35 minute read
PD Poster Presentation-Diabetes (1-26
from 108年年會
by Endo 電子書上傳區
PD01
THE ASSOCIATION OF GLYCEMIC VARIABILITY IN T2DM PATIENTS RECEIVING BASAL OR PREMIXED INSULIN MANAGEMENT
CHIA-FEN WANG, WAN-CHI CHUANG, WEI-CHENG CHANG, CHIH-HSUN CHU
Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. ROC.
Background: This study aims to demonstrate whether premixed insulin, compared to basal insulin (combined with OAD), could provide a superior improvement of glycemic variability (assessed by CGMS) and a better improvement of CIMT in T2DM patients.
Methods: The study conducted with 38 type 2 diabetic patients receiving insulin management (19 with basal insulin, 19 with premixed insulin). The patients are from the outpatient clinic of Endocrinology/Metabolism in Kaohsiung Veterans hospital. The inclusion criteria were aged 20 80 years who has been diagnosed with T2DM. Treatment with basal (combined with OAD), or premixed insulin for more than 1 year. The HbA1c levels were between 6.5 % to 10.0 %. The exclusion biochemistries were analyses, CGM and CIMT were performed.
Results: The age, gender and duration of diabetes were not different. The total insulin dose were 25 ± 16 vs 70 ± 45 units (basal vs premixed insulin). The patients with basal insulin took more OAD than those with premixed insulin. The levels of HbA1c were also not different. (basal vs premixed insulin: 8.6 ± 1.0 vs 8.4 ± 0.9%, p = 0.598). In comparison of the parameters of glucose variability (MAGE, SD, time above range, time in range, time below range, AUC above limit, AUC below limit) value of mean CIMT (basal vs premixed insulin: 0.69 ± 0.12 vs 0.72 ± 0.11mm, p = 0.492). The multivariate linear regression analysis for determining the factors of mean CIMT showed that only age is related to it.
Conclusions: Premixed insulin cannot get less glucose variability than basal insulin in T2DM patient. Moreover, premixed insulin seemed have no beneficial effect in atherosclerotic change measured by CIMT.
PD02
PARTICIPATION IN DIABETES SHARED-CARE NETWORK BENEFICIAL FOR DEPRESSION AND GLYCEMIC CONTROL AMONG DM SUBJECTS
1PEI-LING TSAI,
2WEI-PIN CHANG, 3PI-YUAN WONG, 3I-CHUAN LIN, 3I-JU LIEN, 3JIUN-YIAN LIN, 3TONG-YUAN TAI
1Department of Clinical Laboratory, Taipei Jen-Chi Hospital, Taiwan, R.O.C; 2School of Health Care Administration, Taipei Medical University; 3Department of Internal Medicine, Taipei Jen-Chi Hospital, Taiwan, R.O.C
Background: Diabetes mellitus (DM) and depression are closely related as depression may lead to DM, and DM patients are more susceptible to depression. After the establishment of DM shared of joining a DM shared-care network on depression alleviation and to explore the factors which may relate to the occurrence of depression among DM patients.
Methods: Based on purposive sampling, the study recruited 95 diabetics recently participating in the DM shared- care network hosted by a community hospital in north Taiwan. Data concerning the gender, age, body weight, body height, BMI, marital status, living condition (alone or not), DM duration, DM family history, smoking status, and DM medication of each subject were recorded. The study used the Chinese version of the 18-item Clinically Useful Depression Outcome Scale (CUDOS) with a 4-point Likert scale whose total score ranges from 0-72. Depression was diagnosed if the score read CUDOS questionnaire both upon recruitment (i.e. early stage of their participation in the DM sharedcare network) and six months after recruitment. They also received blood tests for glucose, HbA1c, cholesterol, triglyceride, HDL-C, LDL-C, creatinine, and GPT levels. Independent t-test, paired t-test, one-way ANOVA, Pearson product-moment correlation, and multiple logistic regression methods were
Results: correlated with age (r = -0.255, p < .05). Solitary-living subjects (t = 2.109, p < .05) and divorced subjects (F = 3.082, p < .05) appeared to be more likely to suffer from depression. Results of multiple logistic regression analysis on demographic and clinical characteristics further revealed that solitaryliving subjects (OR = 5.8, p < .05) and divorced subjects (OR = 4.034, p < .05) were more vulnerable to depression. Differences in the following four items upon recruitment and six months after (t = 2.150, p < .05), and HDL-C (t = -2.765, p < .05).
Conclusions: Participation in a DM shared-care network, as the study suggests, helps improve depression, as well as glycemic control, liver function, and HDL-C, among diabetics. Younger age is
associated with a higher CUDOS score, and DM patients living alone or divorced appear to be more susceptible to depression.
PD03
HEMOCHROMATOSIS PRESENTING AS DIABETES MELLITUS: A CASE REPORT
1YU-TZU LIN, 2YI-SUN YANG, 2CHIEN-NING HUANG
1 Department of Nursing, Chung-Shan Medical University Hospital, Taiwan; 2 Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taiwan
Hemochromatosis is common genetic disorder of Caucasians characterized by iron overload syndrome with enhanced intestinal absorption of iron associated with potential iron overload in peripheral tissues presenting with complications as cirrhosis, hepatocellular carcinoma, diabetes mellitus, and heart diseases. However, it is relative rare in Asians. We present a case in a 48-year-old male presented with generalized weakness, easy fatigability, loss of weight, and loss of concentration/ interest in routine work for 6 months. Diabetes mellitus was diagnosed and started with oral antidiabetic drugs. However, persisted weight loss despite of glycemic improvement warrants for further evaluation. No history of blood transfusion or jaundice noted. Family history was insignificant. Physical examination revealed hepatomegaly, and mild splenomegaly. Ultrasound and magnetic resonance imaging showed hepatomegaly with nodular margin, hypertrophied caudate lobe, and hypointensity suggesting cirrhosis of liver associated with hemochromatosis. The ferritin level was hemochromatosis was made. The whole hereditary hemochromatosis genome was sequenced but failed to localize any genetic alterations. The patient was treated with phlebotomy for several times, ferritin level returned to normal. For glycemic control, he is receiving basal insulin and oral-antidiabetic drugs. About 50% cases diagnosed with hemochromatosis will have type 1 or 2 diabetes. The likelihood of hemochromatosis in the adult population of diabetic patients is reportedly between 1% and 2%. Sometimes, diabetes is the only apparent manifestation of hemochromatosis in unrecognized cases. Clinicians should be aware that hemochromatosis may occur in Taiwan population with variable iron overload and should be recognized/diagnosed early for prompt therapy and prevent complication/ premature death.
