109年年會論文摘要集 by Endo 電子書上傳區

Contents Floor Plan of Conference Rooms ........................................................................................... 2 Daily Program Schedule........................................................................................................... 4 Opening Remarks ...................................................................................................................... 6 Board of Directors ...................................................................................................................... 8 Sponsors ..................................................................................................................................... 9 Moderator & Speaker .............................................................................................................. 10 Agenda ...................................................................................................................................... 12 Abstract PL：Plenary Lecture (1-4) ................................................................................................. 34 MTP：Meet the Professor-E1&D1 .................................................................................... 38 ESROC : ESROC 40th Anniversary Special Symposium................................................. 39 DAROC : DAROC 40th Anniversary DAROC – AASD Joint Symposium ..................... 43 SE：Symposium-Endocrine (1-8)...................................................................................... 46 SD：Symposium-Diabetes (1-8) ........................................................................................ 72 ML：Memorial of Prof. Jen-Der Lin ................................................................................. 92 JS-1：ESROC-TSA Joint Symposium .............................................................................. 96 AP：2020 Award .............................................................................................................. 101 OE：Oral presentation-Endocrine (1-6)........................................................................... 105 OD：Oral presentation-Diabetes (1-6)............................................................................. 112 PE：Poster Presentation-Endocrine (1-19) ...................................................................... 118 PD：Poster Presentation- Diabetes (1-21) .................................................................... 138

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

Floor Plan of Conference Rooms

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

社團法人中華民國內分泌暨糖尿病學會第 14 屆第 2 次會員大會暨學術研討會日期：民國 109 年 9 月 5-6 日／地點：張榮發基金會國際會議中心10-11F

節目表 September 05, 2020 (Saturday) ROOM 可容納人數

1101 1001 1002 1003 308 人 211 人 180 人 180 人 SE-1 SD-1 JS-1 Parathyroid How to Interpret ESROC-TSA Update Clinical Trial Data Joint Symposium 09:30-10:30 主持人：李亭儀主持人：莊立民主持人：林彥宏王治元何橈通曾芬郁演講者：呂金盈演講者：葉日弌歐弘毅邱偉益廖國盟朱志勳王舒儀張家勳 ML 林仁德教授演講者：吳允升施銘朗 (09:30- 11:15) 張晉誠紀念演講會路景竹主持人：陳思達中華民國糖尿病演講者：劉鳳炫吳婉禎 10:30-11:30 學會 40 周年活彭康詠林樹福動 : 回顧與前瞻郭昇峯 (11:15-11:45) 李晏榮 LS-1 LS-2 LS-3 LS-4 11:45-12:45 默沙東諾和諾德阿斯特捷利康拜耳

1006 70 人

1007 70 人 WORKSHOP Thyroid Cytology Workshop 主持人：張天鈞演講者：詹一秀林家宏

1008 70 人

1005 36 人

LS-5 輝瑞

LS-6 賽諾菲

LS-7 禮來

LS-8 友華

13:00-13:10

Opening (Room 1101 現場 +1001 同步直播 )

主持人 : 曾芬郁、黃建寧

13:10-13:55

PL-1 Plenary Lecture-1 (Room 1101 現場 +1001 同步直播 )

主持人：曾芬郁演講者：鍾邦柱

13:55-14:40

PL-2 Plenary Lecture-2 (Room 1101 現場 +1001 同步直播 )

主持人：莊立民演講者： George King

Break / Poster Presentation (11F Poster Room ) 海報展示評分 14:40-15:20 PE 主持人：王舒儀、林志弘、周振凱 PD 主持人 : 楊宜瑱，林嘉鴻，王俊興 SD-2 SE-2 SE-3 SD-3 SD-4 OE SE-4 DM and Tyrosine Kinase Pituitary Therapeutic Basic Research 主持人：王治元 Neuroen— Cardiovascular Inhibitors (TKIs) 主持人：張慶忠 Nutritional 主持人：莊峻鍠歐弘毅 docrine Tumor disease in Radioiodine 簡銘男 (NET) 李亭儀 Therapy on 洪乙仁 Diabetes 主持人：陳榮福 (RAI)-Refractory 演講者：林亮羽演講者：蔡曜聲演講者：黃則穎主持人：曾芬郁陳永年劉鳳炫朱志勳 Differentiated 廖偉丞 Management 林樹福 Thyroid 溫緯倫演講者：洪晧彰楊偉勛李晏榮主持人：黃建寧劉漢文 15:20-17:00 演講者：演講者 Carcinoma 鄭祖耀曾慶孝 (DTC) 呂毓苓陳明晃 SILVIO 裴馰王繁棻 INZUCCHI 主持人：陳涵栩演講者：黃國晉林宗憲張宏猷陳思達 (15:20-16:40) 黃禹堯演講者：張雁翔楊宜瑱 OD 吳婉禎主持人：陳清助張義芳胡啟民施翔蓉楊偉勛 MTP-D1 MTP-E1 SE-5 SD-5 演講者：許惠恒謝靜蓉主持人：郭清輝主持人：林宏達 Immunotherapy- 2020 Taiwan DM 李亭儀演講者：演講者演講者：蔡克嵩 related Atlas 李欣樺 GEORGE Endocrinopathy 主持人：許惠恒張立心 KING 主持人：林怡君戴東原曾逸宏 17:00-18:00 施翔蓉莊立民 (16:40-18:00) 演講者：陳榮福杜思德鄭博中演講者：朱志勳李奕德李弘元李建興 18:30-18:40

Group Picture 大合照 (B1 宴會廳 or 1F 大廳 )

18:40-21:00

Welcome Dinner (B1 宴會廳 )

Daily Program Schedule

September 06, 2020 (Sunday) ROOM 可容納人數

1101 308 人

1001 211 人

1002 180 人

1003 180 人

1006 70 人

1007 70 人

1008 70 人

學會成立 40 週年特別活動 ESROC ESROC 40th Anniversary Special Symposium (Room 1101) 主持人：張慶忠、蔡克嵩演講者：曾芬郁、Takashi Akamizu、Eun Jig Lee、Vivien Lim

08:30-10:30

DAROC DAROC 40th Anniversary & DAROC–AASD Joint Symposium (Room 1001) 主持人：黃建寧、葉振聲、蔡世澤、李弘元、Daisuke Yabe 演講者：Daisuke Yabe、何橈通、Andrea OY Luk、Young Min Cho 10:30-11:00

Break General Assembly 會員大會 (Room 1101)

11:00-12:30 12:30-13:30

主持人：曾芬郁、黃建寧 LS-9 百靈佳殷格翰

LS-10 諾華

LS-11 諾和諾德

LS-12 華廣生技

LS-13 杏昌

LS-14 賽諾菲

LS-15 安克生醫

13:45-14:30

PL-3 Plenary Lecture-3 (Room 1101 現場 +1001 同步直播 )

主持人：王佩文演講者：蔡克嵩

14:30-15:15

PL-4 Plenary Lecture-4 (Room 1101 現場 +1001 同步直播 )

主持人：黃建寧演講者：許惠恒

15:15-15:40 SD-6 New Technology in DM Management 主持人：黃建寧陳榮福蘇景傑 15:40-17:20 林慶齡演講者：演講者 Robert Vigersky 謝易庭林嘉鴻

17:20-17:30

Break SE-6 SE-7 SD-7 Endocrine Nuclear Medicine New Paradigm in Disorder in 主持人：王佩文 the Management Pregnancy of Diabetes 林宏達主持人：施翔蓉演講者：張雁翔 Kidney Disease 劉鳳炫胡雅惠主持人：辛錫璋演講者：楊文萍鄭媚方陳清助鄭畬方胡啟民陳冠樺演講者：演講者 MEG JARDINE ALICE CHENG 林昆德

SE-8 Adrenocortical Carcinoma 主持人：陳思達陳涵栩演講者：陳怡文顏家瑞王碩盟

SD-8 Basic and Clinical Advance in Diabetic Foot Care 主持人：黃禹堯林時逸楊偉勛演講者：林承緯李任光鄭乃禎

Closing 主持人：曾芬郁、黃建寧

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

理事長致詞中華民國內分泌學會暨糖尿病學會 109 年年會由內分泌學會主辦，原定於 3 月舉行。欣逢本兩學會成立 40 週年，我們很早就開始籌劃，準備了很充實的學術活動、別緻的紀念品、活潑的晚宴表演、溫馨的時光走廊、衛教作品展示、內分泌會歌及衛教歌的發表等，內容豐富、多彩多姿。因為新冠肺炎疫情，2 月份的理監事會決定將年會移至 9 月份辦理，而場地也由預定的台大國際會議中心更改至張榮發國際會議中心。因為邊境管理，我們原來邀請好的外賓無法來台，因此所安排的學術活動也略有變更。感謝台灣的疫情管控良好，我們得以在 9 月份順利舉辦年會。內分泌學會邀請鍾邦柱院士及蔡克嵩教授擔任 plenary lecture，並安排包含新加坡、日本、韓國等會長的 40 週年紀念特別演講 ( 外賓演講以預錄的演講錄影帶呈現 )、meet professor、與台灣皮質醛酮症學會合辦的 joint symposium、林仁德教授紀念演講會、thyroid cytology workshop 以及 parathyroid update、pituitary、neuroendocrine tumor、immunotherapy-related endocrinopathy、endocrine disorders in pregnancy、nuclear medicine、adrenocortical carcinoma、TKI in thyroid cancer 等 symposium，節目內容多元精彩，是很豐盛的學術饗宴。糖尿病學會的學術節目、兩會會員的口頭或壁報論文報告、藥界同仁安排的 lunch symposium 等也都是精彩萬分，相信所有的會員都能夠在這場學術大會中收穫滿滿。內分泌學會於年會期間出版由蔡克嵩教授主編、邱偉益副秘書長擔任執行編輯的「副甲狀腺新知」，可以提供會員臨床參考。由劉鳳炫理事主編的學會成立 40 週年紀念專刊紀錄了學會成長的軌跡，極具紀念價值。另外，年會晚宴由會員提供的表演節目，使兩學會會員的互動更顯溫馨活潑。由張天鈞教授提供畫作所製作的絲巾及領帶，也讓所有會員更英俊美麗。謹此感謝所有主持人及演講者、糖尿病學會黃建寧理事長、內分泌及糖尿病學會兩會的秘書長、副秘書長、秘書、所有的贊助者，更謝謝所有會員的參予與支持。學會屬於全體會員，謹期待我們的團結合作，能夠為台灣內分泌、糖尿病、新陳代謝疾病之臨床診療及學術研究發展帶入更光輝永恆的發展。謹祝大家身體健康、萬事如意。社團法人中華民國內分泌學會理事長

2020 年 9 月 5 日 6

Opening Remarks

理事長致詞各位會員女士、先生：欣逢中華民國內分泌暨糖尿病學會成立四十周年，竭誠歡迎各位會員來台北參加第 14 屆第 2 次會員大會暨學術研討會，本次年會雖然受到新冠肺炎的影響而延期，學會仍然籌畫兩天豐富的學術演講，包括國內外學者專家，提供最新的醫療知識予會員們分享學習，也安排部分四十周年紀念活動，期待大家都能有滿滿的收穫。除了參酌國際上包括 ADA 及 EASD 的治療建議，我們持續滾動式修訂「糖尿病治療指引」之外，今年學會也完成了 CGM/CSII 指引，將連同四十周年紀念專刊、明信片，於年會發放給會員們參考、留念。此外我們也召開糖尿病營養工作坊，預計將最新的營養照護相關知識，完整的呈現給會員。年會中我們特別與 AASD 聯合舉辦四十周年紀念學術研討會，會中邀請日本 Prof. Daisuke Yabe、韓國 Prof. Young Min Cho、香港 Prof. Andrea OY Lu 及何橈通教授演講，精彩可期。另外有鑑於近年來眾多的糖尿病藥物臨床試驗的發表以及新科技的應用，我們特別安排 How to interpret clinical trial data 及 New technology in DM management 節目。同時我們也安排了目前熱門的相關議題，包括 DM and Cardiovascular disease、New Paradigm in the Management of Diabetes Kidney Disease、Therapeutic Nutritional Therapy on Diabetes Management、2020 Taiwan DM Atlas、Basic and Clinical Advance in Diabetic Foot Care 等；而在 Basic Research 方面，則邀請了國內兩位專家分享他們的研究成果。今年的 Plenary Lecture, 我們很榮幸邀請到 Prof. George King 與大家分享 Diabetic Complications: The Discoveries of Protective Factors，以及許惠恒院長 : 糖尿病精準醫學，都是非常重要且令人期待的課題。因為疫情，許多外賓無法前來台灣，我們採取了預先錄影錄音的方式解決時差與空間隔閡的難題，但我們仍然鼓勵會員們能在防疫原則無虞下參加實體課程，積極參與討論、分享經驗，獲取新知並拓展視野。感謝所有會員女士先生及貴賓們參與四十周年紀念盛會。相信，因著理監事、會員們的共同努力，此次年會一定能圓滿成功。敬祝大家身體健康，特別於疫情期間，平安順利。社團法人中華民國糖尿病學會理事長謹上

109 年 9 月 5 日 7

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

Board of Directors

（依照姓氏筆劃排序）

The Endocrine Society of the Republic of China(Taiwan) President

曾芬郁 Fen-Yu Tseng

Standing Executive Board

王佩文 Pei-Wen Wang

蔡克嵩 Keh-Sung Tsai

Executive Board

王治元 Chih-Yuan Wang 施翔蓉 Shyang-Rong Shih 陳涵栩 Harn-Shen Chen 歐弘毅 Horng-Yih Ou

李亭儀 Annie Lee 陳思達 Szu-Tah Chen 劉鳳炫 Feng-Hsuan Liu 簡銘男 Ming-Nan Chien

Standing Control Board

張慶忠 Ching-Chung Chang

Control Board

林宏達 Hong-Da Lin

Secretary General

吳婉禎 Wan-Chen Wu

Deputy Secretary General

王舒儀 Shu-Yi Wang 林志弘 Chih-Hung Lin 陳思綺 Szu-chi Chen

林怡君 Yi-Jyun Lin 周振凱 Chen-Kai Chou 邱偉益 Wei-Yih Chiu 蘇登煌 Deng Huang Su

The Diabetes Association of the Republic of China(Taiwan) President

黃建寧 Chien-Ning Huang

Standing Executive Board

杜思德 Shih Te Tu 陳榮福 Jung-Fu Chen

楊偉勛 Wei-Shiung Yang 蔡世澤 Shih-Tzer Tsai

Executive Board

朱志勳 Chih-Hsun Chu 林時逸 Shih-Yi Lin 洪乙仁 Yi-Jen Hung 陳清助 Ching-Chu Chen 裴馰 Dee Pei

李弘元 Hung-Yuan Li 林慶齡 Ching-Ling Lin 胡啟民 Chii-Min Hwu 曾慶孝 Chin-Hsiao Tseng 蘇景傑 Ching-Chieh Su

Standing Control Board

許惠恒 Wayne Huey-Herng Sheu

Control Board

何橈通 Low-Tone Ho 葉振聲 Tjin-Shing Jap

Secretary General

張恬君 Tien-Jyun Chang

Secretary

王俊興 Jun-Sing Wang 李建興 Chien-Hsing Lee 林嘉鴻 Chia-Hung Lin

莊立民 Lee-Ming Chuang 戴東原 Tong-Yuan Tai 田凱仁 Kai-Jen Tien 林昆德 Kun-Der Lin 楊宜瑱 Yi-Sun Yang

Sponsors

The Endocrine Society and the Diabetes Association of the R.O.C (Taiwan) Would Like to Recongnize the Following for Their Support of the 41st Annual Meeting （依照中文筆劃排序）

一成藥品股份有限公司

Success Medical Co., Ltd.

力大圖書有限公司

The Leader Book Company Ltd.

友華醫藥生技股份有限公司

Orient EuroPharma Co., Ltd.

台灣田邊製藥股份有限公司

Taiwan Tanabe Seiyaku Co., Ltd.

台灣安晟信有限公司

Ascensia Diabetes Care Taiwan, Ltd.

台灣百靈佳殷格翰股份有限公司

Boehringer Ingelheim Taiwan Ltd.

台灣協和麒麟股份有限公司

Kyowa Kirin Taiwan Co.Ltd.

台灣諾和諾德藥品股份有限公司

Novo Nordisk Pharma (Taiwan) Ltd.

台灣諾華股份有限公司

Novartis (Taiwan) Co., Ltd.

台灣禮來股份有限公司

Eli lilly and company taiwan

安克生醫股份有限公司

AmCad BioMed Corporation

安沛國際有限公司

Aspen Healthcare Taiwan Limited

艾昆緯股份有限公司

IQVIA Solutions Taiwan Ltd.

法商益普生股份有限公司台灣分公司

IPSEN Pharma Taiwan Branch

美商亞培股份有限公司台灣分公司

Abbott Laboratories Services Llc Taiwan Branch (U.S.A.)

美商默沙東藥廠股份有限公司台灣分公司 Merck Sharp 康成生醫科技有限公司

Kang-Cheng medical Technology Co.,LTD.

新加坡商必帝股份有限公司

Becton Dickinson Holdings Pte. Ltd. Taiwan Branch (Singapore)

嘉德藥品企業股份有限公司

Char Deh Drugs Enterprise Co., Ltd.

