th - neurodiab.org - congres... · dear colleagues, 19th -21st october 2017, bucharest, romania 5th...

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th st19 - 21 OCTOBER 2017 BUCHAREST/RAMADA PARC HOTEL, RAMADA PLAZA HOTEL

www.neurodiab.org

Ioan Vereșiu, Romania

Nikolaos Papanas, Greece

Sergiu Bogdan Catrina, Sweden

Nicolae Calomfirescu, Romania

Gabriela Radulian, Romania

Tudor Lupescu, Romania

Nicolae Hancu, Romania

Romulus TimarBogdan Timar

Simona Popescu

Cosmina Bondor, RomaniaBogdan Florea, Romania

Speaker Titlu Abs. Abstract Poza CV

Dan Ziegler, Germany

Peter Kempler, Hungary

Rodica Pop Busui, USA

Laszlo Barkai, Hungary

Gerry Rayman, UK

Daniel Cosma, Romania

Frank Bowling, UK

Nina Petrova, UK

Anca Craciun, Romania

Mieke Franser, Belgium

Anne Scott

Cornelia Bala, Romania

Mihai Ionac, Romania

Sorin Barac, Romania

LabormedAlvogen

Alvogen is an international pharmaceutical company located in New Jersey, SUA; Alvogen is focused on development, manufacturing and marketing pharmaceutical products.

Alvogen has commercial activities in 35 countries (SUA, CEE an Asia – Pacific); the business model ensures competitive advantage through focused in-house capabilities and a network of partners for enhanced speed and flexibility.

Labormed, part of the company Alvogen is present on the pharmaceutical market in Romania for more than 20 years, and is a prestigious company with a rich history in the local pharmaceutical industry. Labormed has the most modern factory in Romania for oral solid drugs since 2007.

LabormedAlvogen is recognized as performant on the generics market through its products and services provided for partners and patients. GMP standard (Good Manufacturing Practice) is supported in our company by quality management system, being present in all stages of the manufacturing process and ensuring quality and safety for all products.

The portfolio includes prescription drugs from various therapeutic areas such as cardiovascular, oncology, central nervous system, respiratory and digestive. In addition to Rx drugs, LabormedAlvogen portfolio includes OTC products, food supplements and medical devices.

th st19 21 October 7- 201 , Bucharest, Romaniath5 Congress of Diabetic Neuropathy and Diabetic Foot

with international participation

Plăgile cronice (ulcerul varicos, piciorul diabetic și escarele) sunt cele mai frecvente tipuri de răni cronice, afectând peste un milion de români. Acestea presupun deseori dureri persistente, risc constant de infecții, limitarea activităților zilnice, vizite interminabile la medicul specialist și costuri ridicate. De cele mai multe ori, tratamentele tradiționale nu dau rezultate, plăgile rămânând expuse la riscul de suprainfectare. În ultimii ani, însă, metodele de tratament au evoluat simțitor, rănile pot fi acum vindecate fără intervenții chirurgicale,

doar cu ajutorul pansamentelor moderne, hidroactive. Hidroterapia în doi pași poate fi cea mai bună decizie pe care o ia pacientul care suferă de plăgi cronice.

Hidroterapia este cel mai nou concept de terapie eficientă în tratarea plăgilor cronice. Realizată în doi pași, cu ajutorul produselor Hydroclean/HydroClean plus și HydroTac, această formă de tratament poate deveni cel mai bun aliat pentru pac ienț i i care se conf runtă cu aceste răn i cumpl i te . Hydroclean/HydroClean plus este folosit în primele două etape de dezvoltare a rănii – în timp ce rana se curăță și la începutul procesului de granulație. Odată ce țesutul nou s-a format, este recomandat să se aplice HydroTac. Acesta susține procesul de vindecare până când rana se închide complet. Pansamentele hidroactive necesită un timp de vindecare semnificativ redus. Metoda pe bază de pansamente hidroactive este singura care sporește substanțial calitatea vieții pacientului. Acțiunea acestora se bazează pe crearea unui mediu echilibrat, favorabil regenerării țesutului și închiderii rănii. Mai mult, acestea nu conțin substanțe medicamentoase și nu provoacă alergii, acțiunea lor bazându-se pe principii fizice, proprii structurii și materialului component. Odată aplicate pe rană, acestea mențin un mediu umed echilibrat, favorabil procesului de vindecare. Mai mult, pansamentele hidroactive mențin un Ph optim, care favorizează regenerarea țesutului. Astfel, vindecarea unor răni tratate ani de zile prin metodele tradiționale nu depășește, cu pansamentele hidroactive, 3-4 luni.

„Hidroterapia poate susține combaterea infecției sau prevenția acesteia, intervenind activ în procesul de vindecare. Rata de vindecare a rănilor cu ajutorul pansamentelor hidroactive ajunge la 75%, o îmbunătățire semnificativă față de variantele tradiționale de tratament. De aceea, ne bucurăm că noi, Paul Hartmann Romania putem oferi și românilor accesul la astfel de produse terapeutice.

Hidroterapia - Succes în doi pași!Tratamentul modern pentru

rănile care nu se vindecă











Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















President: Ioan A. VEREŞIU, Cluj-NapocaPast president: Amorin R. POPA, OradeaVice president: Doina CATRINOIU, ConstanţaVice president: Tudor D. LUPESCU, BucharestGeneral secretary: Norina A. GÂVAN, Cluj-NapocaScientific director: Bogdan FLOREA, Cluj-NapocaTreasurer: Raluca M. POPESCU, IaşiMember: Alin O. ŞTIRBAN, GermanyMember: Gabriela I. CREŢEANU, SuceavaMember: Eduard L. CATRINA, BucharestMember: Cristian G. FALUP-PECURARIU, Braşov

Honorary presidents: Nicolae D. HÂNCU, Cluj-NapocaOvidiu A. BĂJENARU, Bucharest

Administration: Iulia IOSEP, Cluj-Napoca Email: [email protected] Antonina POP, Bucharest Email: [email protected]

Office:23A Trifoiului St.400478, Cluj-Napoca, RomaniaM: +40 743 999 333E: [email protected]: www.neurodiab.org

President: Gabriela RADULIAN, BucharestPast president: Ioan A. VEREŞIU, Cluj-NapocaVice president: Gabriela I. CREŢEANU, SuceavaVice president: Tudor D. LUPESCU, BucharestGeneral secretary: Bogdan FLOREA, Cluj-NapocaScientific director: Alin O. ŞTIRBAN, GermanyMember: Eduard L. CATRINA, Bucharest

Honorary presidents: Nicolae D. HÂNCU, Cluj-NapocaOvidiu A. BĂJENARU, Bucharest

Administration: Iulia IOSEP, Cluj-Napoca Email: [email protected] Antonina POP, Bucharest Email: [email protected]

Office:23A Trifoiului St.400478, Cluj-Napoca, RomaniaM: +40 743 999 333E: [email protected]: www.neurodiab.org

Directory Council

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Honorary Mem

bers

Gheorghe BĂCANU, RomaniaPeter KEMPLER, HungaryAaron VINIK, USARodica POP-BUSUI, USADan ZIEGLER, GermanyAndrew J. M. BOULTON, UK









Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















Messages

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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















Dear colleagues,



Starting from the fact that the diabetic patient with chronic complications

needs a holistic approach by overcoming the boundaries between the medical

fields from the need to provide an integrated management, here we are at the

5th National Congress of Diabetic Neuropathy and Diabetic Foot with

international participation Neurodiab 2017 – a high-level scientific event.

Practice and medical research in the diabetic neuropathy field is continually

getting new orientations, that is why on this annual meeting our desire is to

achieve a modern diabetic foot management through a multidisciplinary

approach.

On behalf of the 5th National Congress of Diabetic Neuropathy and Diabetic

Foot Scientific Committee I warmly invite you, as specialists in diabetic

neuropathy to attend this event organized in Bucharest and to achieve together

with us an active involvement in monitoring and personalizing the treatment of

the diabetic patient with multiple complications in order to increase the

quality of his/her life.

Gabriela Radulian

President

Gabriela RADULIAN

M.D., Ph.D.

President of the Society for Diabetic Neuropathy

Professor of Medicine at “N. Malaxa” Adults Hospital, Discipline Diabetes, Nutrition and Metabolic Diseases

Department of Clinical Education 2 - Infectious Diseases, Epidemiology, Microbiology, Parasitology, Virology, Sugar Diabetes, EndocrinologyFaculty of Medicine, UMF "Carol Davila" Bucharest

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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















General information

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Gerry Rayman, UK


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Nina Petrova, UK



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MEETING VENUE Complex Ramada Plaza and Ramada Parc Hotels, Bucharest Poligrafiei Street 3-5, District 1, Bucharest, Romania www.ramadaplazabucharest.ro

Situated 10 km from the international airport Henri Coanda Otopeni Bucharest and about 20 minutes from the center of Bucharest.

