Diabetes - The Way Forward

Diabetes - the way forward
September 17-18, 2012
Abstract Book
SSR Medical College, Mauritius
SSR Medical
College
IAMBR

Symposium on
September 17-18, 2012
Abstract Book
Organized by
SSR MEDICAL COLLEGE, MAURITIUS
Website: http://www.ssrmedicalcollege.com
&
INTERNATIONAL ASSOCIATION OF MEDICAL
AND BIOMEDICAL RESEARCHERS | IAMBR
Website: http://www.iambr.info

ABOUT IAMBR
The International Association of Medical and
Biomedical Researchers (IAMBR) was founded in a
meeting held at SSR Medical College, Mauritius in
December 2010 with the objective to motivate and
sensitize the people of medical and related
professions to participate in medical research
through symposiums/workshops/conferences/etc. The
IAMBR is an international organization and
multidisciplinary in nature including the members
of basis science and clinical medical faculty as well
as the members from allied sciences.
The International Association of Medical and
Biomedical Researchers (IAMBR) was registered on
February 16, 2011.

Contents
Welcome Address 1-3
Organizing committee of the Symposium 4
Managing committee of the Association 5
Program of the Symposium 9-11
Scientific Sessions - Key notes 12-22
Poster Session - Abstracts 23-34
List of Speakers 6-8

About S S R Medical college
SSR Medical College, Mauritius prides itself in offering
an intimate, collegial environment which fosters
human values and genuine learning. The school offers
the best education in an environment that supports the
practice of new skills as well as an individual student's
capacity to learn and serve. A unique emphasis on
understanding and discipline in every action is the
focal point, and this nurtures the student's intellectual
and personal growth. Progressing with a noble idea to
transform education from being a cluster of well-
understood subjects to becoming well-adapted aspects
and principles of life, SSR Medical College has become a
"Centre of Excellence" in medical education, medicare,
training and research.
Mr. R. P. N. Singh, an educationist and social planner
from India is the Founder Chairman and Managing
Trustee of the Trust.
The College strives to excel in every aspect of education
under the direct guidance of honorable chairman
whose vision has made every success possible.

Message
It is a matter of great pride that the "International Association of Medical & Biomedical
Researchers (IAMBR)", an organisation formed by a group of faculty of the SSR Medical
College, Mauritius, has taken initiative to organise a symposium on "Diabetes- the way forward"
on the occasion of the founders Day of the SSR Medical College.
It is hidden from none that Diabetes has acquired diabolic proportion today affecting almost
1/3rd of humanity as its potential victim and has become a scourge of humanity. Globally, an
estimated 300 million people are affected by diabetes, with type 2 making up about 90% of the
cases. Its incidence is increasing rapidly, and by next decade, this number is feared to almost
double, unless some miraculous remedy is discovered.
Unfortunately, the greatest increase in prevalence is expected to occur in our region i.e. in Asia
and Africa. The increase in incidence in "emerging countries" follows the trend of urbanization
and consequent lifestyle changes further aggravated by imperative and imitative junk diet and
life style.
Diabetes is not new to humanity and its reference is found as early as in early Egyptian
manuscripts as well as in ancient Indian references as madhumeha or "honey urine". Its relation
to life style was also established as early as from Roman times. Its classification as today's Type
1 and type-2 diabetes were identified as separate conditions by the Indian physicians
MAHARISHIs Sushruta and Charaka in 400-500 CE.
Though the disorder and disease has been known for so long, solutions have remained limited in
scope and substance. Such a malicious malady requires a continuous dialogue and research for its
containment, if not its complete eradication.
I am sure that some speaker would certainly harp on the timeless wisdom of the Orient, a result
of timeless delving into depths of human experience and experimentation with self and life,
beyond the limits and limitations of labs; and on the preventive rather than curative usefulness
of holistic oriental remedies like breathing exercises, meditation and 'Yoga', which are “more than
useful”.
Shri. R P N Singh
Chairman,
Patron
1

Message
The International Association of Medical and Biomedical Researchers is organizing its second
symposium on "Diabetes- the way forward" on September 17th -18th, 2012 at SSR Medical
College.
Following the grand success of its first symposium on 'Microbial Resistance to Antibiotics' held
in its inaugural year, the Association has been encouraged to take up the challenge of holding
this scientific meeting on a much larger scale.
There will be a galaxy of international and national speakers, all luminaries in their fields, with
a veritable feast of multi-disciplinary deliberations that will cover every advance and stratagem
in humanity's struggle against Diabetes mellitus.
This symposium, indeed all our endeavours, would not be possible without the constant support,
advice and encouragement of Hon. Chairman, and on behalf of the association I extend him our
heartfelt gratitude. Our Principal as Chief Adviser too deserves our thanks for his inspirational
inputs and facilitation.
Our invited speakers have set aside their busy professional schedules to come and share with us
their knowledge and ideas on the very forefront of diabetology as seen from their respective
viewpoints, and it is they who will give this symposium its unique blend and flavor. For this we
are ever grateful and we welcome them into our midst.
The poster session promises to be a collage of recent scientific opinion at the vanguard of diabetic
research. We would like to extend a warm welcome to all the delegates, the faculty, staff and
students of SSR Medical College and thank them for their participation and contribution.
Not least, I would like to thank the Organising Committee whose months of hard work and
preparation is showcased before you today.
Professor (Dr.) Sushil Dawka, MS
Department of Surgery,
President (IAMBR)
2

Symposium on:
Diabetes the way forward | September 17-18,
Dear Delegates,
I extend a warm welcome to all the participants of the symposium on “Diabetes
the way forward” organized by International Association of Medical and
Biomedical Researchers at SSR Medical College, Mauritius. The symposium
intends to focus on the global solutions to a global problem of diabetes in the
community at crisis levels.
I am extremely grateful to our honourable chairman of SSR Medical College Shri
R P N Singh for taking the initiative to organize this symposium and providing
with all necessary facilities for this event. It is a matter of great joy that this
event is being held at our institute. My gratitude also goes to Prof. A K Lavania
(Principal in charge, SSR Medical College), Prof. Sushil Dawka (President,
IAMBR), Prof. Theeshan Bahorun (Vice-President, IAMBR), Professor A P Singh
(Treasurer), Prof. Okezie I Aruoma (International Advisor, Organizing
committee) and last but not least my wife Prof Smriti Agnihotri (Assistant
Treasurer, IAMBR) for their guidance and encouragement. I would be failing in
my duty if I do not acknowledge the generosity and support of all members of
the association, and also Miss Purgass Kirti.
I am thankful to all the participants for an overwhelming response to the
symposium. I am sure that the symposium would provide a platform for healthy
scientific deliberations and interactions between the researchers and scientists.
Prof. (Dr.) Arun Kumar Agnihotri, MD
Department of Forensic Medicine & Toxicology,
Organizing Secretary
WELCOME ADDRESS
3

ORGANIZING COMMITEE
Patron
Shri. R. P. N. Singh
Chairman,
IOMIT's, SSR Medical College, Mauritius
Chief Advisor
Prof. (Brig. Retd.) A. K. Lavania, MD
Principal (In charge),
President
Prof. (Dr.) Sushil Dawka, MS
Vice-president
Prof. (Dr.) Theeshan Bahorun, PhD
National Research Chair, Personal Chair in
Applied Biochemistry, ANDI Centre of
Excellence for Biomedical & Biomaterials
Research, University of Mauritius,
Mauritius
Organizing Secretary
Prof. (Dr.) Arun Kumar Agnihotri, MD
Department of Forensic Medicine,
Co-organizing Secretary
Prof. (Dr.) Rimli Barthakur, MS
Department of Ophthalmology,
Treasurer
Prof. (Dr.) Ashok Pratap Singh, MS
Professor, Department of Anatomy,
Prof. (Dr.) Okezie I Aruoma, PhD
Dean, American University of Health
Sciences, Signal Hill, CA 90755, USA
Prof. (Dr.) David Owens, CBE MD FRCP
Clinical Professor, Department of
Endocrinology & Diabetes, Cardiff
University School of Medicine, Wales, UK
Scientific Committee
Dr. Smriti Agnihotri MD
Professor, Department of Pathology, SSR
Medical College, Mauritius
Dr. Suranjana Ray MD
Associate Professor, Department of Physiology,
Dr. Anishta Allock MBBS
Assistant Professor, Department of Pathology,
Registration Committee
Dr. Anju Bala Singh MS
Associate Professor, Department of Obstetrics &
Gynecology, SSR Medical College, Mauritius
Ms. Smita Kachhwaha MSc
Assistant Professor, Department of Anatomy,
Dr. Tasneem Ibrahim MBBS
Assistant Professor, Department of
Pharmacology, SSR Medical College, Mauritius
Souvenir Committee
Dr. Sudesh Gungadin MD
Chief Police Medical Officer, Police Medical
Division, Port Louis, Mauritius
Dr. Namrata Chhabra MD
Professor, Department of Biochemistry, SSR
Dr. Vandna Jowaheer PhD
Associate Professor, Department of
Mathematics, University of Mauritius,
Mauritius
Reception Committee
Dr. Nandish Mital MS
Additional Professor, Department of Surgery,
Dr. Manas Kanti Ray PhD
Professor, Department of Physiology, SSR
Dr. Adiilah Soodeen MBBS
Lecturer, Department of Anatomy, SSR Medical
College, Mauritius
International Advisors
4

Managing Committee of
IAMBR
President Professor (Dr.) Sushil Dawka, MS
Vice-president Professor (Dr.) Theeshan Bahorun, PhD
ANDI Centre of Excellence for Biomedical & Biomaterials
Research, University of Mauritius, Mauritius
Secretary Professor (Dr.) Arun Kumar Agnihotri, MD
Department of Forensic Medicine & Toxicology,
Assistant
Secretary
Professor (Dr.) Rimli Barthakur, MS
Department of Ophthalmology,
Treasurer Professor (Dr.) Ashok Pratap Singh, MS
Department of Anatomy,
Assistant
Treasurer
Professor (Dr.) Smriti Agnihotri, MD
Department of Pathology,
Members Dr. Sudesh Gungadin MD,
Chief Police Medical Officer, Police Medical Division,
Victoria Hospital, Mauritius
Dr. Pugo Gunsam Prity, MS
Associate Professor, Department of Health Sciences,
University of Mauritius, Mauritius
Professor (Dr.) Namrata Chhabra, MD
Department of Biochemistry,
Ms. Smita Kachhwaha, MSc
Assistant Professor, Department of Anatomy
Auditor Dr. Vandna Jowaheer, PhD
Associate Professor, Department of Mathematics,
University of Mauritius, Mauritius
5

