PD Poster Presentation-Diabetes (1-25

PD-01

CASE SERIES OF INTERFERON INDUCED TYPE 1 DIABETES MELLITUS

1YU-PING HUANG, 1YE-FONG DU, 1CHING-HAN LIN, 1HAO-CHANG HUNG,

1HORNG-YIH OU

1Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

Objective

Interferon-based treatment is currently used in a number of conditions, including chronic viral hepatitis, hematological malignancies, renal cell carcinoma, and melanoma. On the other hand, interferon (IFN) therapy can also trigger several autoimmune diseases such as type 1 diabetes mellitus (T1DM). However, this adverse effect has not gained much attention. Here, we report on four cases of IFN-induced T1DM at our institution.

Methods

We reviewed the clinical characteristics, anti-islet autoantibodies, and clinical course of four patients for whom T1DM developed shortly after IFN therapy since 2010.

Results

Three of the patients were female and one of the patients was male. The range of the age at onset of T1DM was from 38 to 55 years old. Two of them had history of T2DM before IFN treatment, but none of them had history of autoimmune diseases or family history of T1DM. The time period from initiation of the IFN therapy for their chronic hepatitis C to the onset of T1DM was 3 to 5 months. Three of them presented with diabetic ketoacidosis at diagnosis. They all had positive glutamic acid decarboxylase 65 antibodies (GAD-Ab), and the titers were extremely high in three of them. All the patients remain insulin-dependent for up to 5 years.

Conclusions

Fasting blood glucose level and hemoglobin A1c should be monitored during and after IFN therapy. For high-risk subjects, GAD-Ab may be screened before and after the IFN therapy to detect anti-islet autoimmunity for preventing the life threatening events (such as diabetic ketoacidosis) associated with T1DM.

PD-02

POST-GASTRIC BYPASS HYPOGLYCEMIA(PGBH): A CASE REPORT AND LITERATURE REVIEW

1PO-TSANG CHEN, 1KAI-JEN TIEN, 1CHEWN-YI YANG, 1NAI-CHENG YEH,

1SHANG-GYU LEE

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan

Background. Bariatric surgery is an effective procedure on treatment of severe obesity with comorbidities, including type 2 DM, hypertension, obstructive sleep apnea or dyslipidemia. However, adverse event can occur after procedure. Since 2005, post-gastric bypass hypoglycemia(PGBH),

Methods. We report a morbid obesity woman who had received bariatric surgery developed severe recurrent hypoglycemia and PGBH was suspected.

Results. The 36-year-old woman who has uncontrollable type 2 DM and morbid obesity (BMI 36.7 kg/m2) received bariatric surgery. After three months, she was admitted due to urinary tract infection. During admission, recurrent episodes of cold sweating, dizziness, weakness with low fingerstick blood glucose were found. Lab data confirmed low serum glucose with endogenous hyperinsulinemia. She received diet intervention and pharmacological treatment but in vain. As result, partial pancreatectomy was performed to alleviate her refractory hypoglycemia. The pathology reports showed focally scattered islet hyperplasia.

Conclusion. Post-gastric bypass hypoglycemia is a rare bariatric surgery complication as a result of pancreatic hyperplasia. Clinician should be aware of this rare situation and differentiate other causes of hypoglycemia carefully.

PD-03

HBA1C CHANGE AND 24-HR GLUCOSE FLUCTUATION AFTER VILDAGLIPTIN PLUS METFORMIN (SPC) TREATMENT IN PATIENTS WITH TYPE 2 DIABETES MELLITUS INADEQUATELY CONTROLLED ON METFORMIN MONOTHERAPY: A PROSPECTIVE, OPEN-LABEL STUDY

1SHIH-TE TU, 1JEN-FU KUO, 1SHI-DOU LIN, 2CHIEH-KO KU

1Department of Internal Medicine,Division of Endocrinology and Metabolism,Chang-Hua Christian Hospital,Chang-Hua,Taiwan; 2Novartis Taiwan

Background: Metformin is the most widely used oral anti-diabetes therapy in patients with type 2 diabetes mellitus (T2DM). However, metformin alone is not sufficient to maintain the glycemic vildagliptin and metformin combination has been demonstrated in several randomized clinical trials, clinical importance.

Objective: in patients with T2DM uncontrolled on metformin monotherapy.

Methods: This was a 24-week, prospective, interventional, single-arm, open-label study change in HbA1c from baseline to week 24. Secondary efficacy endpoints included fasting plasma glucose (FPG), postprandial plasma glucose (PPG), percentage of patients reaching the glycemic goal glycemic excursion (MAGE). Adverse events (AEs), serious adverse events (SAEs) and hypoglycemic events (HEs) were monitored and recorded.

Results: Of 40 enrolled patients, 37 (92.5%) completed the study. Mean ± SD age was 53.9 ± 11.9 years, 76.9% were women, mean T2DM duration was 3.9 ± 3.6 years; 69.2% patients had body mass 2. Mean HbA1c, FPG and PPG at baseline were 7.2 ± 0.6%, 143.2 ± 22.5 mg/dL and 182.6 ± 4 4.3 mg/dL, respectively. The mean change in HbA1c from baseline to 12 and 24 weeks was

week 24. Of 40 patients in the safety population, 57 AEs occurred in 23 (57.5%) patients, most of which were mild (89.5%). One SAE was reported (moderate in severity) but was not drug related. No HEs were recorded.

Conclusions: Vildagliptin and metformin combination treatment improved not only hyperglycemia but also glycemic variability, was well tolerated and can be considered as a suitable treatment option in patients with T2DM from Taiwan who were inadequately controlled on metformin monotherapy.

PD-04

THE RELATIONSHIPS BETWEEN GAMMA-GLUTAMYLTRANSFERASE AND INSULIN RESISTANCE, GLUCOSE EFFECTIVENESS, FIRST- AND SECOND-PHASE INSULIN SECRETION IN OLD SUBJECTS

1TE-LIN HSIA, 2JIUNN-DIANN LIN, 3YEN-LIN CHEN, 2CHUNG-ZE WU, 1DEE PEI

1Department of Internal Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, R.O.C.; 2Division of Endocrinology, Department of Internal Medicine, Shuang-Ho Hospital, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, R.O.C.; 3Department of Pathology, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, R.O.C.

The pathophysiology of type 2 diabetes is still a mystery. Till now, insulin resistance (IR), glucose effectiveness (GE), first- and second-phase insulin secretion (FPIS, SPIS, respectively) are glutamyltransferase (GGT) is at least found to be related to IR and insulin secretion. Since diabetes in mostly prevalent in the elderly, to understand the relationships between GGT and IR, GE, FPIS and SPIS would be important.