臺灣阿斯特捷利康股份有限公司

AstraZeneca Taiwan Limited

歐霈德醫療器材股份有限公司

Oped Asia-Paciﬁc Company Limited

輝瑞先進醫藥股份有限公司

Pﬁzer Advanced Pharmaceutical Company Limited 9

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

主持人、演講者列表 ( 外賓 ) 外賓

單位

Alice Cheng, MD, FRCPC

Associate Professor, Endocrinology and Metabolism, Medicine, University of Toronto

Andrea OY Luk, MBChB (Auckland), FHKCP, FHKAM (Medicine)

Associate Professor, Department of Medicine & Therapeutics Faculty of Medicine, The Chinese University of Hong Kong Specialist in Endocrinology, Diabetes and Metabolism Honorary Associate Consultant, Hospital Authority

Daisuke Yabe, MD, PhD

Professor and Chairman, Department of Diabetes and Endocrinology, Gifu University Graduate School of Medicine, Gifu, Japan; Deputy Director, Division of Diabetes and Endocrinology, Kansai Electric Power Medical Research Institute, Kobe, Japan

Eun Jig Lee, MD, PhD

President of Korean Endocrine Society Chairman, Department of Medicine, Yonsei University, College of Medicine

George L. King, MD

Senior Investigator & Section Head, Vascular Cell Biology; Professor, Harvard Medical School; Director of Research

Meg Jardine, MBBS, PhD

Program Head, Innovative Kidney Research and Head, Renal Trials, George Clinical Associate Professor, Faculty of Medicine, UNSW Sydney

Robert Vigersky, MD

Professor, Department of Medicine, Uniformed Services University of the Health Sciences

Silvio E. Inzucchi, MD

Professor of Medicine (Endocrinology) Yale School of Medicine, New Haven, Connecticut, USA

Takashi Akamizu, MD, PhD President, Asia & Oceania Thyroid Association The First Department of Internal Medicine, Wakayama Medical University Vivien Lim, MBBS, MRCP, MMed, FAMS

President, Asean Federation of Endocrine Societies Chairperson, ICE/AOCE/AFES 2022 Vivien Lim Endocrinology Specialist Centre Gleneagles Medical Centre, Singapore

Young Min Cho, MD, PhD

Professor, Department of Internal Medicine, Seoul National University College of Medicine Director, SNU Baegot Hospital Establishment Promotion Group Director, Committee of General Affairs, Korean Diabetes Association ※ 本次年會外賓演講部分採取預錄方式，現場撥放。 ( 依照 First name 字母順序 )

Moderator & Speaker

主持人、演講者列表 ( 國內 ) 王治元王佩文王舒儀王碩盟朱志勳何橈通吳允升吳婉禎呂金盈李弘元李任光李亭儀李奕德李建興李晏榮杜思德辛錫璋周振凱林宏達林志弘林時逸林宗憲林怡君林承緯林昆德林亮羽林彥宏林家宏林嘉鴻林慶齡林樹福邱偉益施翔蓉施銘朗洪乙仁洪晧彰胡啟民胡雅惠張天鈞張宏猷張家勳張晉誠張雁翔張義芳張慶忠

臺大醫院內科部代謝內分泌科高雄長庚醫院新陳代謝科及核子醫學科彰化基督教醫院新陳代謝科臺大醫院泌尿部高雄榮民總醫院內分泌新陳代謝科臺北榮民總醫院臺大醫院腎臟內科臺大醫院內科部代謝內分泌科臺大醫院內科部代謝內分泌科臺大醫院內科部代謝內分泌科臺大醫院心臟內科台北市立萬芳醫院內分泌新陳代謝科臺中榮民總醫院內分泌新陳代謝科三軍總醫院內分泌新陳代謝科林口長庚醫院內分泌暨新陳代謝科彰基醫療財團法人鹿港基督教醫院高雄醫學大學醫學院內分泌新陳代謝內科高雄長庚醫院內分泌暨新陳代謝科科臺北榮民總醫院臺大醫院內科部代謝內分泌科台中榮民總醫院新陳代謝科高雄醫學大學附設中和紀念醫院心臟血管內科榮陽安心診所林口長庚醫院內分泌暨新陳代謝科高雄醫學大學醫學院內分泌新陳代謝內科臺北榮民總醫院內分泌新陳代謝科臺大醫院心臟內科臺大醫院新竹分院代謝內分泌科桃園長庚醫院內分泌暨新陳代謝科國泰綜合醫院內科林口長庚醫院內分泌暨新陳代謝科臺大醫院內科部代謝內分泌科臺大醫學院內科部代謝內分泌科三軍總醫院外科部三軍總醫院內分泌新陳代謝科成大醫院內分泌新陳代謝科臺北榮民總醫院內分泌暨新陳代謝科台北慈濟醫院新陳代謝科臺大醫院內科部及遠東聯合診所林口長庚醫院內分泌暨新陳代謝科臺大醫院內科部臺大醫院影像醫學部高雄長庚醫院核子醫學科台北馬偕紀念醫院血液腫瘤科中國醫藥大學附設醫院內科部

莊立民莊峻鍠許惠恒郭昇峯郭清輝陳怡文陳明晃陳冠樺陳思達陳涵栩陳清助陳榮福彭康詠曾芬郁曾慶孝黃建寧黃國晉黃禹堯楊文萍楊宜瑱楊偉勛葉日弌葉振聲詹一秀路景竹廖偉丞廖國盟裴馰劉鳳炫歐弘毅蔡世澤蔡克嵩蔡曜聲鄭乃禎鄭媚方鄭祖耀鄭博中鄭畬方戴東原謝易庭簡銘男顏家瑞蘇景傑鐘邦柱

臺大醫院內科部代謝內分泌科林口長庚醫院內分泌暨新陳代謝科臺中榮民總醫院基隆長庚醫院內分泌暨新陳代謝科振興醫院內分泌新陳代謝科林口長庚醫院內分泌暨新陳代謝科臺北榮民總醫院腫瘤醫學部義大醫院新陳代謝科林口長庚醫院內分泌暨新陳代謝科臺北榮民總醫院內分泌暨新陳代謝科中國醫藥大學附設醫院內科部新陳代謝科高雄長庚紀念醫院內分泌暨新陳代謝科臺大醫院內科部台東基督教醫院內分泌新陳代謝科臺大醫院內科部代謝內分泌科中山醫學大學附設醫院台大醫院北護分院林口長庚紀念醫院內分泌新陳代謝科臺北市立聯合醫院仁愛院區內分泌暨新陳代謝科中山醫學大學附設醫院內分泌暨新陳代謝科臺大醫學院臨床醫學研究所花蓮慈濟醫院家庭醫學科為恭紀念醫院新陳代謝科臺大醫院檢驗醫學部臺大醫院核子醫學部台北馬偕紀念醫院內分泌暨新陳代謝科臺北市立聯合醫院忠孝院區內分泌暨新陳代謝科輔大醫院新陳代謝科林口長庚醫院內分泌暨新陳代謝科成大醫院內分泌暨新陳代謝科振興醫院營養治療科臺大醫院內科部及遠東診所成功大學臨床醫學研究所臺大醫院整形外科臺大醫學院核子醫學部臺大醫院檢驗醫學部彰化基督教醫院內分泌新陳代謝科彰化基督教醫院內分泌新陳代謝科台北仁濟醫院台大醫院眼科部台北馬偕紀念醫院成大醫院血液腫瘤科蘇景傑診所中研院分子生物研究所 ( 依照姓氏筆畫順序 )

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

社團法人中華民國內分泌暨糖尿病學會第 14 屆第 2 次會員大會暨學術研討會日期：民國 109 年 9 月 5-6 日／地點：張榮發基金會國際會議中心10-11F

Sep. 5, 2020

PL1: Plenary Lecture 1

【Room 1101 + 1001】 Time

PL1

Topic

13:10-13:15

OPENING

13:15-13:55

類固醇的功能與調控：從分子、細胞、到動物之研究

Sep. 5, 2020 Time

曾芬郁

Speaker

Moderator

OPENING

莊立民

14:00-14:40

DIABETIC COMPLICATIONS: THE GEORGE DISCOVERIES OF PROTECTIVE FACTORS KING

莊立民

PL3: Plenary Lecture 3

Time

Topic

13:45-13:50

OPENING

13:50-14:30

台灣骨鬆及骨折防治之回顧與展望

Sep. 6, 2020

Speaker

Moderator 王佩文

蔡克嵩

王佩文

PL4: Plenary Lecture 4

【Room 1101 + 1001】 Time

鍾邦柱

13:55-14:00

【Room 1101 + 1001】

PL4

曾芬郁

Topic

Sep. 6, 2020

PL3

Moderator

PL2: Plenary Lecture 2

【Room 1101 + 1001】

PL2

Speaker

Topic

14:30-14:35

OPENING

14:35-15:15

精準醫學在糖尿病之應用

Speaker

Moderator 黃建寧

許惠恒

黃建寧

Agenda

Sep. 5, 2020 【Room 1001】 Time MTP-E1

Topic

17:00-18:00 成骨不全症與低磷性軟骨病－系列病例分享

Sep. 5, 2020 【Room 1101】 Time MTP-D1

MTP-E1:Meet the Professor

【Room 1101】 Time 08:30-08:40

Moderator

蔡克嵩

林宏達

MTP-D1:Meet the Professor Topic

17:00-18:00 MOLECULAR MECHANISMS OF DIABETES RELATED CARDIOVASCULAR DISEASES

Sep. 6, 2020

Speaker

Moderator

GEORGE KING

郭清輝

40th Anniversary Symposium

ESROC 40th Anniversary Special Symposium Topic

Speaker

OPENING REMARK

ESROC-S-1 08:40-09:05

TAIWAN ACROMEGALY REGISTRY

ESROC-S-2 09:05-09:30

THYROID STORM

TAKASHI AKAMIZU

ESROC-S-3 09:30-09:55

CUSHING DISEASE: DIFFICULTY IN DIAGNOSIS, LOCALIZATION, AND TREATMENT

EUN JIG LEE

ESROC-S-4 09:55-10:20

ENDOCRINOLOGY IN OSTEOPOROSIS

10:20-10:30

Moderator

曾芬郁

張慶忠蔡克嵩

VIVIEN LIM

CLOSING REMARK 13

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

Sep. 6, 2020 【Room 1001】 Time 08:30-08:35

40th Anniversary Symposium DAROC – AASD Joint Symposium Topic

Speaker

Moderator

OPENING REMARK

黃建寧

DAROC-S-1 08:35-09:00

THE SPECIFIC DAISUKE CHARACTERISTICS OF TYPE YABE 2 DIABETES PATIENTS IN ASIA

黃建寧

DAROC-S-2 09:00-09:25

ENDOTHELIN-1 AS A TARGET FOR INTERVENTION IN METABOLIC SYNDROME

何橈通

葉振聲

DAROC-S-3 09:25-09:50

THE WHOLE PICTURE OF YOUNG-ONSET DIABETES IN HONG-KONG

ANDREA OY LUK

蔡世澤

DAROC-S-4 09:50-10:15

THE APPLICATION OF NEW YOUNG TECHNOLOGY IN THE MIN CHO MANAGEMENT OF DIABETES PATIENT: KOREA EXPERIENCE

李弘元

10:15-10:20

CLOSING REMARK

DAISUKE YABE

Agenda

Sep. 5, 2020 【Room 1101】 Time 09:30-09:35

SE1: Endocrine Symposium 1 Parathyroid Update

Topic

Speaker

Moderator

OPENING REMARK

SE1-1 09:35-10:00

副甲狀腺素之新測定法

呂金盈

SE1-2 10:00-10:25

原發性副甲狀腺高能症

邱偉益

SE1-3 10:25-10:50

次發性副甲狀腺高能症：腎因、骨因及其他病症，以及臨床診斷方法

王舒儀

SE1-4 10:50-11:15

副甲狀腺手術之新進展

施銘朗

11:15-11:30

PANEL DISCUSSION

ALL

李亭儀王治元

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

Sep. 5, 2020 【Room 1001】 Time 15:20-15:25 SE2-1 15:25-15:45

SE2: Endocrine Symposium 2

Tyrosine Kinase Inhibitors (TKIs) in Radioiodine (RAI)Refractory Differentiated Thyroid Carcinoma (DTC) Topic

Speaker

OPENING REMARK DEFINITION AND MANAGEMENT OF RADIOIODINE-REFRACTORY DIFFERENTIATED THYROID CANCER

張雁翔

SE2-2 15:45-16:05

TYROSINE KINASE INHIBITORS FOR RADIOACTIVE IODINE – REFRACTORY DIFFERENTIATED THYROID CARCINOMA

吳婉禎

SE2-3 16:05-16:25

ADVERSE EVENTS OF TYROSINE KINASE INHIBITORS AND MANAGEMENT

張義芳

SE2-4 16:25-16:45

FUTURE PERSPECTIVE OF RADIOIODINE-REFRACTORY DIFFERENTIATED THYROID CANCER

施翔蓉

16:45-16:50

Moderator

PANEL DISCUSSION

陳涵栩陳思達

ALL

Agenda

Sep. 5, 2020 【Room 1002】 Time 15:20-15:25

SE3: Endocrine Symposium 3 Pituitary

Topic

Speaker

OPENING REMARK

SE3-1 15:25-15:50

MANAGEMENT OF RECURRENT CUSHING DISEASE

林亮羽

SE3-2 15:50-16:15

HYPOGONADOTROPIC HYPOGONADISM : CLINICAL PRESENTATION, PATHOGENESIS AND TREATMENT FOR ADULT PATIENT

廖偉丞

THYROID-STIMULATING HORMONESECRETING PITUITARY ADENOMA (TSHoma)

李晏榮

SE3-3 16:15-16:40

16:40-17:00

Sep. 5, 2020 【Room 1008】 Time 15:20-15:25

PANEL DISCUSSION

張慶忠李亭儀

ALL

SE4: Endocrine Symposium 4 Neuroendocrine Tumor (NET) Topic

Speaker

Moderator

OPENING REMARK

SE4-1 15:25-15:50

CLINICAL FEATURES AND BIOMARKERS OF NET

洪晧彰

SE4-2 15:50-16:15

ENDOSCOPIC APPLICATIONS ON NET

鄭祖耀

SE4-3 16:15-16:40

UPDATE OF NET TREATMENT

陳明晃

16:40-17:00

Moderator

PANEL DISCUSSION

曾芬郁劉鳳炫

ALL

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

Sep. 5, 2020 【Room 1002】

SE5: Endocrine Symposium 5

Immunotherapy-related Endocrinopathy

Time 17:00-17:05 SE5-1 17:05-17:25

SE5-2 17:25-17:45

17:45-18:00

Sep. 6, 2020 【Room 1001】 Time 15:40-15:45

Topic

Speaker

THE TANGLE BETWEEN DIABETES AND CANCER RELATED TREATMENT

陳榮福

MONITORING, DIAGNOSIS, AND MANAGEMENT OF IMMUNOTHERAPY INDUCED ENDOCRINOPATHY

鄭博中

OPENING

PANEL DISCUSSION

SE6: Endocrine Symposium 6 Endocrine Disorder in Pregnancy Topic

Speaker

Moderator

OPENING REMARK PREGNANCY-ASSOCIATED OSTEOPOROSIS

楊文萍

SE6-2 16:10-16:35

POSTPARTUM HYPOPHYSITIS

鄭畬方

SE6-3 16:35-17:00

HYPERTHYROIDISM INDUCED BY EXCESS β-HCG

陳冠樺

林怡君施翔蓉

ALL

SE6-1 15:45-16:10

17:00-17:20

Moderator

PANEL DISCUSSION

ALL

施翔蓉劉鳳炫

Agenda

Sep. 6, 2020 【Room 1002】 Time 15:40-15:45

SE7: Endocrine Symposium 7 Nuclear Medicine

Topic

Speaker

OPENING REMARK

SE7-1 15:45-16:10

THE ROLE OF NUCLEAR MEDICINE IN THYROID DISEASE

張雁翔

SE7-2 16:10-16:35

ADRENAL GLANDS

胡雅惠

SE7-3 16:35-17:00

APPLICATION OF PET IMAGING IN NEUROENDOCRINE TUMORS

鄭媚方

17:00-17:20

Sep. 6, 2020 【Room 1006】 Time 15:40-15:45

PANEL DISCUSSION

王佩文林宏達

ALL

SE8: Endocrine Symposium 8 Adrenocortical Carcinoma Topic

Speaker

Moderator

OPENING REMARK

SE8-1 15:45-16:10

腎上腺皮質癌的藥物治療

陳怡文

SE8-2 16:10-16:35

標靶治療和免疫療法

顏家瑞

SE8-3 16:35-17:00

腎上腺皮質癌：外科治療

王碩盟

PANEL DISCUSSION

ALL

17:00-17:20

Moderator

陳思達陳涵栩

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

Sep. 5, 2020 【Room 1001】 Time 09:30-09:35

SD1: DM Symposium 1

How to Interpret Clinical Trial Data Topic

Speaker

OPENING REMARK

Moderator 莊立民

SD1-1 09:35-10:05

OVERVIEW OF EVIDENCE-BASED MEDICINE

葉日弌

莊立民

SD1-2 10:05-10:35

THE KEY CONCEPTS OF CLINICAL TRIAL

廖國盟

何橈通

SD1-3 10:35-11:05

SUPERIOR OR NON-INFERIOR? CRITICAL APPRAISAL OF THREE GLP-1 RECEPTOR AGONIST CARDIOVASCULAR OUTCOME TRIALS FROM A METHODOLOGICAL POINT OF VIEW

張家勳

何橈通

ALL

何橈通

11:05-11:15

Sep. 5, 2020 【Room 1101】 Time 15:20-15:23

PANEL DISCUSSION

SD2: DM Symposium 2

DM and Cardiovascular Disease Topic OPENING REMARK

SD2-1 15:23-15:53

PRIMARY PREVENTION OF CVD IN T2D PATIENTS WITH GLUCOSE LOWERING MEDICATIONS

SD2-2 15:53-16:23 SD2-3 16:23-16:53

16:53-17:00 20

Speaker

Moderator 陳榮福

SILVIO INZUCCHI

陳榮福

HEART FAILURE TREATMENT UPDATE IN THE DIABETICS

林宗憲

朱志勳

GLUCAGON-LIKE PEPTIDE 1 RECEPTOR AGONIST AND CARDIOVASCULAR OUTCOMES TRIALS

黃禹堯

楊偉勛

ALL

楊偉勛

PANEL DISCUSSION

Agenda

Sep. 5, 2020 【Room 1003】

SD3: DM Symposium 3

Therapeutic Nutritional Therapy on Diabetes Management

Time 15:20-15:23

Topic

Speaker

OPENING REMARK

Moderator 黃建寧

SD3-1 15:23-15:53

DIABETES FATIGUE SYNDROME AND SARCOPENIA IN DIABETES PATIENTS

黃國晉

黃建寧

SD3-2 15:53-16:23

DIABETES PATIENT LIFESTYLE THERAPY

張宏猷

曾慶孝

SD3-3 16:23-16:53

NUTRITION INTERVENTION FOR PATIENTS WITH DIABETES AND OBESITY

楊宜瑱

裴

16:53-17:00

PANEL DISCUSSION

黃建寧

SD4: DM Symposium 4

Sep. 5, 2020

Basic Research

【Room 1006】 Time 15:20-15:25

ALL

馰

Topic

Speaker

OPENING

Moderator 莊峻鍠

SD4-1 15:25-15:50

THE TRANSCRIPTIONAL NETWORK IN COMPENSATION FOR THE LOSS OF β-CELL FUNCTION AND IDENTITY

蔡曜聲

莊峻鍠

SD4-2 15:50-16:15

NOVEL APPROACHES FOR THYROID CANCER THERAPY

林樹福

洪乙仁

ALL

洪乙仁

16:15-16:20

DISCUSSION AND CLOSING

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

Sep. 5, 2020 【Room 1003】 Time 17:00-17:03

SD5: DM Symposium 5 2020 Taiwan DM Atlas

Topic

Speaker

OPENING REMARK

Moderator 許惠恒

SD5-1 17:03-17:18

EPIDEMIOLOGY OF DIABETES AND TRENDS IN ANTIDIABTIC MEDICAL TREATMENT FROM 2005 TO 2014 IN TAIWAN

朱志勳

許惠恒

SD5-2 17:18-17:33

ACCOUNTABILITY AND UTILIZATION AND PAY FOR PERFORMANCE FOR DIABETES CARE FROM 2005 TO 2014 IN TAIWAN

李奕德

戴東原

SD5-3 17:33-17:48

HOSPITALIZATION AND TRENDS OF MORTALITY IN DIABETIC PATIENTS: A NATIONWIDE SURVEY FROM 2005 TO 2015 IN TAIWAN

李弘元

莊立民

SD5-4 17:48-18:03

PREVALENCE OF DIABETIC MACRO- AND MICROVASCULAR COMPLICATIONS AND RELATED FACTORS FROM 2005 TO 2014 IN TAIWAN: A NATIONWIDE SURVEY