Mr. Henry Cruz
Henry Cruz, diabetes advocate, patient ambassador, community organizer, and
motivational speaker, is the youngest of 12 children of which only four of them
are alive. Diabetes has created havoc on his family. Several years ago, in
response to the impact this loss had created in his family and life, Henry chose to
turn his pain into a weapon against diabetes. Personally the impact of diabetes is
visible in Henry, a month before walking in the first college graduation in his
family, and on his way to Law School, he became completely blind due to
diabetes retinopathy, but miraculously regained sight in his left eye. Formerly, he
served as the Liaison for the Novo Nordisk Community Diabetes Coalition, which
in 2011 was launched in Houston, Los Angeles, and New York. Henry previously
served as the Associate Director of Hospitals, where he was responsible for
implementing accredited DSME programs at 7 major hospitals in the NYC Health
and Hospital Corporation; he also spearheaded the implementation of peer-to-
peer coaching into the HHC HouseCalls Telehealth program, which serves 300
patients living with uncontrolled diabetes. As a chair of the American Diabetes
Association's Latino Advisory Committee, he served as the Manager of Latino
Initiatives and was responsible for reaching 100,000s of Latinos in the NYC area
with the message of diabetes prevention and management education.
Dr. Vidushi Neergheen-
Bhujun PhD
Dr Vidushi Neergheen-Bhujun is a lecturer at the Department of Health
Sciences of the Faculty of Science at the University of Mauritius. She is also a
researcher in the Centre for Biomedical and Biomaterials Research (CBBR), a
multi-disciplinary research centre based at the University of Mauritius and
recognized as an African Network for Drugs and Diagnostics Innovation (ANDI)
Centre of Excellence in Health Innovation. She graduated from the Biosciences
department of the University of Mauritius with a PhD in Biochemistry and
Pharmacognosy in 2008. That dietary or plant biofactors may influence genetic
and epigenetic events associated with several non-communicable diseases
involving oxidative stress, DNA repair, hormonal regulation, cell cycle, apoptosis
and differentiation are novel facets which are important features of Dr Neergheen
-Bhujun’s research interest.
Prof. Okezie I Aruoma
PhD, DSc
Profesoor Okezie Aruoma is founding Chair of Global Pharmaceutical
Education and Research for the School of Pharmacy at the American University of
Health Sciences. Dr Aruoma also serves as the Dean of Biomedical Sciences and
Chair of the Institution Review Board at the American University of Health
Sciences. Prior to the current role, Dr Aruoma was part of the founding faculty to
develop an innovative Doctor of Pharmacy program at Touro College of Pharmacy,
New York. Dr Aruoma has authored numerous books including Molecular Biology
of Free Radical in Human Diseases, DNA & Free Radicals: Techniques,
Mechanisms and Applications and Free Radicals in Tropical Diseases and has had
more than 130 papers published in high ranking scientific peer-reviewed journals.
Dr Aruoma has over 23 years of experience in biomedical research focused on
food biofactors, oxidative stress mechanisms, antioxidant pharmacology and the
pharmaceutical indications of food biofactors as prophylactic agents. Dr Aruoma’s
novel research and teaching endeavors is focused in addition, on promoting public
health nutrition and management of disaeses of overt inflammation (including
diabets) and translational science embracing pharmacogenomics and personalized
medicine. Dr Aruoma received the 2012 Research and Publication Achievement
Award from the Association of Black Health Systems Pharmacists.
6
Symposium on:
Diabetes the way forward | September 17-18, 2012
Introduction to Speakers

Prof. Joseph Indelicato
LCSW, PhD
Professor Joseph Indelicato is a clinical social, and a research psychologist.
He graduated from Fordham University with a degree in Social Work in 1976. His
master's thesis focus on the techniques of increase patient compliance in the
mentally ill and followed that with a second masters 1985 and a doctorate in
psychology at Hofstra University 1987. Dr. Indelicato’s current research interests
include research methodology, patient compliance, pain management, bariatrics,
and statistics. He also works as a clinical psychologist and has testified in over a
hundred court cases, on issues as varied as child custody to neurological damage.
He is currently working on research on the use of Fermented Papaya Preparation
to slow the progress of diabetes. He is involved in work on Mauritian tea for
diabetes management. He is Director of Research for the American Association of
Bariatric Counselors. He is licensed as both a psychologist and a social worker.
Prof. David Owens
CBE MD FRCP
Professor David Owens has been involved in the management of diabetes
and related research activities for more than 35years. His primary interests
include the evolution of glucose intolerance and pathophysiology of type 2
diabetes including new and emerging therapies. He also has a keen interest in all
micro-vascular complications of diabetes especially diabetic retinopathy and
nephropathy, and introduced the first community wide National Diabetic
Retinopathy Screening Service for Wales as its Director & Clinical Lead from its
establishment in 2002 up to 2007. Professor Owens has published over 300 peer-
reviewed papers, in addition to reviews and book chapters. Professor Owens is a
member of the Association of Physicians of Great Britain and Ireland and is a
Fellow of the Royal College of Physicians and Institute of Biology. His opinion has
been sought by numerous diabetes-related advisory boards for both UK and
International governmental organizations and the Pharmaceutical industry. In
2002 Professor Owens was awarded the CBE for his services to diabetes and the
National Health Service.
Prof. Rimli Barthakur
MBBS, MS
Professor Rimli Barthakur passed her MBBS in 1994 and completed her MS
(Ophthalmology) in 2000 from Gauhati Medical College and Hospital, Guwahati,
Assam, India. Subsequently, she joined the Faculty of Ophthalmology, Manipal
College of Medical Sciences, Pokhara, Nepal and worked at Manipal Teaching
Hospital till February 2009. In March 2009, she joined SSR Medical College,
Mauritius, where she is currently Professor of Ophthalmology. She has a
Fellowship in Glaucoma Diagnosis and Therapy from the Aravind-Zeiss Glaucoma
Centre of Excellence, Aravind Eye Hospital, India. She is also a Primary Trauma
Care Provider certified under the Primary Trauma Care Foundation, Oxford, UK.
She has presented papers in many conferences and has publications in various
national and international journals. She is also on the editorial board of a number
of peer reviewed journals.
Dr. Emmanuel Bourdon
MCU, HDR, PhD
Dr Emmanuel Bourdon completed his PhD in Biochemistry in 2000 at Dijon
(France) and has been actively involved in research on the molecular aspects of
diabetes and obesity. He completed his research formation by a two years
postdoctoral position at National Institutes of Health (Bethesda, USA) and by a
one year and a half postdoc in France. In 2004, he got a permanent position as
researcher and Associate Professor in the “Groupe de Recherche sur
l’Inflammation Chronique et l’Obésité » (GEICO) at the Université de la Réunion
(La Réunion, France). Since 2004, Dr Bourdon has lead a working group on
interactions between oxidative stress and cellular pathophysiology in diabetes and
obesity context. He is the author/co-author of more than 35 high level
publications in that field of research. He is a regular reviewer for the evaluation of
scientific articles subjected to review by a peer.
7
Symposium on:

Prof. Theeshan Bahorun
PhD
Professor Theeshan Bahorun has been appointed as National Research
Chair in Applied Biochemistry since January 2012 and is based at the ANDI Centre
of Excellence for Biomedical and Biomaterials Research, University of Mauritius.
His novel research endeavours are focused on promoting public health nutrition
and disease prevention. He was awarded a “Doctorat Sciences de la Vie et de la
Santé” in Plant Biotechnology at the University of Lille I (France). He also holds
a DEA “Génie Enzymatique, Bioconversion et Microbiologie” from Université de
Technologies de Compiègne (France), a “Maîtrise” in “Biochimie Alimentaire” and
a “Licence” in Biochemistry from University of Lille I (France). He has 20 years of
experience in biomedical research including pathophysiological mechanisms in
diabetes, cancer and cardiovascular dysfunctions. Prof Bahorun has authored/co-
authored more than 80 high level publications including the edition of 7 books/
special journal issues and 10 book chapters. In 2010, he received the CV Raman
Senior Fellowship award for African researchers by the Government of India.
Dr. Sandip Hindocha
MBChB, MRCS
Dr Sandip Hindocha, a plastic surgeon, worked for a number of hospitals in
Manchester, Canada and the USA and now works as a senior registrar in plastic,
reconstructive and hand surgery in Liverpool. He is a clinical lecturer at the
University of Manchester and runs a surgical sciences course at the University of
Mauritius. Sandip is the holder of a prestigious Royal College of Surgeons
Research Fellowship and has won several academic prizes including the Society of
Academic Research Surgeons prize at the annual Association of Surgeons in
Training conference. He has published 41 papers and compiled 4 book chapters
and presented his work internationally and nationally equating to over 65 peer
reviewed presentations. His research interests include wound healing and
understanding the etiopathogenesis of abnormal scar formation using
Dupuytren’s disease as a model. Sandip is an enthusiast and keen to teach,
research & operate.
Mr. Arnold Joseph
Arnie Joseph, has more than two decades of experience in public health,
health communication, minority health, cardiovascular disease and diabetes,
community relations, and partnership development. Arnie applies his experience
and commitment to underserved communities, disease prevention, and health
and wellness through collaborative community partnerships as the President and
Founder of Chroma Multicultural Health Communications (Chroma). As the
President of the agency, Arnie is primarily responsible for developing and
implementing strategies to eliminate health disparities by empowering patients,
building stakeholder collaborations, and improving physician and healthcare
provider ability to engage their patients. Arnie is a native New Yorker and studied
biology, inorganic chemistry, biochemistry, and psychology at the State University
of New York at Binghamton.
Dr. Shilpa Sinha
MBBS, MD
Dr Shilpa Sinha post-graduated in Obstetrics and Gynecology from T.N.
Medical College, Nair hospital, Mumbai University in 2001. After post graduation
she worked in Delhi for 1 year. From 2003-2007 she worked with Ministry of
health and Quality of life, Mauritius at Dr A. G. Jeetoo hospital, Port Louis. She
worked as junior and associate consultant at Fortis La Femme and SitaRam
Bhartia Institute of Science and Research till June, 2010. Since July 2010, she is
been working as Consultant in the department of Obstetrics and Gynecology at
Apollo Bramwell Hospital, Mauritius. She has taken special training in infertility
and IVF. She has attended many national and international conferences and
published papers in medical journals. She is a life member of ‘Federation of
Obstetrics and Gynecology societies of India’ and ‘Indian Fertility Society’.
8
Symposium on:

Scientific Program
Monday, September 17
8:15 – 9:00 hours Registration
9:00 – 9:30 hours Inauguration and Welcome Address (by Shri. R P N Singh,
Chairman, SSR Medical College, Belle Rive, Mauritius)
9:30 - 9:45 hours Diabetes - A global health problem
Henry Cruz, Chroma Multicultural Healthcare
Communications, New York, USA
9:45 - 10:00 hours Tea Break
10:00 – 12:15 hours Session 1 - Pathophysiology of Diabetes and its
complications (Chaired by Theeshan Bahorun, Chair in
Applied Biochemistry, National Research Chair, ANDI Centre of
Excellence for Biomedical and Biomaterials Research, University
of Mauritius, Reduit, Mauritius and Joseph Indelicato, Chair of
Touro College Health Sciences, Bay Shore, New York, USA )
10:00 – 10:15 hours Introduction to topic and speakers - Session Chairs
10:15 – 10:40 hours Alterations in antioxidant status of patients suffering from
diabetes mellitus and its associated cardiovascular
complications
Vidushi S Neergheen-Bhujun, Lecturer, Department of
Health Sciences, Faculty of Science and ANDI Centre of
Excellence for Biomedical and Biomaterials Research,
University of Mauritius, Reduit, Mauritius
10:40 – 11:05 hours Integrative biological approaches to diabetic complications
Okezie I. Aruoma, Dean, American University of Health
Sciences, Signal Hill, CA 90755, USA
11:05 – 11:30 hours Proteomic biomarkers of diabetic complications
Emmanuel Bourdon, Groupe d'Etude sur l'Inflammation
Chronique et l'Obésité, Faculté des Sciences, La Réunion –
France
11:55 – 12:15 hours Discussion and conclusion remarks by Chairperson
12:15 – 13:15 hours Lunch
11:30 – 11:55 hours Global clinical research in diabetes
Fatima Morad, Apollo Bramwell Clinical Research,
Mauritius
September 17-18, 2012 Venue – SSR Medical College, Mauritius
9

13:15 – 15:30 hours Session 2 - Diabetic complications (Chaired by
Sandip Hindocha, Clinical Lecturer / Registrar Plastic
Surgery, Whiston Teaching Hospital, Liverpool, UK and
Emmanuel Bourdon MCU HDR, Groupe d'Etude sur
l'Inflammation Chronique et l'Obésité, Faculté des Sciences,
La Réunion – France )
13:15 – 13:30 hours Introduction to topic and speakers - Session Chairs
13:30 – 13:55 hours Management of Cognition Deficit in Diabetes and
Neurodegeneration
Joseph Indelicato, Chair of Touro College Health
Sciences, Bay Shore, New York, USA
13:55 – 14:20 hours The glycaemic management of persons with type 2
diabetes mellitus
David Owens, Clinical Professor, Department of
Endocrinology & Diabetes, Cardiff University School of
Medicine, Wales, UK
14:20 – 14:45 hours Ocular complications of diabetes
Rimli Barthakur, Professor, Department of
Ophthalmology, SSR Medical College, Mauritius
14:45 – 15:10 hours Gestational diabetes - Risk or Myth?
Shilpa Sinha, Consultant, Department of Obstetrics and
Gynecology, Apollo Bramwell Hospital, Mauritius
15:30 – 15:45 hours Tea Break
15:45 – 16:45 hours Session 3 - Poster Session (Venue - A hall near
Examination Room, Second Floor)
10

9:00 – 11:30 hours Session 4 - Prevention and management of
diabetic complications (Chaired by Okezie I.
Aruoma, Dean, American University of Health
Sciences, Signal Hill, CA 90755, USA and David Owens,
Clinical Professor, Department of Endocrinology &
Diabetes, Cardiff University School of Medicine, Wales,
UK )
9:00 – 9:15 hours Introduction to topics and speakers - Session Chairs
9:15 – 9:40 hours Management of diabetic patients - molecular events and
clinical trials
Theeshan Bahorun, Chair in Applied Biochemistry,
National Research Chair, ANDI Centre of Excellence
for Biomedical and Biomaterials Research, University
of Mauritius, Reduit, Mauritius
9:40 – 10:05 hours Role of surgery in diabetic patients
Sandip Hindocha, Clinical Lecturer / Registrar Plastic
Surgery, Whiston Teaching Hospital, Liverpool, UK
10.05 – 10:20 hours Tea Break
10.20 – 10:45 hours Oral health and diabetes
David Owens, Clinical Professor, Department of
Endocrinology & Diabetes, Cardiff University School of
Medicine, Wales, UK
10:45 – 11:10 hours Effective health outreach to "multi-cultural"
communities: the value of collaboration between a
community's health-related stakeholders
Arnold Joseph, CEO, Chroma Multicultural Healthcare
Communications, New York, USA
11:30 – 11:45 hours Vote of thanks and Adjournment
11:45hours onwards Lunch, Prize Giving Ceremony and Cultural Program
Tuesday, September 18
11

Scientific Sessions
Key notes of speakers

Diabetes - a global health problem
Henry Cruz
Chroma Multicultural Healthcare Communication,
New York, USA
The presentation will provide an overview and update on the Global Diabetes pandemic and also highlight
common issues that affect the patient which transcends culture and borders. Although patient-
centeredness in healthcare is becoming a global phenomenon its context appear to be poorly understood in
medical practice. Health policies are important determinants of clinician and patient behavior, and an im-
portant policy issue is what items are included in healthcare quality and performance measures. There is
consensus that patient-centered care and self-management support are essential evidence-based compo-
nents of good diabetes care. The indicators such as patient self-management goal(s), measures of health
behaviors (e.g., healthy eating, medication taking, physical activity, and smoking status), quality of life, and
patient-centered collaborative care are critical components in the assessment of patient-centered problems
in an attempt to harmonize diabetes management on a global scale.
12
Alterations in the antioxidant status of patients suffering from
diabetes mellitus and associated cardiovascular complications
Dr. Vidushi S Neergheen-Bhujun, PhD
ANDI Centre of Excellence for Biomedical and Biomaterials Research,
University of Mauritius, Reduit, Mauritius
Mauritius has a very high prevalence of type 2 diabetes mellitus (T2DM). Patients with T2DM have an
increased risk of cardiovascular complications, which is the major cause of mortality, accounting for more
than 50% of diabetic patients in the island dying from ischaemic heart disease. Oxidative stress has been
implicated in the initiation and progression of diabetes and its associated complications and has been
marked with an increased generation of free radicals and a decreased antioxidant defense system. Thus
this study aimed at determining the total antioxidant capacity and the erythrocyte catalase activity of
Mauritian type 2 diabetics with and without cardiovascular complications. 90 age-, gender- and body mass
index-matched subjects were included in this study and divided into healthy subjects (Group I, n=30),
T2DM patients (Group II, n=30) and diabetic patients with cardiovascular complications (Group III, n=30).
Blood samples were collected from the eligible subjects and the samples were subjected to a number of
biochemical tests and blood total antioxidant activity using the ferric reducing antioxidant power assay and
erythrocyte catalase activity. The mean FRAP value of Group II and Group III were found to be significantly
lower than that of Group I (p < 0.05). A significant decrease was also observed in the mean catalase level
of Group II and Group III as compared to Group I (p < 0.05) while an increase in the level of cholesterol,
triglycerides, LDL, uric acid, urea and creatinine was observed in Group II and Group III as compared to
the healthy subjects of Group I. These data suggest that the in vivo antioxidant defense is highly
compromised in patients with T2DM and associated cardiovascular complications indicating that oxidative
stress plays an important role in the pathogenesis of T2DM, thereby suggesting the potential of exogenous
antioxidants.

Integrative biological approaches to diabetic complications
Professor (Dr.) Okezie I Aruoma, PhD, DSc
Dean, American University of Health Sciences,
Signal Hill, CA 90755, USA
Diabetes mellitus is a group of chronic disorders of the pancreas traditionally regarded as a metabolic
disturbance that involves the elevation of blood glucose, abnormal abdominal fat deposition and insulin
resistance. The insulin dependent diabetes mellitus (Type 1 diabetes) is an autoimmune disease of younger
patients with a lack of insulin production causing hyperglycemia and ketosis and non-insulin dependent
diabetes mellitus (Type 2 diabetes), is a metabolic disorder resulting from the body’s inability to produce
enough or properly utilize insulin. Diabetes is associated with a number of complications including
cardiovascular diseases, nephropathy, neuropathy, retinopathy leading to blindness and embryopathy or
congenital malformations. In diabetic nephropathy, the production of activated protein C in the glomerulus
is abnormal, in part because of hyperglycemia-induced repression of thrombomodulin expression. The
decreased functional activity of activated protein C can affect the permeability of the glomerular capillary
wall enhancing apoptosis of glomerular endothelial cells and podocytes. There is growing emphasis to
assess the integrity of protein C in the subjects and to monitor this biomarker through the commencement
of drug therapy and correlate with the development of atheroma. Further, activated protein C is an
endogenous protein that promotes fibrinolysis and inhibits thrombosis and inflammation. Thus protein C is
not only an important modulator of the coagulation and inflammation associated with severe sepsis but a
biomarker of potential relevance to the pathophysiology of diabetic nephropathy. LDL has been identified as
a major risk factor for atherosclerosis in the general population as well as in diabetic patients. Native LDL,
however, is not atherogenic; the circulating LDL must first undergo some kind of postsecretory modification.
Modifications of LDL (including oxidation and glycation) can facilitate foam cell formation driven in part by the
rapid uptake of the modified LDL by macrophage. Glucose can increase monocyte binding to the endothelial
cells, and as the adhesion of monocytes to the vascular endothelium is a key event in the development of
atherosclerosis (mechanism by which elevated glucose leads to atherosclerosis). Modified LDL contributes to
the fomation of the fatty streak by restricting the macrophage mobility within the arterial wall and stimu-lates
platelets aggregation and procoagulant activity on the surface of the endothelial cells. Interestingly,
lipoprotein lipase may promote the uptake of atherogenic LDL by the different vascular cell types which
eventually contribute to lipid accumulation within the arterial wall. B-type natriuretic peptide (BNP) is a
neurohormone synthesized in the cardiac ventricles, which is released as N-terminal pro-brain natriuretic
peptide (NT-proBNP) and then enzymatically cleaved in to the NT fragment and the immunoreactive BNP.
BNP (and to a lesser extent, N-terminal (pro) BNP) plasma levels are higher in patients with HF and
diabetes, than in those without diabetes. This may be associated with the diastolic dysfunction observed in
these patients, and may have an impact on prognosis. B-type natriuretic peptide is synthesized in the
cardiac ventricles and released as N-terminal pro-brain natriuretic peptide (NT-proBNP) and then
enzymatically cleaved in to the NT fragment and the immunoreactive BNP.
13