PD04
INTERFERENCE OF HEMOGLOBIN VARIANT J-BANGKOK ON GLYCATED HEMOGLOBIN (HBA1C) MEASUREMENT - A CASE REPORT
1CHUN-CHUNG LIN, 1HAO-CHANG HUNG, 1KAI-PI CHENG, 1RU-LAI HUANG, 1HORNG-YIH OU
1Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Hospital
HbA1c is a stander marker to evaluate glycemic control in patients with diabetes mellitus. However, there are clinical conditions interfering the accuracy of HbA1c, which may lead to misestimate the glycemic status. It depends on physician’s awareness of discordance between glucose level and HbA1c value. Here, we report a case with hemoglobin variant (Hb J-Bangkok) interferences HbA1c measurement.
A 42-year-old man was diagnosed diabetes mellitus in 2009, and he received medical control with metformin 1500mg per day since 2010. The patient had ST elevation myocardial infarction of inferior wall on 2018/01/09 and underwent percutaneous coronary intervention. The HbA1c and fasting plasma glucose was 7.6% and 199mg/dL, respectly. He was prescribed with three kinds of oral antidiabetic drugs (metformin 1500mg, glimepiride 4mg, and sitagliptin 100mg) and long acting insulin (Glargine) 40 unit per day due to his hyperglycemic status while admission. Three months later, the HbA1c value was 4.4%, and fasting plasma glucose was 100mg/dL, and there was no hypoglycemia event. And his self-monitoring of blood glucose (SMBG) of fasting glucose was about 90-110 mg/dL. Hemoglobin electrophoresis revealed Hb J-Bangkok 42.9%, then he received empagliflozin and metformin for diabetes control. Three months later, the HbA1c value was 4.6%, and fasting plasma glucose was 97mg/dL.
When discordance between HbA1c and plasma glucose level, conditions interfering the accuracy of HbA1c, such as hemoglobinopathy should be suspected.
PD05
DIABETIC KETOACIDOSIS ASSOCIATED WITH INCREASED LEVEL OF LITHIUM CONCENTRATION - A CASE REPORT
1TZU-CHIEN LIN, 2YE-FONG DU, 2CHING-HAN LIN, 2HORNG-YIH OU
1Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan; 2Department of Internal Medicine, Division of Endocrinology and Metabolism, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
A 52-year-old woman treated with lithium (1050-1,200 mg/day) for bipolar disorder since 2009 was observed of first hyperglycemia episode on 2014/06/28 with random glucose 400 mg/dl when admitted to psychiatric ward for mania with psychotic features. After regular insulin 6U subcutaneous injected once, no more hyperglycemia was noted in subsequent one month. Lithium level reached 1.05mmol/L on 2014/07/01 which is the highest level ever in her record. No anti-diabetic agent was initiated after that episode. However, she was admitted to our hospital again on 2014/08/13 due to fever with diabetic ketoacidosis and hyperglycemia hyperosmolar syndrome. Serum glucose was 591 mg/dL with positive serum and urine ketones. Lithium level reached 1.10mmol/L, which is the highest level ever. After insulin infusion and hydration, she recovered quickly. Her hyperglycemia was controlled with Novomix 28U TID/AC sc after discharge. Besides, lithium was discontinued and 500mg bid and sitagliptin 100mg qd at 6th month follow-up with optimal blood glucose control. There’s no hyperglycemic emergencies episode during four years of subsequent follow-up.
We suggested increased level of lithium may be associated with her diabetic ketoacidosis even when her lithium level is still controlled within optimal therapeutic range. Physician should pay attention to the potential hyperglycemia effect induced by high normal lithium concentration.
PD06
DYSFUNCTION AND APOPTOSIS VIA INSULIN SIGNALING
1HSIN-HUA LI, 1CHIH-LI LIN LIN, 2CHIUNG-HUEI PENG, 3EDY KORNELIUS, 3YI-SUN YANG, 1YI-CHIAO BAI, 1HSIAO-LI HO, 1CHIEN-YIN KUO, 3CHIEN-NING HUANG
1Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; 2Department of Nursing, Hungkuang University, Taichung, Taiwan; 3Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
Background: dysfunction still remains largely unknown. The clinical drug glucagon-like peptide-1 (GLP-1) receptor apoptosis, and proliferation in vivo. But the exact mechanism remains unclear.
Methods: Many studies have demonstrated that several microRNAs (miRNAs) contribute to the pathogenesis of T2D. Particularly, we have previously demonstrated that upregulation of miR-302 is able to alleviate insulin resistance by activation of Nanog. In addition, miR-302 also demonstrated anti-oxidative stress activities that plays a crucial role in the slowing the aging process, suggesting
Results: In the present study, we investigated the mechanisms of miR-302 against downstream signaling. However, upregulation of miR-302 displayed protective effect by attenuating
Conclusions: We expect these results can provide details of miR-302 at molecular basis involved mechanisms may demonstrate potential implications to develop novel preventive, diagnostic, or therapeutic strategies in slowing disease progression of T2D.