HOW TO GET TO THE CONGRESS VENUE

REGISTRATION DESK & SECRETARIAT Desk Opening Hours

thThursday, 19 October, 17 :00 – 19:30 thFriday, 20 October, 08:30 – 19:00

stSaturday, 21 October, 08:30 – 19:00

Participants’ Registration Fee Includes:• The congress materials and the badge;• Admission to the scientific program;• Admission to the industry exhibition;• Lunch on Friday and Saturday;• Dinner Thursday through Saturday;• Coffee breaks Friday and Saturday.

SPEAKERS CORNERIs available in the area of registration desk. Ask for assistance.

PRESS REGISTRATION Press delegates can register at a special press registration desk.

LANGUAGE The congress language is English. Simultaneous translation in any other language is not provided.

INTERNET ACCESS Unrestricted internet access is available throughout the congress venue.











Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















DELEGATE

PRESS

EXHIBITOR

ORGANISER

SPEAKER

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EXHIBITION Exhibition of pharmaceutical and medical equipment industry with interest in diabetes, diabetic neuropathy and diabetic foot will be located and will be open as follows:

thFriday, 20 October, 09:00 – 18:00stSaturday, 21 October, 09:00 – 18:00

CME ACCREDITATION The Conference is awarded with credits by the Romanian College of 18 CMEPhysicians. After the event, an online link with a Feedback Form will be sent to all registered participants. The Certificate of Attendance will be emailed to you immediately after you fill in all fields and complete the Feedback Form.

LUNCH, DINNER AND COFFEE BREAK Lunch and Dinner are served in the area of Restaurant La Parc. Please note that the access to lunch and dinner is possible only for registered participants displaying a valid registration badge included in the registration fee that will be provided with the congress materials .

FOOD AND BEVERAGES Food and beverages are not allowed in the lecture halls. Please note that the access to the coffee breaks, lunches and dinners is possible only with the congress badge. The entire venue is a strictly smoke-free environment.

BADGES The delegates’ name badges serve as an admission pass to all scientific sessions and exhibition. Delegates are asked to keep their name badges displayed at all times during the meeting. Loss of badges can be replaced in special situations and will be charged with 50 Euros.











Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















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EVENT MANAGEMENT The management of the event is provided by Sănătatea Press Group.

For any organizational situation: Sănătatea Press GroupDiana Nanciu - Event CoordinatorPhone: +40 733 011 109Email: [email protected]

LOCAL ORGANIZER FOR ACCOMMODATION New Star Services agency is pleased to help you in organizing your accommodation, as well as to offer the sightseeing tours and other tourist information and services during your stay in Bucharest. Please contact: Catalin Ghitescu, New Star ServicesPhone: +40 744 68 35 79 Email: [email protected] www.newstar.ro

SECURITY Please make sure to wear your badge during the Congress. Any suspicious or unidentified items are to be reported immediately to the nearest staff member. Security staffs are on duty to ensure that all persons entering the venue are wearing a badge. For your safety, it is strongly advised to leave all your valuables in a safe at your hotel.

INSURANCE The registration fees do not include the insurance of participants against accidents, sickness, cancellation, theft, property loss or damage. Participants are advised to make sure that they have the appropriate personal travel insurance.

HEALTH AND SAFETY The emergency telephone number in Romania: Ambulance, Police, Fire Department is 112.

DISCLAIMER All efforts will be made to adhere to the program as printed. However, Neurodiab and its agents reserve the right to alter or cancel, without prior notice, any of the arrangements, timetables, plans or other items relating directly or indirectly to the Meeting, for any case beyond their reasonable control. Neurodiab and the local conference organizer are not liable for any other loss or inconvenience caused as a result of such changes.











Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















Programm

e

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Gerry Rayman, UK


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thThursday, the 19 of October 201715:00 - 18:00 Registration of participants

19:30 - 22:00 Welcome dinner

thFriday, the 20 of October 2017

Coffee break

12:45 - 13:15

13:30 - 14:30 Lunch


11:45 - 12:15

14:30 - 15:00



Panel Discussion




Diabetic neuropathy in children and adolescents

Pre-diabetic neuropathy

Behind the urogenital symptoms

15:45 - 16:00 Panel Discussion

Coffee break 16:00 - 16:30

16:30 - 17:00

19:30 - 22:00 Dinner

15:00 - 15:30

Update on pathogenetic vs symptomatic treatment of diabetic polyneuropathy

Mechanisms for impaired wound healing in diabetes: implications for new therapies.

Recent advances in the diagnosis of neuropathy

09:00 - 09:30

09:30 - 10:00

10:00 - 10:30

11:15 - 11:45

10:30 - 11:00

11:00 - 11:15

Opening ceremony of the National Congres in Diabetic Neuropathy and Diabetic Foot

Rodica Pop Bușui, USA New ADA Statement on Diabetic Neuropathy Charts Success and Guidance for Clinicians and Patients12:15 - 12:45



Cosmina Bondor, Romania

Correlation between skin autofluorescence, diabetic neuropathy diagnostic scores and quality of life in patients with diabetes

15:30 - 15:45 Smoking influnces skin autofluorescence in patients with sensorimotor diabetic neuropathy

Bogdan Florea, RomaniaAssociation between the risk of autonomic cardiac neuropathy and blood pressure in patients with type 2 diabetes

17:00 - 17:30 Tudor Lupescu, RomaniaFocal neuropathies in diabetes mellitus

Daniel Cosma, RomaniaThe role of physical activity in the prevention and management of diabetic neuropathy 17:30 - 18:00


Chairmen: ș - Gabriela Crețeanu, Romania Ioan Vere iu, Romania

Chairmen: Sergiu Bogdan Catrina, SwedenTudor Lupescu, Romania -

Chairmen: Peter Kempler, Hungary - Nikolaos Papanas, Greece

Chairmen: Rodica Pop Bușui, USA - Dan Ziegler, Germany

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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen


















stSaturday, the 21 of October 2017

Coffee break

12:45 - 13:15

13:30 - 14:30 Lunch

11:45 - 12:15

14:30 - 15:00

Panel Discussion


Coffee break 16:00 - 16:30

16:30 - 17:00

19:30 - 22:00 Dinner

09:00 - 09:30

09:30 - 10:00

10:00 - 10:30

11:15 - 11:45

10:30 - 11:00

11:00 - 11:15

12:15 - 12:45


15:30 - 15:45

17:00 - 17:30


Gerry Rayman, UK

Rodica Pop Bușui, USA

Frank Bowling, UKDiabetic foot problems are eminently preventable and yet represent one of the commonest causes of hospital admission

NICE guidelines on Diabetic Foot Disease - putting this into practice

In situ Podiatry and Amputations Risk - a Michigan Experience

Romulus Timar, Bogdan Timar, Simona Popescu, Romania

Gabriela Radulian, RomaniaThe role of an interdisciplinary team approach in the management of the diabetic foot ulcer

Nicolae Hâncu, Anca Crăciun, Romania

Mihai Ionac, Sorin Barac, Romania

Cornelia Bala, RomaniaPatient education – first step in the prevention of diabetic neuropathy and diabetic foot

Is frailty a problem of podiatry? Yes, it is.

Anne Scott, UK The role of nurse in the diabetic foot care

17:45 - 18:30 Closing ceremony

Mieke Fransen, Belgium

Balance Impairment and the Risk of Fallsin Patients with Diabetes and Neuropathy

Age as an independent factor for the development of neuropathy in diabetic patients

Nina Petrova, UKAcute Charcot neuro-osteoarthropathy – current standards

15:00 - 15:30

Romulus Timar, Simona Popescu, Bogdan Timar, Romania

Chairmen: Ioan Vereșiu, RomaniaBogdan Florea, Romania -

Chairmen: Frank Bowling, UK Gerry Rayman, UK -

Chairmen: Anne Scott, UK - Nina Petrova, UK

Chairmen: Gabriela Crețeanu, Romania - Romulus Timar , Romania

The role of interdisciplinary treatment in diabetic foot care. A retrospective study.

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The role and competences of the Podiatrist in Diabetic Foot care. What is the situation of Podiatry in Europe?









Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















Abstracts

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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




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P. KEMPLER

Professor of Medicine, 1st Dept. of Medicine, Semmelweis University, Budapest, Hungary

Member in the European Diabetes Complications Advisory Board

Chairman of the Pro Neuropathia Foundation

Elected President of the Hungarian Diabetes Association

Honorary Member of the Society for Diabetic Neuropathy

Member of the Diabetic Neuropathy Study Group - Neurodiab of the European Association for the Study of Diabetes

Recent advances in the diagnosis of neuropathyThere are a lot of available methods for the assessment of neuropathy. Beside expensive and more sophisticated methods, there are numerous options providing quick results by simple measurements. Testing performed with the calibrated tuning fork provides information on the sense of vibration (deep sensation, pallaesthesia), that is, on large-fibre function. The 128-Hz Rydel-Seiffer calibrated tuning fork has proven appropriate for clinical use. The guideline of the EASD Neuropathy Study Group (NEURODIAB) recommends this tool for evaluating vibration sensation to diagnose neuropathy in the outpatient care setting.

The tool recommended to assess protective sensation is the 5.07/10 gram Semmes-Weinstein monofilament. Interpreting this test is simple: the patient either feels or cannot perceive the pressure exerted by the bent monofilament. The 10-gram instrument should be held perpendicularly to the surface of the body and placed onto the skin for 1.5 seconds. Conventional test-sites are the hallux, the dorsum of the feet between the first and second metatarsals, the soles at the first and fifth metatarsals. In a prospective study comparing different diagnostic methods, the Semmes-Weinstein monofilament was proven – along with clinical examination – as the most sensitive tool for predicting plantar ulceration.

The Neurotip is a sterile, single use testing tool for the appraisal of small fibre injury through the detection of reduced pain sensation during the neurological examination. The NeuroTipTherm device measures the temperature sensitivity of the skin. The polymer side feels warmer and the metal side cooler. Thus, the TipTherm can be used for the assessment of cool and warm sensation.

The Ipswich Touch Test is a novel method that involves lightly and briefly (1-2 sec) touching the tips of the first, third and fifth toes of both feet with the index finger. Reduced foot sensation is defined as ≥ 2 insensate areas.

The Neuropad is a simple non-invasive sweat indicator test for the diagnosis of sudomotor function, which may reveal autonomic neuropathy. The test is based on a colour change of an indicator from blue to pink after 10 minutes. This method is characterised by excellent reproducibility. First of all, due to its high negative predictive value, it is suggested being used as a screening test. The classical standard cardiovascular reflex tests are still considered as the gold standard in the diagnosis of autonomic neuropathy. However, instead of the previous five tests, only four of them are suggested to be performed: the sustained hand-grip test omitted from the standard tests.



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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















N. PAPANAS

Associate Professor in Internal Medicine-Diabetes mellitus

Head Diabetes Centre-Diabetic Foot Clinic

Second Department of Internal MedicineDemocritus University of ThraceAlexandroupolis, Greece

Pre-diabetic neuropathy

There is now sufficient evidence that some patients with pre-diabetes may develop peripheral neuropathy or even neuropathic pain. Vice versa, diagnostic workup of patients with alleged idiopathic peripheral neuropathy may reveal pre-diabetes, especially impaired glucose tolerance. Neuropathy in pre-diabetes is now beginning to be also called pre-diabetic neuropathy. It is, generally, milder as compared with genuine diabetic neuropathy, and it predominantly affects small sensory nerve fibres. Thus, patients’ symptoms and physical signs typically reflect length-dependent small-fibre neuropathy. The pathogenesis of pre-diabetic neuropathy involves hyperglycaemia, microvascular dysfunction, dyslipidaemia and features of the metabolic syndrome. Its therapy should target optimised glycaemic control and correction of cardiovascular risk factors.



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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















D. ZIEGLER

M.D., Ph.D.

Professor of Internal Medicine

Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes

Deputy Director, Senior Consultant Physician, Research Group Leader

Researcher at the Heinrich Heine University and Department of Metabolic Diseases, University Hospital, Heinrich Heine University, Düsseldorf, Germany

Honorary member of the Society for Diabetic Neuropathy

Member of the Diabetic Neuropathy Study Group - Neurodiab of the European Association for the Study of Diabetes



Update on pathogenetic vs symptomatic treatment of diabetic polyneuropathy

Approximately one of three diabetic patients is affected by distal symmetric polyneuropathy (DSPN) which represents a major health problem due to clinical manifestations such as excruciating neuropathic pain, diabetic foot ulceration, and amputations which are associated with substantial morbidity, reduced quality of life, and increased mortality. Treatment of diabetic neuropathy is based on three cornerstones: 1.) multifactorial intervention aimed at (near)-normoglycemia and reduction of cardiovascular risk factors, 2.) treatment based on pathogenetic mechanisms; and 3.) symptomatic treatment. Epidemiological data indicate that not only increased alcohol consumption but also the traditional cardiovascular risk factors such as visceral obesity, hypertension, dyslipidemia, and smoking play a role in the development and progression of diabetic neuropathy and, hence, need to be prevented or treated. However, the protective effects of near-normoglycemia on nerve function are only proven in type 1 but not in type 2 diabetes. Recent experimental studies suggest a multifactorial pathogenesis of diabetic neuropathy. From the clinical point of view it is important to note that, based on these pathogenetic mechanisms, therapeutic approaches have been developed to favorably influence the underlying neuropathic process (disease-modifying treatment). Since in the foreseeable future near-normoglycaemia will not be achievable in the majority of diabetic patients, the advantage of these compounds could be that they exert their effects despite prevailing hyperglycemia. At present, only the antioxidant �-lipoic acid to reduce oxidative stress, actovegin, and benfotiamine are available for treatment of diabetic polyneuropathy in several countries.

The symptomatic pharmacologic and nonpharmacologic treatment of chronic painful neuropathy, which is present in up to 26% of diabetic patients, remains a challenge for the physician. Neuropathic pain exerts a substantial impact on the quality of life, particularly by causing considerable interference in sleep and enjoyment of life. Nonpharmacologic options such as transcutaneous nerve or muscle stimulation should always be given consideration. Centrally acting analgesic drugs are frequently being used to treat neuropathic pain, but it has to be kept in mind that these agents may exert side effects, particularly in the central nervous system, which may limit their use. Moreover, they do not slow the progression of the neuropathy, but rather have been developed for symptomatic pain relief. The individual tolerability and the various comorbidities of diabetes remain a major aspect in any decistion to treat neuropathic pain. Altogether, the strength of evidence derived from systematic reviews, on which recommendations for pharmacotherapy of painful DSPN are based, is highly variable. A recent overview of systematic reviews on interventions for neuropathic pain concluded that evidence for efficacy from

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these reviews is frequently inconclusive or completely lacking and the methodological quality is not satisfactory. Therefore, efforts should be made toward harmonizing these reviews and guidelines to prevent the treating physician from making wrong decisions.

In conclusion, since the protective effects of near-normoglycemia on nerve function are proven in type 1 but not in type 2 diabetes and analgesics only relieve pain without targeting the underlying neuropathy, have limited efficacy and safety issues, efforts must continue to establish disease-modifying treatments. The strength of evidence for analgesic pharmacotherapy in painful DSPN is weak for most drugs and novel approaches are also needed.

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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



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L. BARKAI

M.D., Ph.D., DSc

Center for Child Health, Borsod County University Hospital and University of Miskolc, Hungary

Diabetic neuropathy in children and adolescents

The increasing incidence and prevalence of type 1 and type 2 diabetes in children and adolescents emphasizes the need to also focus on potential diabetic microvascular complications. Clinical manifestations of complications are rare, mainly subclinical signs are present is youths with diabetes. Subclinical neuropathy is the most common complication, it can be demonstrated from the onset of puberty in type 1 diabetes and even at the time of diagnosis in type 2 diabetes. Frequency of complications increases with diabetes duration, impact of prepubertal duration should be considered and puberty is an accelerator of progression. Modifiable risk factors are poor metabolic control, increased body mass index and smoking. Currently, no consensus for neuropathy screening exists in childhood diabetes, however, assessments for peripheral and autonomic function seem to be useful anually from the onset of puberty in type 1 diabetes and since diabetes diagnosis in type 2 diabetes. Successful prevention of microvascular complications play a key role in the management of patients with diabetes at younger age. To efficiently reduce the risk and progression of neuropathy, optimized glycemic control, prevention of obesity and avoidance of smoking are key points during the long-term care of children and adolescents with diabetes.