李建興

杜思德

18:03-18:10

PANEL DISCUSSION

杜思德

Agenda

Sep. 6, 2020 【Room 1101】 Time 15:40-15:43

SD6: DM Symposium 6

New Technology in DM Management Topic

Speaker

OPENING REMARK

Moderator 黃建寧

SD6-1 15:43-16:08

THE LATEST DEVELOPMENT OF TECHNOLOGY IN DIABETES

ROBERT VIGERSKY

陳榮福

SD6-2 16:08-16:33

THE NEW APPLICATION OF A.I. IN DIABETIC RETINOPATHY

謝易庭

蘇景傑

SD6-3 16:33-16:58

THE 2020 CONSENSUS OF CGM AND CSII IN TAIWAN

林嘉鴻

林慶齡

ALL

林慶齡

16:58-17:10

Sep. 6, 2020 【Room 1003】 Time 15:40-15:43

PANEL DISCUSSION

SD7: DM Symposium 7

New Paradigm in the Management of Diabetes Kidney Disease Topic OPENING REMARK

SD7-1 15:43-16:08

COMPLETE THE MISSING PUZZLE FOR CARDIO RENAL SYNDROME

SD7-2 16:08-16:33

THE TREATMENT STRATEGY OF DKD IN CANADA

SD7-3 16:33-16:58

NEW PARADIGM IN THE MANAGEMENT OF DIABETES KIDNEY DISEASE

16:58-17:10

Speaker

PANEL DISCUSSION

Moderator 辛錫璋

MEG JARDINE

辛錫璋

ALICE CHENG

陳清助

林昆德

胡啟民

ALL

辛錫璋

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

Sep. 6, 2020 【Room 1008】 Time 15:40-15:43

SD8: DM Symposium 8

Basic and Clinical Advance in Diabetic Foot Care Topic

Speaker

OPENING REMARK

Moderator 黃禹堯

SD8-1 15:43-16:08

DIABETIC FOOT CARE: THE CHANG GUNG EXPERIENCE AND UPDATED STATUS IN TAIWAN

林承緯

黃禹堯

SD8-2 16:08-16:33

ENDOVASCULAR INTERVENTION IN LOWER EXTREMITY ARTERY DISEASE: NEW TOOLS, TECHNIQUES, AND INDICATIONS

李任光

林時逸

SD8-3 16:33-16:58

CLINICAL APPLICATION OF CELL THERAPY IN TREATMENT OF CHRONIC DIABETIC FOOT ULCERS

鄭乃禎

楊偉勛

ALL

楊偉勛

16:58-17:10

Sep. 5, 2020 【Room 1002】 Time

PANEL DISCUSSION

Memorial of Prof. Jen-Der Lin 林仁德教授紀念演講會 Topic

Speaker

ML-1

10:30-10:40

緬懷林教授—教授生平簡介

劉鳳炫

ML-2

10:40-10:55

林仁德教授的學術研究及展望

林樹福

ML-3

10:55-11:10

甲狀腺癌與放射碘治療

郭昇峯

ML-4

11:10-11:25

循環上皮細胞可偵測甲狀腺球蛋白抗體陽性之甲狀腺乳突癌的復發

李晏榮

Moderator

陳思達

Agenda

Sep. 5, 2020 【Room 1003】 Time 09:30-09:35

JS1-Joint Symposium1

ESROC – TSA Joint Symposium Topic

Speaker

OPENING REMARK

林彥宏

JS1-1 09:35-09:55

THE LONG TERM OUTCOME OF PRIMARY ALDOSTERONISM

吳允升

JS1-2 09:55-10:15

ADRENAL VENOUS SAMPLING: TECHNIQUES AND INTERPRETATION

張晉誠

JS1-3 10:15-10:35

CLINICAL APPLICATION OF NUCLEAR MEDICINE IN PRIMARY ALDOSTERONISM

路景竹

JS1-4 10:35-10:55

AUTONOMOUS CORTISOL SECRETION IN PRIMARY ALDOSTERONISM

吳婉禎

JS1-5 10:55-11:15

GENETIC AND HISTOPATHOLOGIC CHARACTERIZATION OF SPORADIC PRIMARY ALDOSTERONISM

彭康詠

11:15-11:25

PANEL DISCUSSION

11:25-11:30

CLOSING REMARK

Time 09:30-11:30

林彥宏曾芬郁歐弘毅朱志勳

ALL 曾芬郁

Workshop

Sep. 5, 2020 【Room 1007】

Moderator

Thyroid Cytology Workshop Topic THYROID CYTOLOGY

Speaker

Moderator

詹一秀林家宏

張天鈞

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

LS: Lunch Symposium

Sep. 5-6, 2020 ROOM

1101

1001

1002

1003

1006

1007

1008

1005

容納人數

308

211

180

09/05( 六 ) 11:45-12:45

LS1

LS2

LS3

LS4

LS5

LS6

LS7

LS8

默沙東

諾和諾德

阿斯特捷利康

拜耳

輝瑞

賽諾菲

禮來

友華

09/06( 日 ) LS9 12:30-13:30 百靈佳殷格翰

2020/09/05 LS-1

默沙東

LS10

LS11

LS12

LS13

LS14

LS15

諾華

諾和諾德

華廣生技

杏昌

賽諾菲

安克生醫

Topic

Speaker

Moderator

ERTUGLIFLOZIN–A NEWLY EMERGING SGLT2 INHIBITOR FOR PATIENTS WITH TYPE 2 DIABETES

林慶齡

楊偉勛

歐弘毅

黃禹堯

SILVIO E. INZUCCHI

陳榮福

LS-2 諾和諾德 CLINICAL POTENTIAL OF TREATMENT WITH SEMAGLUTIDE IN TYPE 2 DIABETES PATIENTS HAVE WE LOST SGLT2 INHIBITORS TO CARDIOLOGISTS?!

LS-3

阿斯特捷利康

LS-4

拜耳

EVOLVING TREATMENT OPTIONS FOR PATIENTS WITH RAI REFRACTORY DTC: FROM TKI TO PRECISION MEDICINE

諶鴻遠

曾芬郁

LS-5

輝瑞

BEYOND LDL LOWERING EFFECT: HOW TO PROVE PLEIOTROPIC EFFECTS OF STATIN FROM CLINICAL TRIALS TO GENETICS?

李佳霖

胡啟民

MANAGING DIABETIC PERIPHERAL NEUROPATHIC PAIN (DPNP)

蘇郁文

胡啟民

ADVANCES IN INJECTABLE THERAPY: ADDRESSING THE NEED FOR INTENSIFICATION AND HOW WE MAKE IT SIMPLER

蕭雅純

游能俊

SOLIQUA CGMS: HOW FRC IMPROVES GLYCEMIC VARIABILITY AND CONTROL WITHOUT INCREASING HYPOGLYCEMIA

朱志勳

李奕德

LS-6

賽諾菲

LS-7

禮來

PRIMARY PREVENTION OF CVD IN T2D -INSPIRED FROM REWIND STUDY

廖國盟

蔡世澤

LS-8

友華

CURRENT CONCEPT OF LIPID LOWERING THERAPY

李貽恒

杜思德

Agenda

2020/09/06

Topic

Speaker

Moderator

廖國盟

胡啟民

YOUNG ONSET DIABETES: IMPLICATIONS FOR TYPE 2 DIABETES CARE IN THE POST VERIFY ERA

簡銘男

李亭儀

NEW APPROACH TO INITIATION OF INSULIN THERAPY

田凱仁

杜思德

LS-12 華廣生技

控糖新紀元管理新思維

楊宜瑱

黃建寧

LS-13

杏昌

PLEIOTROPIC EFFECT OF AST-120 IN RENAL MEDICINE

盧國城

陳金順

LS-14

賽諾菲

GLYCEMIA MATTERS: HELPING YOUR T2D PATIENTS TO FIND THE RIGHT BALANCE

ALICE CHENG

許惠恒

TITRATION MATTERS: HOW COULD WE CONQUER

江珠影

許惠恒

THYROID NODULE EPIDEMIOLOGICAL STUDY AND COMPUTER-ASSISTED DIAGNOSIS BASED ON MEDICAL GUIDELINES FOR THE HEALTH CHECKUP COHORT

王舒儀

王治元

LS-9 百靈佳殷格翰 T2D LONG TERM CARING STRATEGY : THINK TWICE FOR DIABETES LS-10

諾華

LS-11

諾和諾德

LS-15 安克生醫

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

Sep. 5-6, 2020

【E-Poster Room】

AP: 2020 Award 題目

作者

諾華優秀論文獎 AP-1

RISK OF HEART FAILURE IN A POPULATION WITH TYPE 2 DIABETES VERSUS A POPULATION WITHOUT DIABETES WITH AND WITHOUT THOUT CORONARY HEART DISEASE

AP-2

RACIAL DIFFERENCE IN BIOAVAILABILITY OF ORAL IBANDRONATE BETWEEN CAUCASIAN AND TAIWANESE POSTMENOPAUSAL WOMEN

陳華芬

邱偉益

諾和諾德優秀論文獎 AP-3

DIABETIC FOOT INFECTION PRESENTING SYSTEMIC INFLAMMATORY RESPONSE SYNDROME: A UNIQUE DISORDER OF SYSTEMIC REACTION FROM INFECTION OF THE MOST DISTAL BODY

林承緯

AP-4

EARLY CARDIOVASCULAR RISK AND ALL-CAUSE MORTALITY FOLLOWING AN INCIDENT OF SEVERE HYPOGLYCEMIA: A POPULATION-BASED COHORT STUDY

羅仕昌

Agenda

Sep. 5, 2020 【Room 1007】

OE: Oral Presentation-Endocrine

Time

Topic

Speaker

15:20-15:25

規則說明

OE-1

15:25-15:35

甲狀腺癌腫瘤術後追蹤的生物指標：尿液外泌體蛋白質之先驅研究

黃則穎

OE-2

15:35-15:45

甲狀腺癌 BRAF 突變檢驗方式之比較

陳永年

OE-3

15:45-15:55

停經婦女全甲狀腺切除術後的骨骼肌質量，握力和步態速度

溫緯倫

OE-4

15:55-16:05

甲狀腺亢進與癲癇之風險：以全國人口為對象之研究

劉漢文

OE-5

16:05-16:15

肺癌亦會吸收放射碘：關於甲狀腺癌的世代研究

呂毓苓

OE-6

16:15-16:25

含碘補充劑與社經情況對台灣懷孕女性碘營養之影響

王繁棻

16:25-16:30

CLOSING REMARK

Moderator

王治元歐弘毅簡銘男

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

Sep. 5, 2020 【Room 1007】 Time

OD: Oral Presentation-Diabetes Topic

Speaker

Moderator 陳清助

OD-1

16:40-16:50

恩排糖膜衣錠藥物在東亞常規照護的心血管有效性和安全性：EMPRISE 研究的結果

許惠恒

OD-2

16:50-17:00

第 2 型糖尿病患罹患潛伏結核感染的危險因子

謝靜蓉

OD-3

17:00-17:10

硫化氫可恢復腫瘤壞死因子 -ALPHA- 誘導的 HL-1 細胞線粒體功能障礙和代謝異常

李亭儀

OD-4

17:10-17:20

活化 GLP-1 訊號合併補充 HMB 減弱糖脂毒性所誘發之肌肉衰弱

李欣樺

OD-5

17:20-17:30

第一型腫瘤壞死因子接受體濃度可預測台灣第 2 型糖尿病人腎臟相關預後

張立心

OD-6

17:30-17:40

第二型鈉 - 葡萄糖轉運蛋白抑制劑 (SGLT2 INHIBITOR) 與雙基胜肽抑制劑 (DPP4 INHIBITOR) 在接受一日兩次預混型胰島素注射且控制不佳的第 2 型糖尿病患之療效

曾逸宏

胡啟民

楊偉勛

Agenda

Sep. 5-6, 2020 【E-Poster Room】

PE: Poster Presentation-Endocrine 主持人 : 王舒儀、林志弘、周振凱評分時間 :2020/09/05( 六 ) 14:40 – 15:20 題目

第一作者

PE-1

SANDOSTATIN LAR 20 毫克對於肢端肥大症手術未完全的患者的療效

洪子清

PE-2

復發性副甲狀腺癌的預後因子：52 年文獻回顧之合併分析

蔡文瑄

PE-3

以反複性昏厥表現之嗜鉻細胞瘤

林彥宇

PE-4

尿液外泌體蛋白質：甲狀腺癌腫瘤術後追蹤的新型指標

王治元

PE-5

腎小管內外鉀離子梯度預測原發性醛固酮增多症的末端器官損害

廖宏偉

PE-6

結節大小很重要：射頻消融術後甲狀腺結節破裂之處理

陳玟潔

PE-7

尿液鈉鉀比例和原發性高醛固酮症病患接受腎上腺切除術之預後有關

李明澤

PE-8

腰椎與髖關節之骨密度差異於前列腺癌合併骨頭轉移之病例

陳淑金

PE-9

個案報告：葡萄胎引起之甲狀腺亢進

陳冠樺

PE-10

雙磷酸鹽對心血管疾病後骨質疏鬆症患者死亡率和心血管風險的影響

吳書婷

PE-11

以淋巴或遠處轉移為起始表現的甲狀腺癌 - 病例報告及文獻回顧

林麗珊

PE-12

結核性腦下垂體炎擬似自體免疫腦下垂體炎：個案報告

陳亭均

PE-13

甲狀腺乳突微小癌經皮超音波射頻消融成效評估：台灣經驗

林偉哲

PE-14

R2 手術切除對於分化型甲狀腺癌的治療反應和成果 - 回溯性分析

周依文

PE-15

RIEDEL 甲狀腺炎在甲狀腺超音波檢查以擬似惡性腫瘤為表現之病例報告

林祐霆

PE-16

民國 108 年北台灣都會區哺乳婦女之碘營養調查

黃君睿

PE-17

METHIMAZOLE 引起之膽汁淤積性黃疸：一案例報告

郭峯瑞

PE-18

腦下垂體甲狀腺促進素細胞腺瘤之病患致不孕症於腺瘤切除後成功受孕後分娩之個案報告

吳家德

PE-19

葛瑞夫茲症病人使用 METHIMAZOLE 發生嗜中性白血球細胞質抗體及抗基底膜抗體陽性的快速進行性腎絲球腎炎之案例報告

陳維常

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

Sep. 5-6, 2020 【D-Poster Room】

PD: Poster Presentation-Diabetes 主持人 : 楊宜瑱、林嘉鴻、王俊興評分時間 :2020/09/05( 六 ) 14:40 – 15:20 題目

第一作者

PD-1

以內分泌新陳代謝專科醫師為主之更好的糖尿病照護品質

楊晉州

PD-2

CANAGLIFLOZIN 對於接受一天多次胰島素注射控制不佳的第 2 型糖尿病患在臨床上的療效與安全性

韓承翰

PD-3

GLARGINE U-300 注射過量導致嚴重且持續性的低血糖－病例報告

陳瑋霖

PD-4

家族性乳糜微粒血症症候群：十年追蹤個案報告

王威傑

PD-5

台北市老人的運動與死亡相關研究

賴韻如

PD-6

SECUKINUMAB 造成糖尿病酮酸中毒各案報告

李瑞祥

PD-7

低劑量吡格列酮在非酒精性脂肪肝炎之效果－一病例報告

周宣

PD-8

糖尿病病人之皮質性視損傷個案報告

邱酩淳

PD-9

團體衛教課程運用在服用 SGLT-2 INHIBITORS 藥物第 2 型糖尿病病人之成效

陳亭妤

PD-10

透過 GLP-1RAS 注射介入對於第 2 型糖尿病人在血糖控管及身體組成的影響

盧嫚妮

PD-11

一位 METFORMIN 造成乳酸中毒個案報告

李瑞祥

PD-12

台灣第 2 型糖尿病人合併小血管病變之住院中死亡原因

杜青玲

PD-13

關於 ASPIRIN 和 DIPYRIDAMOLE 對第 2 型糖尿病病人的肝細胞癌風險的影響

黃幸儀

PD-14

以智慧資訊系統輔助改善住院病人的血糖控制

朱嘉琳

PD-15

第 2 型糖尿病老年患者在糖尿病酮酸中毒的臨床表現及預後因子

蔡文瑄

PD-16

GLP-1 針劑結合團體運動療程在第 2 型糖尿病之治療成效

陳思羽

PD-17

台灣基層第 2 型糖尿病患併發症和降血糖用藥普查

蔡昆原

Agenda

題目

第一作者

PD-18

在華裔第 2 型糖尿病病患使用一週一次 DULAGLUTIDE：病患基台灣禮來股份期 BMI 對於醣化血色素和體重的影響有限公司

PD-19

比較 DULAGLUTIDE 相較於基礎胰島素在從未打針的第 2 型糖台灣禮來股份尿病病患的用藥尊囑性和持續性：THE DISPELTM STUDY 有限公司

PD-20

DULAGLUTIDE 相對於基礎胰島素在從未打針的第 2 型糖尿病台灣禮來股份病患有更好血糖控制有效性：THE DISPELTM STUDY 有限公司

PD-21

DULAGLUTIDE 相對於基礎胰島素按尿蛋白狀態在第 2 型糖尿台灣禮來股份病併中重度慢性腎病變病患的慢性腎病變結果： AWARD-7 有限公司

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

PL-1

STEROID FUNCTION AND REGULATION: MOLECULAR, CELL, AND ANIMAL STUDIES BON-CHU CHUNG Institute of Molecular Biology, Academia Sinica, Taipei, Taiwan

Steroids are widely used in medicine and are notorious for their side effects. We aim to study novel functions of steroids in the body and their regulation, with an emphasis of steroid biosynthesis. Three different aspects of steroid functions have been the focus of our investigation. I. Actions of neurosteroid pregnenolone We would like to examine the action of neurosteroids in the brain in order to find a better neurosteroid for the treatment of brain diseases. We previously showed that neurosteroid pregnenolone promotes cell migration by binding to and activating microtubule-binding protein CLIP-170 to stabilize microtubules. Current research focuses on the mechanism of dynamic neurosteroid actions. II. Regulation and functions of steroidogenic genes The first two steps of steroid synthesis are catalyzed by enzymes encoded by CYP11A and HSD3B. In addition to influencing reproduction and endocrine metabolism, we showed that zebrafish cyp11a1 and hsd3b2 controls embryo morphogenesis. Their action mechanism during morphogenesis will bring novel insight about steroid actions. III. Regulation of zebrafish gonad development Zebrafish has been a popular model organism for genetic analysis, but the control of its gonad development is unclear. We would like to understand the factors that control gonad differentiation and sex determination. Both methods of candidate gene approach and transcriptome analysis will be used to understand the mode of germ cell differentiation.