PD07
LIRAGLUTIDE ATTENUATES FREE FATTY ACID-INDUCED LIPOTOXICITY AND INSULIN RESISTANCE IN C2C12 MYOTUBES
1HSIN-HUA LI,
1CHIH-LI LIN LIN, 2CHIUNG-HUEI PENG, 1YI-CHIAO BAI, 1HSIAO-LI HO, 1CHIEN-YIN KUO, 3YI-SUN YANG, 3EDY KORNELIUS, 3CHIEN-NING HUANG
1Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; 2Department of Nursing, Hungkuang University, Taichung, Taiwan ; 3Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
Background: The prevalence of obesity-related diabetes and metabolic disorder has increased dramatically over the past 20 years. Particularly, T2D is a chronic disease characterized by disruption in the metabolism of glucose and lipids, and consequential failure in the production of insulin and insulin resistance. These dysfunctions are due in part to ineffective treatment of blood glucose and lipids by peripheral tissues such as fat and muscle tissue. The abnormal lipid dynamics are caused by increased free fatty acid (FFA) flux and thereby induces insulin resistance. Particularly, chronic elevation in plasma FFA levels is commonly associated with impaired insulin-mediated glucose uptake in skeletal muscles. Although the precise mechanism of FFAs-induced lipotoxicity involved in the development of muscle insulin resistance remains unknown yet, there are not available the effective treatments for obesity-related disorder.
Methods: Recently studies indicated that glucagon-like peptide-1 (GLP-1) increases basal energy expenditure, curtails weight gain, and inhibits the development of insulin resistance, diabetes, and hepatic steatosis. Liraglutide, a GLP-1 receptor agonist, is an analogue of human incretin binding to the same receptors as does the endogenous metabolic hormone GLP-1 and stimulates insulin secretion. However, the protective effects of liraglutide involved in FFA-induced lipotoxicity have not yet been investigated. Here, we aimed the protective effect of liraglutide against FFA-induced lipotoxicity and insulin resistance in C2C12 myotube.
Results: Our results showed that the treatment of FFA in C2C12 myotube increased lipid droplet, FFA-induced lipotoxicity and oxidative stress by restoring insulin downstream signaling.
Conclusions: signaling caused by FFA in C2C12 myotube. This demonstrates potential implications to develop novel preventive or therapeutic strategies in T2D.
PD08
GLP-1 RECEPTOR AGONIST AMELIORATES HIGH FAT DIET-INDUCED NEUROINFLAMMATION AND ANXIETY-LIKE BEHAVIOR IN MICE
1HSIN-YING CHIOU, 2MING-HONG LIN, 1HE-JIUN JIANG, 1WEI-WEN HUNG, 3SHIOU-LAN CHEN, 1PI-JUNG HSIAO
1Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University; 2Department of Microbiology and Immunology, Kaohsiung Medical University; 3Graduate Institute of Medicine, Collage of Medicine, Kaohsiung Medical University
Background: Obesity is associated with multiple comorbidities, such as metabolic abnormalities and cognitive dysfunction. Accumulating evidences indicate that neurodegenerative disorders are associated with chronic neuroinflammation. GLP-1is also produced by neuron and microglia to including hypothalamus, cortex, hippocampus, cerebellum, and brain stem. Increasing evidences demonstrate a neuroprotective effect of GLP-1 RA, which is independent on the glucose-lowering effects. This study was designed to investigate the GLP-1 signaling in obesity-associated brain damage
Methods: In this study, mice were fed with high-fat-diet (HFD) for 16 weeks to induce obesity, and combined with or without weekly injection of GLP-1 RA (Bydureon dose500 ug/kg/w). Bodyweight, energy intake, and blood glucose were measured throughout 16 weeks. The behavior test examined by immunohistochemistry and western blot.
Results: Our results showed that GLP-1 RA ameliorated the HFD-induced obesity, locomotor activity, and anxiety-like behavior. Hippocampal astrogliosis was reduced by GLP-1 RA. SOCS3 expressions were reduced by GLP-1 RA. Moreover, GLP-1 RA reversed the HFD-related hippocampus and hypothalamus, and also improve the insulin sensitivity.
Conclusions: From our biochemical and histological evidences, GLP-1 RA could reduce anxiety-like behavior.
PD09
ASSOCIATION BETWEEN URIC ACID LEVEL AND INCIDENCE OF MACROALBUMINURIA IN PEOPLE WITH TYPE 2 DIABETES MELLITUS: A 4.5-YEAR COHORT STUDY
1YUN-JU LAI, 2YUN-JU LAI CHEN, 3LI-JUNG CHEN, 4PO-WEN KU, 5YUNG-FENG YEN
1Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan; 2Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan; 3Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan; 4Graduate Institute of Sports and Health, National Changhua University of Education, Changhua, Taiwan; 5Section of Infectious Diseases, Taipei City Hospital, Taipei City Government, Taipei, Taiwan
Background: Using animal models and molecular biology researches, hyperuricemia has been shown to instruct renal arteriolopathy, arterial hypertension, and microvascular injury involving the renin-angiotensin system and resulting in renal function impairement. Nevertheless, the association between uric acid levels and the development of macroalbuminuria has been under-investigated in people with type 2 diabetes mellitus.
Methods: Patients with type 2 diabetes and regular outpatient visits were recruited from the Puli Branch of the Taichung Veterans General Hospital in Taiwan since January 2014. Demographics, lifestyle features, and medical history were gathered by well-trained interviewers. All participants underwent comprehensive physical examinations, including a biochemical assay of venous blood specimens and urine samples after an 8-hour overnight fast. Participants were followed until June 2018. The primary outcome was the macroalbuminuria incidence. Univariate and multivariate Cox regression analysis were employed to explore the relation between uric acid and incident macroalbuminuria. Uric acid cutoffs for incident macroalbuminuria were determined with the receiver operator characteristic curve.
Results: 11.29 years]; 138 [55.87%] men). During a 4.5-year follow-up duration, 20 subjects with incident macroalbuminuria were recognized. Serum uric acid was significantly associated with an increased < 0.001) with potential confounders adjustment. The uric acid cutoff point was 6.9 mg/dL (area under
Conclusions: Serum uric acid was associated with incident macroalbuminuria among people with type 2 diabetes.