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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















Rodica POP-BUȘUI

M. D., Ph. D.

Professor of Internal Medicine

Metabolism, Endocrinology and Diabetes

Associate Chair of Clinical Research

Department of Internal Medicine

Co-Director, Neuropathy Center

University of MichiganAnn Arbor, MI, USA

Rodica Pop-Bușui, MD, PhD, is a prominent diabetologist at the University of Michigan in Ann Arbor MI, and a nationally and internally recognized leader in the field of diabetes as a result of her extensive clinical, research, teaching and service activities. She is also an attending physician involved in outpatient and inpatient diabetes care and lead of the diabetes complications clinic at the University of Michigan. A particular focus of her research interest involves diabetic peripheral and cardiovascular autonomic neuropathy. Due to Dr. Pop-Bușui's scholarship efforts, she is internationally recognized as an expert in the field of diabetes complications, especially diabetic neuropathies. She has published more than 150 peer-reviewed manuscripts and book chapters, and received awards from the Fulbright

Diabetic neuropathies are the most prevalent chronic complications of diabetes. This heterogeneous group of conditions affect different parts of the nervous system and present with diverse clinical manifestations. The early recognition and appropriate management of neuropathy in the patient with diabetes is important for a number of reasons: 1) Diabetic neuropathy is a diagnosis of exclusion. Non-diabetic neuropathies may be present in patients with diabetes and may be treatable by specific measures; 2) A number of treatment options exist for symptomatic diabetic neuropathy; 3) Up to 50% of diabetic peripheral neuropathies may be asymptomatic. If not recognized and if preventive foot care is not implemented, patients are at risk of injuries to their insensate feet; 4) Recognition and treatment of autonomic neuropathy may improve symptoms, reduce sequelae, and improve quality of life.

Due to a lack of treatments that target the underlying nerve damage, prevention is a key component to diabetes care. Screening for symptoms and signs of diabetic neuropathy is also critical in clinical practice, as it may detect the earliest stages of neuropathy to enable early intervention. Although screening for rarer atypical forms of diabetic neuropathy may be warranted, distal symmetric polyneuropathy (DSPN) and autonomic neuropathy are the most common forms encountered in practice. The strongest available evidence regarding treatment pertains to these forms.

New ADA Statement on Diabetic Neuropathy Charts Success and Guidance for

Clinicians and Patients.



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Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















Foundation, the American Diabetes Association, the University of Michigan, and the Romanian Society of Diabetes, Nutrition and Metabolic Diseases. Dr. Pop-Busui has been an elected member of the Clinical Practice Committee of the American Diabetes Association (ADA), the world's leading organization dedicated to preventing and curing diabetes, of the ADA Scientific Research Review, and of Research Committee of the landmark DCCT/EDIC study. Dr. Pop-Busui has made significant contributions to the advancements of understanding diabetic neuropathies, and she was elected to chair the ADA Statement on Diabetic Neuropathy published in January 2017 in Diabetes Care. As the site Principal Investigator/CoPI of landmark diabetes trials such as the NHLBI-funded Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, the NIDDK-funded trials: DCCT/EDIC, A Multicenter Clinical Trial of Allopurinol to Prevent GFR Loss in Type 1 Diabetes (“PERL), the “Glycemia Reduction Approaches for Diabetes: A Comparative Effectiveness Study (GRADE), Bypass Angioplasty Revascularization Diabetes 2 (BARI- 2D), and many others,Dr. Pop-Busui has had the privilege of contributing her research efforts to some of the most important national diabetes clinical studies to date, which have advanced the understanding of diabetes, informed changes in its treatment, and impacted the standard of care, thereby improving the lives of people affected by diabetes.

This lecture will discuss real life clinical outcomes before and after the establishment of accredited podiatry services in the Diabetes and Endocrinology clinic at the University of Michigan, and the effects on the risk of major diabetic foot complications, amputations and patient satisfaction. Data comparing patient encounters with diabetes mellitus and a concomitant diabetic foot complication from two different 5-years periods , preceding and following the establishment of podiatry service based upon diagnosis and procedural codes appointed during each encounter and organized by encounter type: emergency, inpatient, or outpatient will be presented.

In situ Podiatry and Amputations Risk- a Michigan Experience



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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















S. B. CATRINA

M.D., Ph.D.

Associate Professor and Senior Consultant in Endocrinology at Karolinska Institute and Karolinska Hospital, Stockholm, Sweden

Mechanisms for impaired wound healing in diabetes:

implications for new therapies Diabetic foot ulcers represent a common and disabling complication of diabetes that frequently leads to amputation. For the moment there is no specific therapy available for diabetic foot ulcers and it has become a priority to develop novel rational therapeutic strategies based on new pathophysiological mechanisms.

A common pathologic finding in the diabetic wound is an impaired angiogenesis, cell migration and differentiation. Recently it was identified that glucose directly modulates two signal systems (HIF and Notch) with a central role for angiogenesis and cell differentiation. Both deregulated systems contribute to the delayed wound healing in diabetes since pharmacologically or genetically correction of each of them improve the outcome of the experimental diabetic wound healing despite chronic hyperglycemia. Moreover preliminary results point to an additive effect of the manipulation of the two systems.

These new pathogenic mechanisms are highly relevant from clinical point of view. Substances that address these signaling systems have been already developed for other indications and can relatively easily be used in patients with diabetic foot ulcers.



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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen


















Behind the urogenital symptoms

N. CALOMFIRESCU

M.D., Ph.D.

Urologist

Sexologist

Urinary and genital symptomatology are apparently easy to quantify for men and for women, but it depends on the experience, specialty and availability of the medical professional. We record from the clinical standpoint variables like pain, tumors, discoloration, urine quantity, but also urine quantity, modification in urinary rhythm, plus/minus fever, etc.

Apparently it is a simple clinical arithmetic in which the urogenital reacts, but what matters is the causality of the clinical picture and the correlations which can be established for each case.

In my clinical practice, the percent of diabetic patients which request a urological/andrological consultation or one for infertility issues, have increased in the last years. Thus the question “are you a diabetic? “ is one of the top 5 questions which I always ask in the beginning of the consultation.

Urogenital symptomatology suffers from interferences from a controlled or uncontrolled diabetes and diabetes complications: neuropathy, nephropathy, etc. A lot of patients separate medical problems: diabetes on one side and urine/urinary, sexual disorders or fertility problems on the other side, this approach is counterproductive and misleading, especially since personally I have discovered diabetics from an urogenital disorder/dysfunction.

Undertaking each clinical case with patience and a meticulous look could clear up difficult points and in the end, help improve the patient’s quality of life.

The cases included in this presentation look to illustrate that a holistic approach is more useful than the separations that some doctors or patients make. Keywords: urogenital symptoms, diabetes, patients.

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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















I. A. VEREȘIU

M. D., Ph. D.

Associated Professor of Diabetes, Nutrition and Metabolic Diseases Department, “Iuliu Haţieganu“ University of Medicine and Pharmacy, Cluj-Napoca, Romania

Chairman of Diabetes Department, County Emergency Hospital, Cluj-Napoca, Romania


President of the Romanian Diabetes Federation

Founder member of the Society for Diabetic Neuropathy

Founder member of the Association for Podiatry

Vice president of the Association for Podiatry

Member of Neurodiab EASD



Correlation between skin autofluorescence, diabetic neuropathy diagnostic scores

and quality of life in patients with diabetesBackground. The patients’ quality of life (QoL) has emerged in the last decades as measurable characteristic and also as a therapeutic target. The Norfolk QoL in diabetic neuropathy (QoL-DN) is a well validated 35 items QoL questionnaire, with a good sensitivity and specificity in identifying patients with diabetic neuropathy (DN). The measurement of skin autofluorescence (SAF) has also emerged as relatively simple method for quantifying the long term glycemic exposure in patients with diabetes, showing a good correlation with the risk/presence for/of chronic complications, including DN.Aim and methods. This is a sub-analisys of a cross-sectional, analytic, multicenter study in which consecutive outpatients with type 1 diabetes mellitus (T1DM) or T2DM who attended diabetic units for regular diabetes care were included. The patients were on a stable regimen of antidiabetic, antihypertensive and lipid lowering treatment for the last 3 months, 30 to 75 years of age, BMI between 25 and 45 kg/m2 and HbA1c </= 9.5 %. The aim of this sub-analisys was to explore correlations between SAF, the presence of DN and the QoL-DN scores. SAF was assessed using the AGE Reader (Groningen, The Netherlands), measurements were performed at the forearm, and results of 3 measurements were averaged. For DNP evaluation the Toronto Clinical Neuropathy Score (TCNS), the Neuropathy Symptoms Score (NSS) and the Neuropathy Disability Score (NDS) were used. The Romanian version of Norfolk QoL-DN was self-administrated by the patients and analyzed as total score and sub-domains (physical functioning/ large-fibre neuropathy, activities of daily living, symptoms, autonomic neuropathy and small fibre neuropathy) scores. We have done descriptive statistics and we used the Sperman’s correlation coefficient.Results. There were 497 patients included in the study, 51.3% females, 93.4% with type 2 diabetes, with a mean (±SD) age of 60.54 (9.10) years and a mean(±SD) duration of diabetes of 17.36 (9.96) and 9.20(5.53) years for with T1DM and T2DM respectively. The median (25th-75th percentile) SAF score (arbitrary units) was higher in those with poorer QoL (total score>5), 2.37 (2.13-2.77) vs. 2.53 (2.17-2.87) but without reaching statistical significance (p=0.178). The same trend, without statistical significance, was observed for all the five sub-domains of QoL-DN. Those who responded “yes” to the question “Have you ever been told that you have neuropathy?” had a significantly higher median (25th-75th percentile) SA score 2.4 (2.13-2.73) vs. 2.6 (2.17-2.9), p=0.008. A small non statistical significant positive correlation existed between total QoL-DN score and SA score in the entire group, r=0.06, p=0.181. There was a surprisingly marginal negative correlation, r = -0.06, p=0.338, between SA score and total QoL-DN score in the patients with DN (TCNS score>5). Conclusions. Our study showed a tendency to concordance between higher scores of SF and poorer quality of life in patients with diabetes. The association between two so different aspects of the DN, the implication of long term glycation process and the quality of life in these patients, should be further explored.