We randomly enrolled 5082 and 5851 normal men and women whose age were over 65 years old (included). IR, FPIS, SPIS and GE were calculated by the equations developed by our group. In short, by using demographic and components of metabolic syndrome, these parameters could be estimated. Simple correlation was applied to evaluate the slopes between GGT and other factors. The slopes of the correlation lines were compared. Due to the different units, the slopes were all converted into percentage so that they can be compared.

IR, FPIS and SPIS were positively and GE was negatively correlated to GGT. By comparing their slopes, it could be noted that, from the highest to the lowest r values, GE was the most tightly related to GGT, followed by IR, SPIS and FPIS. Among them, GE was the most important one and FPIS was the least. Inflammation might play a crucial role in the pathogenesis of diabetes in old Chinese.

PD-05

A CASE REPORT OF ACUTE KIDNEY INJURY AFTER 8 WEEKS OF EMPAGLIFLOZIN USE IN AN UNCONTROLLED TYPE 2 DIABETES

KUO-YANG LEE

Division of Endocrinology and Metabolism, China Medical University Hospital, Taipei Branch, Taiwan

Object uncontrolled type 2 diabetic patient.

Method: The 67 years old woman has underlying disease of type 2 diabetes mellitus and mixed hyperlipidemia since 2011. She was prescribed with metformin (500) 1# tid, glimepiride (2) 1# bid, blood glucose was noted uncontrolled under oral antidiabetic drugs since this year. (HbA1C was linagliptin for better glycemic control.

Result: Her renal function was serum creatinine 0.6 mg/dl (eGFR 98 mL/min/1.73 m2. by MDRD) in March, 2013, Cre 0.9 (eGFR 62) in May, 2014, Cre 1.1 (eGFR 49) in August, 2015, Cre 1.32 (eGFR 40) in April, 2016 and Cre 1.04 (eGFR 53) in June, 2016. Oral antidiabetic drugs were change to nd, 2016. However, she experienced nausea, dizziness, general discomfort and visited our emergency department on September, 28th. No fever, abdominal pain, vomiting or diarrhea was associated. No diuretic, renin-angiotensin system blockade, non-steroidal anti-inflammatory drug or Chinese medicine was taken. Deteriorated renal function was noted (BUN 70 mg/dl, Cre 3.56 mg/dl, eGFR 13 mL/min/1.73 m2 ). She was treated with intravenous hydration and was referred to endocrine outpatient the next day. Anti-diabetic drugs were adjusted to linagliptin 1# qd and Novomix (70/30) 12 U bid ac. Four weeks later (Oct, 26th), her serum Cre returned to 1.2 mg/dl (eGFR 45) and HbA1C decreased to 6.8%.

Conclusion: Although recent data (EMPA-REG Renal) had shown that empagliflozin could prevent worsening diabetic nephropathy, acute renal injury may also occurred especially in elderly patients or patients with chronic kidney disease (e GFR < 60). This class of drug should be used with

PD-06

DYNAMIC CHANGES OF INSULIN REQUIREMENT IN DIFFERENT MEAL TIMES IN PATIENTS WITH TYPE 1 DIABETES

1CHUNG-CHIH SHEN, 1CHING-JUNG HSIEH

1Division of General Internal Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Taiwan, R.O.C.

Purpose: to evaluate different insulin requirement in different meals’ time in patients with type 1 diabetes.

Method: This is a retrospective study. We enrolled 30 patients from our carbohydrate counting education records in ward of Endocrine& Metabolism between Jan. 2005 and Dec. 2015. They had been admitted to the ward and received carbohydrate counting education and insulin dose adjusting. The including criteria is: type 1 diabetes mellitus, receiving basal + bolus insulin injection, carbohydrate/insulin (C/I) ratio and insulin sensitivity factor (ISF) noted before discharge. The exclusion criteria is: type 2 diabetes mellitus, receiving premixed or self-mixed insulin.We recorded the C/I ratio in different meals’ time, ISF from education chart. We also recorded age, gender, duration after carbohydrate counting education 3, 6 and 12 months later.We will use T-Test to test the different C/I ratio in different meals. The changes of all parameters before and after carbohydrate counting education 3,6 and 12 months later will be tested using a paired t-test.

Results:The demographic characteristics of study subjects are presented in Table 1. Our data carbohydrates-to-insulin at lunch and carbohydrates-to-insulin at dinner( at morning v.s. at lunch, p = baseline but there was no difference between baseline and after 12months(baseline v.s. after 3months, p = 0.02; baseline v.s. after 6months, p = 0.013; baseline v.s. after 9 months, p = 0.024; baseline v.s. higher at morning. It allows for reduced total insulin doses at noon and night and was associated with somogyi effect. Patient’s sugar control was improved after carbohydrate counting methods according to reduced carbohydrate counting. Further research is required to determine if factor confound the usual estimates of carbohydrate to insulin ratios and need to be factored into advice on insulin dosing for those with type 1 DM.

PD-07

TESTING FOR HBA1C, IN ADDITION TO OGTT, IN PATIENTS WITH NO HISTORY OF DIABETES MAY HELP TO IDENTIFY PATIENTS WITH EARLY -CELL FUNCTION IMPAIRMENT

1YU-HSUAN LI, 1WAYNE HUEY-HERNG SHEU, 1WEN-JANE LEE, 1I-TE LEE, 1SHIHYI LIN, 1WEN-LIENG LEE, 1KAE-WOEI LIANG, 1CHIA-PO FU, 1JUN-SING WANG

1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

OBJECTIVE

2-h plasma glucose from low normal to diabetic range. We aimed to investigate whether testing for glycosylated hemoglobin (HbA1c), in addition to oral glucose tolerance test (OGTT), may help to

RESEARCH DESIGN AND METHODS

This was a cross-sectional study included 1044 patients with no history of diabetes who were previously admitted for coronary angiography (CAG). Two to four weeks after hospital discharge, calculated to assess their beta cell function.

RESULTS

According to OGTT, there were 432 (41.4%) patients with normal glucose tolerance (NGT), 432 (40.5%) with pre-diabetes, and 189 (18.1%) with newly detected diabetes. In patients classified as

CONCLUSIONS

Testing for HbA1c may help to detect early beta cell dysfunction, even in those who had normal glucose tolerance according to OGTT

PD-08

INDICATOR ANALYSIS FOR RESPONSIVENESS TO SODIUMGLUCOSE CO-TRANSPORTER-2 INHIBITORS (SGLT2I) IN TYPE 2 DIABETIC TAIWANESE

1CHIUNGYA CHEN, 1SUZ-TAH CHEN

Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Taiwan, R.O.C.