PD10
1YEN-LIN HUANG, 1YUAN-HAW WU, 1JIA-YIN GUO, 1KUO-CHIN HUANG, 1WEI-LUN HUANG, 1YIN-HUEI CHEN, 1MAO-TSU FUH, 1CHING-CHU CHEN
1Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung, Taiwan, R.O.C
Introduction: According to published literature, iatrogenic hyperglycemia has been witnessed in patients undergoing TKI target therapy. The mechanism behind TKI-induced hyperglycemia is related to metabolites of the drugs that have activity against IGF-1R[1]. In fact, it was recorded that up to 41% of patients taking Pazopanib, a TKI, could experience hyperglycemia[2]. In this report, we present an autoimmune diabetes mellitus case that was possibly induced during the course of cancer treatment that included Pazopanib.
Case report: We present a 60-year-old female with BMI of 20.2 kg/cm2 and no medical history for metabolic diseases. Her family history was only significant for gout. Initially, this patient was diagnosed with right axillary high-grade myxofibrosarcoma with lung metastasis. She underwent surgical excision for the lesions and received adjuvant MAID regimen chemotherapy. Six months later, patient was diagnosed with recurrence of STS and a new primary lung adenocarcinoma. Patient underwent another lung wedge resection operation and initiated Pazopanib treatment, postoperatively. Patient’s urine glucose concentration was 70 mg/dL before initiating Pazopanib therapy. Four months later, we incidentally found that patient’s HbA1c value was 9%. Due to difficulty in effectively controlling her blood glucose, C-peptide level and GADA titer were measured and laboratory data of < 0.1 ng/mL and 22.9 U/mL (Normal < 5.0) were obtained, respectively. She was completely dependent on insulin injection for blood glucose control soon after we discovered her hyperglycemia condition.
Discussion and Conclusion: The etiology of hyperglycemia and elevated HbA1c is unknown in this patient. The rapid progression to insulin dependence in less than 6 months makes the diagnosis of LADA for this patient less likely. We, however, strongly suspect the diagnosis of iatrogenic autoimmune diabetes mellitus in this case and it could be related to one or a combination of components during her cancer treatment course.
PD11
USING WHOLE EXOME NEXT GENERATION SEQUENCING TO IDENTIFY THE CAUSATIVE GENES IN TWO TAIWANESE FAMILIES OF MATURITY ONSET DIABETES OF THE YOUNG
1YU CHEN, 2CHIH-SHAN CHEN, 2,3,4,5PEI-LUNG CHEN, 3,4,5WEI-SHIUNG YANG
1Genetic Counseling Master Program, Graduate Institute of Molecular Medicine, College of Medicine, National Taiwan University (NTU); 2Department of Medical Genetics, NTU Hospital; 3Department of Internal Medicine, NTU Hospital; 4Graduate Institute of Medical Genomics and Proteomics, College of Medicine, NTU; 5Graduate Institute of Clinical Medicine, College of Medicine, NTU
Background: The monogenic form of diabetes mellitus (DM) has not been well investigated in Taiwan.
Method: We have recruited two Taiwanese families of maturity onset diabetes of the young (MODY). The genomic DNA of two affected members and one unaffected members from each family was collected for whole exome next generation sequencing (WE NGS). Bio-informatic processing taking linkage analysis, variant allele frequency (T;p.V42A) as the causative mutation in family A. In family B, the causative mutation is in glucokinase gene, GCK (c.1318G > T;p.E440X).
Conclusion: This study demonstrate that WE NGS is a sensible approach to identify the diabetes causative genes in Taiwanese MODY families.
PD12
EVALUATE THE GLYCEMIC EFFECTS OF OCTREOTIDE AND SURGICAL RESECTION WITH INTRA-OPERATIVE RAPID INSULIN ASSAY IN INSULINOMA: A CASE REPORT
1RU-LAI HUANG, 1KAI-PI CHENG, 1CHIH-CHEN WANG, 1HORNG-YIH OU, 2SHIH-MING HUANG
1 Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Hospital; 2 Department of General Surgery, National Cheng Kung University Hospital
Background: Insulinoma is a rare neuroendocrine tumor that causes insulin over-secretion and octreotide, a somatostatin analog, is an alternative choice in certain circumstances. We reported a case of insulinoma whose glycemic variability were evaluated by continuous glucose monitoring (CGM).
Methods: A 79-year-old female without the past history of diabetes was found hypoglycemia (serum glucose: 45 mg/dL) with unconsciousness in February 2018. Hyperinsulinemic hypoglycemia (serum glucose 40 mg/dL, Insulin:12.08 uU/ml , C peptide:2.5 ng/ml) was confirmed. Abdominal magnetic resonance imaging and subsequent intra-arterial calcium stimulation study were therefore arranged, which revealed a 1.2 cm insulinoma at pancreatic head. Octreotide (0.05 mg per day via subcutaneous injection) was prescribed before the surgery and there was no more hypoglycemic episode detected by CGM.
Results: The glycemic level rose from 128 mg/dl to 440 mg/dl in 10 hours after the octreotide injection, and the glycemic effect persisted for around 24 hours. For definite treatment, the patient underwent tumor enucleation with rapid insulin assays used. The serum insulin level changed from 41.61 uU/ml at baseline to 7.1 uU/ml and 5.7 uU/ml at 8 and 16 minutes after the tumor excision, respectively. Meanwhile, CGM demonstrated the glycemic levels at a range of 140 mg/dl to 200 mg/dl during the period of operation.
Conclusions: CGM can investigate the glycemic variability closely and timely. With the aid of this novel tool, the clinicians can comprehensively evaluate the glycemic effects of octreotide and tumor excision in the cases of Insulinoma.
PD13
GREATER LOW-DENSITY LIPOPROTEIN CHOLESTEROL VARIABILITY INCREASES THE RISK OF CARDIOVASCULAR EVENTS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
1,3WEI-HAO HSU,
1Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan; 2Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Taiwan; 3Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Taiwan; 4Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Taiwan; 5Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan; 6Center for Lipid and Glycomedicine Research, Kaohsiung Medical University, Taiwan
Background: Lipid variability has been shown to be associated with worse cardiovascular outcomes in patients with coronary artery disease. The main purpose of this study was to determine whether low-density lipoprotein cholesterol (LDL-C) variability can be used to predict cardiovascular events in patients with type 2 diabetes mellitus (DM).