Proteomic biomarkers of diabetic complications – Enhanced
glycoxidative modifications impair albumin properties in
diabetes
Dr. Emmanuel Bourdon , MCU, HDR, PhD
Groupe d'Etude sur l'Inflammation Chronique et l'Obésité ,
Faculté des Sciences et Technologies , La Réunion – France
Oxidative stress and oxidative modifications of proteins are involved in many physiological and pathological
processes such as aging, neurological diseases, metabolic syndrome, type 2 diabetes, obesity and
cardiovascular disease, leading cause of death in Western countries. Albumin is the most abundant serum
protein. Among the variety of biological mechanisms which have been proposed to explain the beneficial
effects of higher albumin concentrations, there is now ample evidence for a significant antioxidant activity
of albumin.
Alterations in the structure of albumin may result in impairments of its biological properties. These
modifications could occur in diabetes, which is one of the pathological conditions associated with early
occurrence of vascular complications, together with functional alterations of albumin, which undergoes
increased glycation. This phenomenon corresponds to the nonenzymatic attachment of a glucose molecule
to a free primary amine residue. Amadori rearrangement of the glycated protein gives rise to the
deleterious advanced glycated end products (AGE). Interaction of AGE with their receptors (RAGE) induces
several cellular phenomena potentially relating to diabetic complications. A recent study showed that AGE-
modified bovine serum albumin can be endocytosed by adipocytes via CD36.
The objectives of our work are:
• to analyze the structural and functional properties (antioxidant and binding capacity of pharmaceutical
molecules) of albumin purified from plasma from patients with diabetes,
• to study albumin pro-inflammatory or antioxidant action on cultured human adipocytes and monocytes,
and
• to clarify the involvement of the CD36 receptor in oxidative disturbances in cell cultures of monocytes
and human adipocytes treated with AGEs, and in rats made diabetic by chemical treatment with
streptozotocin.
Our work first revealed oxidative modifications of albumin purified from diabetic patients. We showed that
albumin can act as a biomarker of oxidative stress in diabetic pathology. We established correlations
between biochemical parameters of patients with the structural and functional properties of albumin
(antioxidant properties and binding capacities of biological molecules and pharmaceuticals).
Oxidative damage were then shown in cell culture (monocytes and adipocytes) incubated in the presence
of AGEs formed by glycated albumin. In particular, we observed in cells treated with AGEs: an increased
oxidative stress, an accumulation of oxidized proteins, increased expression of RAGE, an alteration of the
multicatalytic system, the proteasome, involved in the degradation of oxidized proteins. In addition, we
have clarified the role of apolipoprotein E (apoE) in adipocytes. ApoE participates in cholesterol
homeostasis and metabolism of plasma lipoproteins. Despite the major involvement of ApoE in both
neurological disorders (Alzheimer's) and metabolic (metabolic syndrome) its role in adipocyte was very
poorly documented. With the development of SW872 cell lines over-expressing apoE, we were able to
evidence an antioxidant action of ApoE in adipocytes subjected to AGEs-mediated oxidative stress.
These data may suggest an association of oxidative damage in albumin with the progression of diabetes
disorders at the cellular level.
Further experiments are under progress in our laboratory on a rat model of diabetes in order to achieve a
better understanding of glycoxidation impact on albumin properties.
14

Diabetics frequently have the concomitant problem of suffering from cognitive deficits and cognitive
degeneration. Managing and treating these deficits and slowing the degeneration involves both an
understanding of the etiology of both the cognitive deficits and degeneration themselves in order to focus
interventions which may delay or totally impaired the disease processes. The affects of these cognitive
impairments on the actual behaviors of the diabetic will be addressed and interventions both currently
being used and those which are still theoretical.
Measurement of the impairment must be part of the process to determine both the severity of the
condition and the effects of the treatment. While Diabetes and Alzheimer’s have been determined to be
two of the most common causes of dementia in the world, generally diabetics have not been screened for
cognitive impairment although diabetes has been frequently shown to be a precursor of dementia. There
have been a number of theoretical etiologies for these cognitive deficits including duration of the diabetic,
hypertension, dyslipidemia, and small vessel diseases of brain, amongst others, but evaluation of the level
of the cognitive deficits are still not part of the normal screening process.
These concerns are more than just theoretical in nature, since about one third of adults with diabetes have
shown evidence of cognitive impairment. This impairment interferes with a number of processes including
their likelihood to participate in exercise programs, their ability to do basic self care, and their tendency to
stay on appropriate diets or for that matter track a diet and track blood glucose levels. This issue becomes
paramount in the case of diabetes where compliance stands not only in the singular area of medication but
also frequently includes major lifestyle changes. These impairments are not only related to the elderly but
research has also shown their effects much younger patients in which cognitive impairments are rarely
looked for by medical practitioners.
Impairments in cognition can worsen the course of diabetes in a number of ways; interventions must follow
multiple paths depending upon the patients stressors and severity of cognitive impairment. While the
multifactorial ways in which diabetes worsen dementia are not completely understood, these deficits are
evident in neurophysiologic effects on the brain. These stressors cause a speed the course of the
neurological deficits leading to a vicious cycle which must be addressed to truly and fully treat the diabetic
condition.
15
Management of Cognition Deficit in Diabetes and Neurode-
generation
Professor Joseph Indelicato, LCSW, PhD
Touro College School of Health Sciences ,
New York, USA

The prevalence and incidence of type 2 diabetes mellitus (T2DM) continues to increase at an alarming rate
globally and especially in developing countries accompanied by a worrying trend towards younger persons.
Currently 366 million people world wide are estimated to have diabetes which is projected to reach 552
million by 2030 of which more than 90% will have T2DM. As the leading cause of blindness, renal failure,
amputations and cardiovascular disease T2DM represents a significant health-economic burden underlying
the urgent need for the implementation of effective management strategies.
The relationship between glycaemic control and both micro-vascular and macro-vascular complications is
well established, thereby providing a focus for therapeutic intervention along with the recognised need to
control existing co-morbidities such as hypertension and dyslipidaemia.
Historically, several International and National guidelines/consensus statements have been generated over
the years in an attempt to provide the clinician with a structured approach to the total management of
persons with T2DM. The increasing plethora of pharmacological agents presents an additional level of
complexity and controversy to the current unsatisfactory situation. Consequently the American Diabetes
Association (ADA) and the European Association for the Study of Diabetes (EASD) recently issued a Position
Statement on ‘A patient Centred Approach to the Management of Hyperglycaemia in T2DM’, which is the
subject of this presentation. In addition to the need to understand the pathogenesis of T2DM and its
clinical expression based on the stage of the disease process, age, racial, ethnic and genetic differences,
the risk-benefit of the various therapeutic modalities and overcoming clinical inertia addressing the specific
needs of the person with T2DM is an essential pre-requisite for a successful outcome.
In the management of hyperglycaemia a key consideration is arriving at an appropriate glycaemic target
for the individual concerned. Defining the individualised intervention strategy, be it more or less intensive,
necessitates an evaluation of the person’s attitude and expected treatment outcome, disease duration, life
expectancy, important co-morbidities and established vascular complications. Other aspects include the
potential risk of hypoglycaemia and other adverse events from therapeutic agents along with the question
of available resources and support system availability.
Pivotal among the spectrum of options for intervention, is the ‘first-line’ personalised lifestyle adjustments.
Subsequent failure to achieve glycaemic goal requires consideration for the introduction of oral and
injectable anti-diabetic agents. Metformin continues to be the primary oral agent, unless otherwise
contraindicated. Thereafter, based on an inadequate HbA1c response at approximately 3 months, there is
the choice to add a second agent either a sulphonylurea, thiazolidinedione (TZD), DPP-4 inhibitor, GLP-1
receptor agonist or insulin usually as basal insulin. After a further 3 months if glycaemic control remains
inadequate a third alternative agent can be introduced or in the context of insulin, a more complex insulin
strategy can be employed. At each stage from initial drug monotherapy, progressing to two and then three
drug combinations there is need to evaluate efficacy (HbA1c reduction), frequency and severity of
hypoglycaemia, weight, side effect(s) and also costs need to be taken into consideration. The presence of
co-morbidities such as coronary heart disease, heart failure, chronic kidney and liver disease will also
determine the treatment choice.
Education and understanding is central to the whole management process of persons with T2DM, with
structured self-monitoring of blood glucose an essential aid to support the making of appropriated decisions
conjointly between the individual concerned and the responsible clinician based on preferences, needs and
values.
16
The glycaemic management of persons with type 2 diabetes
mellitus
Emeritus Professor David R Owens, CBE MD FRCP
Department of Endocrinology & Diabetes,
Cardiff University School of Medicine, Wales, UK

The current global epidemic of diabetes mellitus is responsible for an unprecedented magnitude of human
suffering and death. Diabetics are at heightened risk for cardiovascular, renal and neurological
complications. Compounding the morbidity of these patients is the threat of visual impairment and eventual
blindness.
According to the World Health Organization, of the 37 million cases of blindness due to eye diseases
worldwide, diabetic retinopathy is responsible for 4.8%. 10% of people who have diabetes for 15 years
develop severe visual problems and about 2% become blind. More than 75% of diabetics will have
developed retinopathy after 20 years.
The retinal complications of diabetes mellitus occur due to damage to the retinal microvasculature. The
main risk factor for developing retinopathy is the duration of diabetes. The other risk factors include poor
glycaemic control, hyperlipidemia, hypertension, pregnancy, renal disease etc. Retinopathy may be non-
proliferative (mild, moderate or severe) or proliferative. Fundus findings in non-proliferative retinopathy
include micro-aneurysms, hard exudates, retinal haemorrhages, oedema, cotton wool spots, intra-retinal
microvascular abnormalities etc. Diabetic maculopathy may also occur leading to severe visual impairment.
Eventually, the retina becomes hypoxic and vascular endothelial growth factors are released, leading to the
development of proliferative retinopathy. Neovascularization may occur on the optic disc or elsewhere on
the retina. These vessels are abnormal and bleed easily, leading to vitreous haemorrhage and ultimately
tractional retinal detachment with serious visual consequences.
Fortunately, diabetic retinopathy can be treated and therapeutic options include laser photocoagulation,
use of intra-vitreal steroids (triamcinolone acetonide), intra-vitreal vascular endothelial growth factor
inhibitors (bevacizumab, ranibizumab), vitrectomy etc.
Diabetics also tend to develop cataracts early and retinopathy may worsen following lens extraction. The
diabetic population is also seen to have a higher risk of developing open angle glaucoma. Proliferative
retinopathy may cause iris neovascularization, which in turn may progress to neovascular glaucoma.
Diabetic peripheral neuropathy may predispose towards reduced corneal sensitivity and some patients may
develop corneal trophic ulcers. Other ocular complications include oculomotor, trochlear and abducent
nerve palsies, pupillary dysfunctions, vascular occlusions, refractive changes, conjunctival abnormalities and
increased risk of ocular bacterial or fungal infections etc.
Ocular complications of diabetes mellitus are increasingly becoming a major cause of blindness throughout
the world. Regular ocular examination of diabetics is of utmost importance in early recognition of
complications. Patient education, cost-effective screening methods and appropriate treatment when needed
can prevent most blindness caused by diabetes.
17
Ocular complications of diabetes
Professor Rimli Barthakur, MS
Head, Department of Ophthalmology,

