OD Oral Presentation-Diabetes (1-6

OD1

CLINICAL PREDICTIVE FACTORS FOR ALL-CAUSE MORTALITY AND RENAL FUNCTION DETERIORATION IN TYPE2 DIABETIC PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE 3

CHIPIN-PING CHEN, SZU-TAH CHEN, CHUNG-HUEI HUANG

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

To explore the factors predicting all-cause mortality and renal function deterioration in Type2 diabetic patients with chronic kidney disease stage 3(CKD3). METHODS: We collected 850 Type2 diabetic patients who joined in shared care with CKD3 from 2010 January 1 to December 31, 2017. The prospective cohort data from the north medical center, and the deadline of the follow-up was December 31, 2017. Survival analysis was performed by Kaplan- Meier method. Cox proportional hazards regression model was used to assess the all- cause mortality after adjustment for confounding factors. RESULTS: The average age of the subjects was 68.27 ± 10.20 years. During the seven-years follow-up period, 66 (7.8%) patients dialysis and 130(15.3%) patients died. Results of Cox regression model showed thatthe progression of dialysis risk in the Type 2 diabetic patients with CKD3 were the 1.15), CKD3duration (HR = 1.11, 95% CI:1.00-1.24), age (HR = 0.97, 95% CI:0.94-0.99) and baseline retinopathy (HR = 2.39, 95% CI:1.14-5.01).The all-cause mortality risk in the Type 2 diabetic patients with CKD3werethe second year decline eGFR (HR = 1.03, 95% CI:1.01-1.06), and age (HR = 1.09, 95% CI:1.06-1.123).CONCLUSION: We should focus on the prevention and treatment of the Type 2 diabetic patients with CKD3in order to attenuate progression of renal dysfunction and mortality.

OD2

SERUM RIBONUCLEASE L AS A FIRST-TRIMESTER BIOMARKER FOR PREDICTION OF GESTATIONAL DIABETES MELLITUS

1YI-TING WANG, 2SHIN-YU LIN, 3WEI-SHIUNG YANG

1Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University; 2Department of Obstetrics and Gynecology, National Taiwan University Hospital; 3Department of Internal Medicine, National Taiwan University Hospital

Background: by glucose intolerance during pregnancy. Ribonuclease L (RNase-L) was considered as a ubiquitous enzyme involved in various cellular functions such as innate immunity and adipogenesis. Moreover, serum RNase-L was found to be negatively associated with human blood glucose level in our previous study. The aim of this study is to evaluate the association between serum RNase-L level and the risk for GDM.

Methods: 87 pregnant women were recruited in this study. For GDM diagnosis, the participants have received a one-step 75-g oral glucose tolerance test (OGTT) between 24-28 weeks of pregnancy in accordance with the International Association of the Diabetes and Pregnancy Study Group. Binary logistic regression analysis was used to estimate the association between GDM risk and the serum RNase-L levels in three trimesters of pregnancy with the adjustment of age, body mass index, medical was used in the GDM predictive model of serum RNase-L.

Results: The serum RNase-L levels of pregnant women tended to descend with gestational age (P for trend = 0.001). The pregnant women with GDM had lower serum RNase-L level than those trimester: OR = 0.77, 95% CI:0.62-0.97, P = 0.026). The area under the ROC curves of the serum

Conclusions: The serum RNase-L level as a novel early biomarker for GDM was inversely

OD3

THE EFFICACY OF HIGH-FREQUENCY EXTERNAL MUSCLE STIMULATION FOR SYMPTOMATIC PERIPHERAL NEUROPATHY IN PATIENTS WITH TYPE 2 DIABETES

1JUI-HUNG CHEN, 1, 2YI-JEN HUNG, 3SU-CHEN WANG, 3CHIEH-HUA LU, 3CHANG-HSUN HSIEH, 3CHIEN-HSING LEE

1Division of Endocrinology and Metabolism, Tri-Service General Hospital Songshan branch, National Defense Medical Center, Taipei, Taiwan, ROC; 2Division of Biochemistry, National Defense Medical Center, Taipei, Taiwan, ROC; 3Division of Endocrinology and Metabolism, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC

Background: Diabetic distal symmetric sensory polyneuropathy (DSP) approximately accounts for 20-30% patients with type 2 diabetes in Taiwan. While the etiology of DSP in diabetes is not well understood, symptomatic treatment using pharmacological therapies is often less effective. Noninvasive, non-pharmacological therapy of high-frequency external muscle stimulation has been useful for management of DSP in Caucasian diabetic patients. However, it is still unknown in Asian (hfEMS) for symptomatic peripheral neuropathy in patients with type 2 diabetes in Taiwan.

Methods: Thirty adult patients with type 2 diabetes complicated with DSP and symptom questionnaire of pain or numbness more than score 3 (score range from 1 to 10) were enrolled. Each patient received an hfEMS device (HITOP 191, gbo-Medizintechnik AG, Rimbach/Germany) for 60 min twice per week for 12 weeks. Symptom questionnaires were evaluated at baseline, 6-week and 12week. Blood metabolic parameters were also determined.

Results: 11 male and 19 female with mean age of 65.7 years were enrolled. After 12-week treatment, the symptoms of formication, burning, pain and numbness sensations of low limbs were (P < 0.001). However, body weight, blood pressure and blood metabolic parameters including fasting

Conclusions: Non-invasive hfEMS may provide a useful tool for ameliorating the neuropathic symptoms in patients with type 2 diabetes in Asian population.