Methods: A total of 5,354 patients with type 2 DM were enrolled in this study. Cardiovascular events including coronary artery disease, stroke, peripheral arterial disease, and cardiovascular death individual lipid variability.
Results: Univariate Cox proportional hazards analysis showed that LDL-C standard deviation with an increased risk of cardiovascular events in patients with type 2 DM. Multivariate Cox proportional hazards analysis showed that an increase in LDL-C standard deviation significantly increased the risk of cardiovascular events (HR, 1.063; 95% CI = 1.025 to 1.102; p = 0.01). KaplanMeier analysis of cardiovascular event-free survival (log-rank p < 0.001) in the patients grouped according to tertile of the standard deviation of LDL-C showed that the patients in tertile 2 and tertile 3 had a worse cardiovascular event-free survival than those in tertile 1.
Conclusion: Variability in LDL-C is a predictor of cardiovascular events in patients with type 2
DM.
PD14
THE ASSOCIATION BETWEEN GLYCATED ALBUMIN AND GLYCOHEMOGLOBIN IN DIABETIC RETINOPATHY OF PRE-DIABETES
Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan, R.O.C
Background: Pre-diabetes is the stage before the onset of diabetes, which is often referred to as the gray area. Glycohemoglobin (HbA1c) is clinically used as the gold standard for glycemic control of diabetes, but it may be affected by the life of red blood cells and the condition of hemoglobin. glucose. Correlation between GA concentration and severity of diabetic retinopathy has been reported in patients with type 2 diabetes. However, there are limited studies to investigate the association between GA and diabetic retinopathy in pre-diabetic patients in Taiwan.
Methods: This study recruited 291 patients with pre-diabetes from January 2016 to February 2017. Blood and urine samples were obtained from all patients after fasting for 12 hours within 1 month of enrollment, including fasting glucose, lipid profile, HbA1c, GA, urine microalbumin and urine creatinine.
Results: A total of two hundred and ninety-one pre-DM patients are included. In the univariate analysis, diabetic retinopathy is found to be associated with older age, male, high systolic blood pressure, low body mass index, high GA, high HbA1C, low total cholesterol and low eGFR. After multivariate logistic regression analysis, old age, male, high systolic blood pressure, high HbA1C, and GA is not.
Conclusions: retinopathy. However, GA is not associated with diabetic retinopathy in this population.
PD15
ENDOTHELIN-1 STIMULATES PREADIPOCYTE CELL GROWTH THROUGH MULTIPLE KINASE SIGNALING PATHWAYS
1AN-CI SIAO, 1TSAI-YUN CHAN, 2HUI-CHEN KU, 3YI-WEI TSUEI, 3YEN-YUE LIN, 4YOW-CHII KUO, 1YUNG-HSI KAO
1Department of Life Sciences, National Central University, Jhongli City, Taoyuan, Taiwan; 2Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; 3Department of Emergency, Taoyuan Arms & Forces General Hospital, Taoyuan, Taiwan; 4Department of Gastroenterology, Landseed General Hospital, Taoyuan, Taiwan
Background: Endothelin (ET)-1 possesses numerous functions in regulating fat cell activity. This study investigated the pathways involved in ET-1 modulation of 3T3-L1 preadipocyte proliferation.
Methods: 3T3-L1 preadipocytes were treated with ET-1 in the presence or absence of its signal molecule inhibitor, and then cell number, cell proliferation, and growth-controlling proteins were measured by trypan blue method, bromodeoxyuridine (BrdU) incorporation, and Western blot, respectively.
Results: Preadipocyte proliferation as indicated by an increased number of cells and greater incorporation of BrdU was stimulated by ET-1 in dose- and time-dependent manners. ET-1 also time- or dose-dependently stimulated phosphorylations of signal transducer and activator of transcription mitogen-activated protein kinase (MAPK) pathway proteins, ERK, but not JNK and p38. Treatment STAT-3, ERK1/2, JNK, AMPK, and PKC prevented ET-1-increased levels of cell proliferation and ceramide synthase (CerS) such as Fumonisin B2, were also found to suppress ET-1-induced increases in cell number, BrdU incorporation, and ERK and c-Jun phosphorylations. However, the p38 MAPK antagonist SB203580 did not alter the effect of ET-1.
Conclusions: These results imply that functional proteins of ETAR, JAK2, ERK1/2, c-Jun, of preadipocyte proliferation. The ETAR-dependent and ETBR-independent effects of ET-1 were increases in both cell number and cell proliferation of stromal-vascular preadipocyte fraction.
PD16
THE ROLE OF HYPOGLYCEMIC AGENTS USE IN CARDIOVASCULAR EVENTS IN INTENSIVELY CONTROLLED DIABETES
1WEI-LUN WEN,
1Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan, R.O.C; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Taiwan, R.O.C
Background: Physicians aim to manage diabetic patients with balancing adequate glycemic control and occurrence of hypoglycemia to improve patients’ health. It remains unclear whether cardiovascular outcomes were associated with the use of hypoglycemic agents (insulin dependent
Methods: We enrolled 3,261 type 2 diabetes patients with two consecutive HbA1C levels of 6.4% or lower from Kaohsiung Medical University Research Database during 2010 to 2011. All patients were followed until December 31, 2015. The study cohort was divided into two groups: patients receiving insulin dependent agents (sulfonylureas and insulin) and those receiving insulin independent agents (metformin, acarbose, pioglitazone and dipeptidyl peptidase 4 inhibitors) for glycemic control.
Results: During the mean follow-up period of 4.2 ± 0.9 years, 325 patients had cardiovascular events. Compared to the insulin independent group, the insulin dependent group had significantly higher hypoglycemic episodes and cardiovascular events (both p < 0.001). In multivariate analysis, the patients in the insulin dependent group were associated with an increased risk of cardiovascular events
Conclusions: Type 2 diabetes patients receiving insulin dependent agents were associated with an increased risk of cardiovascular events compared to those receiving insulin independent agents, suggesting that insulin independent agents may be preferential in diabetic patients with high risk of hypoglycemia.