Gestational Diabetes is defined as any degree of glucose intolerance with onset or first recognition during
pregnancy. The prevalence may range from 1 to 14% of all pregnancies depending on the population
studied and the diagnostic tests employed. Importantly the prevalence of Gestational Diabetes is
increasing, probably because of increased rates of overweight and obesity.
Pregnancy is characterized by insulin resistance and hyperinsulinemia. Gestational Diabetes occurs when
pancreatic functions are not sufficient to overcome the insulin resistance created by changes in
diabetogenic hormones secreted by placenta during pregnancy. Several reasons could contribute to this like
family history, defects in earlier pregnancy (still born, large for date baby), obesity and maternal age over
30 years. There are many myths regarding Gestational Diabetes. A diabetes condition is not developed by
consumption of too many sweet products. Sugar contains high amount of glucose and if it is consumed as
a part of a balanced diet (along with exercise), then people can consume it without the risk of Diabetes.
Life style acts as a trigger to development of Diabetes. Lack of activity may lead to Diabetes.
This condition is associated within increased risks for the fetus and newborn, including congenital
abnormalities, macrosomia, late still born, shoulder dystocia, hyperbilirubinemia, hypoglycemia, Respiratory
distress syndrome and childhood obesity. Offspring of Gestational Diabetic mother are prone to developing
type - 2 Diabetes later in life. Maternal risks include preeclampsia, caesarean delivery and are at increased
risk of developing type -2 diabetes later in life.
It is controversial whether all pregnant patients should be screened for Gestational Diabetes. The American
Diabetes Association has proposed that screening be limited to women with risk factors for Gestational
Diabetes. In September 2011, the committee on obstetric practice of the American College of Obstetricians
and Gynecologists recommended a two step approach to screening and diagnosis. All pregnant women
should be screened for Gestational Diabetes whether by patient’s history, clinical risks factors or 50 grams,
1 hour glucose challenge test at 24-28 weeks of gestation. The diagnosis of Gestational Diabetes can be
made on the result of the 100 grams, 3 hours oral glucose tolerance test.
It is important that multidisciplinary approach be used to improve pregnancy outcome. Effective treatment
regimens consisting of dietary therapy, blood glucose monitoring and administration of insulin if target
blood concentrations are not met with diet alone can decrease maternal and fetal morbidity. Since
Gestational Diabetic have increase risk of type-2 diabetes life style modification, education, follow up and
intervention is important later in life. Offspring should be closely followed up for the development of
obesity and abnormality of glucose intolerance.
18
Gestational diabetes - Risk or Myth?
Dr. Shilpa Sinha, MD
Consultant, Department of Obstetrics and Gynecology,
Apollo Bramwell Hospital, Mauritius

Diabetes is a ROS-mediated pathology with a worldwide prevalence estimated to increase alarmingly in the
coming years. A major effort is ongoing to find therapeutic means to improve health conditions of diabetic
patients. Our group has been actively involved in clinical trials and molecular studies demonstrating that
supplemental natural antioxidants from polyphenolic rich plant foods represent a potential strategy as
adjunct therapy. We hereby report the analyses of twenty-one varieties of tropical citrus fruits for their
total phenolic, flavonoid and vitamin C contents and antioxidant activities. Furthermore in randomized
clinical trials we investigated the effect of a fermented papaya preparation (FPP®
) and polyphenolic rich
green tea infusate on diabetic risk factors of pre-diabetics.
Using a diabetes-like oxidative stress model, the potential protective effect of antioxidative flavedo, albedo
and pulp extracts of selected citrus species were investigated on human adipocytes. In the clinical trials,
study groups consumed 6 g FPP®
/day or 1 standard cup of green tea (without additives) 3 times a day
before main meals for 14 weeks followed by a 2-week wash-out period while the control groups followed a
water regimen. Anthropometric and biochemical characteristics of pre-diabetics were assessed.
Our data show that besides retarding free radical-induced hemolysis of human erythrocytes, non-cytotoxic
concentrations citrus flavedo extracts significantly reduced the levels of protein carbonyls in response to
AGEs generated by albumin glycation in SW872 cells. Flavedo extracts lowered carbonyl accumulation in
H2O2-treated adipocytes while flavedo, albedo and pulp extracts suppressed ROS production in SW872 cells
with or without the addition of H2O2. The FPP clinical trial data show C-reactive protein levels significantly
decreased (P=0.018), LDL/HDL ratio was considerably changed (P=0.042), and uric acid levels were
significantly improved (P=0.001). ANOVA results also validated the same findings with significant
differences in C-reactive protein, LDL/HDL ratio, uric acid and in serum ferritin levels. Green tea modulated
the level glucose of women and prevented a significant elevation after week 14. Its consumption non-
significantly reduced ferritin in men by 3.0 % and significantly increased the antioxidant potential of men
and women sera by 2.7 % (P < 0.1) and 5.1 % (P < 0.01) respectively after week 14.
Our data show that citrus fruit extracts represent an important source of antioxidants with a novel
antioxidative role at the adipose tissue level and that FPP®
and green tea regimens could form part of a
healthy lifestyle that might ameliorate features of metabolic syndrome and subsequent risks for type 2
diabetes.
19
Management of diabetic patients - molecular events and
clinical trials
Professor (Dr.) Theeshan Bahorun, PhD
National Research Chair, ANDI Centre of Excellence for Biomedical and
Biomaterials Research, University of Mauritius, Reduit, Mauritius

Diabetes poses a challenge for the surgeon at pre, peri and post operative stages of surgical treatment. It
is imperative that the patients diabetes is under control so as to avoid post operative complications such as
infection, poor wound healing, osmotic diuresis and dehydration. The insulin deficiency can also lead to
keto-acidosis and protein catabolism.
Non-insulin dependent diabetic patients are at risk of hypoglycaemia which if not managed appropriately
can lead to brain injury.
Diabetic patients should be placed first on the operating list and oral hypoglycaemic drugs should be
stopped and as with insulin dependant diabetics started on an insulin sliding scale.
The increase in prevalence of diabetes increases the number of diabetic related surgical procedures such as
peripheral vascular by-pass grafts, major abdominal surgery, amputations and the need for more extensive
reconstructions following wound breakdown or trauma as a result of poor wound healing. This is in addition
to the rising obesity epidemic fueling the diabetic epidemic increasing the number of gastric by-passes and
body contouring following massive weight loss.
It is absolute that the surgeon and the physician work in harmony and in collaboration in order to reduce
these complications when the diabetic patient is to face the knife.
20
Role of surgery in diabetic patients
Dr. Sandip Hindocha, MBChB, MRCS
Registrar Plastic Surgery ,
Whiston Teaching Hospital, Liverpool, UK

Periodontal disease (PD) evolves from exposure to pathogens in the oral cavity in a susceptible host. The
process is based on an initial immuno-inflammatory response which leads to the formation of a dental
biofilm (plaque), gingivitis (bleeding, swollen gums) followed by periodontitis with local connective tissue
degradation, alveolar bone loss and finally tooth detachment. This situation represents an inter-play
between environmental, acquired and genetic putative risk factors.
Periodontal disease and diabetes have a bi-directional relationship with periodontal disease able to
adversely impact on glycaemic control by virtue of deteriorating insulin sensitivity whilst chronic poor
metabolic control in a person with diabetes will increase the hosts’ susceptibility to infection thus enhancing
the risk of gingivitis which in the presence of continuing dysglycaemia will eventually result in periodontal
disease. Therefore periodontal disease has for sometime been regarded as the sixth complication of
diabetes following on to visual impairment/blindness, amputations, cardiovascular disease, hypoglycaemia
and sexual dysfunction. Improving oral health and diabetes appears to have a positive influence on each
other. Smoking is a strong environmental risk factor for periodontal disease that cannot be ignored.
Other oral complications observed in persons with diabetes include xerostomia (dry mouth), fungal
infections – candidiasis, alteration in taste, burning mouth syndrome and dental caries.
There are two clinical questions for the diabetic community which were addressed in the IDF Oral Health
Guideline published in 2008. They were: (i) what level of surveillance for periodontal disease should be
recommended, in persons with diabetes? and (ii) is active management of periodontal disease
recommended for people with diabetes?
In 2008 the evidence to support the adoption of specific surveillance programmes as part of structured
diabetes care was not available nor the suggestion that periodontal disease managed more efficiently in
diabetes results in immediate or long-term gain. This was due to the evidence being derived from studies
of variable quality highlighting the need for more and higher quality research. However in the meantime it
is recommended that efforts to prevent periodontal disease in people with diabetes should be encouraged.
Day-to-day dental care should be part of normal diabetes self-management. Enhancement of professional
education and awareness, oral health education for people with diabetes, communication between the
dental and diabetic professionals and collaboration in future research both basic and clinical is being
strongly advocated.
A review of the evidence on the interaction between diabetes and periodontal disease will be presented.
21
Oral Health in persons with Diabetes Mellitus
Emeritus Professor David Owens, CBE MD FRCP
Department of Endocrinology & Diabetes,
Cardiff University School of Medicine, Wales, UK