OD4

MACHINE LEARNING APPROACH TO PREDICT LONG-TERM MORTALITY FOR DIABETIC INPATIENTS

1YU-HSUAN LI, 2YUNG-CHUN CHANG, 1I-TE LEE

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung 2Graduate Insititute of Data Science, Taipei Medical University

Background: Inpatients with diabetes have higher mortality than those without, and a variety of adverse outcomes has been observed after their discharge. Although several traditional predictors have

Methods: Diabetic patients who admitted due to a primary diagnosis of poor glucose control between 1996 and 2007 were included in this study. Clinical data during hospitalization were collected for analyses. The mortality data were obtained from registry in Taiwan. We applied support vector selection approach to seek for the best combination of features. To derive credible evaluation results, we utilize the 10-fold cross validation method on the dataset. The evaluation metrics are the accuracy and receiver operating characteristic (ROC) curve.

Results: A comprehensive performance evaluation of the proposed approach with other methods is provided. A total of 1214 patients were included for analysis. During a median of 6.7 years follow up, 641 patients died. The results demonstrated that our proposed method utilizes the top 20 percentile selected features (i.e. follow up time, age, chronic kidney disease status, diabetic duration, diabetic retinopathy, and history of hypertension) could achieve a remarkable performances with 78% accuracy. ROC curve showed an area under the curve of 0.824.

Conclusions: Prediction of long-term mortality for diabetic inpatients is an important and widely studied task in smart healthcare. To this end, we proposed a supervised learning approach for detection of long-term mortality. We also utilized feature selection method to explore different features, and diabetic duration, diabetic retinopathy, and history of hypertension.

OD5

THE INFLUENCE OF MEAN HBA1C ON THE ASSOCIATION OF HBA1C VARIABILITY WITH ALL-CAUSE MORTALITY IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

1CHING-CHU CHEN,

1CHWEN-TZUEI CHANG, 2KUO-CHIN HUANG, 1RONG-HSHING CHEN, 1TZU-YUAN WANG, 1KUEI-MEI YEH, 1CHI-YU HUANG, 1JUEI-YU TSENG, 1MAO-TSU FUH

1Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung, Taiwan; 2Integration of Traditional Chinese-Western Medicine, Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.

BACKGROUND: HbA1c variation had been reported to be related with mortality in patients with type 2 diabetes mellitus (T2DM) but the effect of mean HbA1c on this relationship in different variability status is unclear. We aimed to evaluate the effect of mean HbA1c on this relationship in both low and high variation status in patients with T2DM.

METHODS: Enrollees with T2DM, age of diabetes onset 30 years or greater, at least three measurements of HbA1c were included. HbA1c variability score, HbA1c-CV and HbA1c-SD were analyzed by quartile. HbA1c variability score 50 was used as a cut point to define low and high glycemic variability.

RESULTS: years observation period. The all-cause mortality increased with quartile of HbA1c variability score, HbA1c-CV and HbA1c-SD. The associated strength attenuated after an adjustment for mean HbA1c. The associated risk was similar between variability status and glycemic control status. The highest 6.0% was associated with a higher mortality risk in both low and high glycemic variability status. The glycemic variation status, respectively.

CONCLUSIONS: HbA1c variation independently associated with all-cause mortality in a trend manner. Mean HbA1c contributed to this relationship. A J-distribution of men HbA1c related to the mortality in both low and high variation status.

OD6

ELECTRONEGATIVE LDL OF PEOPLE WITH METABOLIC SYNDROME INDUCES ATHEROGENESIS VIA DISRUPTION OF STRA6 CASCADE

1CHAO-HUNG CHEN, 2LIANG-YIN KE, 2CHIH-SHENG CHU, 2HUA-CHEN CHAN, 4TATSUYA SAWAMURA, 3CHIA-WEI LAI, 5CHU-HUANG CHEN, 3SHYI-JANG SHIN

1Graduate Institute of Medicine, Kaohsiung Medical University; 2Lipid Science and Aging Research Center, Kaohsiung Medical University; 3Divison of Endocrinology and Metabolism, KMU Hospital; 4Department of Physiology, School of Medicine, Shinshu University, Japan;5Vascular and Medical Research, Texas Heart Institute, Houston, TX, USA.

Background: Electronegative LDL(L5) is the most atherogenic fraction of LDL and is elevated in people with metabolic syndrome (MetS). RBP-4 receptor (STRA6) cascade is disrupted in a few organs of obesity-related diseases. Our objective is to investigate whether L5 from people with MetS capably induces atherosclerosis through the disruption of STRA6 cascade.

Methods: We examined the in vivo and in vitro effects of L5 on STRA6 cascade and atherosclerosis in mice and vascular cells. To investigate the role of STRA6 cascade on atherosclerotic formation, crbp1 transfection was performed in vitro.

Results: in aortas of L5-injected mice and L5-treated aortic endothelial and smooth muscle cells. These L5induced changes of STRA6 cascade and atherogenic markers were reversed in aortas of LOX1-/- mice and in LOX1 RNA silenced-vascular cells. Furthermore, crbp1 gene transfection reversed the disruption of STRA6 cascade and the increase of atherogenic pathway in L5-treated cells.

Conclusions: This study reveals that L5 from people with MetS induces atherosclerosis by disrupting STRA6 signaling pathway. Suppression of STRA6 may be one novel pathway of atherosclerosis in people with MetS.