PD17
HYPERGLYCEMIA AND HYPOGLYCEMIA TRENDS WITH CURRENT GLUCOSE-LOWERING AGENTS IN TAIWAN ON YEAR 2005-2013
1SHU-HENG HUANG, 1WEI-LUN WEN, 1NAI-WEI SHEU, 2KUN-DER LIN, 1PI-JUNG HSIAO, 1SHYI-JANG SHIN, 1MEI-YUEH LEE
1Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan, R.O.C; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Taiwan, R.O.C
Background: To examine temporal trends in utilization of glucose-lowering medications, glycemic control, and rate of severe hypoglycemia and hyperglycemia among patients with type 2 diabetes (T2DM).
Methods: Using claims data from 1 million insured Taiwan National Health Insurance patients with T2DM from 2005 to 2013, we estimated the annual 1) age- and sex-standardized proportion of patients who filled each class of agents and sex-standardized rate of severe hypoglycemia and hyperglycemia among those using medications.
Results: From 2005 to 2013, use increased for metformin and sulfonylureas was still observed despite increased use of dipeptidyl peptidase 4 inhibitors since entry on year 2009 to 2013. However, use in insulin, thiazolidinediones , glucagon like peptide -1 receptor agonist meglitinides, and alpha glucosidase inhibitors was stable. The overall rate of severe hypoglycemia and hyperglycemia remained the same until year 2011, declined modestly .
Conclusions: During the recent 9-year period, the use of glucose-lowering drugs has changed after 2 years of entry of DPP4 inhibitors on year 2011, which overall rate of severe hypoglycemia and hyperglycemia remains largely unchanged before 2011 and declined after.
PD18
DIDN’T IN DB/DB MICE VIA RETINOL SIGNALING
1CHAO-HUNG CHEN,
1PI-CHEN LIN, 1KUN-DER LIN, 1MEI-YUEH LEE, 1PI-JUNG HSIAO, 1YI-CHI HUANG, 1 SING -YI HUANG, 1SHYI-JANG SHIN
1Division of Endocrinology and Metabolism, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
Background: Sodium glucose co-transporter 2 (SGLT2) inhibitors have been proved to be beneficial for CV and renal outcome in diabetic patients. However, the protective mechanism of mass on pancreas. Our study also indices that aberrant intracellular retinol signaling is associated with diabetic kidney. The vitamin A metabolism is also regulated by RBP4/STRA6/CRBP1/LRAT/RARs pathway in pancreatic tissue.
Methods: Thus, this study aims to investigate the protective effects of SGLT2 inhibitor, cells including MafA, Pdx1, and NKX6.1 in pancreas of db/db, glibenclamide-treated db/db, and
Results: In pancreas of db/db mice, insulin secretion, MafA, Pdx1, and NKX6.1 expression were also conserved in pancreas of empagliflozin-treated db/db mice. However, glibenclamide could not
Conclusions:
PD19
ASSOCIATION OF HBA1C VARIABILITY AND RENAL PROGRESSION IN PATIENTS WITH TYPE 2 DIABETES WITH CHRONIC KIDNEY DISEASE STAGES 3–4
1Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan, R.O.C; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Taiwan, R.O.C
Background: Little is known about the predictive value of glycosylated hemoglobin (HbA1c) variability in patients with advanced chronic kidney disease (CKD). The aim of this study was to investigate whether HbA1c variability is associated with progression to end-stage renal disease in diabetic patients with stages 3–5 CKD, and whether different stages of CKD affect these associations.
Methods: Three hundred and eighty-eight patients with diabetes and stages 3–5 CKD were enrolled in this longitudinal study. Intra-individual HbA1C variability was defined as the standard
Results: The results indicated that, during a median follow-up period of 3.5 years, 108 patients started dialysis. Adjusted Cox analysis showed an association between the highest tertile of HbA1c not in stage 5 CKD. Further subgroup analysis showed that the highest two tertiles of HbA1c SD were associated with a lower risk of the renal endpoint in the group with a decreasing trend of HbA1c.
Conclusions: Our results demonstrated that greater HbA1c variability and a decreasing trend of HbA1c, which may be related to intensive diabetes control, was associated with a lower risk of
PD20
COMPARE THE EFFICACY OF TOUJEO WITH LEVEMIR AS BASAL INSULIN THERAPY IN NON-CRITICAL HOSPITALIZED DM POOR CONTROL PATIENTS IN A REGIONAL TEACHING HOSPITAL
JUI-HSIANG LI, SU-HUEY LO
Department of Internal Medicine Tao-Yuan General Hospital
Background: critical DM poor control patients
Methods: This study is a retrospectively chart review study. Non-ciritical hospitalized poor control type 2 diabetes who were consulted endocrinologist with increasing insulin doses or random access to initiating Toujeo hs + Novorapid tidac or Levemir hs + novorapid tid ac from 1, July, 2018 to
Results: Twenty patients received Toujeo + Novorapid control and another twenty patients received Levemir+ Novorapid control. There were no significant difference in baseline character such as age, body weight, height, A1C and Cr level. The pre-treatment glucose level is similar in both group. In Toujeo group, the four points blood glucose level ( tid ac+ hs, mg/dl ) is 251 ± 58.1, 265.8 ± 73.6, 301.4 ± 100.3, 272.2 ± 85.6. In Levemir group, the blood glucose level is 230.0 ± 85.1, 293.2 ± 85.0, 274.3 ± 99.2, 296.3 ± 74.1. After seven days intervention, the four points blood glucose level in Toujeo group is 206.4 ± 84.0, 226.2 ± 83.0, 209.3 ± 88.7, 207.2 ± 76.0, while in Levemir group the blood sugar is 187.1 ± 92.9, 219.7 ± 109.8, 209.9 ± 95.8, IU tidac and Levemir 17 ± 7IU qhs+ Novorapid 11 ± 3IU tidac. In the seventh day, the insulin dose is Toujeo 19 ± 9IU qhs + Novorapid 14 ± 5IU tidac and Levemir 17 ± 5U qhs + Novorapid 13 ± 3IU tidac. Similar hypoglycemia risk was noted in both group (6 times in Toujeo group and 7 times in Levemir group).