Background: As a new class of glucose-lowering drugs, sodium-glucose co-transporter 2 inhibitors (SGLT2i), such as Dapagliflozin (Dapa) and Empagliflozin (Empa) are effective for controlling hyperglycaemia. This study aimed to identify possible indicators between SGLT2i responders and non-responders.

Design and Methods: Sixty-three poor controlled Type 2 Diabetic (T2D) patients were enrolled for either Dapa or Empa treatment. The duration of SGLT2i usage ranged from 3 to 6 months. Dipeptidyl peptidase-4 inhibitors, if ever used, were ceased on switching to SGLT2i. Clinical characteristics and parameters were documented initially and every 3 months. The dosing of Dapa and Empa or other hemoglobin A1c (HbA1c) equal to or more than 0.8% decrement. Binary logistic regression analysis was used to compare the difference between responder and non-responder groups.

Results: 63 out of 93 patients received more than 3 months of SGLT2i treatment, 9 stopped initially and 5 non-responders discontinued SGLT2i 3 months later due to adverse effects. 22 out of 63 (34.92%) were responders. Demographically, pre-treatment HbA1c level was higher (10.8 [10.1; 12.5] vs. 9.1 [8.4; 10.4]%, P = 0.000); initial Cr was lower (0.67 [0.615; 0.9] vs. 0.87 [0.77; 1.12] mg/ dL, P = 0.015); and eGFR was higher (98 [85; 137] vs. 82.7 [64.0; 99.5] mL/min/1.73m2 , P = 0.004) in responders than in non-responders. HbA1c was significantly better in responders than in nonresponders (-1.65 [-2.9; -1.3] vs. -0.1% [-0.4; 0.7], P = 0.000). Average of 1 Kg body weight loss was in responders than in non-responders (4.91 vs. 39.59 months, P = 0.012). For individual SGLT2i, the responders have higher pretreatment HbA1c (11.1 [10.2; 11.9] vs. 9.0 [8.3; 9.9], P = 0.001), higher eGFR (115 [85; 139] vs. 84.2 [52.8; 100.8], P = 0.009), and better HbA1c (-1.6 [-3.1; -1.3] vs. 0.3 [-0.4; 0.7], P = 0.000) in the Empa group; and higher pre-treatment HbA1c (10.6 [9.5; 12.6] vs. 9.1 [8.4; 10.7], P = 0.023) and better HbA1c (-1.7 [-2.4; -1.3] vs. -0.15 [-0.4; 0.33], P = 0.000) in the Dapa group as well.

Conclusion: Higher HbA1c and eGFR are 2 independent factors for SGLT2is responsiveness.

PD-09

METABOLIC CONTROL IN PATIENTS WITH TYPE 2 DIABETES MELLITUS IN A REGIONAL TEACHING HOSPITAL IN TAOYUAN CITY: A CROSS-SECTIONAL STUDY IN DIABETES SHARED CARE MODEL OUTPATIENTS

LI JUI-HSIANG, LO SU-HUEY

Tao-Yuan General Hospital

Objective: the objective of this survey was to assess patients’ achievement of ADA guideline in T2D outpatient clinics.

Methods: This is a descriptive cross-sectional study with 3875 ambulatory T2DM patients recruited between January and September 2016 and who are being treated in in a regional teaching hospital in Taoyuan city . Data was gathered via standardized interviews, clinical surveys, and anthropomorphic measurements for each patient. Blood samples were drawn in fasting state for measures of glycosylated hemoglobin (HbA1c), creatinine, lipid profile, and urinary analysis. Laboratory parameters and blood pressure were evaluated according to ADA guideline recommendations

Result Of the 3875 patients, 51.5% were female and the mean age was 63.2 ± 13.1 years. The proportion of age less than thirty years old was only 1.4% but the proportion of old than sixty-four years old was 43.9%. The mean diabetic duration was 11.9 ± 8.6 years. The proportion of glycemic Triglyceride < 150mg/dl was 40.6%,79.0%, 59.5% and 57.0% respectively. The diabetes with normal

Conclusion: Among individuals with type2 diabetes, there was still poor attainment of ADA recommendation (A1C, BP and LDL). 65.5% type 2 diabetes patients was overweight or obesity. Interventions are urgently needed in order to prevent long term diabetic complication and overweight or obesity.

PD-10

A RESEARCH OF S14 PROTEIN IN THE LIPOGENESIS AND METABOLIC DISORDERS

1YEN-TING CHEN,

2FEN-YU TSENG, 2PING-HUEI TSENG, 3DER-SHENG HAN, 2YU-CHIAO CHI, 1,2WEI-SHIUNG YANG

1Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan 2Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 3Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Beihu Branch, Taipei, Taiwan

Objectives: Spot 14 (S14) is a protein involved in the regulation of fatty acid synthesis in lipidproducing tissues, primarily in the liver, lactating mammary gland and adipose tissue. However, the exact role of S14 in adipose tissue has not been investigated. In this study, we planned to study the regulation and function in adipogenesis and metabolic disorders.

Methods: We utilized S14 knockdown (KD) 3T3-L1 as an in vitro cell model to observe adipocyte differentiation. Adipogenesis-related gene mRNA expressions were analyzed by real-time PCR. An immunoassay was set-up to measure serum S14 concentration in human subjects.

Results: S14 KD reduced 3T3-L1 adipocyte differentiation and lipid accumulation. Several down-regulated during S14 KD. The mRNA expression level of S14 was related to insulin resistance and the serum S14 concentration was negatively associated with thyroid-stimulating hormone and triglyceride levels.

Conclusions: S14 might play a critical role in adipocyte differentiation and participated in the mechanism of endocrine and metabolic disorders.

PD-11

THE RELATIONSHIP BETWEEN SERUM RNASE-L LEVEL AND METABOLIC SYNDROME: A CROSS-SECTIONAL STUDY

1YI-TING WANG, 2PING-HUEI TSENG, 1, 3CHI-LING CHEN, 1, 4YU-CHIAO CHI, 4FENG-YU TSENG, 1, 4, 5, 6WEI-SHIUNG YANG

1 Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taiwan; 2 Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital, Taiwan; 3 Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan; 4 Division of Endocrinology & Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taiwan; 5 Center for Obesity, Lifestyle and Metabolic Surgery, National Taiwan University Hospital, Taiwan; 6 Graduate Institute of Medical Genomics & Proteomics, College of Medicine, National Taiwan University, Taiwan

Objectives: Ribonuclease-L (RNase-L) was considered as a ubiquitous enzyme involved in various cellular functions, especial in innate immunity. Recently, it was reported to participate in adipogenesis and myogenesis in rodents. Here, we developed a method to measure serum levels of RNase-L and analyze the association of RNase-L with metabolic syndrome (MetS).