Abstract PL-2

DIABETIC COMPLICATIONS: THE DISCOVERIES OF PROTECTIVE FACTORS GEORGE KING Harvard Medical School, Boston, MA

Diabetic complications are the leading cause of morbidity and mortality in people with diabetes. In spite of the great strides that have been made in the medical care of people with diabetes, diabetic complications are still the leading causes of kidney failure, loss of vision, limb amputation, cardiovascular disease, and now a major contributor to the development of cognitive decline and certain forms of cancers. The major known risk factors are hyperglycemia, insulin resistance, dyslipidemia, and hypertension. However, recently it is also clear that the presence and severity of the complications of diabetes are counter-balanced by endogenous protective factors which have begun to be identified. Clinical longitudinal studies have shown that a majority of people with diabetes with microalbuminuria will not progress to chronic end stage renal disease. The Joslin Medalist Study which has followed a cohort of over a thousand subjects (N = 1023) with duration of insulindependent diabetes > 50 years (mean duration = 67 years) has clearly demonstrated that over 35% of the Medalists do not have significant retinopathy, nephropathy, and neuropathy, even in the presence of hyperglycemia. Studies including the clinical characteristics, biochemical genetic and “omic” analysis of the Medalists’ blood and specific tissues such as retina or the kidney have identified protective profiles that are associated with lack of significant abnormalities in the retina and kidney, even with hyperglycemia of long duration. Analysis of the glomeruli from protected and non-protected Medalists and people with type 1 and 2 diabetes, has identified that the preservation of enzymes of glycolysis and mitochondria has the ability to preserve glomerular cells from early death and loss of function. Further, the activation of glycolytic enzyme pyruvate kinase M2 can reverse metabolic memory in animal models of diabetic nephropathy. Similarly, the elevations of a unique retinal photoreceptor protein (RBP-3) were associated with prevention of retinopathy in the Medalists, and its overexpression prevented and stopped the progression of diabetic retinal pathology in rodent models of diabetic retinopathy. These studies of the Joslin Medalist Study have identified novel protective factors for diabetes retinopathy and nephropathy which can be used as new therapeutic agents for diabetes complications.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

PL-3

台灣骨鬆及骨折防治之回顧與展望蔡克嵩臺大醫院檢驗醫學科及內科

骨鬆症因盛行率高，病人數超過糖尿病，WHO 已將之定義為第二重大的流行病。骨鬆症又以婦女停經後發生者為最大宗。其致病的最重大因素是老化與缺乏雌激素。老化所造成之生理現象是破骨作用增加而造骨作用減少。依此現象看，骨鬆症實是骨代謝問題造成，屬代謝內分泌疾病。但在台灣，骨鬆症的預防及治療，比起糖尿病及其他內分泌代謝疾病，較晚被歸類於代謝內分泌科醫師的範圍。測量骨量的雙光子核醫骨密儀在 1984 年左右開始引進國內。其後抑鈣素、雙磷酸類藥物、 SERM 類及 1-34 副甲胜肽、 RANKL 單株抗體等藥物陸續為台灣健保採納。骨密儀在 1990 年後大都改用 X 光雙能量方式，速度大增，費用也大減。但因濫用嚴重，遭健保設限，只能給付於已有骨鬆骨折及其他少數病人。給付用藥則限於已有較低之骨密度，且已有脊椎或髖部骨折之病人。這就有如已發生中風之病患才給付高血壓藥物一樣。另一方面，台灣的病人在使用中長期之抗破骨細胞藥物後，發生顎骨壞死的機會遠較歐美所報告的機率高，一般民眾也較不願意接受雙磷酸鹽甚至抗 RANKL 單株抗體之藥物治療，從而造成治療上的困擾。此外，相對於糖尿病藥物近十五年之快速發展而各類藥物不斷推陳出新，骨鬆新藥的發展則因種種因素而失敗，這十年來均沒有新藥上市，殊為可惜。對於藥物治療對象之決定，全球均漸以未來骨折風險之高低來決定，台灣也有專用之評估工具可用。由於骨鬆骨折之原因還包括肌肉及關節問題所導致之傷害，近年來全球骨鬆骨折之防治已將肌少症及關節疾病之防治包含在內。由於骨鬆症的病人需要長期治療、定期檢查、衛教及追蹤，所以我們也比照糖尿病管理，建立個案管理制度。台灣在骨鬆骨折個案管理之推動，享譽全球。骨鬆症的治療經過四十年的發展，已建立了完整的診斷方法。骨折風險評估系統及既有的藥物，加上神經、肌肉及關節之保健和通行的個案管理制度，可以大幅減少骨折風險。不過台灣目前仍是全亞洲骨折最盛行的地區，值得我們醫界同仁繼續努力，一起加強防治工作。

Abstract PL-4

PRECISION MEDICINE IN DIABETES WAYNE HUEY-HERNG SHEU Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

Although the main feature of type 2 diabetes is chronically hyperglycemia, its etiology and pathophysiology vary greatly. With the help of advanced technology and biology, we had better understanding of diabetes and its complex traits. Globally, several precision medicine initiatives plus consortia that generate huge genotypes data while enriched phenotype data from electronic medical records or insurance data drive precision medicine to further step. The practice of precision diabetes medicine is currently confined to rare monogenic forms of the disease. However, because characterizing variation in a patient’s nuclear genome is inexpensive and easily achieved and DNA variation remains constant across the life course, it is likely that genetic sequences will feature in most patients’ clinical records. As genetic databases grow, genotypes will be increasingly used to discover new drug targets. In addition, the roles other‘omics technologies, digital imaging devices, and wearable devices will play in precision diabetes medicine. Finally, many precision medicine initiatives focus predominantly on pharmacotherapy, optimizing lifestyle (and possibly surgical) interventions using biotechnologies also has great potential for improving type 2 diabetes prevention and treatment.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

MTP-E1

成骨不全症與低磷性軟骨病－系列病例分享蔡克嵩臺大醫院檢驗醫學科及內科

除婦女的停經後骨鬆症以及兩性都有的老年性骨鬆症之外，內分泌代謝醫師也會應骨科或腎臟科醫師的照會，一起照顧其他的代謝性骨病患者。同仁們不妨大略了解一下這些疾病的診斷和治療。軟骨病以骨疼痛及明顯升高的鹼性磷酸酶濃度為醫師所要注意的診斷警訊。其中又以低磷性軟骨病為大宗。維他命 D 缺乏引起的軟骨病反而在台灣少見。所以對所有疑有骨鬆症的病人，血清鈣磷及鹼性磷酸酶三項都應被列為必要檢驗項目。以單一病因而言，低磷性軟骨病大部分病人屬腫瘤相關軟骨病 (tumor induced osteomalaisia, TIO)，少部分是 B 肝藥物、多發性骨髓瘤等引起的腎小管傷害導致。其診斷與治療將在演講時細述。成骨不全症 (osteogenesis imperfecta) 是第一型膠原蛋白基因缺陷所導致。病人有不同程度的骨構造缺陷及骨量不足。嚴重者在胎兒時期就於子宮中骨折而早逝。輕微者可能在中老年時以一般骨鬆症，但較為嚴重的方式呈現。骨密度通常會較低，但也有家族是以超乎正常的高骨密度，但仍易骨折的形式呈現。 ( 將於演講時一併介紹 )

Abstract ESROC -1

TAIWAN ACROMEGALY REGISTRY FEN-YU TSENG National Taiwan University Hospital, Taipei, Taiwan

Taiwan Acromegaly Registry was performed with the objectives to describe epidemiological data, treatment outcomes, and quality of life (QOL) of patients with acromegaly in Taiwan. From 2013 to 2015, subjects with acromegaly were recruited through five medical centers. After enrollment, each patient was kept on observation for 1 year. The analyzed cohort included 272 acromegalic subjects (117 males, 155 females) with a mean age of 51.4 ± 12.9 years. Their mean age at diagnosis was 41.8 ± 12.1 years. The duration between the onset of symptoms/signs and diagnosis was 6.9 ± 8.1 years. Around 70.3% patients harbored a macroadenoma. At enrollment, percentages of patients ever received surgical intervention, radiotherapy, somatostatin analogs, and dopamine agonists were 94.8%, 27.9%, 64%, and 30%, respectively. At the final following-up visit, the remission rate assessed by random GH level ( ≤ 2 μg/ L) was 63.8%. The mean AcroQoL scores for the total 22 items were 64.0 ± 19.7. Remission, defined by normalization of IGF-1, had significant positive association with QOL scores in psychological/ appearance (PSY/APP) dimension. Somatostatin analogues therapy had negative associations with total score and score in psychological (PSY) dimension. Diabetes mellitus had negative associations with score in PSY dimension and psychological/personal relations (PSY/PER) dimensions. Cerebral vascular accident (CVA) had significant negative associations with total score and scores in physical (PHY), PSY, and PSY/PER dimensions. All these associations remained significant even after adjusted with sex and age. This study described the profiles of acromegaly in Taiwan. It is important to enhance early diagnosis and timely commencement of treatment to prevent serious complications of acromegaly. Our analysis suggested that not only hormone control but also therapeutic regimens and presence of comorbidities might affect QOL of patients with acromegaly in some dimensions.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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ESROC -2

THYROID STORM TAKASHI AKAMIZU The first department of Medicine, Wakayama Medical University, Japan

Thyroid storm (TS) is a life-threatening disorder with over 10% mortality. In the mid-2000s, its incidence was poorly defined, peer-reviewed diagnostic criteria were not available, and management and treatment did not seem to be verified based upon evidence and latest advances in medicine. We first developed diagnostic criteria based on literature and our patients. We then conducted initial and follow-up surveys from 2004 through 2008, targeting all hospitals in Japan to obtain and verify information on patients who met diagnostic criteria for TS. Based on these nationwide-survey data, we revised the diagnostic criteria. Furthermre, including the latest information, guidelines for the management and treatment for TS were extensively revised and algorithms were developed. A prospective prognostic study to validate the guidelines is currently ongoing. References 1. Akamizu T. Thyroid Storm: A Japanese Perspective. Thyroid. 2018 28:32-40 2. Satoh T, Isozaki O, Suzuki A, Wakino S, Iburi T, Tsuboi K, Kanamoto N, Otani H, Furukawa Y, Teramukai S, Akamizu T. 2016 Guidelines for the management of thyroid storm from The Japan Thyroid Association and Japan Endocrine Society (First edition). Endocr J. 2016 63:1025-1064. 3. Isozaki O, Satoh T, Wakino S, Suzuki A, Iburi T, Tsuboi K, Kanamoto N, Otani H, Furukawa Y, Teramukai S, Akamizu T. Treatment and management of thyroid storm: analysis of the nationwide surveys: The taskforce committee of the Japan Thyroid Association and Japan Endocrine Society for the establishment of diagnostic criteria and nationwide surveys for thyroid storm. Clin Endocrinol (Oxf). 2016 84:912-8. 4. Akamizu T, Satoh T, Isozaki O, Suzuki A, Wakino S, Iburi T, Tsuboi K, Monden T, Kouki T, Otani H, Teramukai S, Uehara R, Nakamura Y, Nagai M, Mori M; Japan Thyroid Association. Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys. Thyroid. 2012 22:661-79

Abstract ESROC -3

CUSHING’S DISEASE: DIFFICULTY IN DIAGNOSIS, LOCALIZATION & TREATMENT EUN JIG LEE Endocrinology, Pituitary Tumor Center, Severance Hospital, Yonsei University, College of Medicine, South Korea

Cushing’s disease (CD) is a rare disease caused by ACTH secreting pituitary tumors, which cause the overproduction of glucocorticoid by the adrenal cortex. Because the overall mortality of patients with uncontrolled hypercortisolism is 4–5 times greater than that in the general population, appropriate treatment of CD is important. Surgical removal of the pituitary adenomas is the treatment of choice in patients with CD; however, until now there have been limitations for diagnosis and localization of the tumor because about 40–50% of corticotroph adenomas are too small to be detected even though by dynamic MR imaging. It has been reported, improved preoperative localization increases the cure rate of transsphenoidal surgery (TSS). Two principal preoperative examinations, inferior petrosal sinus sampling (IPSS) and dynamic MRI imaging are used to identify the tumor. None of the tests used in the diagnosis of CD is 100% reliable, and the best method for localizing pituitary microadenomas remains a challenge. Therefore, particularly in patients with discordant results between IPSS and MRI, the outcome of patients is primarily influenced by the neurosurgeon’s ability. In this session, with illustration of CD patients, we will discuss 1. Diagnosis and differential diagnosis of CD; 2. Usefulness of high-resolution MRI and IPSS for localizing pituitary adenomas; 3. A variety of MR imaging technologies to detect invisible tumor at initial dynamic MRI; 4. A concept, surgical and histological identification (SHI) of tumors while operation by neurosurgeon; and 5. Effectiveness of new steroidogenesis inhibitor.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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ESROC -4

ENDOCRINOLOGY IN OSTEOPOROSIS VIVIEN LIM Vivien Lim Endocrinology Specialist Centre, Gleneagles Medical Centre, Singapore

Practical aspects of osteoporosis Osteoporosis is underdiagnosed in Asia and globally. There are pitfalls associated with every aspect of its management from diagnosis to management, not least of which are the secondary endocrine causes that are linked with it. The talk will focus on some pearls of management of various aspects of osteoporosis and will be illustrated by case studies.

Abstract DAROC-2

ENDOTHELIN-1 AS A TARGET FOR INTERVENTION IN METABOLIC SYNDROME LOW-TONE HO Departments of Medical Research and Internal Medicine, Taipei Veterans General Hospital, and National YangMing University School of Medicine

“Metabolic Syndrome” (Mets) is a cluster of “pre-disease states” including diabetes, hypertension, dyslipidemia and obesity, with common roots in insulin resistance (IR) and low grade systemic inflammation (LGSI). The molecular mechanism linking high blood pressure (BP) and glucose (PG) in Mets is still not clear. Endothelin-1 (ET-1) is the most potent endogenous vasoconstrictive polypeptide with action much longer than another similarly potent angiotensin-II (AT2). Both ET-1 and AT2 are well known deeply involved in pathophysiology of hypertension and many other cardiovascular events. We firstly discovered ET-1 inhibited insulin-stimulated-glucose-uptake (ISGU) in rat adipocyte via ET-1 receptor and post-insulin binding mechanism. A series of subsequent experiments have accumulated convincing evidences supporting its pivotal role in the development of Mets in rats. These include as following: (1) Modest hyperinsulinemia (HI) induced by exogenous insulin caused sequential elevations in order of plasma triglyceride (TG) and ET-1 levels, then BP and PG finally, of which BP elevation was abolished by pretreatment with ET-1 receptor A antagonist (ETARA). (2) Similarly an endogenous HI model of fructose fed rat (FFR) also showed same phenomena. (3) Increase of plasma ET-1 level and sensitivity to ET-1 induced aortic ring constriction was found in the FFR and also upregulation of mRNA of ET-1 and ETAR in their tail vessel walls. (4) Infusion of physiological doses of ET-1 in conscious rats induced IR shown by glucose clamp and mild PG elevation. (5) AT2 enhanced ET-I induced vasoconstriction via upregulating ETAR in aortic ring, and via increase of binding capacity and decrease of binding affinity to ETAR in the aortic tissue of a high fat rat (HFR) model of Mets. (6) Combination of sub-pressor doses of ET-1 and AT2 caused persistent hypertension. (7) Other evidence related to ET-1’s role in atherosclerosis: enhance lipolysis in vivo and in vitro; decrease of cholesterol efflux from macrophages via degradation of ABCG1; and stimulation of proliferation and migration of vascular smooth muscle cells (VSMC), etc. In summary of these evidences, a hypothesis may be formed so that ET-1 may negatively interact with insulin in its metabolic pathway, i.e., IR, in conjunction with its vasoconstrictive potency to induce hypertension, and meanwhile synergistically with its mitogenic pathway, e.g., proliferation and migration of VSMC, fatty acid metabolism interact with inflammatory macrophage and foam cells to induce atherosclerosis. Suffice it to say, ET-1 serves well as a target for intervention of Mets in animal models. Although there are a few ET-1 receptor antagonists are available in clinical use, better efficacy and safety profiles are yet to find, in aspects of either intervention or prevention of Mets in clinical trials. A platform of high throughput cell based drug screening system has been established, which composed of ETAR and ETBR transfected cell lines for both screening and counter-screening purposes. However, it always needs luck in the realm of drug discovery. 43

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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DAROC-3

THE WHOLE PICTURE OF YOUNG-ONSET DIABETES IN HONG KONG ANDREA LUK Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong

The burden of type 2 diabetes is rising in all parts of the world with rapid increases observed in Asia. Using territory-wide database of over 0.5 million Hong Kong people with diabetes, we detected increases in incidence rates of type 2 diabetes in youth and young adults but not in older groups. In wider Asia, up to one in five people with diabetes were diagnosed before the age of 40 years. People with young-onset diabetes have higher lifetime risks of diabetes-related complications and consume more healthcare resources than their usual-onset counterparts. We estimated that a person with youngonset diabetes will spend approximately 100 days in hospital by the age of 75 years. Furthermore, the life expectancy of a person with diabetes at the age of 40 years is shortened by 7-8 years. Whilst complication and mortality rates have declined for most people with diabetes over the past two decades, improvements were not observed in the young. This is in part related to suboptimal control of blood glucose due to poorer adherence to diabetes self-management and therapeutic inertia. Undertreatment also pertains to other metabolic risk factors. The challenge in the management of youngonset diabetes is compounded by the heterogeneity in the underlying cause and clinical phenotypes. From the Hong Kong Diabetes Register, among people with young-onset diabetes, 10% have type 1 diabetes based on classical presentation with diabetic ketoacidosis, and another 8% habour antiislet autoantibodies and have latent autoimmune diabetes. The mechanisms underlying progression of diabetes determine response to glucose-lowering treatment and prognosis. Treatment algorithms incorporating genetic and clinical biomarkers to guide drug therapy in young people are desirable but this will require vigorous evaluation in well-executed clinical trials. There are windows of opportunity to intervene early in the clinical trajectory of people with young-onset diabetes who are most likely to benefit from metabolic legacy.