What are ‘working’ community-based diabetes Coalitions?
‘Working’ Coalitions are comprised of organizations that collaborate in order to address the barriers to
improved diabetes outcomes in those cities’ African American and Latino communities
Why are Coalitions necessary? What role do they serve?
Despite the combined efforts of many health-related organizations, there are significantly higher rates of
diabetes in most cities’ African American and Latino communities than in the general population. In
addition, racial and ethnic disparities in diabetes morbidity and mortality continue to grow.
Barriers to stakeholders’ efforts to improve diabetes outcomes may include:
ο Patients with diabetes may remain undiagnosed until they present with complications
ο Many patients are unaware that while they are being treated for diabetes, they are not treated to ‘goal’
ο Patients do not understand the importance of diabetes self-management in the prevention of
complications
ο Patients sometimes do not comply with physician and healthcare provider recommendations to be more
physically active, to improve nutrition, or to take medicines as prescribed
ο Health-related organizations often work “in silos”, and do not work together to share resources and
best practices
ο Patients and their physicians and healthcare providers are often unaware of, or not connected to, the
local health-related resources that are available
How do the Coalitions achieve their objective?
Coalitions provide a vehicle to address key barriers to patient engagement
ο Improving synergy and collaboration between health-related stakeholders
ο Developing and implementing culturally relevant local strategies to improve patient engagement
ο Improving patient, physician, and healthcare provider awareness and usage of local resources and
organizations
How do the Coalitions work?
ο The Coalitions meet every 2-3 months to share ‘best practices’ for improving patient engagement
ο Coalition members volunteer to participate in Working Groups, which meet every 2 months to discuss
development of city-specific strategies to address local barriers to improved engagement
What types of organizations are a part of successful Coalitions?
A few examples include: Managed care organizations; Local chapters of medical, nursing, and healthcare
provider organizations; Community-based healthcare organizations; Large medical clinics; “Lay health”
organizations; Patient advocacy groups; “Ethnic” media outlets; Civic agencies; Faith-based organizations;
Employers; Professional schools; Medical institutions and hospital clinics
22
Effective health outreach to "multi-cultural" communities:
the value of collaboration between a community's health-
related stakeholders
Arnold Joseph,
CEO, Chroma Multicultural Healthcare Communications,
New York, USA

Screening of medical students for future risk of type 2 Dia-
betes Mellitus using IDRS
AR Joshi, A Pranita, JS Kharche, AV Phadke
Bharati Vidyapeeth Deemed University, Medical College, Pune - 411 043, India
Incidence of type 2 Diabetes Mellitus is on the rise even in developing countries like India due to
urbanization and socioeconomic development. As of today every fifth diabetic person in the world is Indian.
A disease which was conventionally known to have onset at middle age, is now being identified in younger
age group. This underscores the need for mass awareness and screening programs to detect diabetes at
an early stage.
In our study we have used a simplified Indian Diabetic Risk Score (IDRS) for prediction of risk of diabetes
in undergraduate medical students. In India, Mohan et al have developed a simple screening tool, namely
Indian Diabetes Risk Score (IDRS) to determine the risk of developing type 2 diabetes mellitus for general
population. Step 1 is to determine this score which is a simple and inexpensive procedure. It includes age,
waist circumference, physical activity and family history of DM. Accordingly scoring is made for IDRS. Step
2 consists of estimation of Random Capillary Blood Glucose (RCBG) in those with high IDRS score (score ≥
60). Step 3 consists of estimation of post glucose blood sugar level in those having RCBG >113mg/dl
during step 2, for definitive diagnosis of type 2 D M. Those having post glucose blood sugar level >140 mg/
dl are labeled as diabetics and those having post glucose blood sugar level ranging between 100 to 140mg/
dl are labeled as prediabetic.
In our study 261 medical students (18-22 years) were screened for IDRS score. In step 1, we observed
that 5 % students had high risk(score ≥ 60), 55 % students had moderate risk (score 30-50) and 38% had
low risk (score < 30) of developing type 2 diabetes mellitus in future. In step 2 random capillary blood
glucose was estimated in 21 students having IDRS score more than 50. Two students showed RCBG > 113
mg/dl. In these two students, step 3 was performed i.e. estimation of FBG and blood glucose
2 hour post 75 gms of glucose load. After performing this step, one student was found to have FBG level >
100 mg/dl but post glucose level was less than 140 mg/dl and was labeled prediabetic.
This underscores the need for investigation of all those who are found to have high risk after applying IDRS
score to detect diabetes at an early stage so that its complications can be minimized with aggressive
treatment. Prevention of obesity and promotion of physical activity should be the integrated approach for
population in general and for those having high risk of developing type 2 DM in future in particular.
23

Subtle changes in nerve conduction is the first reliable sign of nerve complications from diabetes and this
changes can be measured long before other symptoms or signs of nerve damage develops. About 60 to
70% people with diabetes develop some type of nerve damage (neuropathy) caused indirectly by high
blood sugar levels. Distal symmetric sensorimotor polyneuropathy is most common type, affects the most
distal extremities first, and extends up the legs & upper extremities. It is insidious from the beginning and
progressive in nature that has a long asymptomatic stage. Hence it is important to identify neuropathy in
the asymptomatic stages.
The present study was undertaken to find out the correlation between peripheral nerve conduction velocity
and type 2 diabetes in obese people ( BMI >30). Type 2 diabetes often remains undiagnosed until the pa-
tient presents with chronic complications. 42 normal non-diabetic healthy male, body mass index (BMI
<25), Michigan Neuropathy Screening Instrument (MNSI score >15); and 42 male, no history of diabetes
(BMI >30), (MNSI score >15), age in the range of 25-50 years were included. Exclusion criteria was age
less than 25 and more than 40 yrs, suffering from any neuromuscular or musculoskeletal disorders, tri-
cyclic anti-depressants, Pregabalin medication. The nerves tested were median (motor, sensory), ulnar
(motor, sensory), common peroneal (motor, sensory) by clinical electromyography (Neuroperfect EMG-
2000). Orthodromic motor and antidromic sensory parameters of the nerves were measured. Sural nerve
(sensory) conduction velocity was measured antidromically by using surface electrodes, active electrode
was placed just below the lateral malleolus. The stimulating electrode was kept at a distance of 14 cm from
the active electrode and kept constant in every subject. For ulnar nerve, stimulating electrode placed at 5
cm below the medial epicondyle and the recording electrode were placed over the abductor digiti minimi
(ADM) muscle on the ulnar side of the hand.
Average age, weight, height and BMI in normal and obese people were ( 34.4 ± 9.3 yrs, 72.5 ± 9.5 kg,
171 ± 11.1 cm, 23.7 ± 0.85) compared to (42.1 ± 7.2 yrs, 98.3 ± 18.6 kg, 167 ± 7.6 cm, 34.8 ± 3.3) re-
spectively. The mean velocity for median nerves (motor & sensory) were 54.87 ± 3.46 m/s and 53.58 ±
6.92 m/s; ulnar nerves (motor and sensory) were 61.12 ± 4.08 m/s and 53.42 ± 5.16 m/s in subjects (BMI
<25). Median and ulnar nerves (motor & sensory), mean velocity in obese people were significantly low
(p<0.01), median motor (49.81 ± 4.92 m/s), sensory (51.32 ± 6.17 m/s) and in ulnar nerves, motor
(60.23 ± 4.67 m/s) and sensory (52.38 ± 4.29 m/s). Common peroneal (motor) nerve velocity was (50.63
± 3.46 m/s), sural nerve sensory (48.42 ± 3.81 m/s) was significantly lower in obese people (49.80 ±
3.12 m/s) and (48.0 ± 3.21 m/s) (p <0.05) respectively.
This study demonstrates that BMI (Kg/m2
) can affect the nerve conduction velocity in obese people (BMI
>30) and that type 2 diabetes can be detected at an early stage (i.e. asymptomatic stage).
Early detection of type 2 diabetes by nerve conduction veloc-
ity in obese people
Manas Kanti Ray*, Suranjana Ray*, Sundeb Sanyal**
*SSR Medical College, Mauritius; **North Bengal Medical College, West Bengal, India
24

The human microbiome, especially the gut microbiome have a role, in protecting the body from harmful
bacteria. The factors that shape and cultivate each person’s interior microbial world are both genetic and
environmental. Emerging evidence suggest, that the relationship between certain gut microbes and the
immune system may be a critical factor in the development of both Type I and Type II diabetes. Mutually
beneficial host-microbe interactions, is critical for immune maturation. Type II diabetes is a life-style
disease which has a major genetic preponderance. Life style factors like high waist-hip ratio, lack of
physical activity, poor diet (sweetened carbonated drink, trans fatty acids intake), stress, urbanization and
obesity (BMI> 30). Whereas Type I is an autoimmune disease which may be due to the presence of the
wrong type of gut bacteria in plentiful.
Scientist found that defective copy of a gene called Toll-like Receptor-2 (TLR-2) plays an important role in
pathogen recognition and innate immunity, which can lead to diabetes related symptoms like obesity,
glucose intolerance, insulin resistance and increased weight gain on high fat diet. Persons having defective
TLR-2 have higher proportion of a group of bacteria called Firmicutes and a reduction of another kind of
bacteria called Bifidobacterium in their gut microbiome. Those who have higher levels of Firmicutes are
obese, as these bacteria helps extract energy from food by producing enzymes which break down
otherwise indigestible compounds. Bifidobacterium are important in maintaining the gut barrier as
increased gut permeability allows a molecule called LPS (Lipo Polysaccharide) to get into the blood stream.
The immune system recognises LPS as a toxin and responds causing inflammation and liver-related insulin-
resistance. Hence, the constituent of a person’s gut microbiota can be linked to metabolic diseases like
Type-II diabetes. A modification of this microbiota that is a change in the ratio of Firmicutes to
Bacteroidetes characterizes the ability of the individual to combat the development of the disease.
Genetic engineered non-pathogenic E. coli can make Glucagon like peptide 1 (GLP-1), which is a
transcription product of pro-glucagon gene. It is secreted by intestinal L cells and dependent on presence
of nutrients in the gut. It is a potent antiglycaemic hormone inducing glucose dependent stimulation of
insulin secretion while suppressing glucagon secretion. GLP-1 appears to restore the glucose sensitivity of
pancreatic β-cells with the mechanism involving increase expression of GLUT-II and glucokinase. It is
known to inhibit pancreatic β-cells apoptosis or to stimulate the proliferation and differentiation of β-cells.
World-wide it has been found that genetic mutation of gut microbes compromise the immune system
causing obesity and insulin resistance. They also found that healthier the child more diverse the human
microbiome. Bacterial markers which could predict the occurrence the given metabolic phenotype (diabetes
prone or obesity prone) and genetically engineered nutritional additives can be given to genetically prone
diabetic persons targeting intestinal microbiota to predict or reduce the risk of development of diabetes.
This can be given as probiotics in yogurt or smoothies or pre-biotics and fibre-laden foods.
Human microbiome and diabetes
Suranjana Ray, Manas Kanti Ray
25