Methods: A total of 396 subjects were recruited from a health check-up program of National Taiwan University Hospital (NTUH). An in-house RNase-L immunoassay was developed, and the serum RNase-L levels of these subjects were then measured. The association of MetS-related factors with serum RNase-L levels was assessed. To investigate this relationship, independent t-test assay, multivariate linear regression analysis, and odds ratio estimation were applied.

Results: The mean level of serum RNase-L of the subjects with MetS were lower than those P = 0.016). It was observed that the subjects with central obesity, elevated blood pressure, or impaired fasting glucose (IFG) had lower serum RNase-L P = 0.031) and high P = 0.037) were related to serum RNase-L in multivariate linear regression analysis. It is associated with a reduced risk of MetS (OR, 0.84, 95% CI, 0.71-0.99, P = 0.036), central obesity (OR, 0.82, 95% CI, 0.71-0.94, P = 0.004), elevated blood pressure (OR, 0.86, 95% CI, 0.74-0.99, P = 0.049), or low HDL-C (OR, 0.85, 95% CI, 0.73-0.99, P = levels of RNase-L in various analyses.

Conclusions: The serum RNase-L levels were negatively associated with MetS, unfavorable metabolic profiles and age in these subjects from a health check-up program. The mechanism underlying the link between RNase-L and MetS warrants further investigation.

PD-12

EXPRESSION AND PURIFICATION OF CNTA PROTEIN FROM MICROBIOTA

1,2SHIH-TING TSENG, 3CHIA SHIN YANG, 3YEH CHEN

1Department of Endocrinology and Metabolism, Kuang Tien General Hospital, Taiwan; 2 Department of Food and Nutrition, Providence University, Taiwan; 3 Department of Biotechnology, Hungkuang University, Taiwan;

L-carnitine supplements are used to increase L-carnitine levels in people whose natural level of L-carnitine is too low because they have a genetic disorder, are taking certain drugs that uses up the body’s L-carnitine.. Choline supplements are often taken as a form of ‘smart drug’ or nootropic, due to the role the neurotransmitter acetylcholine plays in various cognition systems within the brain.

Omnivorous human subjects produced more TMAO than did vegans or vegetarians following ingestion of L-carnitine and Choline through a microbiota-dependent mechanism. Previous study demonstrated that microbial produced TMA from L-carnitine by Rieske-type protein oxygenase/ reductase, CntA and CntB, and from Choline by Choline radical enzyme, CutC and CutD. To decrease the risk of dietary L-carnitine and Choline, inhibiting the function of CntA, CntB, CutC or CutD can be an idea for consideration. Therefore, CntA, CntB, CutC and CutD protein structures could be a basis for searching the suitable inhibitors. Until now, the CntA, CntB and CutD do not have the similar structures established. In this study, we plan to construct the plasmids containg cntA gene chemicals searching will be conducted using the bioinformatics’ software. The suitable inhibitor may be produced as a functional food with the dietary L-carnitine and Choline. It will help to decrease the risk of atherosclerosis.

PD-13

SEASONAL VARIATION OF HBA1C CAN BE INDEPENDENT OF THE ANNUAL CHANGES OF GLYCEMIC CONTROL IN EACH SEASON

1PO-HSUN CHEN, 2SHEU-CHEN LIU, 3CHIA-LIN LEE

1Department of Internal Medicine, Taichung Veterans General Hospital, Chiayi branch, Chiayi, Taiwan; 2Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan; 3Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

Introduction:

temperature in different countries in northern hemisphere. Decreased physical activity and increased calorie intake, especially during cultural events, were proposed causes.

Objective:

This retrospective study was designed to evaluate the relationship between annual HbA1c changes of each season and seasonal variation of glycemic control at different HbA1c levels.

Methods:

Among the patients in Diabetic Shared Care Network in Taichung Veterans General Hospital from spring, June to August as summer, and September to November as fall/autumn.

Results:

A total of 2014 patients with T2DM in the Diabetic Shared Care Network were investigated HbA1c (%) of each group was 6.4 ± 0.4, 7.7 ± 0.6, and 10.3 ± 1.1, respectively (p < 0.001). In each p-values were < year (Y1) in each season (Y1 vs Y3: 6.5 ± 0.7 vs 6.9 ± 0.9 in spring, 6.5 ± 0.7 vs 6.7 ± 0.8 in summer, 6.6 ± 0.8 vs 6.8 ± 0.8 in fall, 6.7 ± 0.7 vs 6.8 ± 0.9, repectively, all p-values were < 0.001). The opposed changes were found in the other two groups. In the middle-HbA1c group, the annual changes of HbA1c in each season (Y1 vs Y3) were 7.7 ± 0.9 vs 7.6 ± 1.1 in spring, 7.6 ± 0.9 vs 7.4 ± 1.0 in summer, 7.7 ± 1.0 vs 7.5 ± 1.1 in fall, 7.7 ± 1.0 vs 7.6 ± 1.1 in winter, respectively (all p-values were < 0.001). In the highest-HbA1c group, the annual changes of HbA1c in each season (Y1 vs Y3) were 9.6 ± 1.6 vs 8.6 ± 1.7 in spring, 9.2 ± 1.7 vs 8.3 ± 1.6 in summer, 9.1 ± 1.6 vs 8.5 ± 1.6 in fall, 9.3 ± 1.6 vs 8.5 ± 1.7 in winter, respectively (all p-values were < 0.001). The annual changes of fasting blood

glucose in each season were not consistent with the HbA1c changes.

Conclusion:

Clinical comprehensive diabetes care involving physicians, educators, nurses, and dietitians in real world could not improve the annual HbA1c in each season in the patients with good glycemic control despite seasonal variation of HbA1c still exhibited in all groups in 3 years. Previous proposed temperature or sunlight exposure may be more important.