Abstract DAROC-4

APPLICATION OF NEW TECHNOLOGY IN THE MANAGEMENT OF DIABETES PATIENT: KOREA EXPERIENCE YOUNG MIN CHO Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea

Diabetes is a chronic disease requiring lifelong management with lifestyle modification, medication, or both; therefore, diabetes self-management education and adherence to the treatment plans are considered key components in the management of diabetes. As information technology (IT) advances, medical services using IT devices such as mobile healthcare (mHealth) systems have been developed to aid chronic disease management. Currently, approximately 259,000 mHealth applications are available from major application stores. Among various chronic diseases, an IT-based intervention has most frequently been applied to diabetes. Although there was considerable heterogeneity among different applications and patient characteristics, a recent systematic review and meta-analysis of the mHealth application for diabetes self-management (which included 13 randomized, controlled studies with 1,022 patients with type 2 diabetes) showed that the overall HbA1c reduction was -0.40% (95% CI: -0.69 to -0.11%). However, smartphone applications for the management of type 2 diabetes that deal with diet, physical acitivity, glucose monitoring, insulin titration, and social networking service altogether are not common. In addition, although there are numerous commercial smartphone applications for diabetes management, only a few small-scale, randomized, controlled trials have examined their glucose-lowering efficacy. We also developed a smartphone-based, patient-centered diabetes care system (mDiabetes) featuring an individualized diabetes management algorithm, automatic input of daily glucose levels and physical activity, guidance for basal insulin dosage, and a range of interactive components, including a social networking service. In the 12-week, single arm, non-controlled pilot study, HbA1c decreased by 0.6% from baseline and was accompanied by significantly improved diabetes self-management in areas including diet, exercise, and blood glucose monitoring. Recently, we upgraded the mDiabetes system and conducted a 24-week, multicenter, randomized, controlled trial to evaluate its efficacy and safety. HbA1c reduction from baseline was greater in the mDiabetes group (-0.40 ± 0.09%, n = 90) than in the control group (-0.06 ± 0.10%, n = 82). The difference of adjusted mean changes was 0.35% (95% CI: 0.14-0.55, p = 0.001). The proportion of patients whose HbA1c fell below 7.0% (53 mmol/mol) was 41.1% for the mDiabetes group and 20.7% for the control group (OR = 2.01, 95% CI: 1.240-3.25, p = 0.003). The number of patients who attained HbA1c levels below 7.0% (53 mmol/mol) without hypoglycemia was 31.1% in the mDiabetes group and 17.1% in the control group (OR = 1.82, 95% CI: 1.03–3.21, p = 0.024). There was no difference in the event numbers of severe hyperglycemia and hypoglycemia between the two groups. From our experience, we may conclude that the implementation of the mDiabetes for patients with inadequately controlled type 2 diabetes resulted in a significant reduction in HbA1c levels, with tolerable safety profiles. 45

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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SE1-1

PARATHYROID HORMONE NEW ASSAYS JIN-YING LU Department Internal Medicine, National Taiwan University Hospital, Taipei , Taiwan

Parathyroid hormone (PTH) is a peptide molecule containing 84 amino acids with a molecular weight of 9,500 Daltons and is secreted by the four parathyroid glands located behind the thyroid. PTH plays a major role in the regulation of calcium and phosphate metabolism. Many disorders resulted from dysregulation of PTH secretion. Primary hyperparathyroidism due to parathyroid hyperplasia or adenoma causes increased bone resorption, hypercalcemia, and hypophosphatemia. Hypoparathyroidism as a complication of thyroid surgery results in adynamic bone disease, hypocalcemia, and hyperphosphatemia. Chronic kidney disease often hampers the excretion of phosphate and thus causes secondary hyperparathyroidism and renal osteodystrophy. The correct measurement of PTH is especially important for the diagnosis and evaluation of therapeutic effects for these disorders. The biological activity of PTH derives from the interaction between its N-terminal 34 amino acids 1-34 (PTH 1-34) and the PTH receptor. The C-terminal amino acids 7-84 (PTH 7-84) even suppresses the receptor and exerts an opposite effect to those of whole PTH. There are several different PTH N- and C-terminal fragments in normal circulation. How to measure exactly the whole length PTH and avoid the inactive fragments is the major concern of clinical laboratory. Correct measurements of different PTH fragments is crucial for the diagnosis, treatment, and prognosis of many different disorders. In clinical laboratories, the conditions of blood collection and storage, and different assay methods all affect the measurements of PTH. The first-generation immunoassay is radioimmunoassay (RIA) uses an antibody against the C-terminal PTH (c-PTH), which might detect the inactive fragments of PTH and thus has already been abandoned from clinical use. Excluding the first- generation immunoassay, in current laboratories we have two kinds of assays for the examination of PTH, the second-generation immunoassay detects the intact PTH (i-PTH) and has been thought to detect only the active form of PTH. However, it is later noted to also detect the inactive N-terminal PTH 7-84. The third-generation PTH immunoassay detects only the whole PTH (w-PTH) containing the N-terminal amino acids. However, almost all clinical laboratories still use the second-generation immunoassays to detect i-PTH, thus might lead to falsely elevated results when measuring the concentration of serum PTH levels in patients with chronic kidney disease.

Abstract SE1-2

原發性副甲狀腺高能症邱偉益臺大醫院內科部代謝內分泌科

原發性副甲狀腺高能症一種常見的內分泌疾病，其特徵在於高鈣血症和血清副甲狀腺素濃度升高或過高，現今主要是由生化檢驗數據異常而診斷。在過去的 50 年中，原發性副甲狀腺高能症最常見的臨床表現，如尿路結石，骨病變等症狀已不如以往明顯，演變為幾乎無症狀的疾病。原發性副甲狀腺高能症的臨床表現變異進一步擴大，一個新的特異型態已逐漸被注意，那就是血鈣正常的原發性副甲狀腺高能症。在排除造成副甲狀腺高能症的繼發原因後，可診斷為血鈣正常的原發性副甲狀腺高能症。但是相關自然史、手術的適應症和術後成效的研究數據有限，將從此病的定義、流行病學、診斷、臨床表徵及其治療做一個扼要的整理。

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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SECONDARY HYPERPARATHYROIDISM: ETIOLOGY AND DIAGNOSIS SHU-YI WANG Department of Endocrinology & Metabolism, Changhua Christian Hospital, Taiwan

Secondary hyperparathyroidism (SHPT) is characterized by an increase in parathyroid hormone (PTH) that is appropriate and in response to a stimulus low serum calcium. The most common causes of secondary hyperparathyroidism are chronic kidney failure but can also be seen in a variety of bone and metabolic conditions (e.g. malnutrition, malabsorption, vitamin D deficiency, lithium use, thiazide use and chronic cholestasis). The recent increase in bariatric surgery has created an emerging population of patients with malabsorptive syndromes. SHPT is a common complication in chronic kidney disease. Hypophosphatemia, decreased 1,25-dihydroxyvitamin D, and the resultant slight decrease in serum calcium, fibroblast growth factor 23 (FGF23) have been considered to the main contributors to the pathogenesis of SHPT. Elevated PTH levels are associated with an increased risk of mortality and cardiovascular outcome. High-turnover bone disease has been the most widely recognized consequence of SHPT. The best treatment for SHPT is fixing the cause. For patients with kidney failure, the main treatments include phosphate binders, vitamin D supplements, and calcimimetics. The main reasons for a parathyroidectomy include: worsening bone density, severe pruritus, calciphylaxis, PTH levels that are consistently higher than 800 pg/ml, and inability to control calcium and phosphorus levels by dialysis.

Abstract SE1-4

RECENT ADVANCES IN SURGICAL TREATMENT FOR PRIMARY HYPERPARATHYROIDISM SI-YUAN WU, MING-LANG SHIH Division of General Surgery, Department of Surgery, Tri-Service General Hospital, Taipei, Taiwan

Parathyroidectomy is the sure treatment for primary hyperparathyroidism. The hypercalcemia, bone density loss, and urolithiasis could be cured by surgery. Minimally invasive parathyroidectomy, which uses a small incision and minimal dissection, has become the preferred surgical procedure since 2000. However, it requires more dedicated preoperative planning and intraoperative decision making than a traditional standard bilateral neck exploration. Several new technologies, including 4DCT scans, intraoperative PTH analysis, or even autofluorescence, have been introduced to optimize preoperative planning and intraoperative decision. The clinician needs to recognize the advantages and limitations of each tool. A successful parathyroid surgery involves multidisciplinary teamwork. We will cover the surgical indication, proper use of the localization tests, parathyroid exploration procedure, and intraoperative verification of disease gland removal.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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SE2-1

DEFINITION AND MANAGEMENT OF RADIOIODINE-REFRACTORY DIFFERENTIATED THYROID CANCER YEN-HSIANG CHANG Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.

The vast majority of thyroid cancers of follicular origin have a very favorable outcome, but 5–10% of cases will develop metastatic disease. Around 60–70% of this subset, hence less than 5% of all patients with differentiated thyroid cancer (DTC), will become radioiodine refractory (RAI-R), with a significant negative impact on prognosis and a mean life expectancy of 3–5 years. We will present consensus or guidance currently available for this challenging condition. Criteria for advanced RAI-R DTC will be proposed, and the most appropriate diagnostic tools and the local, systemic and palliative treatments will be described. Systemic therapy with multikinase inhibitors will be fully discussed, including recommendations on how to start it and at which dosage, on the duration of treatment, and on the management of side effects. The appropriate relationship between the specialist and the patient/family as well as ethical issues will be covered. Based on the available studies and on personal experience, we will provide recommendations aimed to improve the management of advanced RAI-R TCs. Above all of them is the indication to treat and follow these patients in a specialized setting which allows the interaction between several specialists in a multidisciplinary team.

Abstract SE2-2

TYROSINE KINASE INHIBITORS FOR RADIOACTIVE IODINE – REFRACTORY DIFFERENTIATED THYROID CARCINOMA WAN-CHEN WU Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

Differentiated thyroid carcinoma (DTC) typically has a good outcome following standard treatments, which include surgery, radioactive iodine ablation and thyrotropin hormone-suppressive levothyroxine. DTCs that persist or recur following these therapies have a poorer prognosis. Cytotoxic chemotherapy or external beam radiotherapy has a low efficacy in these patients. Tyrosine kinase inhibitors (TKIs) represent an important therapeutic option for the treatment of these advanced radioactive iodine refractory differentiated carcinoma (rr-DTC), and sorafenib and lenvatinib have been approved for use in clinical practice. Previous studies have reported significant improvement regarding the progression-free survival rates of these patients. However, TKIs cause various severe adverse events that damage patients’ quality of life and can even be life-threatening. Therefore, it is difficult to determine who is a candidate for TKI therapy, as well as how and when physicians start and stop the therapy. The present speech will present the molecular basis of these drugs, and how to appropriately use TKIs by describing what we do and do not know about treatment using TKIs.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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ADVERSE EVENTS OF TYROSINE KINASE INHIBITORS AND MANAGEMENT YI FANG CHANG Cancer Center, MacKay Memorial Hospital, Taipei, Taiwan

The introduction of tyrosine kinase inhibitors (TKIs) has revolutionized cancer therapy and has contributed to a steady decline in cancer related mortality since the early 2000s. The trend to treat cancer with so-called target drugs of TKIs ranging from BCR/ABL, EGFR, VEGFR to multi-target agents is on the rise. And ushered in a new era of personalized medicine for cancer. However, with the accumulation of experience in the use of TKIs, including gastrointestinal symptoms, fatigue, hypertension, and skin or mucosa, renal dysfunction, and other related adverse reactions also caused clinical care problems. We clinically need to establish close monitoring to actively manage possible adverse reactions to the use of TKIs. I’ll give a brief overview of the possible mechanisms of adverse toxicities, and clinical treatment for adverse reactions from TKIs. It is hoped that it will help to improve the patient’s compliance of treatment by TKIs and reduce the adverse reactions that lead to dose reduction, short-term interruption of use, and even discontinuation of the drugs. Finally, we could maximize the effectiveness of helping patients to receive the treatment of TKIs and improve the quality of life of patients.

Abstract SE2-4

FUTURE PERSPECTIVE OF RADIOIODINE-REFRACTORY DIFFERENTIATED THYROID CANCER SHYANG-RONG SHIH Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

Sorafenib and lenvatinib are approved by FDA to be used in the treatment of radioiodine refractory differentiated thyroid cancer (rrDTC). Mitogen‑activated protein kinase (MAPK) pathway involves in the main pathogenesis of papillary thyroid cancer. BRAFV600E mutation and RAS are the two main initiators. Other mutations such as genes in the phosphatidylinositol 3’ -kinase (PI3K) pathway or fusion gene variants are reported. Sorafenib and lenvatinib are multi-kinase inhibitors to block MAPK pathway, but tumor escape effect exists. Therefore, other medications are urged to be developed. Lapatinib (HER2 inhibitor) and neratinib (pan-ErbB inhibitor) target on HER2/3 receptor to block MAPK and PI3K pathways. ALK translocation, especially STRN-ALK fusion, occurs in thyroid cancer. It will stimulate MEK and activate MAPK pathway. Crizotinib is an ALK inhibitor. Temsirolimus and everolimus are mTOR inhibitors, which block PI3K pathway. BRAF inhibitors and MEK inhibitors block MAPK pathway, and can be used in combination to treat thyroid cancers with BRAFV600E mutation. Down-regulation of sodium-iodide symporter (NIS) gene results in disability of iodine absorption in thyroid cancer and thus radioiodine refractories. Several medications, such as retinoids, rosiglitazone, selumetinib, and dabrafenib, were shown to be able to improve NIS gene expression and thus radioiodine sensitivity. Immunotherapies are under investigation for the treatment of rrDTC. The most commonly used immunotherapy currently are CTLA-4 antagonist (such as ipilimumab and tremelimunab), PD-1 antagonist (such as pembrolizumab and nivolumab), and PD-L1 antagonis (such as atezolizumab and durvalumab). Combination of immunotherapy and multi-kinase inhibitors are also used to treat rrDTC in several studies. Other emerging medications for the treatment of rrDTC include histone deacetylase inhibitors, miR-335-5p, miR-205, 177Lu-DOTA-RGD2, miRNA-497, MDM2-p53 antagonist, HSP90 inhibitor, miRNA-146b, and etc. They also shed lights on the improvement of survival and life-quality in patients with rrDTC.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

SE3-1

MANAGEMENT OF RECURRENT CUSHING DISEASE LIANG-YU LIN Division of Endocrinology and Metabolism, Taipei Veterans General Hospital, Taipei, Taiwan

Cushing disease is caused by pituitary adenomas, most common form of endogenous Cushing syndrome, that secrete adrenocorticotrophic hormone (ACTH). Transsphenoidal surgery is the treatment of choice in patients with these tumors because of reported remission rates of 69–93%. A therapeutic challenging for neurosurgeons and endocrinologists, however, is management of the remaining patients whose Cushing disease is refractory to initial transsphenoidal surgery or recurs after initial remission. Findings in recent published reports on the treatment of recurrent ACTH–secreting tumors suggest that repeat resection, radiation-based therapies such as Gamma Knife surgery and proton-beam radiosurgery, pharmacotherapy, and bilateral adrenalectomy all have important roles in the treatment of recurrent CD. Each of these interventions has inherent risks and benefits that should be presented to the patient during counseling on retreatment options. Radiation-based therapies increasingly appear to have efficacies similar to those of repeat resection in achieving biochemical remission and tumor control. In addition, an expanding retinue of medication-based therapies, several of which are currently being evaluated in clinical trials, has shown some promise as tertiary adjunctive therapies. Lastly, bilateral adrenalectomy may offer durable control of refractory recurrent CD. An increasing number of published studies with long-term patient outcomes highlight the evolving treatment patterns in the management of recurrent CD.

Abstract SE3-2

HYPOGONADOTROPIC HYPOGONADISM : CLINICAL PRESENTATION, PATHOGENESIS AND TREATMENT FOR ADULT PATIENT WEI-TSEN LIAO Division of Endocrinology & Metabolism, Department of Internal Medicine, Mackay Memorial hospital, Taiwan

Idiopathic hypogonatropic hypogonadism is a rare reproductive disorder. It was defined as deficient hypothalamic gonadotrophinreleasing hormone (GnRH) or pituitary gonadotrophin secretion. We will discuss its clinical presentation, genetics, pathogenesis, and management. and share experience of fertility treatment in adult cases.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

SE3-3

THYROID-STIMULATING HORMONE-SECRETING PITUITARY ADENOMA (TSHoma) YAN-RONG LI Division of Endocrinology and Metabolism, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taiwan

TSHoma is rare, accounting for only 2% of all secretory pituitary tumors, and <1% of all causes of hyperthyroidism. TSHoma is usually diagnosed in the fifth-sixth decades of life, and affects males and females equally. Most patients have the typical symptoms and signs of hyperthyroidism, but a few patients have mild or even no hyperthyroid symptoms; instead, with symptoms related to the expanding tumor mass. Here we reported 3 cases (2 men an 1 woman, aged from 35 to 53 years-old) of TSHoma initially presenting with typical hyperthyroidism and treated with anti-thyroid drugs, all of them received transsphenoid surgery 1 to 3.5 years after the diagnosis. The clinical presentation, differential diagnosis, pathogenesis, treatment modalities, and prognosis of TSHoma will be reviewed and discussed.