The association between periodontal disease and diabetes mellitus has been explored by many researchers
over the years. Periodontitis, now considered as the ‘sixth complication of diabetes’ can induce or
aggravate systemic conditions. Hence a proper periodontal treatment may curb the sugar level in diabetic
patients. In this project, a programmed systematic longitudinal study has been conducted to evaluate the
effect of professional periodontal maintenance therapy on the serum levels of glycated haemoglobin (Hb
A1c) in patients suffering from type 2 diabetes from Mauritius.
Forty subjects with type 2 diabetes mellitus were included in the study and all of them were treated in
dental clinic for periodontal maintenance therapy (scaling & root planning). Doxycycline 100mg/day was
prescribed to all for 14 days after which the parameters - the plaque index, probing depth, clinical loss of
attachment and Glycated Hb A1c were recorded. Those subjects who had less than 7% of Hb A1c were not
included in the study, hence 10 patients were excluded. Based on this the patients were randomly put
under two groups – the control and the study groups. All of them prescribed Doxycycline 50mg/day for 1
month. Home care was instructed for both groups for 3 months and they were called periodically every
month for 3 months. Plaque index was recorded every month for both the groups. Periodontal maintenance
care was given in the clinic for the study group every month. At the 3rd month clinical data - Hb A1c,
probing depth and clinical loss of attachment were recorded for all patients in both groups.
Data exploration indicates that the measurements of plaque index, probing depth, clinical loss of
attachment and the values of Hb A1c for both samples’ comparativity decreased after the period of 3
months. However, as compared to control group, treatment group shows much more decrease in Hb A1c
levels. The analytical result indicate that this therapy significantly helped in reducing the plaque index,
probing depth and clinical loss of attachment. The reduction in Hb A1c levels were found to be statistically
significant in patients who followed periodontal maintenance therapy in addition to home care maintenance
as compared to the control group subjected only to home care maintenance.
Periodontal maintenance therapy improved the sugar level in diabetic patients. However in order to
understand the potential of this treatment to improve glycaemic control among people with diabetes, large
sample studies are needed.
Periodontal maintenance therapy in type 2 diabetes
Lily Misra*, Vandna Jowaheer**, Suranjana Ray*
*SSR Medical College, Mauritius; **University of Mauritius
26

Neurological problems are the major complications in early onset of Type I diabetes mellitus which causes
the potential physiomorphological changes on central nervous system which can’t be ignored during the
early childhood cognitive behavior. The early recognition and initiation of treatment can prevent possible
complications especially in the young children with early onset of diabetes mellitus. The ancient good old
alternative medical science Ayurveda has mentioned substantial use of many herbs and herbal formulations
to combat diabetes and its complications, one such herb known as Salacia chinencis is selected for our
experimental research trials by considering its antihyperglycemic effect to treat diabetes in its early stage.
Diabetes was induced in 22 days (post natal) wistar rats by giving intraperitoneal injection of
Streptozotocin at a dose of 60mg/kg body weight. After the confirmation of diabetic state the treatment
with alcoholic root extract of Salacia chinencis at a dose of 100mg/Kg body weight was started immediately
and it is continued for one month of duration. At the end of 30 days treatment schedule the animals were
scarified and the brain tissue was collected; after completing the histological tissue processing and
sectioning it was stained with cresyl violet and it was subjected to histological studies by considering the
changes in frontal cortical neurons. The sections with Golgi staining were subjected to camera Lucida
drawings and later they were analyzed by considering changes in its dendritic arborization.
Salacia chinencis show significant impact on the gross neuronal morphology of frontal cortex along with
their increased dendritic arborization when compared with age matched normal and diabetic control
groups. The phytochemicals present in the alcoholic root extract of Salacia chinencis might have interfered
directly or indirectly on the glucose metabolism of early juvenile diabetic rat brain cortex by preventing
possible adverse changes. This herbal root extract not only supports the effective glucose control but also
can influence the dendritic growth which is essential for cognitive functions during the early childhood by
influencing the effective survival of neurons.
Effect of root extract of salacia chinencis (Linn) on frontal
cortical neuron morphology and its dendritic arborization in
early diabetic young rat experimental model
Mathada V Ravishankar
JN Medical College, KLE University, Belgaum, Karnataka, India
27

Four hundred is the number of limb amputations carried out every year for non-traumatic cases
of gangrene foot out of a population of 1.2 million. This occurs in a small island where healthcare
facilities are provided free of charge in government institutions. Yet, this small island in Indian
Ocean has the second highest prevalence of diabetes mellitus in the world and first in Africa. The
aim of this survey is to see how far the young generation stands from diabetes. They might be
among the future diabetics patients. Diabetes leads to many dreadful complications, are those
youngsters aware of this fact? If yes, what precautions are they taking? To answer these
questions and many others, a questionnaire based study was carried out. 250 youngsters (age 14
-25 years) coming from secondary schools across the island and tertiary institutions (UOM, UTM
and SSRMC) were made to fill in questionnaire. Their eating habits, sports activities and
background knowledge about DM were inquired. The results clearly demonstrates the nibbling
habits of those Mauritians - 55% eat in between breakfast and lunch, 62% in between lunch and
dinner and 53% before going to bed. Surprisingly, in an island with vast economic exclusive zone,
20.4% do not eat fish at all while 12.4% only consume fish about thrice a week. About 50%
participants eat only one fruit per day and 13.6% do not like fruits. Furthermore, 38.4% said that
they do not drink a cut of tea/coffee without adding two teaspoons of sugar. A significant amount
(43.2%) affords to take out only 1 hour per week to practice some physical activities and 12.4%
seem to have no time at all. Regarding complications of diabetics, 13.2% clearly are ignorant
about those.67.9% agree that DM leads to eye problems, 49.6% agreed about foot ulcers, 46.8%
were aware of kidney damage and 39.2% knew that CVS problems/MI/stroke are among the
complications. 75% of the interviewees have a family history of Diabetes. But 50.4% of the
participants say they are not taking any precautions at all. The majority of those taking some
precautions think that only controlling sugar intake is going to protect them from this disease.
These alarming results should be taken into consideration. Else, Mauritius will come out first
worldwide with the highest prevalence of Diabetes. Also, it will increase the burden of the
healthcare department and the economic process of this small island. The young Mauritians need
to be educated again and again on a regular basis. In addition, physical activities should be made
compulsory at all levels. Adding Nutritional Studies as part of the curriculum and organizing
health camps during vacations will be of great help. Act today for a healthier population with a
low prevalence of Diabetes Mellitus type ll, for a better progress of the whole country.
A preliminary study to investigate prevalence of diabetes
among young Mauritians
Chut-Kai Nuzhah Widaad*, Rassool M. Yusuf Ali*, Sadally Mouneerah Bibi**
*SSR Medical College, Mauritius; **University of Mauritius, Mauritius
28

The prevalence and incidence of diabetes are growing steadily, affecting an estimated 285 million adults
worldwide, out of which approximately 85% to 95% have the type 2 diabetes (T2DM). The conventional
agents used to treat type 2 diabetes frequently display reduced efficacy over time and their use is often
limited by adverse effects such as weight gain and hypoglycemia. With the increased awareness of
pathophysiologic mechanisms of diabetes mellitus, clinical attention has shifted to the incretin system. The
two most recently approved therapies in T2DM are based on this pathway. These molecules have proved to
help better glycemic control while reducing the common adverse effects of conventional anti diabetic
agents.
The pathophysiology of type 2 diabetes mellitus (T2DM) has so far been based on the triad of a
progressive drop in insulin-producing pancreatic beta cells, a rise in insulin resistance as well as an
increased hepatic glucose production. Recent research has indeed revealed that other factors such as the
defective actions of the gastrointestinal (GI) incretin hormones glucagon-like peptide–1 (GLP-1) and
glucose-dependent insulinotropic polypeptide (GIP) also have a substantial role to play. These endogenous
incretins are secreted from endocrine cells in the small intestine. Within minutes of nutrient ingestion, GLP-
1 is secreted from intestinal L cells in the distal ileum and colon, while GIP is released by intestinal K cells
in the duodenum and jejunum. GLP-1 and GIP trigger their insulinotropic actions by binding beta-cell
receptors. GLP-1 also inhibits glucose-dependent glucagon secretion from alpha cells on the pancreas.
A key limitation to therapeutic use of the endogenous incretins is their rapid turnover (1- to 2-minute half-
lives), resulting from the action of the circulating enzyme dipeptidyl peptidase 4 (DPP4), which rapidly
inactivates GIP and GLP1. Promising therapeutic approaches for T2DM therefore include stabilizing
endogenous GLP1 using a DPP4 inhibitor (sitagliptin, vildagliptin or saxagliptin) or supplying an exogenous,
more stable molecule with the action of GLP1 (the GLP1 mimetic, exenatide, or the human GLP1 analogue,
liraglutide).
As peptide-based therapies, the GLP1 receptor agonists require subcutaneous administration. Clinical
studies have shown beneficial effects of the GLP-1 receptor agonists on weight, blood pressure and lipid
profile and this may imply substantial benefit in terms of macrovascular outcomes. Oral DPP4 inhibitors
increase the availability of endogenous GLP1, thus enhancing glucose-induced insulin secretion and
inhibiting glucagon release. These agents have no effect on gastric emptying and are weight neutral.
Current statistics are highly encouraging with regards the safety and efficacy of incretin based therapy in
T2DM. Due to their original glucose-dependent action, they reduce the incidence of hypoglycemia and
decrease the β-cell stress therefore preserving the β-cell function. These alternative forms of treatment
appear very promising and will contribute positively to the available therapeutic field. Having already
gained widespread use in the developed world, they will indeed help remedy weight-gain related issues,
hypoglycemia and also lead to effective glycemic control in patients.
Incretin-based therapy as a new alternative treatment in
type 2 diabetes
Oodesh Kumar Ramdin, Reshad Kurrimbukus, Neelkant Rai Rajcumar
Dr. Jeetoo Hospital, Port Louis, Mauritius
29