PD-14

THE JOINTED EFFECT OF VASCULAR CELL ADHESION MOLECULE-1 AND CORONARY ARTERY DISEASE ON BRAINDERIVED NEUROTROPHIC FACTOR

1I-TE LEE, 1JUN -SING WANG, 1CHIA-PO FU, 1WAYNE HUEY-HERNG SHEU

Division of Endocrinology and Metabolism, Taichung Veterans General Hospital

Background: There is a high prevalence of depression in subjects with coronary artery disease (CAD). Brain-derived neurotrophic factor (BDNF) is important for neural protection. In the present

Methods: Subjects who had undergone diagnostic angiography for angina were enrolled. Serum BDNF was determined at 0, 30 and 120min during an oral glucose tolerance test (OGTT) to calculate area under the curve (AUC) for BDNF. Serum vascular cell adhesion molecule-1 (VCAM-1) was

Results: higher serum VCAM-1 (583 ± 383 vs. 482 ± 171 ng/mL, P = 0.017) were noted in subjects with CAD than those without CAD. High VCAM-1 levels were an independent factor for low AUC of BDNF in subjects with and without CAD (95%CI between -0.011 and -0.002, P = 0.008; and 95%CI between -0.033 and -0.002, P = 0.029, respectively). Serum BDNF was lowest in the CAD subjects with high VCAM-1 levels at all time points during OGTT.

Conclusion: Our results show that CAD was associated with low serum BDNF in response to OGTT, and VCAM-1 contributed a jointed effect with CAD on the BDNF.

PD-15

ASSOCIATION BETWEEN SYSTOLIC BLOOD PRESSURE AND FUTURE RISK OF MORTALITY IN DIABETIC SUBJECTS AMONG U.S. ADULTS

1CHING-YUN HU, 1YI-TING KUO, 2CHIA-LIN LEE

1Taichung Veterans General Hospital, Wanciao Branch, 2Taichung Veterans General Hospital

Title: Association between systolic blood pressure and future risk of mortality in diabetic subjects among U.S. adults: NHANES 2001-2010

Background:

Hypertension is a common comorbidity of type 2 diabetes. Epidemiological analyses show that hypertension is associated with increased cardiovascular(CV) event rates and mortality in individuals blood pressure. However, optimal range of systolic blood pressure (SBP) in diabetes still remained controversial.

Object:

The aim of this study was to examine the association between SBP and the risk of overall and CV mortality in subjects with diabetes.

Study design:

This study was derived from National Health and Nutrition Examination Survey (NHANES) 2001-2010. Subjects less than 18 years old were excluded. Blood pressure and questionnaire of diabetes were recorded in NHANES enrollment. Diabetes was assigned if the subject reported a physician diagnosis of diabetes . The primary endpoint was all-cause mortality. CV mortality was

Result:

Overall, 2744 subjects with diabetes were included. Among them, weighted percentage of male were 49.7%. The weighted average SBP was 130 + 0.5 mmHg. Over an average of 60 months of follow-up, the CV mortality rate was 4.8% and all- cause mortality was 17%. Comparing with the subjects of SBP 110-119 mmHg, the weighted risk of overall mortality were 1.96(1.02-3.78), 1.41 (0.79- 2.52), 1.40 (0.72- 2.70), 1.14 (0.54- 2.41), 3.01 (1.44- 6.30) and 1.88 (0.98- 3.58) for SBP of < 110mmHg, 120-129,130-139,140-149,150-159 and greater than 160, respectively.

Comparing with the subjects of SBP 110-119 mmHg, the weighted risk of CV mortality were 3.36(1.34- 8.38), 1.38 (0.46- 4.14), 2.04 (0.64- 6.54), 1.37 (0.35- 5.36), 4.75 (1.35- 16.72) and 3.71 (1.30- 10.60) for SBP of < 110mmHg, 120-129,130-139,140-149,150-159 and greater than 160, respectively.

Conclusion

SBP below 110 mmHg was associated with higher risk of overall and CV related mortality in subjects with diabetes.

PD-16

A CASE REPORT: USE OF GLP 1 AGONIST IN AN OBESE TYPE 2 DIABETES MELLITUS PATIENT WITH WEIGHT LOSS FAILURE AFTER VERTICAL BANDED GASTROPLASTY

1HUAN-WEN CHEN, 1HSIAO-LIEN CHEN

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yi-Lan, Taiwan, R.O.C

Introduction: Bariatric surgery (weight reduction surgery) includes a variety of procedures: reducing the size of the stomach with a gastric band; removing a portion of the stomach (sleeve gastrectomy); or resecting and re-routing the small intestines to a small stomach pouch (gastric weight regain after bariatric surgery is a challenging problem. Glucagon-like peptide-1 agonists (GLP1 agonists) may be a resolute. We reported an obese type 2 diabetes case with weight loss failure after vertical banded gastroplasty. She received exenatide and then she had adequate blood glucose control and her body weight decreased gradually. We changed exenatide to liraglutide when her renal function 2. After more 2 years, she still had adequate glucose control and her body weight maintained.

CASE REPORT: A 66-year-old female was obese since young adulthood. She was diagnosed with type 2 diabetes and hypertension at the age of 47. She initially received medication with oral antidiabetic drugs (OADs) and then had weight reduction surgery (vertical band gastroplasty, VBG) in the following year, September 1997. Her body weight decreased from 93 kg (BMI 40) in Sep 1997 to 70 kg (BMI 30.7) in Jun 1999. However, her body weight increased gradually to 113 kg (BMI 49.6) in April 2008. She tried some over-the-counter medication, which maintained her body weight at around 100~105 kg. Although she received OADs and basal insulin for many months, her blood glucose level was often more than 200 mg/dl. She received exenatide twice a day starting from May 2012. In August 2013, her body weight decreased to 86.7 kg (101.3 kg, BMI 44.4 before exenatide) and her HbA1C decreased to 6.4% (8.2% before exenatide). We tapered the dose of OADs and she still had adequate blood glucose control (A1C < 7%). We ever reported that exenatide is effective in controlling body weight and blood sugar level in an obese type 2 diabetes case with weight loss failure after vertical banded gastroplasty in the 35th annal meeting of the endocrine society and the diabetes association of the R.O.C (Taiwan) in March 2014. The patient’s renal function went downhill gradually. So we changed exenatide to liraglutide when her renal function decreased to eGFR < 50 mL/min/1.73m2 . After more 2 years and 5 months till Oct 2016, she still had good body weight (around 86 kg) and blood glucose control (A1C < ).

After VBG, the patient lost about 23 kg in around 22 months. Unfortunately she regained her

body weight after that, and she became heavier than before the weight reduction surgery. After receiving exenatide, her appetite decreased and her weight decreased gradually. Her blood glucose level was also under better control. We changed exenatide to liraglutide when her renal function went downhill. She did not regain her body weight and she still had blood glucose control. Although exenatide can not be used in impaired renal function, we can use liraglutide to keep the benefit of exenatide.