Abstract SE4-1

CLINICAL FEATURES AND BIOMARKERS OF NET HAO-CHANG HUNG Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Hospital,Tainan, Taiwan

Neuroendocrine tumor (NET), or neuroendocrine neoplasm (NEN), represent a heterogenous group of rare neoplasms, which are derived from the neuroendocrine cell throughout the whole body. The incidence and prevalence of neuroendocrine tumor (NET) are steadily rising. In the USA, the ageadjusted incidence rate increased from 1.09 per 100000 in 1973 to 6.98 per 100000 in 2012. In Taiwan, the age-standardized incidence rate increased from 0.3 per 100000 in 1996 to 1.51 per 100000 in 2008. The most common sites of NETs were gastroenteropancreatic site and lung. NETs are classified as being functional and nonfunctional based on the ability to secret hormones. The clinical presentation depends on the location of the tumor and its secreted hormones. The WHO classification of NETs includes criteria for determining malignant potential, tumor histopathology (well or poorly differentiated), and proliferative activity (grade 1,2 or 3). Most NET have an indolent clinical course, whereas some grow rapidly with distal metastasis. Due to its heterogeneity, the diagnosis of NET should be confirmed based on the presence of clinical symptoms and associated syndrome, measurement of hormone as biomarkers of disease, radiological and nuclear imaging, and histological conﬁrmation. Additionally, genetic testing for multiple endocrine neoplasia-1 mutation or von Hipple-Lindau disease should be considered for patients with suspected familial syndrome.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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SE4-2

ENDOSCOPIC APPLICATIONS ON NET TSU-YAO CHENG Department Laboratory Medicine, National Taiwan University Cancer Center, Taipei, Taiwan

Neuroendocrine tumor (NET) is a relatively rare cancer arising from most organs of the body, especially in lung and gastrointestinal (GI) tract. NETs have attracted more attention in recent years because there is a five-fold increase of the incidence rates of NETs in Taiwan from 1996 to 2008. Among all NETs, gastroenteropancreatic (GEP)-NETs account for 54% in one nation-wide study of NETs in Taiwan. Traditional white light endoscopy along with biopsy is the most common tool for detection of intra-luminal GI NETs. Endoscopic ultrasound (EUS), an excellent imaging tool for both intra-luminal assessment of layer differentiation and extra-luminal evaluation of surrounding tissues of the GI tract, has played a pivotal role in these GEP-NETs in spite of advances in radiological and metabolic imaging studies. EUS can offer information about both the depth of tumor invasion and regional nodal status (T and N staging) in intra-luminal GI NETs. Endoscopic resection of rectal NETs with modified endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) has become an alternative treatment choice to traditional surgical resection. Currently, EUS along with fine needle aspiration/biopsy (FNA/FNB) is the modality of choice for diagnosing pancreatic NETs and for locoregional staging of all GEP-NETs. EUS is also helpful in treatment planning, such as parenchymapreserving resection/ enucleation for small pancreatic NETs. Newer diagnostic techniques such as contrast enhanced harmonic EUS (CEH-EUS) have been shown to be helpful in detecting small pancreatic NETs. Therapeutic applications including EUSguided tumor injection and radiofrequency ablation (RFA) of small pancreatic NETs have also been under investigation. The future endoscopic applications on GEP-NETs are exciting and worthy of more enthusiastic studies.

Abstract SE4-3

UPDATE OF NET TREATMENT MING-HUANG CHEN Department Medical Oncology, Taipei Veterans General Hospital, Taipei, Taiwan

Neuroendocrine tumors are a group of heterogeneous malignancies arising from neuroendocrine cells throughout the body. Data from population-based registries indicate that 51% of neuroendocrine tumors arise from the gastrointestinal (GI) tract, 27% from the lungs, and 6% from the pancreas. Clinically, neuroendocrine tumors are regarded as functional if they are associated with symptoms of hormonal hypersecretion, or non-functional if they are not associated with these symptoms. Although carcinoid syndrome is classically associated with metastatic, well-differentiated neuroendocrine tumors of the small intestine, an analysis of National Comprehensive Cancer Centre database showed that most (74%) neuroendocrine tumors are nonfunctional. Advanced neuroendocrine tumors are incurable in nearly all cases. The somatostatin analogue, approved for control of hormonal syndrome, has been shown to delay disease progression in patients with neuroendocrine tumors. Targeted therapies such as everolimus and sunitinib are approved for advanced pancreatic neuroendocrine tumors. In addition, everolimus showed robust anti-tumor activity with acceptable tolerability across a broad range of neuroendocrine tumors, including those arising from the GI tract and lung (RADIANT 4 study). Other treatment strategies, including chemotherapy (E2211 trial) and peptide receptor radiotherapy (NETTLER study) are also approved for advanced well differentiated NETs. Furthermore, several potential targeted therapies were developed in well differentiated NETs and showed promising results in phase 2 clinical trials. NETs have emerged due to an improved understanding of the molecular mechanisms responsible for tumor development and progression.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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SE4-4

UPDATE OF NET TREATMENT MING-HUANG CHEN Department Medical Oncology, Taipei Veterans General Hospital, Taipei, Taiwan

Abstract SE5-1

THE TANGLE BETWEEN DIABETES AND CANCER RELATED TREATMENT JUNG-FU CHEN Kaohsiung Chang Gung Memorial Hospital, Taiwan

Diabetes was associated with a 26% increased risk of death from any cancer in Asians. The pattern of associations with specific cancers suggests the need for better control (prevention, detection, management) of the growing epidemic of diabetes (as well as obesity), in order to reduce cancer mortality. People with malignancies and diabetes had significantly more emergency department presentations, more inpatient admissions, longer length of hospital stay and higher rates of all-cause mortality compared to people with a malignancy without diabetes. Diabetes and cancer commonly co-exist, and outcomes in people with both conditions are poorer than in those who have cancer but no diabetes. There is no randomized trial evidence that treating hyperglycemia in people with cancer improves outcomes, and a personalized approach to managing hyperglycemia in people with cancer is needed. Notwithstanding massive efforts and investment in improving cancer therapy, the limited progress made in reducing overall mortality has mostly been achieved through early diagnosis. As cancer therapeutics continues to improve and progress, the adverse side effects associated with anticancer treatments have also attracted more attention and have become extensively explored. Immune checkpoints are small molecules expressed by immune cells that play critical roles in maintaining immune homeostasis. Targeting the immune checkpoints(ICPi) cytotoxic T-lymphocyteassociated protein 4 (CTLA-4) and programmed death 1 (PD-1) with inhibitory antibodies has demonstrated effective and durable antitumor activity in subgroups of patients with cancer. ICPirelated hypophysitis and thyroid dysfunction are relatively common irAEs(Immunotherapy related adverse effects) and Pip-related insulin deficient DM and PAI(Adrenal insufficiency) may occur as well. This rare form of iatrogenic diabetes is a result of an accelerated, fulminant islet autoimmunity induced by immune checkpoint inhibitors. Further studies are eagerly awaited and it would be prudent at least for now to instruct diabetic patients to follow healthy lifestyles and to encourage them to have evidence-based cancer screening.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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SE5-2

MONITORING, DIAGNOSIS, AND MANAGEMENT OF IMMUNOTHERAPY INDUCED ENDOCRINOPATHY PO-CHUNG CHENG Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Taiwan

Cancer cells evade the immune system by interacting with immunologic checkpoints to prevent T lymphocyte activation. In recent years, medications that block immune checkpoints to enhance the clearance of cancer cells have shown clinical efficacy against a variety of malignancies. However, immune checkpoint inhibitors can induce undesirable response against self-antigens to trigger the development of endocrinopathy. Commonly prescribed cancer immunotherapies, including Cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) inhibitors and Programmed death 1 (PD1) inhibitors, are associated with autoimmune-related endocrinopathy. Cancer immunotherapies may trigger endocrinopathy by activating quiescent T lymphocytes that target self-antigens in the endocrine system. Both CTLA-4 and PD-1 are abundantly expressed in the pituitary, thyroid, and adrenal glands, which may become susceptible to immunotherapy related injury. Furthermore, CTLA-4 and PD-1 can trigger the expression of autoantibodies against the pancreatic islet, resulting in insulitis and overt hyperglycemia. A characteristic pattern of adverse reactions may follow the use of immune checkpoint inhibitors. After the use of CTLA-4 or PD-1 inhibitors, allergic skin reactions, gastrointestinal side effects, and liver dysfunction usually precede the onset of endocrinopathy. Management of immunotherapy induced endocrinopathy involves periodic monitoring of endocrine hormone and plasma glucose levels after initiating immune checkpoint inhibitors. Cancer immunotherapies may be continued after adequate hormonal replacement therapy. In the case of immunotherapy induced insulitis, insulin therapy may be necessary to alleviate the subsequent hyperglycemia. In summary, clinicians should be vigilant in screening for endocrinopathies during the course of cancer immunotherapies and initiate appropriate hormonal replacement therapy to prevent complications.

Abstract SE6-1 PREGNANCY -ASSOCIATED OSTEOPOROSIS WEN-PING YANG Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei City Hospital, Ren-Ai branch, Taipei, Taiwan

Pregnancy-associated osteoporosis (PAO), also termed pregnancy and lactation-associated osteoporosis (PLO), is a rare syndrome of fragility fractures affecting women during late pregnancy and the early postpartum period. Formation of the fetal skeleton during pregnancy requires substantial calcium transfer. Whilst this is predominantly achieved through pregnancy adaptations such as increased intestinal calcium absorption, it can also lead to maternal skeletal resorption , and comparison of BMD measurements before and after pregnancy suggests that pregnancy is associated with some degree of bone mass reduction in the mother. In mothers who go on to breastfeed, marked decreases in BMD are frequently observed. Management of these patients has a limited evidence base. Treatment with anti-resorptive therapy, whilst effective, is controversial and has the potential to cause harm to the fetus. Clinicians should be aware of PAO, a rare but recognised complication of pregnancy. The condition should be especially considered in women presenting with new onset back pain in pregnancy or the postpartum period.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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SE6-2

POSTPARTUM HYPOPHYSITIS YU-FANG CHENG Section of Endocrinology and Metabolism, Department of Medicine, Changhua Christian Hospital, Changhua County, Taiwan

Hypophysitis is a rare inflammatory condition of the pituitary gland that has three main histologic subtypes: lymphocytic hypophysitis (LH), granulomatous hypophysitis (GH), and xanthomatous hypophysitis (XH). Among these, LH is the most common and is strongly associated with the postpartum state, while XH is the least common. Lymphocytic hypophysitis most often occurs in women in late pregnancy or the postpartum period, but can also occur in pre-pubertal or postmenopausal women, and in men. Of the 57% of patients who develop the disorder in association with pregnanacy, most do so during the last month of pregnancy or the first 2 months after delivery. In this section, we will discuss the subtype of hypophysitis associated with Pregnancy, include their clinical features, laboratory finding and how to management.

Abstract SE6-3

HYPERTHYROIDISM INDUCED BY EXCESS β-HCG KUAN-HUA CHEN Department of Endocrinology and Metabolism, E-Da Hospital, Kaohsiung City, Taiwan

Gestational trophoblastic disease includes complete and partial hydatidiform moles, choriocarcinoma, and placental-site trophoblastic tumor. All these neoplasms secrete β-hCG, free β-units, or other additional forms of these molecules. The patient may thus bear extreme high hCG levels and its subsequent reaction. β-hCG is a glycoprotein heterodimer composed of α and β subunits. Like other glycoprotein hormones, such as TSH, LH, and FSH, hCG shares common α-subunits with the rest while it carries a specific β-subunits. Despite of the unique β subunit, hCG can bind to human TSH receptor with a weak in vitro potency, and it is estimated that 1U hCG equals to only 0.7μU of human TSH. In normal pregnancies, β-hCG is first detected in maternal serum 6 to 9 days after conception, and the placenta is the major source. Its concentration rises in a logarithmic fashion and it peaks at the 8th week after last menstrual period. The average peak serum concentration is about 50 IU/mL, and this concentration rarely induced serious thyrotoxicosis. However, under conditions where hCG is severely elevated, patients suffer from β-hCG induced hyperthyroidism. The patient may be characterized by diffuse goiter, elevated free T4, and suppressed TSH. Meanwhile, thyroid auto-antibodies remained low. Hydatidiform moles are initially treated with uterine dilatation and curettage with or without adjunctive chemotherapy with methotrexate or actinomycin D. β-hCG itself may also serve as a tumor marker reflecting the effect of the therapy. As β-hCG is lowered, transient hyperthyroidism may resolve, and long-term medical therapy is not necessary.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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SE7-1

THE ROLE OF NUCLEAR MEDICINE IN THYROID DISEASE YEN-HSIANG CHANG Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.

Nuclear medicine is directly involved in both the diagnosis and treatment of thyroid disease. The management of thyroid disease using radioisotope has changed over the last 60 years and recent work suggests “risk-adapted” approach, especially in differentiated thyroid cancer. Post-operative radioiodine ablation has been no longer used routinely in those with small tumor and low risk features. Scintigraphic characteristics also help differentiate between nodular and Graves’ disease. However, it is no longer used routinely to assess patients with normal thyroid function test. Advances in imaging especially using (18)F-fluorodeoxy-glucose PET has enabled patients with thyroid cancer to be more accurately imaged, especially if uptake of (131)I is poor. Another approach has been the idea of using radiolabeled somatostatin analogs, which are able to demonstrate uptake in the tumor and, more recently, beta-emitting isotopes have been used for therapy when other options have failed.

Abstract SE7-2

個案分享：腎上腺胡雅惠台北慈濟醫院新陳代謝內分泌科

腎上腺疾病這個範圍很大，臨床醫師透過抽血檢測以及 24 小時尿液的分析，判斷個案是否罹患內分泌過量的疾病，在影像方面，常常透過電腦斷層或是核磁共振，搜尋腫瘤位置，核子醫學影像造影協助定位功能性腫瘤的位置。 1. 原發性醛固酮增多症合併皮質類固醇分泌過量 (primary aldosteronism with cortisol excess)，確診原發性醛固酮增多症 (primary aldosteronism) 之後，需要區分亞型，是單側還是雙側的病灶，用來建議病患治療方針，目前臨床上用以區分亞型的黃金標準檢測是雙側腎上腺靜脈採血 (bilateral adrenal venous sampling, AVS)，但是 AVS 在原發性醛固酮增多症合併皮質類固醇分泌過量的病人，數據會受到干擾，影響判讀，核子醫學造影 (NP59 with SPECT CT)，此時可以輔助定位皮質功能性腫瘤的位置。 2. 庫欣氏症雙側腎上腺增生 (Cushing’s syndrome with bilateral macronodular adrenal hyperplasia BMAH) ，倘若此疾病患者需要進行手術治療，核子醫學造影 (NP59 with SPECT CT) ，在此可提供手術部位 ( 內分泌較強的一側 ) 指引。 3. 嗜鉻細胞瘤副神經節瘤 (pheochromocytoma paraganglipma PPGL) 核子醫學造影 (MIBG with SPECT CT) 可以協助定位腫瘤的位置，但越是惡性度高的腫瘤或副神經節瘤，MIBG 的顯像率越低，需要其他的核子醫學造影提供協助。

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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SE7-3

APPLICATION OF PET IMAGING IN NEUROENDOCRINE TUMORS MEI-FANG CHENG Department Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan

Neuroendocrine tumors (NETs) are slow-growing malignancies, mostly occur in the respiratory and gastrointestinal tracts, and can cause significant morbidity. Symptoms and signs relate to the location and overproduction of bioactive substances or hormones in the functioning tumors. Not all NETs secrete bioactive hormones (non-functioning tumors), their diagnosis is even more difficult and often are present at an advanced stage. More than 90% of NETs express somatostatin receptors (SSTRs), especially type 2. Positron emission tomography (PET) imaging using 68Ga-DOTATOC (DOTATOC) is a radiotracer that targets SSTR2 and SSTR5. In contrast, 18F-flurodeoxyglucose (FDG) measuring the differential tissue glucose transport in tumors, can be used in aggressive NETs that do not express SSTRs. I will focus on the clinical use of SSTR PET and FDG PET/CT in the standard of care in patients with NETs.

Abstract SE8-1

MEDICAL TREATMENT OF ADRENOCORTICAL CARCINOMA I-WEN CHEN Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan

Adrenocortical carcinoma (ACC) is a rare malignancy with an annual incidence of 1 per 1 million population. The diagnosis of malignancy relies on careful investigations of clinical, biological, and imaging features before surgery and pathological examination after tumor removal. Sixty percent of tumors are functional, most commonly secreting glucocorticoids alone (45%), glucocorticoids and androgens (45%), or androgens alone (10%). Fewer than 1% of all tumors secrete aldosterone. Patients present with features of the hormone excess state (glucocorticoid, androgen, or both) but abdominal pain, weight loss, anorexia, and fever occur in 25% of cases. Large tumors can press on other organs in the abdomen, causing pain or a feeling of fullness. An adrenal tumor larger than 5 or 6 cm is assumed to be a cancer. In one study, the average size of an adrenal cancer was about 13 cm. After the diagnosis, in order to assess the ACC prognosis and establish an adequate basis for treatment decisions different tools are proposed. Two major staging systems used for adrenal cancer are the American Joint Committee on Cancer (AJCC) TNM staging system and the ENSAT (European Network for the Study of Adrenal Tumors) staging system. Pathology reports define the Weiss score, the resection status and the proliferative index, including the mitotic count and the Ki67 index. As far as the treatment is concerned, in case of tumor limited to the adrenal gland, the complete resection of the tumor is the first option. Most patients benefit from adjuvant mitotane treatment. In metastatic disease, mitotane is the cornerstone of initial treatment, and cytotoxic drugs should be added in case of progression.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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SE8-2

TARGET THERAPY AND IMMUNOTHERAPY FOR ADRENAL CORTICAL CARCINOMA CHIA- JUI YEN National Cheng Kung University, Tainan, Taiwan

Adrenal cortical carcinoma (ACC) is a rare disease. It is caused by a cancerous growth in the adrenal cortex, which is the outer layer of the adrenal glands. The adrenal glands lie on top of the kidneys. They play an important role in the endocrine system, which is the system that produces and regulates hormones. In metastatic disease, different parameters had to be considered: the tumoral volume, the number of metastatic organs, the progression slopes. Mitotane remains the only drug approved by the U.S food and drug Administration (FDA) and European Medicine Executive Agency (EMEA) for treatment of “metastatic ACC.” M-EDP (mitotane with etoposide-cisplatin-doxorubicine) is considered as first-line therapy for patients requiring cytotoxic treatment. Yhe sunitinib, a multiTKI, demonstrated in a cohort of 35 patients 14% of stable disease. The association of cituximab with temsirolomus, an inhibitor of mammalian targets of IGF-1R signaling, led to a stable disease in 42% of the patients. The disappointing results of a huge phase 3 trial “GALACCTIC” with a highly specific IGF-1R inhibitor linstinib (OSI-906) showed the progression-free and overall survival did not differ between the “OSI-906” and placebo groups. Immune checkpoint inhibitors can be tested in selected ACC patients, such as those with alterations in the mismatch repair (MMR) pathway that leads to high levels of microsatellite instability (MSI-H). There is an increasing interest in combining chemotherapy, radiotherapy or molecular target therapies with immunotherapy.