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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















Cosmina BONDOR

Ph.D.

Scientist in Bioinformatics

Assistant lecturer – Medical Informatics and Biostatistics Department

“Iuliu Haţieganu“ University of Medicine and Pharmacy, Cluj-Napoca, Romania



Smoking influnces skin autofluorescence in patients with sensorimotor diabetic neuropathy

ObjectivesSkin autofluorescence (SAF), as a measure of skin advanced glycation endproducts (AGEs) accumulation, represents an integrated parameter of glucose exposure, oxidative stress and smoking over years. We hereby present the results of secondary parameters’ analysis of a study which aimed at investigating the relationship between SAF and sensorimotor diabetic neuropathy (SSDNP).

MethodsA multi-centric (8 centers) cross-sectional study was conducted in 2016. Consecutive patients between 30 and 75 years old with type 1 or type 2 diabetes mellitus were included. Exclusion criteria were HbA1c level > 9.5%, smoking of more than 15 cigarettes/day, severe pain that required treatment with more than one drug. Assessment of SDNP was performed using the Neuropathy Symptom Score (NSS) and the Neuropathy Disability Score (NDS). The pain scale and SAF (measured with the AGE-Reader, Groningen, The Netherlands) were also recorded. Patients with NDS score≥3 were considered to have SDNP.

ResultsA total of 497 patients were investigated. SAF was increased in the presence of SDNP and smoking. Mean SAF was found to be lowest in patients who did not smoke and had no SDNP (n=198, 2.42±0.53), and gradually increased in patients who did not smoke and had SDNP (n=229, 2.56±0.57), in those who smoked and had no SDNP (n=37, 2.61±0.51), and was highest in patients who smoked and had SDNP (n=26, 2.82±0.49), p<0.001. Interestingly, patients with SDNP who smoked had lower mean score of pain scale (3.62±2.76) than those who did not smoke (4.14±2.69),p<0.001. Anova two-way analysis revealed that both NDS score ≥ 3 (p=0.019) and smoking (p=0.002) were significantly associated with SAF, but no significant combined effect was found (p=0,630). Similar results were obtained if the NSS score was used for the definition of SDNP.

ConclusionsSmoking and SDNP contribute both to increased SAF, their interplay in influencing SAF warranties further research. A limitation of this study is that we did not include heavy smokers.

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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















B. FLOREA

M.D.

Senior Specialist in Neurology

Scientific Director of the Society for Diabetic Neuropathy

Founder member of the Society for Diabetic Neuropathy

Founder member of the Association for Podiatry

Secretary of the Association for Podiatry

Managing director of the “Clinica de Podiatrie”, Cluj-Napoca



Association between the risk of autonomic cardiac neuropathy and blood pressure in patients with

type 2 diabetesAimThe purpose of this study was to investigate the association between the risk of cardiac neuropathy given by sudomotor function assesment and systolic (SBP) and diastolic (DBP) blood pressure, antihypertensive treatment in patients with type 2 diabetes.

Material and methodsFor this study, 33 patients with type 2 diabetes were selected from the patients of a private podiatry clinic in Cluj-Napoca. They were investigated with SUDOSCAN, which is an medical echipment for assesment of the galvanic response of epidermis. SUDOSCAN echipment had incorporated the calculation of a risk-score for cardiac neuropathy based on the electrochemical sweat conductance of hands and foot, age, glicated hemoglobin and body mass index. Neuropathy Disability Score (NDS) and Neuropathy Symptoms Score (NSS) were apply also. Blood pressure was measured, antihypertensive treatment was noted.

Results Of the 33 patients, 18 (54.5%) were male, the mean age of the patients was 64.61 ± 15.92 years, the duration of the diabetes was 12.85 ± 9.25 years. Sudoscan identified 25 (75.8%) patients with possible risk (25 <risk-score ≤ 50) of cardiac neuropathy, and 7 (21.2%) with increased risk of cardiac neuropathy (risk-score> 50). NDS scores above 2 had 14 (42.4%) patients, of whom 9 (27.3%) had mild periferic neuropathy, 4 (12.1%) patients had moderate periferic neuropathy, 1 (3.0%) patient had severe periferic neuropathy. The risk of cardiac neuropathy was significantly correlated with TAD (r = 0.35, p = 0.04), NDS score (r = 0.59, p <0.001), NSS score (r = 0.37, p = 0.037). Antihypertensive treatment was significantly different among patients with risk of cardiac neuropathy ≥50 (42.9%) and those with risk of cardiac neuropathy <50 (88.5%), p = 0.023. The risk of cardiac neuropathy was not significantly correlated with TAS (r = 0.01, p = 0.97).

ConclusionThe risk of cardiac neuropathy given by the Sudoscan device is associated with TAD, antihypertensive treatment and NDS and NSS scores, but not with TAS.

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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















T. LUPESCU

M.D., Ph.D., senior specialist in neurology

Chair of Neurological Department, Emergency Clinic Hospital Agrippa Ionescu, Bucharest, Romania

Vice-President of Society for Diabetic Neuropathy

President of ASNER –Society for Electrodiagnostic Neurophysiology of Romania



Focal neuropathies in diabetes mellitus

The burden of neurologic complications in diabetic patients is very high. Distal symmetric sensory polyneuropathy is the most frequent neuropathy associated with diabetes. Nevertheless, there are also other types of peripheral nerve involvement that can be encountered in diabetic patients. These are the focal and multifocal forms. It is important to recognize them, since some of them that are quite frequent (even more frequent than in non-diabetic patients), like the entrapment neuropathies, might benefit from therapeutic measures. Others, although less frequent (cranial neuropathies, radiculoplexus neuropathies) are important as well, since their diagnosis poses some really challenging difficulties. We must be aware of them, in order to have a correct approach to these patients.

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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















The role of physical activity in the prevention and management of diabetic neuropathy

D. COSMA

M.D., Resident in Diabetes, Nutrition and Metabolic Diseases

Center for Diabetes, Nutrition and Metabolic Diseases, Cluj-Napoca

The role of physical activity in the diabetes management was recognized since the ancient times and represented and important therapeutic tool in the preinsulin era. Its importance was clearly stated by inclusion in the Joslin triad of diabetes management together with diet and insulin.

The continuously increasing number of diabetic patients who practice sports (recreational or competitive) led to an extensive medical research in the last two decades regarding the role of exercise and nutrition in the prevention and treatment of the diabetic complications.

Regarding diabetic peripheral neuropathy (DPN) it was demonstrated that mild to moderate exercise may help prevent its onset. Loprinzi et al revealed the same findings in case of adults with well-controlled diabetes engaging in higher levels of moderate to vigorous physical activity. Although regular physical activity cannot fully reverse the symptoms of DPN, engaging in aerobic and strengthening exercise programs exhibited significant reductions in pain and neuropathic symptoms and increased intraepidermal nerve fiber branching in a proximal skin biopsy (Kluding et al). Exercise can prevent further loss of muscle strength and flexibility commonly experienced by patients with both small and large nerve fiber damage. The last evidence regarding the effects of long-term lifestyle modification program (including physical activity) on peripheral neuropathy came from the Look-AHEAD study which showed a significant decrease in questionnaire-based DPN associated with the magnitude of weight loss, changes in HbA1c and lipids.