Conclusions: In this study, similar glycemic control and hypoglycemia risk was noted with Toujeo and Levemir control. But the rate of glycemic control reaching the target was low. The goal of fasting (70~140mg/dl), pre-lunch, pre-dinner and pre-bedtime (70~180mg/dl) blood glucose was 26.3%, 25%, 47%, 15% in Toujeo group and 37.5%, 54.5%, 46.7%, 20% in Levemir group respectively. We should aggressive titrate the insulin dose to reach the goal to improve the care quality and outcome.
PD21
TO EVALUATE THE EFFICACY AND SAFETY OF GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONIST PLUS BASAL INSULIN THERAPY IN SUBJECTS WITH TYPE 2 DIABETES WITH POOR GLYCEMIC CONTROL UNDER TWICE-DAILY PREMIXED INSULIN THERAPY
1JHIH-SYUAN LIU,
1SHENG-CHIANG SU, 1CHIEH-HUA LU, 1CHIEN-HSING LEE, 1CHANG-HSUN HSIEH
1Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
Background: The current guideline recommends several strategies to intensify injectable therapy peptide-1 receptor agonist (GLP-1 RA) and basal insulin among subjects of type 2 diabetes (T2DM) previously treated with premixed insulin.
Methods: It is a single arm, open study. Anti-diabetic regimen was shifted to GLP-1 RA plus basal insulin to replace previous treatment of premixed insulin with inadequate glycemic control (HbA1C level between 7 to 11%) T2DM subjects. The glycemic index, clinical cardiovascular risk
Results: A total twenty subject with 55% males; mean age of 58 ± 11 years, mean diabetes BMI reduction of 1.1 kg/m2 (p < 0.001), HbA1c improvement of 0.9% (p < 0.001), fasting plasma glucose reduction of 50 mg/dL (p = 0.004), and LDL cholesterol reduction of 11 mg/dL (p = 0.012). However, the incidence of hypoglycemia was not different between these two treatment strategies.
Conclusions: In this pilot study, the combination treatment with GLP-1 RA and basal insulin uncontrolled T2DM on previous therapy with premixed insulin. It provided important information for physicians to decide to modify therapeutic strategy as individualized needs. A larger scaled study is
PD22
LIRAGLUTIDE INHIBITS HEPATITIS C VIRUS REPLICATION THROUGH AN AMP ACTIVATED PROTEIN KINASE DEPENDENT MECHANISM
1MEI-YUEH LEE, 2WEI-CHUN CHEN, 1WEI-HAO HSU, 1YU-LI LEE, 2JIN-CHING LEE,
1SHYI-JANG SHIN
1Division of Endocrinology and Metabolism, Department of Internal Medicine,Kaohsiung Medical University Hospital Chung-Ho Memorial Hospital; 2Department of Biotechnology, College of Life Science, Kaohsiung Medical University, Kaohsiung, Taiwan
Background: Insulin resistance and diabetes are both associated with chronic hepatitis C virus (HCV) infection, and the glucagon-like peptide-1(GLP-1) receptor agonist, liraglutide, is a common therapy for diabetes. Our aim was to investigate whether liraglutide treatment can inhibit HCV replication.
Methods: A cell culture-produced HCV infectious system was generated by transfection of in vitro-transcribed genomic JFH-1 ribonucleic acid (RNA) into Huh-7.5 cells. Total RNA samples were cell viability was calculated. Western blot analysis of the protein expression was performed. The immunoreactive blot signals were also detected.
Results: Liraglutide activated GLP-1 receptors in the HCV infectious system, and inhibited subgenomic HCV RNA replication in the HuH-7.5 cells. Western blot analysis revealed both HCV protein and replicon RNA were reduced after treatment with liraglutide in a dose-dependent manner. ml, activated 5’ adenosine monophosphate-activated protein kinase (AMPK) and phosphorylated- transducer of regulated cyclic adenosine monophosphate (CAMP) response element-binding protein 2 (TORC2), thereby decreasing the cell viability of phosphoenolpyruvate carboxykinase (PEPCK) and G6pase RNA.
Conclusions: Liraglutide can inhibit HCV replication via an AMPK/TORC2-dependent pathway.
PD23
INTENTIONAL INSULIN OVERDOSE-A CASE REPORT
I-MIN PAN, WEI-HSIN HSU
Division of Endocrinology and Metabolism, Department of Internal Medicine, Tainan Sin-Lau Hospital, Taiwan, R.O.C.
A 55-year-old male was a case of type 2 DM, positive hepatitis C virus antibody. Insulin novomix 30/70 was used for diabetes control at a local hospital. He injected around 480-600unit insulin to right lower abdominal wall around 8-9 PM after quarrel with his family. He felt weakness and lied on the roadside. He was found by police and emergency medical technician(EMT). On ambulance, finger sugar showed 53 mg/dl, conscious level E2V2M4. D50W(50% dextrose) 40 cc was given intravenously. GCS improved to E4V1M5. At ER, blood sugar revealed 95 mg/dl. He was started on a dextrose 10% drip at 60-100mL/h. Upon physical examination, there are several injection trace with ecchymosis but no induration on right lower abdomen (12 hours post insulin injection). During the first 24 hours in the intensive care unit and ward, low blood sugar levels between 43-80mg/dl high lactic acid level, hypokalemia, hypophosphatemia, very high insulin level and low C-peptide. Despite continuous drip 9% dextrose at 100mL/h and a liberal carbohydrate diet, the last episode of hypoglycemia 47 mg/dl was observed in the early morning 5AM on 2nd day when was 33th hours post massive insulin dose injection. After this hypoglycemia, blood sugar elevated. We started insulin injection subcutaneously for diabetes control. He was disposed to psychiatrist for further evaluation.