Abstract SE8-3

ADRENAL CORTICAL CARCINOMA: SURGICAL TREATMENT SHUO-MENG WANG Department of Urology, National Taiwan University Hospital, Taipei, Taiwan

Adrenal cortical carcinoma (ACC) is also called cancer from adrenal cortex. Cancer from adrenal medulla is called pheochromocytoma. Adrenal cortical carcinoma is rare but aggressive disease. Abdomen mass is usually the first sign at nonfunctional cases. At functional (hormone-secreting) cases may present as Cushing's syndrome and/or virilization,. There are different types of treatment for patients with adrenocortical carcinoma including surgery, radiation therapy and chemotherapy. Surgery to remove the adrenal gland (adrenalectomy) is often used to treat adrenocortical carcinoma. Sometimes surgery is done to remove the nearby lymph nodes and other tissue where the cancer has spread. Surgery (adrenalectomy) can be done at Stage I-III adrenocortical Carcinoma. And at stage IV Adrenocortical Carcinoma, treatment may include the following several modalities as palliative therapy to relieve symptoms and improve the quality of life, and role of srgery to remove cancer that has spread to tissues near the adrenal cortex. Treatment Options for Recurrent Adrenocortical Carcinoma including surgery, radiation therapy and clinical trial of chemotherapy or biologic therapy.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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SD1-1

OVERVIEW OF EVIDENCE-BASED MEDICINE JIH-I YEH Department of Family Medicine, Tzu-Chi General Hospital, Hualien County, Taiwan

The application of clinical epidemiology principles to clinical practice is the foundation of evidence-based medicine. Evidence-based medicine (EBM) is an essential topic in medical school curriculum, resident training program and accreditation of hospitals and training programs. The aims of this talk is to give an overview of levels of evidence pyramid in clinical medicine and the steps to practice EBM. We will focus on the strength of evidence based on randomize controlled trials and meta-analyses. For the steps to practice EBM, we will describe the structure of the PubMed and useful strategies to conduct literature search in PubMed. The strategies include using medical subject headings, title search, and clinical queries.

Abstract SD1-2 THE KEY CONCEPTS OF CLINICAL TRIAL KUOMENG LIAO Department endocrinology and metabolism, Taipei City Hospital, Zongxiao branch, Taiwan

Randomized double blind placebo control studies are considered the “gold standard” of epidemiologic studies. If well-blinded and designed, they provide the strongest possible evidence of causation. However, how to interpretate the clinical trial data remains a challenge to many clinical doctors. So, in this lecture, we try to elucidate some concepts which frequently misunderstood but very important, by using recently published outcome trials, including EMPA-REG, CAVAS, DECLARE, and CREDENCE trials as examples . These concepts including: 1. Blindness, randomization, controls 2. Superiority trial vs. non-inferiority trial 3. Efficacy trial vs. safety trial 4. Intention-to-treat vs. Ontreat analysis 5. Primary endpoint, secondary endpoint, other pre-specified endpoint 6. Subgroup analysis, and test of heterogeneity 7. RCT vs. RWE 8. Interim analysis, and early termination criteria. And we will provide an overview of RCT, including aims, designs, methods, results and interpretations.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

SD1-3 SUPERIOR OR NON-INFERIOR? CRITICAL APPRAISAL OF THREE GLP-1 RECEPTOR AGONIST CARDIOVASCULAR OUTCOME TRIALS FROM A METHODOLOGICAL POINT OF VIEW CHIA-HSUIN CHANG Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

Large placebo-controlled randomized clinical trials have shown that in addition to SGLT2 inhibitor, GLP-1 receptor agonist is another class of hypoglycemic agent that can significantly reduce the risk of cardiovascular adverse events. This presentation will focus on the three large GLP1 receptor agonist cardiovascular outcome trials – “Liraglutide and cardiovascular outcomes in type 2 diabetes (LEADER)”, “Effects of once-weekly exenatide on cardiovascular outcomes in type 2 diabetes (EXSCEL)”, “Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomized placebo-controlled trial”, and have an in-depth discussion about the similarities and differences in their study designs, conduct, analyses, and results. From the documents of the US FDA Endocrinologic and Metabolic Drugs Advisory Committee Meeting, we can learn about what should be considered to approve liraglutide for the reduction the risk of major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke) in adults with type 2 diabetes mellitus and established cardiovascular disease. We will further talk about whether there is one GLP-1 receptor agonist superior to others in terms of cardiovascular protection, and emphasize “rational drug use”, that is, physicians need to consider both the risks and benefits of treatment for each individual type 2 diabetic patient.

Abstract SD2-2

HEART FAILURE TREATMENT UPDATE IN THE DIABETICS TSUNG-HSIEN LIN Division of cardiology, Department of internal medicine, Kaohsiung medical university hospital,Taiwan

The diabetics have not only higher risk of developing cardiovascular disease (CVD) but also heart failure. For heart failure with reduced ejection fraction (HFrEF), conventional treatment agents including renin-angiotensinogen system inhibitors, β blockers and sacubitril/valsartan work similarly in those with and without the diabetes. Although intensive glycemic lowering by various drugs or strategies could reduce the risk of CVD, it might increase the risk of heart failure. Furthermore, mortality in diabetic patients with heart failure have up to 6-fold risk compared with those without heart failure in major clinical trials. Although new anti-diabetic therapy with GLP1-RA has neutral effect on heart failure outcomes, cardiovascular outcome trials found SGLT2 inhibitors reduce the risk of cardiovascular death and heart failure hospitalization in the diabetics. Recently, DAPA-HF trial shows the risk of worsening heart failure or death was lower among those who received dapagliflozin, regardless of the presence or absence of diabetes among patients with heart failure and a reduced ejection fraction. Further studies will clarify the role of SGLT2 inhibitors on the heart failure with preserved ejection fraction.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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SD2-3

GLUCAGON-LIKE PEPTIDE 1 RECEPTOR AGONIST AND CARDIOVASCULAR OUTCOMES TRIALS YU-YAO HUANG Department of Medical Nutritional Therapy, Chang Gung Memorial Hospital at Linkou, Taiwan

Not until the publish of major cardiovascular outcome trials (CVOTs) with sodium glucose cotransporter 2 inhibitor (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RAs) in recent 5 years did the anti-diabetic medication can demonstrate their cardiovascular safeties and benefits in patients with type 2 diabetes. The potential cardioprotective effect of incretin-based therapies is attributed to their glycemic-lowering and multiple non-glycemic actions in the CV system, including changes in insulin resistance, weight loss, reduction in blood pressure, improved lipid profile and direct effects on inflammations and possible mechanisms on vascular plague stabilization. Liraglutide, Semaglutide, Albiglutide and Dulaglutide have been demonstrated to reduce the risk of major adverse cardiac event (MACE), whereas Lixisenatide and extended-release Exenatide had a neutral effect. Thus, it is conceivable that there are some class-effects and some different drug-specific properties across the class of GLP-1 RAs. In this talk, we will discuss the results of the published major CVOTs between GLP-1 RAs and SGLT2i. Understanding the pros and cons of these drugs on individual component of MACE, along with the different action and mechanism of each drug may give lights for personalized treatment to achieve cardiovascular benefits.

Abstract SD3-1

DIABETES FATIGUES SYNDROME AND SARCOPENIA IN DIABETES PATIENTS KUO-CHIN HUANG Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan

Diabetes Fatigues Syndrome (DFS) is commonly encountered in diabetic patients. DFS may be caused by lifestyle, nutritional, medical, and psychological factors. Fatigue could impair physical and mental function then lead to muscle weakness, impaired mobility, functional limitation, fall, sarcopenia, and frailty. Eventually, it will cause disability, reduce the quality of life, and increase mortality. The clinical characteristics of fatigue can be divided into psychological aspects related to cognitive function and physiological aspect related to muscle weakness. Patients may show reduced activity, low energy, decreased concentration, and depression. Hyperglycemia, chronic inflammation and vascular or neurological complications are possible underlying causes of fatigue in diabetic patients. Studies have shown that 61% of newly diagnosed diabetes patients have symptom of fatigue; nearly 70% of the 18-70-year-old type 2 diabetes patients of industrial workers have suffered from fatigue. Furthermore, it has been found that blood sugar levels are associated with the severity of fatigue in type 2 diabetic patients. Therefore, the diabetic patients with fatigue symptom should be carefully evaluated and then adopt therapeutic lifestyle modification, mental support, and adequate comorbidities management. Good sleep, regular exercise, healthy eating and better blood sugar control with reduced glycemic variability can improve DFS, reduce muscle loss, and may improve the sarcopenia and frailty in diabetic patients.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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SD3-2

DIABETES PATIENT LIFESTYLE THERAPY HUNG-YU CHANG Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan

The American Diabetes Association and the Diabetes Association of the Republic of China recommend that all patients with type 2 diabetes should undergo lifestyle therapy, including medical nutrition therapy. The current guidelines emphasize “Pyramid of Risk” (postprandial blood glucose, fasting blood glucose and glycosylated hemoglobin) as three important glycemic targets that should be controlled in diabetes care. However, more and more studies have disclosed that blood glucose variability (GV) also plays an important role in glycemic control. Compared with healthy people, diabetic patients have more unstable glucose fluctuation, which means that blood glucose variability is greater. Guidelines recommend that when patients with type 2 diabetes are diagnosed, medical nutrition therapy should be listed as the first-line treatment. Research also pointed out that medical nutrition intervention such as meal replacements can significantly improve blood glucose fluctuations in patients with type 2 diabetes. This method can be regarded as an effective treatment to reduce blood GV; at the same time, it can significantly reduce the postprandial blood glucose of type 2 diabetic patients, significantly increase the secretion of GLP-1, and promote satiety, thereby achieving the goal of weight loss. Type 2 diabetes is a progressive disease and studies have shown that the sooner a patient receives medical nutrition treatment after being diagnosed with type 2 diabetes, the greater the improvement of glycemic control.

Abstract SD3-3

NUTRITION INTERVENTION FOR PATIENTS WITH DIABETES AND OBESITY YI-SUN YANG Chung Shan Medical University Hospital, Taichung, Taiwan

The nutrition therapy goals for the individual with diabetes have evolved and have become more flexible and patient centered. The goals from the American Diabetes Association (ADA) 2020 include the following: to promote and support healthful eating patterns, emphasizing a variety of nutrient dense foods in appropriate portion sizes in order to improve overall health and achieve and maintain body weight goals、attain individualized glycemic, blood pressure, and lipid goals、delay or prevent complications of diabetes; to address individual nutrition needs based on personal and cultural preferences, health literacy and numeracy, access to healthful food choices, willingness and ability to make behavioral changes, as well as barriers to change; to maintain the pleasure of eating by providing nonjudgmental messages about food choices, to provide an individual with diabetes the practical tools for day-to-day meal planning rather than focusing on individual macronutrients, micronutrients or single foods. Knowledge and individual application to improve adherence to the core foundational nutrition principles is one of the most important aspects of diabetes lifestyle management. There is no longer such a thing as a 1200 or 1800 calorie ADA diet! The dietary goals covered here, along with other lifestyle changes, if consistently applied, can help to improve metabolic profiles and ultimately help prevent long-term complications associated with diabetes. Motivating the persons with diabetes to make changes by working with a diabetes management team to implement an individualized program may help to elicit positive outcomes.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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THE TRANSCRIPTION NETWORK IN COMPENSATION FOR THE LOSS OF β-CELL FUNCTION AND IDENTITY YAU-SHENG TSAI Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan

Rationale: Subjects unable to sustain β-cell compensation develop type 2 diabetes. Early growth response-1 protein (EGR-1), implicated in the regulation of cell differentiation, proliferation, and apoptosis, is induced by diverse metabolic challenges, such as glucose or other nutrients. Therefore, we hypothesized that deficiency of EGR-1 might influence β-cell compensation in response to metabolic overload. Methods: Mice deficient in EGR-1 (Egr1−/−) were used to investigate the in vivo roles of EGR-1 in regulation of glucose homeostasis and beta-cell compensatory responses. Results: In response to a high-fat diet, Egr1−/− mice failed to secrete sufficient insulin to clear glucose, which was associated with lower insulin content and attenuated hypertrophic response of islets. High-fat feeding caused a dramatic impairment in glucose-stimulated insulin secretion and downregulated the expression of genes encoding glucose sensing proteins. The cells co-expressing both insulin and glucagon were dramatically upregulated in islets of high-fat-fed Egr1−/− mice. EGR1-deficient islets failed to maintain the transcriptional network for β-cell compensatory response. In human pancreatic tissues, EGR1 expression correlated with the expression of β-cell compensatory genes in the non-diabetic group, but not in the diabetic group. Conclusion: These results suggest that EGR-1 couples the transcriptional network to compensation for the loss of β-cell function and identity. Thus, our study highlights the early stress coupler EGR-1 as a critical factor in the development of pancreatic islet failure.

Abstract SD4-2

NOVEL APPROACHES FOR THYROID CANCER THERAPY SHU-FU LIN Division of Endocrinology and Metabolism, New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation)

Anaplastic thyroid cancer (ATC) is a rare but very aggressive human malignancy, occurring in 1-2% of all thyroid cancers but contributing to 14-39% of thyroid cancer mortality. The disease is typically fatal, with a median survival of 3 to 5 months for ATC patients. Recently, the US Food and Drug Administration (FDA) approved dabrafenib (BRAF inhibitor) plus trametinib (MEK inhibitor) for locally advanced, metastatic ATC with BRAFV600E mutation. However, many patients develop refractory disease or discontinue treatment due to adverse effects of these drugs. There is an urgent need for novel therapies with different mechanisms of activity for patients with ATC. Our preclinical work demonstrates therapeutic efficacy of small molecules targeting different pathways: PI3K/AKT/MTOR (BEZ235), cyclin-dependent kinases (roniciclib), heat shock protein 90 (ganetespib); polo-like kinase 1, and Wee1 kinase against ATC, with promising safety profiles.These findings reveal potential approaches in the treatment of patient with ATC.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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SD5-1 EPIDEMIOLOGY OF DIABETES AND TRENDS IN ANTIDIABTIC MEDICAL TREATMENT FROM 2005 TO 2014 IN TAIWAN CHIH-HSUN CHU Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

From 2005 to 2014, total population with DM increased by 66% and age-standardized prevalence in patients aged 20-79 years increased by 41%. The DM prevalence was generally higher in men; however, the prevalence was higher in women aged > 65 years. The prevalence of DM was approximately 50% in those aged >80 years. DM incidence increased by 19%; the increase was most obvious in patients aged 20-39 years (p < 0.001). The standardized incidence of T1DM slightly decreased by 11% (p = 0.118) and standardized prevalence of T1DM increased from 0.04% to 0.05%. Number of T1DM accounted for 0.51-0.59% of the entire diabetic population during the observation period. Several new antidiabetic drugs have been introduced in Taiwan. We studied data from the Taiwan National Health Insurance Database to identify outpatient prescriptions for antidiabetic drugs from 2005 to 2014. The total and mean prescriptions gradually increased during the study period. Prescription of oral antidiabetic drugs (OADs) only or insulin-only therapy decreased slightly. Prescriptions of monotherapy and dual therapy decreased, whereas those of triple or higher order combinations increased. Prescriptions of sulfonylureas (SUs) decreased, whereas those of metformin and dipeptidyl peptidease-4 (DPP4) inhibitors increased. Insulin prescriptions increased but accounted for only 13.07% of prescriptions in 2014. Among monotherapy prescriptions, SU prescriptions decreased, but metformin and DPP4 inhibitor prescriptions increased. Among dual OAD prescriptions, those including SUs decreased, and those of metformin and DPP4 inhibitors increased. Although prescriptions of the metformin-SU combination decreased, they remained the most common among all dual OAD prescriptions, followed by the metformin-DPP4 inhibitor combination. Prescriptions of human insulin decreased and those of insulin analogs increased considerably; those of basal insulin increased, and those of mixed insulin decreased. However, mixed insulin was prescribed more than basal-bolus insulin. In conclusion, antidiabetic treatment has become complex in Taiwan. Although combination therapy would become the major treatment strategy gradually, the underuse of insulin therapy must improve.

Abstract SD5-2 ACCOUNTABILITY AND UTILIZATION AND PAY FOR PERFORMANCE FOR DIABETES CARE FROM 2005 TO 2014 IN TAIWAN I-TE LEE Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

Background/Purpose: Comprehensive and continuous care is crucial for patients with diabetes. The diabetes pay-for-performance (P4P) program launched by the National Health Insurance (NHI) administration in Taiwan provides a financial incentive to facilitate this goal. In this study, we explored the characteristics of patients in the P4P program between 2005 and 2014. Methods: Data of patients with diabetes enrolled in the NHI program between 2005 and 2014 were extracted from the NHI research database. Patients were classed as having diabetes if they had three or more outpatient visits within 365 calendar days with an International Classification of Diseases, 9th Revision, Clinical Modification diagnostic code of 250 or hospitalization one or more times with such a diagnosis. The trends of participating in the P4P program were analyzed. Results: Participation rate of the P4P program increased from 12.1% to 19% between 2005 and 2014. Participants were younger and more likely to be female than those not participating in the program. Lower risks of cancer-related mortality, annual mortality and heart failure were seen in patients participating in the P4P program than in those not participating. Conclusion: Older, male patients with a high disease severity may be less likely to enroll in the P4P program. Although participation rate is increasing, a broad enrollment is expected. (Adapted from Lee IT, et al. J Formos Med Assoc. 2019;118 Suppl 2:S122-S129)

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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HOSPITALIZATION AND TRENDS OF MORTALITY IN DIABETIC PATIENTS: A NATIONWIDE SURVEY FROM 2005 TO 2015 IN TAIWAN HUNG-YUAN LI Department of Internal Medicine, National Taiwan University Hospital, Taiwan

Diabetes mellitus has become a major cause of death and hospitalization worldwide. In 20052014, the number of diabetic patients increased from 1.3 to 2.2 million in Taiwan. Meanwhile, the rate of hospitalization among patients with type 2 diabetes mellitus decreased from 395.4 per 1000 person-years in 2005 to 336.96 per 1000 person-years in 2014, which is in contrast to the fact that the hospitalization rates of non-diabetic patients was stable during this period. An increase in hospitalization rates for malignancies and sepsis/infection was observed from 2005 to 2014 in patients with and without type 2 diabetes. The risk of hospitalization for heart diseases, cerebrovascular diseases, malignancies, respiratory diseases other than pneumonia, sepsis/infection other than pneumonia in patients with type 2 diabetes (vs. without diabetes) decreased from 2005 to 2014. However, the risk of hospitalization for pneumonia in patients with type 2 diabetes increased during these years. In 2005-2014, all-cause mortality in patients with diabetes decreased continuously across sexes and age groups in Taiwan. The diabetic patients exhibited a shorter life expectancy than the entire population. The differences decreased from 2005 to 2014 and were greater when diabetes was diagnosed early in life. In 2014, the estimated loss of life was 2.6 and 3.2 years in the women and men, respectively, when diabetes was diagnosed at 40 years of age. The top five causes of death in diabetic patients were malignancy, diabetes, heart diseases, cerebrovascular diseases, and pneumonia. In conclusion, there were continuous improvement in diabetes care in Taiwan, which resulted in a significant reduction in the rate of hospitalization and mortality from 2005 to 2014.

