that there are differences in their prevalence and in the people

categorised as having one or the other. In most populations, IGT is considerably more prevalent than IFG. Furthermore, there is limited overlap between the

categories - the majority of people with IGT do not have IFG, and the majority with IFG do not have IGT. Hence the terminology of 'isolated IGT' and 'isolated IFG'. The table shows data from a variety of populations demonstrating that the highest prevalence of isolated IGT and limited overlap between IGT and IFG is

found in most of them. Thus, IFG and IGT identify substantially different segments of the population with impaired glucose regulation.

In addition to differences in the overall prevalence between IGT and IFG, there is now clear evidence of differences in phenotype between the two

categories. The most consistent and statistically significant difference is that IFG is commoner in men than women in virtually all age groups, typically being 1.5

to 3 times higher, but up to 7 or 8 times higher in Europeans aged 50 to 70 years. Conversely the prevalence of IGT is higher in women than men in all age groups

except over the age of 60 in Asian populations and over the age of 80 in the European groups .

There are now global calls for strategies to prevent the emerging global epidemic. Several recent successful intervention studies, both lifestyle and

pharmacological, targeting subjects with IGT have stimulated enthusiasm for prevention of type 2 diabetes. Lifestyle interventions were successful in over 50% of subjects in the Finnish Diabetes Prevention Study and the Diabetes Prevention Program. We now need to know whether the findings of these two studies can be

applied .

72

PP.30 Nursing Management for diabetic Elderly

Dr. Mahbouba Sobhy Abed El Aziz

Lecturer of community Health Nursing

Faculty of Nursing

Benha university

Diabetes mellitus is considered one of the most major health problems in

Egypt, the WHO recently emphasized that diabetes will represent the major

public health burden in the 21st century.

Diabetes is surprisingly common among elderly people and represents an

important health problem for this population, diabetes is a serious disease

among the elderly, but its seriousness is often underestimated by them and

occasionally by health care professionals. One of the most important steps is to

help diabetic elderly to manage the disease in order to prevent its complications,

avoidance of many hospital admissions, and improve their quality of life.

The role of the nurse in management relates to the identification,

monitoring and education of the diabetic elderly at risk for the development of

diabetes mellitus. The nurse has the potential for more contact with the diabetic

elderly than other health care professional , mean while the nurses are the first

to suspect a problem and have the assessment, counseling, support, education

and coordination skills needed to care for the diabetic elderly in a variety of

setting.

73

PP.31 Health promotion and diabetes risk factors in children

Iman Abd Al- Moneim ,Ain Shams University

Childhood is a time of increased physical and cognitive development during

which individuals establish dietary and physical activity behaviors that are

determinates of obesity and diabetes, especially type 2, later in life .

Thus , attempts to define diabetes risk factors in children should focus not only

on genetic predisposition, but also on the environmental impact of risk related

behaviors. Health promotion that includes health education and organizational,

economic, and environmental support for behaviors conductive to improved health

and decreased risk factors should include diabetes risk screening .

74

PP.32 Family Centered Care for New Diagnosed Diabetic Child

Dr. Naglaa Girgis Megallaa

Lecture of Public Health Nursing

Faculty of Nursing

Benha University

Diabetes is a disease that requires ongoing active involvement of the child and the family in its management. When the child is first diagnosed with

diabetes, the emotional transition of the child may effect his or her ability to manage the physical aspects of the condition. Family centered care recognizes that family is the constant in the child’s life and this vital to the child’s success in meeting his or her potential. Because cure is not possible for many chronic

conditions as diabetes, the family members must focus on care, that the goal of this care is aimed to minimize the manifestations of the disease and maximize

the child’s physical, cognitive and psychosocial potential. Parents must be involved in treatment decisions for their children that they responsible for the

ongoing physical, emotional, medical and financial care of the child who survives with serious disabilities .

75

PP.33 Diabetic Emergencies: Role of pediatric nurse

Orban Ragab BayoumyPediatric Department, Faculty of Nursing,

Ain Shams University

Diabetes mellitus is the medical condition that results from insulin

deficiency. It is an important condition as it has such a major impact on the child

and the family in terms of; daily life the possibility of unpredictable emergencies

and the severity of the medical problem that occur later in life .

The body is continuously balancing sugar and insulin in turn too

much insulin and not enough sugar leads to low blood sugar possibly insulin

shock, as well as too much sugar and not enough insulin leads to high blood

sugar, possibly diabetic coma. The diabetic children may become comatose

because of DKA and hypoglycemia, all diabetic coma are life threatening

emergency and require prompted and appropriate therapy. Counselor is

instrumental in the process of treatment for the child and his family physically

and emotionally .

76

PP.34 Diabetes and Breast-Feeding

Safaa Fouad El-Sayed, Pediatric Department, Faculty of Nursing,Ain Shams University

The incidence of Juvenile –onset, insulin-dependent diabetes

mellitus (IDDM) is slightly decreased in children breast fed as babies and

diabetes can be induced by feeding cow's milk in strains of rat genetically at

risk . newly diagnosed diabetic children have antibodies to 17 amino acid

fragment of bovine serum albumin (BSA) which are not found in the serum of

siblings or healthy children. Currently it is speculated that these antibodies form

as a result of exposure to cow's milk in early life and precipitate the autoimmune

process leading to diabetes. However it is not yet clear when exposure to BSA is

critical or what does and duration of exposure are important.

77

PP.35 Guidelines for management of DMAziza younis, Ain Shams University

The goals of diabetes general guidelines are to enable the patient

to become the most active participant in his or her care, while matching

level o general guidelines to the ability of the individual patient. Patients

who activity manage their diabetes care have better outcomes than those

who don't for this reason an educational guidelines that facilitates

informed decision making on the part of the patient is widely advanced.