CONCLUSIONS: This case showed that GLP-1 agonist is effective in reducing body weight and improving diabetes control in an obese type 2 diabetes mellitus patient with weight loss failure after vertical banded gastroplasty.

PD-17

PAINFUL DIABETIC POLYNEUROPATHY IS ASSOCIATED WITH 3-YEAR ALL-CAUSE MORTALITY IN T2DM

1SHENG-SHU CHIANG,

2CHING-YUN HU, 3SHIH-YI LIN, 3HSIU-CHEN LIU, 3JUN-SING WANG, 3I-TE LEE, 3YUH-MIN SONG, 3CHIA-PO FU, 3YI-TING TSAI, 3WAYNE H-H SHEU, 3CHIA-LIN LEE

1Divisions of Internal Medicine, Sinying Hospital, Tainan, Taiwan; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Wanqiao branch, Taichung Veterans General Hospital, Chiayi, Taiwan;3 Divisions of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

Introduction

Diabetic neuropathy is one of the most common complications in patients with T2DM. According to the previous study, there were increased mortality rate in those who had cardiovascular autonomic neuropathy. In addition, diabetic polyneuropathy was also an independent predictor of diabetes-related and all-cause mortality. However, there was no study reporting about the relationship between the cardiovascular risks or all cause mortality and the painful diabetic polyneuropathy (PDPN.) Our aim is to investigate whether there is increased risk of cardiovascular disease and all-cause mortality in PDPN in patients with T2DM.

Method:

This retrospective study enrolled 2,877 outpatients with type 2 diabetes with completed survey of Douleur Neuropathique en 4 Questions (DN4) questionnaire from January 2013 to October 2013 in one characteristics and current medication list were also recorded. We reviewed the medical records and calculated about the CHA2DS2_VASc score (Congestive heart failure/left ventricular dysfunction, category [female]) of each patient. One-way ANOVA was used to compare the CHA2DS2_VASc score among different DN4 scores. Cox proportional hazard model was used to estimate the impact of PDPN on future risk of overall mortality.

Results:

Overall, 226 (7.9%) patients were diagnosed as having PDPN, who were 109 (48.2%) men, mean 69.3 ± 12.8 years old, mean HbA1c 7.72 ± 1.63%, mean DM duration 13.1 ± 9.3 years, and insulin user 23%. Reviewing past history, there were 8% (non-PDPN, 3.4%) patients with PDPN had congestive heart failure (CHF), 15% (non-PDPN, 8.4%) had cerebrovascular accidents (CVA),

and 9.7% (non-PDPN, 4.9%) had coronary artery disease (CAD). The higher DN4 total score was associated with higher CHA2DS2_VASc score (p for trend < 0.001.) After adjusting the association factors (HbA1c, age, sex, eGFR < 60, albuminuria, history of CHF, CVA, and CAD), three-year allcause mortality was increased in the patients with PDPN (HR = 1.862, p = 0.049.)

Conclusion:

PDPN may be a predictor of all-cause mortality in T2DM.

PD-18

HYPOGLYCEMIA-RELATED EMERGENCY DEPARTMENT VISITS IN PATIENTS WITH TYPE 2 DIABETES: FOCUSING ON DPPIV INHIBITOR VS. SULFONYLUREA TREATMENT ON TOP OF METFORMIN

1,2YING-JU CHEN, 2,3CHEN-CHANG YANG, 4MING-CHIA HSIEH, 5,6CHII-MIN HWU

1Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 2Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 3Division of Clinical Toxicology & Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 4Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; 5Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 6Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan

Background: Add-on dipeptidyl peptidase-4 (DPP-IV) inhibitor treatment is an option for patients with type 2 diabetes mellitus when metformin is not sufficient to achieve the desired therapeutic targets. However, real-world clinical data for this combination treatment are sparse.

Objective: The purpose of the study was to compare the occurrence of hypoglycemia-related emergency department (ED) visits associated with a combination therapy of DPP-IV inhibitor vs. sulfonylurea on top of metformin by using data extracted from The Taiwan National Health Insurance Research database (NHIRD).

Methods: We used a version of the Longitudinal Health Insurance Dataset of the NHIRD (with one million subjects sampled from all beneficiaries of the NHRID in 2010) for the current study. All medical records of the selected insurers from 2000 to 2012, including outpatient, ED visits, hospitalization, medication use, and diagnostic data were obtained for the analysis. Patients with type 2 diabetes on dual oral combination antidiabetic therapy of metformin plus a DPP-IV (n = 5,319) vs. metfmormin plus a sulfonylurea (n = 13,601) were followed up. The primary outcome is the time to estimate the survival curves and the log-rank test to test the homogeneity between survival curves. used to evaluate the association between treatments of interests and primary outcome.

Results: Sulfonylureas were associated with higher risks for hypoglycemia-related ED visits (adjusted HR 9.45, 95% CI, 5.40 to 16.54) compared with DPP-IV inhibitors as add-on therapy to metformin. Other risk factors for hypoglycemia-related ED visits in this cohort included aging, female sex, and history of ischemic stroke.

Conclusion: concerning reduced risk for severe iatrogenic hypoglycemia compared with sulfonylureas.

PD-19

OBESITY/OVERWEIGHT REDUCES THE RISK OF ACTIVE TUBERCULOSIS: A NATIONWIDE POPULATION-BASED COHORT STUDY IN TAIWAN

1,2YUNG-FENG YEN,

3,4HSIAO-YUN HU, 5,6YA-LING LEE, 7PO-WEN KU, 2,8,9DACHEN CHU, 2,10YUN-JU LAI

1Section of Infectious Diseases, Taipei City Hospital, Taipei City Government, Taipei, Taiwan; 2School of Medicine, National Yang-Ming University, Taipei, Taiwan; 3Department of Education and Research, Taipei City Hospital, Taipei, Taiwan; 4Institute of Public Health and Community Medicine Research Center, National YangMing University, Taipei, Taiwan; 5Department of Dentistry, Taipei City Hospital, Taipei, Taiwan;6School of Dentistry, National Yang-Ming University, Taipei, Taiwan; 7Graduate Institute of Sports and Health, National Changhua University of Education, Changhua, Taiwan; 8Department of Neurosurgery, Taipei City Hospital, Taipei, Taiwan; 9Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; 10Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan

BACKGROUND: In animal studies, obesity was associated with impaired T cell immune function. However, the effect of obesity on tuberculosis (TB) development has not been extensively studied. This nationwide population-based cohort study investigated the effect of obesity on TB from 3 rounds (2001, 2005, and 2009) of the Taiwan National Health Interview Survey. Obesity was 2). Data on BMI and other covariates at baseline Health Insurance database. Multivariate logistic regression was used to estimate the associations of obesity and overweight with active TB, with adjustment for age, sex, smoking, alcohol consumption, socioeconomic status, and other covariates.