In patients with diabetes and autonomic neuropathy (AN), it was demonstrated that exercise training improves baroreflex sensitivity in type 2 diabetes subjects in addition to increasing the exercise capacity, muscle strength and improving glucose control (Loimaala et al). The most benefits seems to be in patients with early forms of cardiac AN in which regularly performed endurance training increased heart rate variability by improving the sympathetic and parasympathetic supply (Howorka et al). Despite all the benefits previously mentioned, any form of autonomic dysfunction entails a conservative approach to exercise. Patients may need to avoid the rapid changes in movement that may result in fainting and should engage in longer warm-up and cool-down periods, especially for more intense resistance or aerobic training. If postural hypotension is present, lower intensity activities with mild changes in both heart rate and blood pressure are recommended.



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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















G. RAYMAN

Professor, MB, BS, MD, FRCP

Head of service at the Diabetes and Endocrine Centre, the Diabetic Foot Clinic and lead of the Diabetes Research Unit at Ipswich Hospitals NHS Trust and Hon

Professor at the University of East Anglia

Member of the Joint British Diabetes Societies guideline development group, immediate past president of the Royal Society of Medicine Diabetes and Endocrine section, DiabetesUK lead for Inpatient Diabetes, the National GIRFT (Getting It Right First Time) lead for Diabetes and the lead of the East of England Diabetes Foot Network.

NICE Guidelines have played an important part in improving medical care in the UK. Over the last 10 years there have been 3 guidelines related to diabetic foot disease. The most recent NG19 published in 2015 brings together all previous recommendations into one guidance to standardize care and reduce variation across the country. It gives recommendations for care within the first 24 hours, care across all care settings, referral criteria for diabetic foot problems and recommendations on the investigation and management of diabetic foot ulcers, diabetic foot infections and Charcot arthropathy. This presentation will summarize the key recommendations and describe how these are influencing structures of diabetes foot care in hospitals and Multidisciplinary Diabetes Foot Clinics in the UK. It will also present new information from the recently developed National Diabetes Inpatient Audit which assesses the referral pathway from community care to the Multidisciplinary Diabetes Foot Service. It will also describe a number of initiatives which local communities have developed to support adherence to the guidance.



NICE guidelines on Diabetic Foot Disease - putting this into practice

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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















F. BOWLING

Dr., MSc, DPM, PhD, FFPM, RCPS

University of Manchester,Faculty of Medical & Human Sciences, UK

Manchester Royal Infirmary, Depts. Vascular Surgery & Diabetes, UK



Diabetic foot problems are eminently preventable and yet represent one of the commonest causes

of hospital admission In practice, Diabetic Peripheral Neuropathy remains a major cause of diabetic foot ulceration. Treatment of Diabetic Foot Ulcers is based on a sound understanding of the physiological changes that occur in the lower limb as a result of diabetes. However, prevention is always more preferable than attempting to heal an acute or chronic ulcer. Targeting prevention through daily self-inspection of feet for signs of injury is just one example of risk reduction. Falls in the home or outside and an associated soft tissue injury could be the catalyst for foot ulceration and the development of acute Charcot Neuropathy. Ulcers can have a devastating impact on a patient’s quality of life and psychological profile, not to mention the economic considerations to the healthcare provider.

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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen


















Population aging is unprecedented, without parallel in the history of humanity. As type 2 diabetes mellitus is predominantly more prevalent in aging populations, this creates a major public health burden. Older adults with diabetes have the highest rates of major lower-extremity amputation, myocardial infarction, visual impairment, and end-stage renal disease of any age group. The aims of our study were to assess whether age is an independent factor for the occurrence of diabetic neuropathy (DN), and to evaluate the relationship between the presence and the severity of DN and the diabetes duration and blood glucose level. In this study, we enrolled 198 patients, previously diagnosed with type 2 diabetes mellitus. For all patients, we measured hemoglobin A1c (HbA1c), lipid profile, and body mass index and we assessed the presence and severity of DN using the evaluation of clinical signs and symptoms. Patients had a median age of 62 years, with a median of diabetes duration of 7 years; 55.1% of the patients were men and the average HbA1c in the cohort was 8.2%. The prevalence of DN according to Michigan Neuropathy Screening Instrument was 28.8%, being significantly and positively correlated with higher age (65 vs 59 years; P=0.001) and HbA1c (8.6% vs 8.0%; P=0.027). No significant correlations were observed between the severity of DN and diabetes duration, body mass index (31.9 vs 29.9 kg/m2), or the number of centimeters exceeding the normal waist circumference (25.2 vs 17.3 cm; P=0.003). In conclusion, age influences the presence of DN, independent on other risk factors. This influence persists even after adjusting for other, very important risk factors, like blood glucose level or diabetes duration.

Age as an independent factor for the development of neuropathy in diabetic patients

R. TIMAR

Professor

Chief Diabetes, Nutrition and Metabolic Diseases, "Pius Brinzeu" County Emergency Clinical Hospital Timisoara, Romania

Coordinator Diabetes County Clinic Center, Timisoara, Romania

Dean Faculty of Medicine, UMF "Victor Babes" Timisoara, Romania

SRDNBM next president, January 2018

Simona POPESCU

University assistant - Metabolic Disease, Rheumatology, County Emergency Clinical Hospital Timisoara, Romania

Specialist Diabetes, Nutrition and Metabolic Diseases, County Emergency Clinical Hospital Timisoara, Romania

B. TIMAR

M.D. Ph.D.

Associate Professor "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania

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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















The role of an interdisciplinary team approach in the management of the diabetic foot ulcer



Gabriela RADULIAN

M.D., Ph.D.


Professor of Medicine at “N. Malaxa” Adults Hospital, Discipline Diabetes, Nutrition and Metabolic Diseases

Department of Clinical Education 2 - Infectious Diseases, Epidemiology, Microbiology, Parasitology, Virology, Sugar Diabetes, EndocrinologyFaculty of Medicine, UMF "Carol Davila" Bucharest

Diabetic foot ulcer (DFU) is a common complication and an important factor of mortality among patients with diabetes.It is estimated up to 25% of all patients with diabetes will experience ulceration of the foot during their lifetime.DFU can precede more than 8 in 10 non-traumatic amputations.

Acquiring optimized results in treatment of of the diabetic foot ulcers involves an appropriate interdisciplinary management of the wound care.

Globally, diabetic foot complications and management are one of the most important medical, social, and economic challenge.The management of DFU should be optimized by using a multidisciplinary team, due to a holistic approach.An appropriate patient education encourages them to regular foot care in order to prevent DFU, wound extension and an eventually amputation.

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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen


















Balance Impairment and the Risk of Fallsin Patients with Diabetes and Neuropathy

Background and aimsDiabetic neuropathy (DN) is a prevalent complication of Type 2 Diabetes Mellitus (T2DM) with a major impact on the health of the affected patient. We hypothesized that mediated by the dysfunctionalities associated with DN’s three major components: sensitive (lack of motion associated sensory), motor (impairments in movement coordination) and autonomic (the presence of postural hypotension), the presence of DN may impair the balance in the affected patients. Our study’s main aim is to evaluate the possible association between the presence and severity of DN and both the balance impairment and the risk of falls in patients with T2DM.

Patients and MethodsIn this cross-sectional study we enrolled, according to a consecutive-case population-based setting 198 patients with T2DM. The presence and severity of DN was evaluated using the Michigan Neuropathy Screening Instrument, a tool which allows both diagnosing and severity staging of DN. The balance impairment and the risk of falls were evaluated using four validated and standardized tools: Berg Balance Scale (BBS), Timed-up and Go test (TUG), Single Leg Stand test (SLS) and Fall Efficacy Scale (FES-I).

ResultsThe presence of DN was associated with significant decreases in the BBS score (40.5 vs. 43.7 points; p<0.001) and SLS time (9.3 vs. 10.3 seconds; p = 0.003) respectively increases in TUG time (8.9 vs. 7.6 seconds; p = 0.002) and FES-I score (38 vs. 33 points; p = 0.034). The MNSI score was reverse and significantly correlated with both BBS score (Spearman’s r = -0.479; p<0.001) and SLS time (Spearman’s r = -0.169; p = 0.017). In the multivariate regression model, we observed that patient’s age, DN severity and depression’s symptoms acted as independent, significant predictors for the risk of falls in patients with T2DM.

ConclusionsThe presence of DN in patients with DM is associated with impaired balance and with a consecutively increase in the risk of falls.

Disclosure A part of this research’s results were published in PLoS One (2016: doi.org/10.1371/journal.pone.0154654)

R. TIMAR

Professor

Chief Diabetes, Nutrition and Metabolic Diseases, "Pius Brinzeu" County Emergency Clinical Hospital Timisoara, Romania

Coordinator Diabetes County Clinic Center, Timisoara, Romania

Dean Faculty of Medicine, UMF "Victor Babes" Timisoara, Romania

SRDNBM next president, January 2018

B. TIMAR

M.D. Ph.D.