Sometimes his is referred to as the empowerment approach to education.

78

PP.36 The Study of The Effect of Licorice Root Extract

on

Blood Sugar in Diabetic Rat Induced with Streptozotocin.

M shahabinejad1, M Rahmani, M. khaksarie hadad,1.Department of medical surgical nursing Rafsanjan university.

Licorice is a medicinal plant which used in traditional medicine , and

it’s effects have been enumerated. Since the root of there plant is very sweet , if it could reduce the blood sugar or at least not increase it , it could be used an effective remedy in treating and or consumption of diabetic patients for this experimental prevention study performed on eight groups of adult male rats (200-250gr) five groups were diabetic by injection of 25mg / kg STZ and the rats that there blood sugar was higher than 250 mg/dl were entered in to the study. tree groups of diabetic rat and 3 groups healthy rats were given the different doses of licorice root extract (100,200,300 mg/kg) were fed to them everyday and one group of healthy rat were fed normal salin everyday and one group of diabetic rat were injected insulin (4u/kg) blood sugar was measured in zero , seven , fourteen, twenty one, and thirty five day. The results showed that the licorice extract did not change the blood sugar in the healthy rats but the diabetic rats decrease the blood sugar although it did not reduce the blood sugar level to the normal point. There was no significant differences.

It could be concluded that licorice root extract is able to reduce blood sugar and could be use as a treatment and consumption for diabetic patient.

Keywords : blood sugar, licorice root , stereptozotocin, rat, diabetes mellitus.

79

PP.37 Anthropometric Cutoffs for Prediction of Type 2 Diabetes in Tunisian Adult Population

Ben Salem Hachmi L*, Smida H*, Bouguerra R*,Ben Rayana C*, El Atti J*,Gaigi S*, Ben Slama C*, Zouari B**.

**Preventive Department, Faculty of Medicine.*National Institute of Nutrition – Tunis – Tunisia

Obesity is associated with risk of diabetes and cardio-vascular disease. Body mass index (BMI) as an index of obesity is related to this disease risk, but the pattern of body fat distribution is a more important determinant of cardio-vascular disease.

The majority of studies suggest that waist circumference (WC) is a better indicator of abdominal obesity witch is associated with increased risk of developing insulin resistance, diabetes and hypertension. The predictive power of this anthropometric indexes is population-dependent and vary from race to race.

The aim of this study is to identify the anthropometric indexes (BMI, WC) at which risk of diabetes and impaired fasting glucose can be identified with maximum sensitivity and specificity in a representative sample of the Tunisian adult population.

Material and methods: the Tunisian National Nutrition Survey (TNNS) is a cross sectional study performed on a total of 7860 subjects and was conducted on 1996-1997 to estimate the nutritional status of the population. The TNNS included 3846 adults over 19 years or older for whom anthropometric measurements (body weight, height, waist circumference) and fasting plasma glucose were recorded. Receiver operating characteristic (ROC) curves were used to identify the sensitivity and specificity.

Results:Appropriate WC cutoff for identifying fasting hyperglycaemia ³5.6mmol: In men: 83cm (sensitivity 60%, specificity 59%) and in women: 82cm (sensitivity 62%, specificity 61%).Appropriate WC cutoff for identifying diabetes:

In men: 87cm (sensitivity 68 %, specificity 68%) and in women: 87cm (sensitivity 71%, specificity 70%). The current internationally (NCEP, IDF) accepted WC cutoff points showed lower sensitivity (30 – 40%) for identifying glucose tolerance abnormalities in Tunisian men. For BMI: cutoff points of BMI where sensitivity approximates specificity for diabetes and fasting hyperglycaemia were between 23 and 24 kg/m² in men and 25 and 27 kg/m² in women.

Conclusion: The high prevalence of diabetes at low BMI and WC values in our study, suggest the need for lower cutoff points, especially in men. 85 cm (between 82 et 87cm) seem to be the optimal WC cutoff point for predicting diabetes in both men and women.

A body mass index of 24 kg/m² in men and 27 kg/m² in women are appropriate cutoff points of obesity in Tunisian population.

80

PP.38 Diabetics require not only health-care services, but

also training in how to cope on a daily basis Nehal Lasheen

Diabetics require not only health-care services, but also training in how to cope on a daily basis with this chronicdisease that affects every aspect of their lives.This sort of training is rarely available, either due to lack of human and financial resources in health institutions, or due to the inappropriateness of timing of such training for the patients’ own circumstances. As a result, online training might be an alternative solution to provide diabetics with the training they so desperately need to cope with their disease on a daily basis. This is increasingly so as indications show youth in the Arab world to be going online more frequently, while at the same time diabetes is reported to be afflicting youth in the region at an increasing rate.

E-training is a tool that gives trainers the flexibility they need, and at the same time is accessible to normal users of personal computers wherever they may be and at times suitable to their needs. As a result of IslamOnline.net’s desire to provide diabetes patients with the skills and tools they need to cope with their disease, a three week online e-training course titled “Living With Diabetes” was devised and implemented that aimed at helping patients with Type II Diabetes (Juvenile Diabetes) to cope with their disease medically, emotionally, and through making lifestyle changes.

81

PP.39 Rights of diabetic children in schoolSalma El- Sayed, Pediatric , Ain Shams University

No--------- Abstract

82

PP.40 Role of diabetes Educators in Studied Improvement of Diabetes out –Come

Karima El-Shamy, Ph,D , E-Mansora University

No--------- Abstract

83

PP.41 Prevention and Control of Diabetic Foot Problem Karima El-Shamy, Ph,D , E-Mansora University

No--------- Abstract

84