There has been an appalling rise of type 2 diabetes mellitus in the pediatric population in the past 10-15
years in the U.S., in parallel to the rise of obesity in this age group. Studies among the Japanese, Indian,
British, Chinese, Taiwanese, Libyan, Bangladeshi and Australian populations also have shown similar trends
in the U.S. during early 1990s it was rare to have a child with type 2 diabetes in a pediatric clinic. By the
year 2000, it accounted for 8-45% of new cases depending on geographic location and ethnicity. Potential
risk factors for type 2 diabetes are genetic and environmental and out of these obesity appears to be the
most significant one. In the United States, 1 out of every 5 children was found to be overweight and had
double the risk of developing diabetes as compared to children with normal weight. Among youth with
Type 2 diabetes in USA, the prevalence of overweight was 10.4% and obesity was 79.4%. 45–80% had a
parent with type 2 diabetes. Other risk factors include minority ethnic groups (American Indian, African-
American, Asian, or Hispanic/Latino), sedentary lifestyle, puberty, intrauterine exposure to diabetes and
female sex. The mean age range of onset of type 2 diabetes is 12-16 years, with earlier onset in females
than males. 60–90% of children present with acanthosis nigricans, which is the most important physical
sign of insulin resistance. The earlier the onset of diabetes, the earlier is the risk of long-term complications
like atherosclerosis, nephropathy, retinopathy. Elevated apoB and dense LDL were common lipoprotein
abnormalities in youth with type 2 diabetes, which explains the high risk of cardiovascular problems as
early as second decade of life. Co-morbidities usually present in these children because of co-existing
obesity are hypertension, fatty liver, obstructive sleep apnea, orthopedic and behavioral problems.
Screening for children with risk factors may begin at age 10 years or at onset of puberty, if puberty occurs
at a younger age and should be performed every 2 years, thereafter. ADA recommends fasting plasma
glucose as the preferred screening study. Ideally, management of diabetes should involve a pediatric
endocrinologist, a diabetes nurse educator, a nutritionist, and a behavioral specialist. Treatment of type 2
diabetes in youth is a combination of various strategies. Less than 10% children are treated with diet and
exercise alone. Pharmacological intervention appears to be necessary in form of either insulin or one of the
oral drugs. The persistence of obesity interferes with the response to treatment. WHO encourages to
strengthen the national policies for prevention and control of diabetes as well as promotes research in the
field. Population strategies focusing on increasing the physical activity and improving nutrition must be
implemented. Every member of the community plays a role to put an end to the rise of this debilitating
disease in children.
Pediatric type 2 diabetes: a modern epidemic
Bhanu Gogia*, Supriya Singh Toor, Rajat Mehta**
*SSR Medical College, Mauritius; **Civil Hospital, Sonipat, India
30

Diabetes Mellitus (DM) a lifelong disease has put a considerable morbidity burden in the worldwide
population including Mauritius. It is estimated that 150 million people worldwide have DM, as per textbook.
The Non Communicable Disease (NCD) Survey with Mauritius and Australia Collaboration done in
January,2010 by Ministry of Health and Quality of Life found 18% DM in 1995,19.3% DM in 2004 and
23.7% DM in 2009.
While participating in health camps conducted by Positive Approach to Total Health (PATH) an NGO in
Mauritius, from 17th April 2011 to 9th July 2012 a period of 15 months we found 163 Type2 DM, a
percentage of 11.8%.
During our clinical posting in three major hospitals (Victoria, JNH and Moka Eye hospital), we got a
morbidity data of 110 case in a period of seven months (Jan’12-July’12). Out of these cases, 56 had ocular
complication, 19 had Gestational Diabetes Mellitus (GDM) and 35 had other complication like podiatric and
surgical. Of the Ophthalmic complication, 41.7% were Retinal Detachment (RD) and others cataract (both
early age and post vitrectomy). Of the patient having GDM the number below the age of 30 were more and
smoking and alcohol consumption was found to be contributing factor and they also had a diet which
include more of saturated fat. Some of them had GDM even in previous pregnancies. Fetal macrosomia was
the most common complication. Of the surgical and podiatric cases complication like gangrene,
amputation, non-healing ulcers and wounds were observed.
In all the cases of observed DM in both community and out-patient we found that poor lifestyle i.e. more
intake of saturated fat, low fiber diet, abnormal Basal Metabolic Index (BMI), and increase stress were
contributing factors. Also those having DM were smoker and consumed alcohol and lacked physical activity.
The incidence of DM rose from 1995 to 2009 as observed by the survey by Ministry of Health and Quality of
Life. Hence Diabetes and Vasculopathy Center was established under the collaboration of UK and Mauritius
in 2010. This center does screening and registration of all diabetic patients in Mauritius. It is fully equipped
with podiatric unit, retinal screening and other modern equipment. They advise diabetic diet, life style
changes and proper management and follow up. The therapy advised are oral (Gliclazide, metformin) and
Actrapid (insulin). But now new therapies are being used in other countries like ICRETINS are intestinal
hormones which potentiate glucose induced insulin response.
With all said and done, around 53.4% of Mauritius population is pre diabetic or diabetic. With every person
detected to have diabetes another remains undiagnosed. Despite management and follow up the control
rate remains poor because of undetected cases, sedentary life style, lack of physical activity and
lackadaisical behavior towards screening and follow up. Hence we plan to conduct diabetes awareness
camps in Mauritius with Ministry of Health and Quality of Life permission.
Current trends in type 2 diabetes mellitus in Mauritius and
the impact of prevention, management and complications
Kumar Sourabh, Daurat Marie Dominique, Suranjana Ray
31

Diabetes is a major public health concern in Mauritius. The control of diabetes in the population is based on
primordial prevention of dietary risk factors and primary prevention of behavioral risk factors. The present
survey attempted to find the clustering pattern of risk factors for the young and middle aged diabetics.
A total of 40 diabetics were interviewed regarding their environmental, behavioral and anthropometric risk
factors. A quarter (n=10) of them were young (i.e. less than 35 years of age). The data was collected in
paper format and then entered using epi-data software. Differences were analyzed by chi square and
significance of difference reported at p<0.05.
The female to male ratio for identified diabetic patients was roughly 1:3. About 83% of the diabetic
patients had a family history of diabetes. About 67% of the diabetics had adverse body habitus. About 85%
of the diabetic were not undertaking exercise. However, only 12.5 % of the diabetic patients were not
consuming fruits and vegetables regularly. A third of the diabetics (35%) were smokers and quarters
(25%) of them were also reported to be suffering from hypertension. The prevalence of risk factors in
young diabetics and middle aged diabetics was not significantly different (p>0.05) indicating the long
standing pre-existence of risk factors well before diabetes mellitus was diagnosed.
The high level familial clustering of diabetics (83%) and adverse body habitus (67%) indicate the fact that
diabetes is more commonly afflicting families not following the healthy life styles. The important finding is
also corroborated by the observation that 85% of the diabetic patients are not exercising. A primary
prevention program targeting high risk population segment suffering from metabolic syndrome is the need
of the hour. Primary prevention interventions like behavior change communication aiming to increase
physical activity and primordial prevention measures like provision of sporting facilities to enable activity
based leisure time life style activity would be very important in reducing the prevalence of diabetes mellitus
in the general population. Screening activities for secondary prevention of metabolic syndrome and
smoking are a missing service in the healthcare service of Mauritius. The survey indicates an urgent need
to introduce these secondary prevention services. The prevalence of smoking is also high (35%) and
important co-morbidities like hypertension are also seen correlated to the diabetic status. An important
observation of the study is the high proportion of diabetics reporting regular fruits and vegetable
consumption. This indicates successful implementation of primordial prevention based population strategies
of control in Mauritius.
The results of this survey might help prioritize the interventions and consequently optimize the existing
control strategies. The future control strategies should focus upon controlling the high prevalence of
smoking in the general population. This can be achieved by decentralising the smoking cessation clinic
services to all Area Health Centres. In addition, behaviour change communication aiming to increase
awareness about the importance of adequate exercise should be implemented The high prevalence of
comorbidities like hypertension justifies the integration of the existing health care services for the various
non-communicable diseases like hypertension and diabetes.
Clustering of environmental, behavioral and
anthropometric risk factors in young and middle aged
Mauritian diabetics
Mahabir CA, Mahadeo AM, Uddin H, Beniwal R
32

There are strong evidences of abnormal metabolism of several micronutrients in diabetic individuals. The
study was planned to determine the alterations in plasma level of magnesium and zinc; and to correlate
them with the degree of hyperglycemia and the presence of complications in diabetic patients. The study
included 50 patients of type 2 diabetes mellitus and 50 normal healthy control subjects. All the subjects
were evaluated for serum magnesium, zinc, fasting blood sugar and lipid profile (Total cholesterol,
triglycerides, low density lipoprotein, high density lipoprotein) estimations.
The patient’s group had significantly lower serum magnesium (p<0.001) and serum zinc levels (p<0.001)
in comparison to control subjects. A negative correlation of these two parameters was observed with the
degree of hyperglycemia and the presence of complications. Statistically significant variations were also
observed in serum cholesterol, triglyceride and high density cholesterol levels (HDL) in the patients group
in comparison to control group.
In type-2 diabetic mellitus the concentration of both Mg and Zn levels are significantly reduced, probably
suggesting lower antioxidant status in this condition. The implication of this is the greater susceptibility of
LDL-cholesterol oxidation and the risk of development of premature coronary heart disease. Thus
Magnesium and zinc should be essentially supplemented to the diabetic patients to prevent the progression
of the disease and to improve the quality of life.
Role of micronutrients - Magnesium and Zinc, in the
therapeutics of Type 2 Diabetes Mellitus
Chhabra N*, Chhabra S*, Sodhi KH**, Ramessur K*
*SSR Medical College, Mauritius; **MMIMS & Research, Mullana, Ambala (Haryana),
India
33

Variations in uric levels have been increasingly associated with insulin resistance, hyperinsulinemia and
diabetes mellitus. The present study was undertaken to evaluate alterations of serum uric acid levels and to
correlate then with glycemic control in patients of type 2 diabetes mellitus.
The study subjects were distributed in to three groups A, B and C. Group A included 30 normal healthy
individuals to serve as controls, group B comprised of 30 patients of Type 2 diabetes mellitus on oral
hypoglycemic drugs with HbA1c<7% and Group C included 30 patients of Type 2 diabetes mellitus on oral
hypoglycemic drugs with HbA1c>7%. Fasting blood glucose, glycated hemoglobin (HbA1c), serum uric
acid, BUN and serum creatinine were estimated for all the subjects under study.
The mean serum uric acid levels of Group B study subjects were significantly higher than Group C
(p<0.001) whereas levels of mean serum uric acid in Group C subjects were significantly lower than Group
A study subjects (p=0.014). Thus, suggesting that there are relatively higher serum uric acid levels in
patients with HbA1c <7% and lower serum uric acid levels in patients with HbA1c >7%, showing a bell-
shaped relationship. Possibly, glomerular hyperfiltration occurring with progressing and poorly controlled
type 2 diabetes mellitus lowers the serum uric acid by increasing the renal clearance of urate.
Hypouricemia can predict the future progression of incipient nephropathy in type 2 diabetes mellitus.
“Diabetic hypouricemia, an indicator of clinical nephropathy”-A case control
study to determine the relationship between serum uric acid levels and
glycemic control in patients of type 2 Diabetes Mellitus
Chhabra S*, Chhabra N*, Kukreja S**, Ramessur K*
*SSR Medical College, Mauritius; **Sri Guru Ram Das Institute of Medical Sciences and
Research, Amritsar, India
34

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