PD24
HIGH LEPTIN TO SUBCUTANEOUS ABDOMINAL FAT RATIO CHANGE REDUCE METABOLIC SYNDROME RISK IN TAIWANESE OBESE MEN AFTER WEIGHT REDUCTION PROGRAM
1,2CHUN-CHENG LIAO,
3,4,5I-TE LEE, 4,6SHIH-YI LIN, 7WEN-JANE LEE, 3,4,8WAYNE HUEY-HERNG SHEU
1Department of Family Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan; 2National Defense Medical Center, Taipei, Taiwan; 3 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; 4School of Medicine, National Yang-Ming University, Taipei, Taiwan; 5School of Medicine, Chung Shan Medical University, Taichung, Taiwan6 Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taiwan; 7Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan; 8Rong Hsing Research Center For Translational Medicine, National Chung Hsing University, Taichung, Taiwan
Background: Leptin is associated with metabolic syndrome (MetS) but not know that leptin to subcutaneous abdominal fat area ratio (leptin/SAFA ratio) or change after weight reduction program (WRP) whether is associated with MetS. This study was to evaluate leptin to subcutaneous abdominal fat ratio or change whether is associated with MetS in Taiwanese obese men.
Methods: Forty middle-aged, obese men (age: 42.8 ± 10.7 years and body mass index: 33.8 ± 4.0 kg/m2) were enrolled and thirty-six with or without MetS completed 12-week WRP which was conducted in the Division of Endocrinology and Metabolism at Taichung Veterans General Hospital Anthropometry and metabolic risk factors were measured before and after WRP. Subcutaneous abdominal fat area (SAFA), intra-abdominal fat area (IAFA) before and after WRP were determined by magnetic resonance imaging (MRI). Multiple logistic regression analysis estimate the odds of reducing MetS by adjusting age, baseline SAFA, IAFA and leptin/SAFA ratio change after WRP.
Results: waist circumference, systolic and diastolic blood pressure, fasting sugar, HDL-ch and triglyceride after Total 34 participants have MetS before WRP and 15 participants progressed not to MetS, whereas 15 did. 50% of MetS risk reduction was detected by using McNemar’s Test analysis after this program intervention. Multiple logistic regression analysis also showed lower odds of MetS risk with 1-SD greater leptin/SAFA ratio change (OR, 0.59; 95% CI, 0.01-0.74; p = 0.029) after adjustment including age, baseline VAT, SAT and leptin/SAFA ratio change after WRP.
Conclusions: The effect of WRP to reduce metabolic syndrome risk in Taiwanese obese men association in other ethnic/racial populations.
PD25
DIPEPTIDYL PEPTIDASE 4 INHIBITORS CAN DECREASE ALLERGIC RHINITIS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS IN TAIWAN
1.2.3HSIN -HUNG CHEN
1.Institute of Medicine and Public Health, Chung Shan Medical University, Taichung, Taiwan; 2.College of Nursing and Health Sciences, Dayeh University, Changhua, Taiwan; 3.Division of Metabolism & Endocrinology, Changhua Christian Hospital, Changhua, and Nantou Christian Hospital, Nantou, Taiwan
Background: Dipeptidyl peptidase 4 inhibitors (DPP4i) are considered to be a safer drug with rare side effects among anti-diabetic agents. Most frequent reported adverse reaction with DPP4i are nasopharyngitis (3.5-13.2%) and upper respiratory infection (4.5-11%). But we think some of the adverse reports may be the allergic rhinitis .This study was designed to evaluate the association between allergic rhinitis and DPP4i user in type 2 diabetic patients in Taiwan.
Methods: There were 28810 patients with T2DM from Taiwan National Health Insurance greater as a DPP4i cohort and subjects never use DPP4i as a control cohort from 2009 to 2017. The intervals (CIs) for the cohorts. Nonparametric Kaplan-Meier analysis was used to determine the cumulative event rates of allergic rhinitis, and the log-rank test was used to test the difference between these two cohorts. Data management and analysis were carried out using SAS 9.4 software (SAS testing.
Results: We identified 6443 individuals taking DPP4i and 22367 matched cohort without taking DPP4i. DPP4i cohort had a higher proportion of comorbidities with CAD, stroke, HTN and dyslipidemia .The incidence rate of allergic rhinitis was higher in non-DPP4i cohort(1.56 vs1.23) in our study. The subgroup analysis of our study also showed that in non-DPP4i cohort, there was higher incidence rate of allergic rhinitis in female(1.75vs 1.16) ,age more than 40 years-old(1.52vs1.16),age more than 65 years-old (1.60vs 1.23) and diabetic patients with comorbidities group(1.58vs 1.22).
Conclusions: DPP-4 i were associated with an increased adverse reaction with nasopharyngitis and upper respiratory infection but not allergic rhinitis. The mechanism of immune change with DPP4 i may be one of the reason.
PD26
FULMINANT TYPE 1 DIABETES MELLITUS: A REPORT OF A SINGLE-CENTER EXPERIENCE
NAN-HAU HUANG, CHEWN-YI YANG, KAI-JEN TIEN, NAI-CHENG YEH, SHANG-GYU LEE, MEI-CHEN YEH
Chi Mei Medical Center Endocrinology Department
by Imagawa in 2000. It is a clinical condition that is characterized by remarkably rapid and complete (1) Occurrence of diabetic ketosis or ketoacidosis soon (approximately 7 days) after the onset of peptide level < 0.3 ng/mL (< 0.10 nmol/L) and <0.5 ng/mL (< 0.17 nmol/L) after intravenous glucagon (or after meal) load at onset. However, the pathophysiology of this condition remains still unclear. Most of FT1DM have been reported in Asian populations and rare cases have been reported in Caucasians or native American. The prevalence of FT1DM is estimated to account for 1.5% to 19.4% in Asia. Here, we present the cases diagnosed with FT1DM in a medical center in Tainan, Taiwan.