RESULTS: In total, 241 new cases of active TB occurred during the study period. Obesity 95% CI, 0.49-0.91) were associated with lower risk of incident TB, after adjusting for demographic characteristics and comorbidities. There was a linear dose–response relation of BMI with active TB incidence (AOR per unit change in BMI, 0.92; 95% CI, 0.88-0.95; P < 0.001).

CONCLUSION: Obesity and overweight are associated with lower risk of active TB. Future studies should investigate the underlying mechanisms and clinical and epidemiological consequences

PD-20

FACTORS ASSOCIATED WITH VISIT-TO-VISIT GLUCOSE VARIABILITY IN PATIENTS WITH TYPE 2 DIABETES

1YU-WEI CHEN, 1JUN-SING WANG, 1WAYNE H-H SHEU, 1SHIH-YI LIN, 1I-TE LEE, 1YUH-MIN SONG, 1CHIA-PO FU, 1CHIA-LIN LEE

Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

Introduction: Previous studies have demonstratedvisit-to-visit variability (VVV) of fasting plasma glucose (FPG) was associatedwithvascular events and mortality in patients with diabetes.We

Method:This retrospective cohort studyhad followed clinical data from7490 type 2 diabetes patients for one year. All of them had checked FPG at least once per season and coefficients of variance (CVs) of the patients’ FPG was calculated. The subjects were divided into two groups based on CVs of VVV of patients’ FPG. Baseline biochemical and demographicvariableswere measured and correlations of VVV with these clinical factors were investigated.

Result: The mean age and diabetes mellitus (DM) duration of the study population were66.7 years and 8.7 years, respectively, and the mean FPGand HbA1c levels of the patients were 148 mg/ dLand 7.6 %, respectively. Multivariate logistic regression analysis showed that CVs value was injection (OR = 3.33, p < 0.001),lower in those taking metformin (OR = 0.77, p = 0.002), and no baseline FPG (OR = 1.06, p < 0.001), HbA1c levels(OR = 1.42, p < 0.001) and DM duration (OR = and it was not associated with age or gender.

Conclusion: like SU or insulin, and in patients with longer DM duration or poorer glycemic control during the study period. VVV of FPG was lower in subjects with better renal function or under metformin treatment.

PD-21

HYPERTRIGLYCERIDEMIA IS A RESIDUAL RISK FACTOR ASSOCIATED WITH NEW-ONSET DKD IN TYPE 2 DIABETIC PATIENTS WITHOUT HYPERTENSION

1LI-LUN CHUANG, 1YU-HUNG CHANG, 1,2DER-WEI HWU, 1KUN-CHEN LIN,

1YAU-JIUNN LEE

1Lee’s Endocrinology Clinic, Pingtung 90000, Taiwan; 2Graduate institute of Clinical Medicine, Kaohsiung Medical University, Taiwan

Background: Under standard care, risk factors for new-onset diabetes kidney disease (DKD) were not yet clear, particularly in patients with type 2 diabetes mellitus (T2DM) without hypertension. The aim of this study is to reveal residual risk factors associated with new-onset DKD in T2DM patients without hypertension

Material and Methods: Non-albuminuric normotensive T2DM patients with estimated GFR 2 who had followed in the Taiwan Diabetes Shared Care Program were included. Physical and metabolic factors regarding the quality of diabetes control were recorded and calculated for their mean value. The development of DKD was defined as the new-onset of albuminuria or eGFR < 60 ml/min/1.73m2. Multivariate cox-regression analysis was used to identify the risk factors associated with new-onset DKD.

Results: 563 T2DM patients with mean age of 58.4 were included. During the 4.8-year follow-up period mostly covered with statin therapy (72.8%), there were 67 patients (11.9%) recognized as the disease duration, body mass index, mean HbA1C (non-DKD vs. DKD: 7.5 ± 1.1 vs. 7.6 ± 1.3%), mean total cholesterol (185.3 ± 18.1 vs. 186.2 ± 16.0 mg/dl), mean LDL-C (99.0 ± 15.1 vs. 100.4 ± 12.4 mg/dl) and mean diastolic pressure (74.1 ± 7.3 vs. 74.8 ± 7.5 mmHg) between the two groups. ± 11.2 vs. 125.7 ± 12.0 mmHg; P = 0.036), triglycerides (130.2 ± 50.2 vs. 111.8 ± 44.0 mg/dl; P = 0.048) and lower mean HDL-C levels (54.5 ± 12.9 vs. 57.4 ± 10.6 mg/dl; P = 0.045). After multivariate risk factor associated with new-onset DKD with OR of 3.52 (95%C.I.: 1.48~8.34; P = 0.004).

Conclusion: In T2DM patients without hypertension under standard diabetes management, hypertriglyceridemia is an independent risk factor associated with new-onset DKD.

PD-22

OPTIMIZING GLYCEMIC CONTROL IN TUBE-FED DIABETIC PATIENTS WITH CONTINUOUS GLUCOSE MONITORING

1YE-FONG DU, 1HORNG-YIH OU, 1HAO-CHANG HUNG

1Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Hospital, Taiwan, R.O.C

Background

Long-term care had become an important issue in recent years. Up to one-half of tube-fed elderly in diabetic patients receiving bolus feeds 5~6 times a day, 3~4 hours apart. There was no consensus on how to improve the unintended hyperglycemia events and glycemic variability in long-term tube-fed patients with type 2 diabetes. Execution of basal bolus insulin injection as guideline suggested in this group of patients increase the care burden of the caregivers. Patient will need 5~6 times of injection a day if completely compliant to this regimen. An easier implemented regimen is more applicable for caregivers.

Method

Type 2 diabetic patients who were under enteral nutrition, aged 18-90 years old, followed at endocrinologist’s OPD in National Cheng Kung University Hospital were retrospectively reviewed if they had ever received CGM before and after regimen adjustment.

Enteral formula of these patients were evaluated by registered dietitian with re-designed food before receiving CGM. Patients receiving bolus feeds were controlled with either metformin plus insulin glargine once-daily with or without DPP4 inhibitors or metformin/pioglitazone plus humulin N (NPH) and/or DPP4 inhibitors.