Associate Professor "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania

Simona POPESCU

University assistant - Metabolic Disease, Rheumatology, County Emergency Clinical Hospital Timisoara, Romania

Specialist Diabetes, Nutrition and Metabolic Diseases, County Emergency Clinical Hospital Timisoara, Romania

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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




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N. HÂNCU

Honorary member of the Romanian Academy

Honorary Professor, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Romania

Honorary President of Society for Diabetic Neuropathy

The frailty is described as the condition of being weak and delicate. The physical frailty phenotype model as a clinical tool was validated in multiple studies as a predictor of poor outcomes. This model consists of five elements: exhaustion, physical activity, walking speed, grip strength and weight loss. The prevalence of frailty in people with diabetes over 55 years ranges between 20-50%. Aging, diabetes and sarcopenia have combined effects on lower limb dysfunction: increased fatigability, muscle weakness, decreased endurance and muscle wasting, leading from frailty to disability due to falls, hospitalization, decreased quality of life and increased mortality. The bone fragility induced by diabetes increases the risk of fractures after falls. Other factors such as neuropathy, poor balance, orthostatic hypotension, foot ulcers or amputations, vision impairment, hypoglycemic events and vitamin D deficiency increases also the risk of falls and fractures.

In many cases physical frailty is associated with cognitive frailty. The multidimensional phenotype of frailty includes: disability, comorbidity, impaired cognition, altered mood, sensory limitation and physical impairment. Nutritional, hormonal, metabolic and immunologic factors are determinants for frailty. There are previously described modifiable risk factors: obesity, diabetes, hypertension, dyslipidemia, and smoking. Combining various components of Mediterranean dietary pattern has shown benefits in patients with frailty. Other protective factors described are regular moderate physical activity and cognitive stimulation.

Detection of frailty in elderly patients with or without diabetes must be included in clinical management of the patient, in order to assess the risk of further functional decline and adopt a care plan that focuses on quality of life.



Anca CRĂCIUN

M.D., Ph.D.

"Regina Maria" ClinicDepartment of Diabetes, Nutrition, Metabolic Diseases Cluj-Napoca, Romania

"Iuliu Hatieganu" University of Medicine and Pharmacy, Department of Diabetes, Nutrition, Metabolic Diseases, Cluj-Napoca, Romania

Is frailty a problem of podiatry? Yes, it is.

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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















S. BARAC

M.D., Ph.D.,

Plastic and reconstructive surgery specialist doctor“Pius Branzeu” Emergency County Hospital, Timisoara, Romania

Assistant Profesor“Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania

IntroductionOne of four priority non-communicable diseases listed by the World Health Organization, diabetes affects approximately 415 million individuals worldwide and it’s prevalence continues to rise. Diabetic foot ulcers (DFU) and infections occur in up to 25% of people with diabetes and it is estimated that a lower extremity is amputated every 20 seconds due to diabetes. Diabetic foot ulcers are increasingly prevalent, and associated with significant morbidity, mortality, and cost. This study aimed to assess the impact of an interprofessional team approach on DFU diagnosis and management for a cohort of patients and determine the risk of amputation with the SVS WIFi classification.

Material and methods We performed between January 2016 until September 2017 a retrospective study in the Vascular Surgery Clinic of the “Pius Branzeu” County Hospital from Timisoara. We included in our study 488 patients, men and women cu type II diabetes mellitus, 159 with peripheral arterial disease and plantar ulcer (108 undergone bypass surgery and 51 endovascular procedures) and 158 with plantar ulcer associated with neuropathy. The stage of ischemia was performed after the Leriche-Fontaine classification and the Ankle Brachial Index (ABI).Medium age was 64 yo. We used WIFi for grading the plantar lesions (wound, ischemia and foot infection). Patients with WIFi clinical stage 3 and infection received specific systemic antibiotic therapy. The patients were followed from clinic and paraclinic point of view during the admission (Seldinger angiography, CT Angio, Rx, probe to bone test, ABI, biological tests). On discharge, all the patients surgically cured used off-loading devices. Clinical follow-up of patients was 3 months, 6 months and one year.The patients with revascularization procedures were loaded with clopidogrel, anticoagulants and statins.

ResultsFrom all the patients with ulcers and PAD, 32 had limited toes amputation or metatarsal amputation, and from the other patients, 40 had limited toe amputations (from both groups, the patients were in WIFi moderate risk amputation stage, proposed clinical stages 3). 110 patients were healed through a correct nursing and off-loading devices (WIFi low risk & clinical stage 1) and 8 patiens had reconstructive procedures (free muscle flap, rotated local fascio-cutaneous flap, skin grafting); these last patients had an ABI above 0.92.From the total of 488 patients, 171 had a above or below-the knee amputations due to severe sepsis (WIFi high risk, stage 4).From 6 months to one year of follow-up 10 patients with non-ischemic pressure



M. IONAC

M.D., Ph.D.,

Chairman of the Committee for National Registries and Territorial Expansion

UEMS Section and Board of Vascular Surgery

Secretary general of the Romanian Society for Vascular Surgery

Chief, Clinic of Vascular Surgery and Reconstructive Microsurgery, Emergency Clinical County Hospital Timisoara, Romania

Profesor, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania

The role of interdisciplinary treatment in diabetic foot care. A retrospective study

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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















ulcer required surgical retreatment (recurrence ulcer) and 11 patients with PAD (Peripheral Arterial Disease) required amputation above the knee due to bypass thrombosis.

ConclusionsThe role of the interdisciplinary approach is essential in the treatment of diabetic foot ulcers with ischemic or neuropathic etiology. Initiatives including best practice interprofessional diabetic foot care pathways are recommended with timely vascular management of ischemia, treatment of deep and surrounding infections as well as availability of foot care and footwear.



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Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




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Nina PETROVA

M.D., Ph.D.

Diabetic Foot Clinic, King’s College Hospital NHS Foundation Trust, London, UK

Member of the Executive Committee of the Diabetic Foot Study Group of EASD

Faculty member of the “Train the Foot Trainers – Europe” programme of the International Working Group on the Diabetic Foot

Acute Charcot neuro-osteoarthropathy – current standards

Charcot neuropathic osteoarthropathy (CN) is one of the most debilitating complications of diabetic neuropathy. It classically presents as a red hot swollen foot, precipitated by trauma. The latter leads to fracture, bone fragmentation and ultimately foot deformity. Early diagnosis and timely intervention are essential for improved outlook of these patients.

In the last 15 years, considerable progress has been made in the early recognition of the acute Charcot foot when the X ray is still negative (stage 0 or incipient Charcot foot). Recent advances in imaging modalities have enabled the detection of initial signs of inflammation and underlying bone damage before overt bone and joint destruction has occurred. Casting therapy remains the mainstay of medical therapy of acute CN. If timely instituted, offloading can arrest disease activity and prevent foot deformity.

Emerging new studies into the cellular mechanisms of severe bone destruction have furthered our understanding of the mechanisms of pathological bone and joint destruction in CN. It is hoped that these studies may provide a scientific basis for new interventions with biological agents.

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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















Anne SCOTT

Senior Diabetes Nurse, Ipswich Diabetes Centre and Diabetes Foot Unit, UK

The role of nurse in the diabetic foot care Diabetes specialist nurses are key members of the diabetes team. For people with diabetes and their families the diabetes specialist nurses are the principal patient educators, motivators and counselors. Their unique role in patient advocacy gives them the privilege of gaining a better understanding of the needs of the patient and their families to help focus delivery of the most appropriate high quality care for the individual.

These qualities lend themselves perfectly to the support of people with diabetes foot disease. In the UK, the diabetes specialist foot nurse has become an essential member of the Multidisciplinary Diabetes Foot Team. Their excellent communication, leadership and persuasive skills allow them to facilitate smooth and prompt transition of patients between the various diabetic foot services. Unlike diabetes specialist nurses working in the routine diabetes clinic the diabetes specialist foot nurse must also acquire the skills from other healthcare professionals in the multidisciplinary foot team so that they can support the team by being able to undertake a basic vascular and neurological assessment, to have a knowledge of wound care including off loading, wound dressings, and vac therapy and where necessary be able to undertake conservative debridement.

A proactive and effective diabetes specialist foot nurse is an invaluable diabetic foot champion!



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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















Mieke FRANSEN

Podiatrist

Lecturer Artevelde University College, Ghent, Belgium

Treasurer of Enpodhe (European network of Podiatry in Higher Education)

Board Member of the ECP (European Council of Podiatry of the FIP)

The role and competences of the Podiatrist in Diabetic Foot care.

What is the situation of Podiatry in Europe?

The podiatrist plays an important role in the prevention and treatment of the diabetic foot. Unfortunately there is a huge difference in the profession and competences of a podiatrist trough Europe. Where do we want to go as podiatrist and how can we help to develop Podiatry in other countries.



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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















Patient education – first step in the prevention of diabetic neuropathy and diabetic foot

According to a definition from the World Heath Organisation in 1998, therapeutic patient education (TPE) is education managed by health care providers trained in the education of patients, and designed to enable a patient (or a group of patients and families) to manage the treatment of their condition and prevent avoidable complications, while maintaining or improving quality of life. Its principal purpose is to produce a therapeutic effect additional to that of all other interventions (pharmacological, physical therapy, etc.).

Diabetic neuropathy is the most frequent specific complication of diabetes and diabetic foot is associated with high burden and costs as well as high risk of ampulation with decreased quality of life. Their pathogenesis includes hyperglycemia and atherosclerosis but also poor foot care.

Education can be one of the most efficient interventions in the prevention of both diabetic neuropathy and diabetic foot. It requires a structured programme delivered by trained health care providers or other persons involved in TPE. The content of a session on diabetic foot should include topics like alert symptoms of diabetic neuropathy and need to present for diagnosis in a specialized facility (diabetes clinic, neurology clinic, diabetic foot clinic); risk factors for diabetes neuropathy and diabetic foot; available treatments for diabetic foot; need for regular check-up; rules to follow for self-care of foot to prevent ulcerations and amputation.

In a recent review published in the Cochrane Database Systematic Reviews, it was shown that there is insufficient robust evidence that limited patient education alone is effective in achieving clinically relevant reductions in ulcer and amputation incidence but this was due mainly to lack of well-designed and powered clinical studies in this field of interest.

Therefore, continuous efforts should be done by both clinicians and researchers to practice and demonstrate that TPE is indeed an important non-pharmacological intervention in diabetic neuropathy and diabetic foot.



Cornelia BALA

Lecturer, University of Medicine and Pharmacy, Cluj-Napoca, Romania

Dr. med., Ph.D., senior specialist in DiabetesClinical Center of Diabetes, Nutrition, Metabolic Diseases, Cluj-Napoca, Romania

President of Romanian Association for Education in Diabetes

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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















Exhibitor profiles

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Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















Society for Diabetic Neuropathy

The Society for Diabetic Neuropathy (NEURODIAB) was established in August 2012 by a national and international group of clinicians and basic researchers, in order to promote a strong collaboration platform for interdisciplinary medicine and to strengthen the knowledge flow from the academic community towards practitioners.

NEURODIAB is a scientific organization that focuses on basic and clinical research creating a discussion platform to contribute to a better understanding of endogenous basic biological processes and, consequently, to the development of pharmacological and non-pharmacological strategies against the complications of Diabetes Mellitus, especially against diabetic neuropathy and diabetic foot.

In order to provide an accurate framework for the future and to accomplish the goals of our Society, annually, the 3rd week of October is dedicated to diabetic neuropathy, and it is called Diabetic Neuropathy Week. With this opportunity, we organize round tables with general practitioners and patients, which are led by specialists in diabetes, neurology, and also surgeons. In the last days of the 3rd week of October we organize an international conference to open the stage for debates and updated theories in the discussed field. Once every year, in the 3rd week of July, we organize the Summer School for Diabetic Neuropathy and Diabetic Foot. This event is relying on the top opinion leaders and it is dedicated to young doctors who specialize in diabetes, neurology, internal medicine, and orthopedy, being structured as an interactive academic forum for them.

NEURODIAB is also involved in post-graduate educational projects that aim to create bridges between the academic community, researchers, and practitioners.

Young doctors can benefit from scholarships while basic and clinical researchers can benefit from grants. NEURODIAB can also provide other complex communication approaches.

The Society for Diabetic Neuropathy is an association recognized by the Romanian College of Physicians as a provider of continuous medical education.

If you have a question about something you read on this presentation, or you are interested in starting a collaboration, please feel free to contact us by email at [email protected]

www.neurodiab.org /neurodiab



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Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



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Wörwag Pharma GmbH&Co.KG

The modern treatment of diabetes employs a holistic approach that also includes the treatment of its concomitant diseases. Thus, the treatment area of diabetic polyneuropathies, the leading cause of diabetic foot syndrome and diabetes related amputations, has emerged as an area of interest over the last several years. Within the last 40 years, Wörwag Pharma has developed its international competence and reputation in the treatment area of diabetes and its sequelae – it has developed a specialized portfolio of micronutrients, called biofactors that covers both the pathogenetic and the symptomatic treatment of diabetic neuropathies.

From now on, Wörwag Pharma wants to take the opportunity to support and to continue as a partner of all the activities concerning the diabetic neuropathies and diabetic foot, in the benefit of all the people involved in this pathology: patients, nurses, doctors.

Renowned international Key Opinion Leaders will present findings from local scientific projects and will share their expertise and its connection to your daily work with you. We appreciate this opportunity to share these results with you and hope you will find them useful as well.

We would like to invite you to visit Wörwag Pharma Exhibition in all scientific and marketing events where we will meet.

www.woerwagpharma.ro

/woerwagpharma.ro



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Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















Your communication expert in the health domain

Sănătatea Press Group is a company which offers ideas, consultancy and strategies applied in services of communication, event organizing and video productions for the health/medical domain.

Our clients’ success is our business card. We want to provide comprehensive and complete services so we developed the following divisions:

The values of Sănătatea Press Group are founded on three principles: force, beauty and wisdom. We apply in all our projects originality, creativity, efficiency, enthusiasm and most importantly the involvement of a young motivated team!



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LabormedAlvogen
















Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
























Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















Exhibition Plan

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Simona Popescu







Gerry Rayman, UK


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Săptămâna Neuropatiei Diabetice

Ediția a V-a

Nu ești singur! Împreună, putem face diferența!

www.neurodiab.orgwww.podiatrie.ro

04-27 Octombrie 2017A

Asociația de Podiatrie

Botoșani

Oradea

Ploieşti

Craiova

Iaşi

Piteşti

Tmișoara

Târgoviște

Buzău

Bistrița

Târgu Mureș

Carei

Onești

Alexandria

Galați

București

Râmnicu Vâlcea

Constanța

Brașov

BistrițaBuzăuIașiOradeaTârgovișteTimișoara

17.10.2017

16.10.2017 BotoșaniConstanța

04.10.2017 Alexandria

GalațiPitești

10.10.2017

București11.10.2017

Râmnicu Vâlcea12.10.2017

Onești13.10.2017

18.10.2017 BrașovCraiovaPloieștiSuceavaTimișoara

27.10.2017 Târgu Mureș

19.10.2017 Carei

Suceava









Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



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EASD 1 - 5 201 OCTOMBRIE 8 / BERLIN, GERMANIA

Premiul NeurodiabEASD 2018 BerlinCONDIȚII DE PARTICIPAREPremiul se adresează tinerilor medici rezidenți și specialiști,având activități sau lucrări în domeniul neuropatiei diabeticesau al piciorului diabetic. Pentru înscriere, vă rugăm sătrimiteți lucrarea in extenso însoțită de un CV și o scrisoarede recomandare la adresa [email protected]ână la data de 31 mai 2018.

PREMIULConstă în sponsorizarea participării laEASD octombrie 2018, 1-5 Berlin, Germania.

Premiul este sponsorizat de Wörwag Pharma.

www.neurodiab.org

Event management:









Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















18 - 22 JULY 2018th nd / NEW MONTANA HOTEL, SINAIA

SUMMER SCHOOL

ORGANIZED BYNeurodiab - Society for Diabetic Neuropathy

Diabetes and Podiatry:what’s the connection?

www.neurodiab.org

Event management:









Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















The Association for Podiatry Opens the debates on foot care and organizes

ndThe 2 National CongressWith international participation

2 days of intensive workshopsand state of the art lecturesfor physicians and nurses

June 7-9, 2018Ramada Parc Hotel, Ramada Plaza HotelBucharest, Romania

Find out more and register on www.podiatrie.rowww.podiatrie-event.org

Event Management:

SAVE THE DATE









Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















6

th th18 - 20 OCTOBER 2018 BUCHAREST/RAMADA PARC HOTEL, RAMADA PLAZA HOTEL

www.neurodiab.org









Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















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Nu ești singur! Împreună putem face diferența!www. neurodiab.org









Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
























Simona Popescu







Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




LabormedAlvogen
















www.neurodiab.org

Find us on

Neurodiab - Society for Diabetic NeuropathyMany thanks to all who helped us organize the National Congress with International Participation

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Gerry Rayman, UK


Frank Bowling, UK

Nina Petrova, UK



Anne Scott




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