Patients receiving regimen adjustment had CGM exam at baseline and 3 months after implementation of new regimen when fasting blood glucose had been maintained below 130 mg/dl steadily. All glycemic variability was calculated using EasyGV© software

Result

criteria. There were 2 patients received metformin plus NPH, 4 received metformin plus once daily insulin glargine with DPP4 inhibitors, 1 received pioglitazone plus DPP4 inhibitor and NPH, and 1 received metformin plus DPP4 inhibitors only. A participant self removed nasogastric tube before scheduled 3 months CGM follow-up (Case 8). For newly diagnosed diabetes patients on NG feeding (case 7) and patient with good response to SU (case 2), it is easier to control blood glucose within target range with metformin plus DPP4 inhibitors, with or without once daily long acting insulin.

Metformin plus NPH twice daily and metformin plus insulin glargine plus DPP4 inhibitors both improved postprandial peak after bolus feeding with better quality of glycemic control.

Conclusion

Glycemic pattern in diabetic patients receiving bolus-feed were highly oscillated, especially at postprandial phase. Both regimen, metformin plus NPH bid injection or plus insulin glargine and DPP4 inhibitors offer altervative choice to improve quality of glycemic control in type 2 diabetic patients receiving bolus feeding.

PD-23

LONG-TERM GLYCEMIC CONTROL AFTER 5 YEARS OF HEALTH EDUCATION ON GLYCEMIC CONTROL DURING HOLIDAY TIME IN TYPE 2 DIABETIC PATIENTS

1FY CHEN, 1,2HS CHEN

1Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital; and 2National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.

OBJECTIVE— Our previous study demonstrated that type 2 diabetic patients receive holiday than those received diabetic managed care. However, it is not well known whether the effects of regular, professional health education could improve long-term glycemic control during winter holidays.

RESEARCH DESIGN AND METHODS— Subjects were randomized to receive regular health education between Oct. 20 and Nov. 25 in 2004 and then every 3-4 months (program 1) or a special reminder pamphlets were given during the holidays (program 2). In this 5-year follow-up, we collected data from November 1st to the beginning of the Chinese New Year’s holiday as the pre-holiday period, and from the end of the holiday to April 30th as the post-holiday period.

RESULTS— A total of 110 subjects with type 2 DM were recruited for the study, and 89 patients were available for completing data (80%). The HbA1c levels before holiday was marginally statistically lower in the program 2 in the 5th year. The HbA1c levels after holiday was marginally statistically lower in the program 2 in the 1st, 2nd and 5th year. The mean HbA1c increased during holiday was marginally statistically lower in the program 2 in the 1st and 2nd year.

CONCLUSIONS—Our findings demonstrated that a special educational reminder pamphlet for the holidays led to improvements in glycemic control is non-inferiority to regular, professional health education during Chinese New Year’s holiday for 5 years.

PD-24

ONE STOP SERVICE OF DIABETIC INTEGRATED CARE

1CHUNGSEN CHEN, 1KUOMENG LIAO, 1PISUNG CHENG

Division of Endocrinology and Metabolism, Zhongxiao Branch, Taipei City Hospital

Introduction:

Diabetes mellitus with poor glycemic control was notorious for its chronic complications. It schedule to check other complications. Because of no survey of complications, no diagnosis, thus no managements were happened in the real world.

Methods:

One visit in our clinics, we will provide survey of microvascular complications including of urine albumin excretion rate (nephropathy), non-mydriatic retinal camera (retinopathy), and quantitative sensory testing (neuropathy). Macrovascular complication (peripheral artery disease) was also assessed by ankle brachial index at the same visit. We served four complications survey in one stop. We will check the rate of four examinations before and after the service. Satisfaction survey was also performed.

Results:

The percentage of four examinations were increased after the service. Retinal examination rate increased from 67.6% to 72.8%, urine albumin excretion from 63.5% to 79.8%, quantitative sensory testing from 0% to 45%, and ankle brachial index from 89.9% to 95.1%. Satisfaction survey selected increased from 4676 to 5147.Care quality including of Hba1c < 7 % rate was raised from 56.3% to 57.8%. LDL (low density lipoprotein) < 100 mg/dl from 59.5% to 61%.

Conclusions:

One stop survey complications of diabetes were a patient-center service. Integrated care of patient could increase the percentage of diagnosed complications; thus, we could provide managements. One road to walk. but it was a patient-center service. After the procedure reconstruction, we can see the

PD-25

GENETIC VARIANTS OF UROKINSE PLASMINOGEN ACTIVATOR IN SUBJECTS WITH TYPE 2 DIABETES MELLITUS AND DIABETIC NEPHROPATHY IN UREMIC STATE

1,2CHUNG-ZE WU, 3JIN-SHUEN CHEN, 4LI-CHIEN CHANG, 5YUH-FENG LIN, 1,2JIUNN-DIANN LIN, 1,2AN-TSE HSIEH, 6DEE PEI

1 Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, R.O.C; 2 Division of Endocrinology and Metabolism, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan, R.O.C 3 Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C; 4 School of Pharmacy, National Defense Medical Center, Taipei, Taiwan, R.O.C; 5 Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan, R.O.C; 6 School of Medicine, College of Medicine, Catholic Fu Jen University, Taiwan, R.O.C

Background: The prevalence of type 2 diabetes mellitus (T2DM) rapidly boosts in recent decades in worldwide. Diabetic nephropathy with uremia is one serious complications and leads to disability. How to identify the patients with high risk of T2DM and diabetic nephropathy with uremia is an cellular remodeling and repaired, and is associated with insulin secretion, islet cell regeneration, and atherosclerosis. The present study investigated the polymorphism of uPA in patients with T2DM, T2DM with fatty liver and T2DM in uremia. In addition, we also explored the uPA levels and activity in different genotype.

Material and Methods: There were 187 subjects enrolled. They were divided to health, T2DM, T2DM with fatty liver, and uremia groups. The uPA polymorphisms rs2227564 (C- > T), located on exon 6 and kringle domain of uPA, and rs2227568 (C- > T) located on exon 8 were explored. Meanwhile, the uPA levels and activities in different genetic variants were measured.

Results: of CC genotype on rs2227564. In other hand, uremia group had higher frequency CT genotype on rs2227568. Subjects carried with C allele of rs2227564 had significant lower uPA levels, but no significant difference on uPA activities. Subjects carried with T allele of rs2227568 had significant higher uPA levels, but lower uPA activities.