Abstract SD5-4

PREVALENCE OF DIABETIC MACRO- AND MICROVASCULAR COMPLICATIONS AND RELATED FACTORS FROM 2005 TO 2014 IN TAIWAN: A NATIONWIDE SURVEY CHIEN-HSING LEE Songshan Banting ChienHsing Clinic, Taipei, Taiwan; Division of Endocrinology and Metabolism, Tri-Service General Hospital, Taipei, Taiwan

Background/Purpose: Patients with diabetes have a higher risk of developing chronic complications and cause a huge burden to the public health care system as well as on patients and their families. Diabetic macrovascular complications contribute to nonignorable causes of morbidity and mortality in patients with diabetes mellitus (DM). In this study, the trends of risk factors, microvascular and macrovascular complications were examined in patients with DM in Taiwan. Methods: Health care information and International Classification of Diseases, Ninth Revision diagnostic codes were retrieved from the Taiwan Bureau of National Health Insurance claims files between 2005 and 2014. Using these data, the number of cases and annual prevalence of diabetic microvascular and macrovascular complications in individuals with DM were stratified by age and sex. Results: The prevalence of DM with either stroke or cardiovascular disease (CVD) showed a decreasing trend in enrolled patients with DM (p for trend < 0.005), but that of DM with peripheral vascular diseases (PVDs) showed an increasing trend (p for trend < 0.001). Notably, the trend of changes in the prevalence of heart failure (HF) was similar to that of changes in the prevalence of stroke, although the decrease in prevalence was not statistically significant (p for trend 0.053). The prevalence of diabetic kidney disease (DKD) significantly increased from 10.49% to 17.92% from 2005 to 2014. The prevalence rate of diabetic foot significantly decreased from 1.34% to 1.05% from 2005 to 2014, and the rate of severe infection also significantly decreased from 50.69% to 45.85%. The amputation rate significantly decreased from 24.91% to 17.47% among all patients with diabetic foot. Conclusion: From this nationwide study, we observed a decrease in the prevalence of diabetic macrovascular complications, such as stroke, CVD, and HF, but an increase in the prevalence of PVDs in the past decade in Taiwan. The trends in DKD and dialysis prevalence were similar to those of the 2012 report. The rate of increase in dialysis prevalence is lower in this study than in the 2012 report. The prevalence of diabetic foot, severe infection, and amputation in this report exhibited significantly decreasing trends. This improvement may be attributable to care from multidisciplinary teams.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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SD6-2

THE NEW APPLICATION OF A.I. IN DIABETIC RETINOPATHY YI-TING HSIEH Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan

Diabetic retinopathy (DR) is one of the major microvascular complications in diabetes mellitus. Almost all patients who have type 1 diabetes for 20 years or more develop DR; among them, 20 to 30% suffer visual loss. During the lifetime, over 60% of patients with type 2 diabetes develop DR, which is also the main cause for legal blindness among the population within 20 to 74 years of age. The American Diabetes Association suggests that patients of type 1 diabetes should receive fundus examinations for DR within 5 years after diagnosis, and patients of type 2 diabetes should receive DR screening at the time of diagnosis. However, not all diabetic patients receive DR screening regularly. In Taiwan, only 45.5% of patients with diabetes received fundus examinations for DR screening in 2019. This results in delayed diagnosis of DR in many patients, to whom adequate referral or treatment cannot be given in time. One of the reasons for the poor DR screening rate is that many general practitioners or internal physicians are not confident in diagnosing DR with retinal fundus photography by themselves. In recent years, artificial intelligence (AI) with deep learning has been developed for the diagnosis of DR, and previous studies have demonstrated its applicability, while most of them used open-access datasets only for the development and validation of their algorithms. National Taiwan University Hospital and Acer Inc. cooperated in developing a computer-aided diagnosis system Verisee™ for the diagnosis of DR. We used an open-access dataset as well as a local dataset collected in Taiwan to train the Verisee™ for diagnosing DR, and to validate its efficacy by comparing the precision rate of diagnosis with those made by internal physicians and ophthalmologists. Our study found that the AUCs for VeriSee™ in diagnosing any DR, referable DR and proliferative diabetic retinopathy (PDR) were 0.955, 0.955 and 0.984, respectively. VeriSee™ had better sensitivities in diagnosing any DR and PDR (92.2% and 90.9%, respectively) than internal physicians (64.3% and 20.6%, respectively) (P < 0.001 for both). VeriSee™ also had better sensitivities in diagnosing any DR and referable DR (92.2% and 89.2%, respectively) than ophthalmologists (86.9% and 71.1%, respectively) (P < 0.001 for both), while ophthalmologists had better specificities. VeriSee™ has been proved to have good sensitivity and specificity in grading the severity of DR from color fundus images. Now it is under the application for the approval in DR screening by the TFDA. We hope in near future VeriSee™ can offer clinical assistance to non-ophthalmologists in DR screening with nonmydriatic retinal fundus photography.

Abstract SD6-3 THE 2020 CONSENSUS OF CGM AND CSII IN TAIWAN CHIA-HUNG LIN Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou; Taoyuan City, Taiwan

Continuous glucose monitoring (CGM) has been greatly implicated in clinical practice for various parts of diabetic management. The CGM could be set as professional or blinded and unblinded in different clinical application.The standardized reading and reporting disciplines are developed in this 2020 consensus in Taiwan. Continuous subcutaneous insulin infusion (CSII) or insulin pump therapy is the promising paradigm for intensive therapies in diabetes (DM). The basal insulin is supplied in the form of a continuous infusion (comprising between 40 and 60 percent of the total daily dose) with pre-meal bolus doses given to minimize postprandial glucose excursions. The adjustment of dose and device maintenance are discussed and advised in the context. The latest sensor-augmented pump therapy composed of CSII and real-time CGM is the perfect paradigm to cure not only type 1 but type 2 diabetes. The suspension of insulin before low blood glucose and automatic increase in basal insulin delivery are the main characteristics of this smartguarded insulin pump. Further automatic basal insulin adjustment and bolus infusion corresponding to high glucose are well developed and implicated in the clinical care of diabetes.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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SD7-3 NEW PARADIGM IN THE MANAGEMENT OF DIABETES KIDNEY DISEASE KUN-DER LIN Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.

Diabetic Kidney Disease (DKD) is the major cause of end-stage renal disease (ESRD) in Taiwan and is associated with many kinds of chronic complications such as stroke, ischemic heart disease and congestive heart failure (CHF) in patients with diabetes mellitus. It is a serious problem to prevent the incidence and progression of DKD both in family and public health issues. In recent years, several kinds of anti-diabetic agents including injection and oral forms, showed the great glucose lowering effects and additional kidney protection effects on patients of type 2 diabetes. These large random control trials showed the solids evidences and would affect our treatment of DKD in patients of diabetes. There was also some evidence on the limitations about metformin treatment on patients with DKD. About SGLT2i, in the different stages of DKD, there were different limitations of kidney function on each SLGT2i agent based on their own clinical studies. Empagliflozin is the first one to show the heart and kidney protection effects on patients with DKD. Dapagliflozin and canagliflozin also showed the similar effects after on. However, there were some tiny differences among these trials including the sides effects especially about amputation. GLP-1 injection also provides the great glucose lowering effects on patients with type 2 diabetes and it’s random control trials also showed additional cardiovascular protection and kidney protection in patients with diabetes. However, the protection effects of GLP-1 on DKD seems different from SLGT2i. Based on the different mechanism, further discussion on these two classes of anti-diabetic agents should be dressed more and need more random control trials to prove the effects of combination of these two classes. There are more and more kinds of anti-diabetic agents and we needs more data on the clinical use of these new generation agents. We should emphasize on the new clinical experiences of these new agents and pay more attention to the updated guidelines to treat our patients with DKD.

Abstract SD8-1 DIABETIC FOOT CARE: THE CHANG GUNG EXPERIENCE AND UPDATED STATUS IN TAIWAN CHENG-WEI LIN Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan

Diabetic foot ulcer (DFU) was the leading cause of non-traumatic lower-extremity amputation (LEA). The annual population-based prevalence of DFU is 1 to 11%, and the estimated lifetime risk is 25% for diabetic patients. Among the diabetic foot complications, diabetic foot infection (DFI) is the leading threatening problem for limb loss and sepsis, and is the most common cause of hospital admissions and costly expenditure in diabetic populations. Among the in-hospital DFU cases, 82% have been reported to have DFIs in Europe and 94% in Taiwan. According to the current study, diabetic foot complications continue to remain a major medical and public health issue as we face patients in increased numbers, age, and comorbidities. The annual incidence of LEAs in Taiwan decreased from 2.85 to 2.06 per 1000 type 2 diabetic population from 2007 to 2014. Commensurately, the proportion of people receiving peripheral artery intervention increased from 6.2 to 19.5% over the same time period. In Chang Gung, the annual amputation rate also decreased along with the dramatic increasing cases of peripheral artery intervention. Despite the success in revascularization for limb preservation, nevertheless, we are facing a trend of more patients with higher associated comorbidities, particularly the ESRD. That’s a big challenge in DFU treatment for such patients, whether in limb or life salvage.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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SD8-2

ENDOVASCULAR INTERVENTION IN LOWER EXTREMITY ARTERY DISEASE: NEW TOOLS, TECHNIQUES, AND INDICATIONS JEN-KUANG LEE Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

Advances in endovascular therapies during the past decade have broadened the options for treating peripheral vascular disease percutaneously. Endovascular treatment offers a lower risk alternative to open surgery in many patients with multiple comorbidities. Noninvasive physiological tests and arterial imaging precede an endovascular intervention and help localize the disease and plan the procedure. The timing and need for revascularization are broadly related to the 3 main clinical presentations of claudication, critical limb ischemia, and acute limb ischemia. Many patients with claudication can be treated by exercise and medical therapy. Endovascular procedures are considered when these fail to improve quality of life and function. In contrast, critical limb ischemia and acute limb ischemia threaten the limb and require more urgent revascularization. In general, endovascular treatments have greater long-term durability for aortoiliac disease than femoral popliteal disease. Infrapopliteal revascularization is generally reserved for critical and acute limb ischemia. Balloon angioplasty and stenting are the mainstays of endovascular therapy. New well-tested innovations include drug-eluting stents and drug-coated balloons. Adjunctive devices for crossing chronic total occlusions or debulking plaque with atherectomy are less rigorously studied and have niche roles. Patients receiving endovascular procedures need a structured surveillance plan for follow-up care. This includes intensive treatment of cardiovascular risk factors to prevent myocardial infarction and stroke, which are the main causes of death. Limb surveillance aims to identify restenosis and new disease beyond the intervened segments, both of which may jeopardize patency and lead to recurrent symptoms, functional impairment, or a threatened limb.

Abstract SD8-3

CLINICAL APPLICATION OF CELL THERAPY IN TREATMENT OF CHRONIC DIABETIC FOOT ULCERS NAI-CHEN CHENG Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan

Among the devastating complications related with diabetes, these patients are particularly susceptible to poor wound healing, especially chronic foot ulcer. Diabetic patients were estimated to have a lifetime risk of 25% to develop a foot ulcer, and 14–24% of them will have progressive disease that necessitates amputation. As the prevalence of diabetes keeps on increasing, the medical and socioeconomic burden of diabetic wounds is expected to increase accordingly. Therefore, the diabetesassociated wound complications have emerged as important clinical problems nowadays, but current treatments have their limitations. In recent years, cell therapy has become an emerging practice in the international medical community to promote diabetic wound healing. Among the various options of cell, stem cell therapy shows great potential for clinical application considering its unique biological properties. Particularly, mesenchymal stem cells (MSCs) have gained increased attention because they can contribute to tissue repair and regeneration through differentiation and paracrine effects. For example, adipose-derived stem cell (ASC) is a potential source of abundant mesenchymal stem cells, which can be applied to promote tissue regeneration. The mechanism underlying the ASC-associated tissue regeneration has yet been thoroughly understood, but it probably involves increased collagen deposition, reduction of inflammatory states, and several paracrine effects of ASCs. In September 2018, the Ministry of Health and Welfare Taiwan issued the Regulations Governing Specific Cellular Therapeutic Technology, which conditionally allowed clinical application of six cell therapy technologies with ascertained safety and efficacy. For example, the clinical use of ASCs has been included for five indications: chronic wound, large-area burn injury, subcutaneous/soft tissue deficiency, osteoarthritis/knee cartilage defect and adjuvant superficial minimally invasive techniques. Through this talk, we will discuss about the new developments of cell-based regenerative therapy in diabetic wound healing. Moreover, we will give a brief overview regarding the necessary steps to perform such a cell therapy in compliance with the current regulations in Taiwan.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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MEMORIAL OF PROF. JEN-DER LIN: TO SIR, WITH LOVE FENG-HSUAN LIU Division of Endocrinology & Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan

Professor Jen-Der Lin was born on December 13, 1953 and died on September 4, 2019. He was graduated from the department of medicine of Kaohsiung Medical University in 1980. He completed the training courses of Internal Medicine (1980~1983) and Endocrinology & Metabolism (1983~1985) at Chang Gung Memorial Hospital (CGMH), Linkou. He was the director of Endocrinology & Metabolism between 1993 and 2003. During the period, he was also the director of the health department (1997~1998) and the director of the nutrition therapy department (2000~2003). And from 2001 to 2007, he was also the deputy minister of Internal Medicine. Professor Lin brought together Taiwan’s largest thyroid cancer database, led colleagues to publish dozens of clinical papers, and summarized them into cancer management guidelines. He completed the registration of thyroid cancer and acromegaly cases. He also organized and systematized of clinical case seminars by integrated department of surgery, pathology, and radiology in CGMH. He had 245 peer review papers, 54 research projects; 33 honorable guest speaker; 37 major medical journals as the reviewer. He started as the seventh standing executive board (1998~2001), and was later elected to serve as two-term president of Endocrine Society of ROC (2001~2007). From 2007 to 2019, he had been as standing control board. Professor Lin’s contributions during his tenure as president: established a dedicated email account; expanded the function of the website; invited foreign scholars to Taiwan; actively participate in exchanges between Huaxia, Asia, and the International Endocrine Society; actively participate in publications abroad; strengthen the bridge between the clinical and basic research. We remember our teacher here, hoping that future generation will understand his attitude of pursuing knowledge is broad and deep. He has his principle and persistence in handling things. He is a typical clinician, but his research has moved beyond basic medicine.

Abstract ML-2

MEMORIAL OF PROF. JEN-DER LIN: PROF. LIN’S ACADEMIC RESEARCH AND PROSPECT SHU-FU LIN Division of Endocrinology and Metabolism, New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation)

Professor Jen-Der Lin was a kind and generous physician who devoted in the basic and clinical research for more than 3 decades. He initiated his first study addressing the epidemiology of diabetes mellitus and hypertension in Keelung in 1988. Since then, he conducted more than 46 research projects. The scopes of his study included epidemiology, establishment and characterization of human thyroid cancer cell lines, evaluation of therapeutic effects of various drugs in the treatment of thyroid cancer cells, assessment of biologic behavior and genetic expression of thyroid cancer cells, and conducting clinical trials to evaluate therapeutic effects of various agents for acromegaly and diabetes. In addition, he had established a thyroid cancer registry at Chang Gung Memorial Hospital in 1976. This dataset consisted of more than 5000 patients managed at this institute between 1976 and 2018. His first paper entitled “Analysis of diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic coma” was published in 1985. Until 2019, he had published more than 240 peer-reviewed papers in 114 journals, including British Medical Journal and Thyroid. Prof. Lin served as the chief of Thyroid Cancer Team at Chang Gung Memorial Hospital for more than 10 years. Under his guidance and supervision, the quality of care for patients with thyroid cancer achieved an exceeding level at this medical center. In the future, we will continue doing medical research and providing high-quality of care for patients to meet Prof. Lin’s expectations.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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ML-3 THYROID CANCER AND RADIOACTIVE IODINE THERAPY SHENG-FONG KUO Department of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Keelung, Taiwan

Radioactive iodine therapy has been extensively used for more than 60 years in the treatment of differentiated thyroid cancer after total or near-total thyroidectomy, and is suggested for remnant ablation in high and intermediate-risk patients with differentiated thyroid cancer. Under the Professor Lin's guidance, we performed studies at the Chang Gung Memorial Hospital regarding to “Thyroid cancer and radioactive iodine therapy”. Although radioactive iodine therapy is generally accepted in the management of patients with papillary thyroid carcinoma postoperatively, the data regarding radiation exposure to the household environment from patients with thyroid cancer who received radioactive iodine therapy were still insufficient, and also the factors associated with radiation exposure from the patients to the household environment, our study showed higher body weight and distant metastases may be the best predictors for higher radiation exposure to the household environment from patients with thyroid cancer after radioactive iodine therapy. In addition, the policy toward radioactive iodine therapy in childhood with papillary thyroid carcinoma is varied because of the unwanted side-effects of radiation exposure in young patients and limited long-term data. The prognosis of young PTC patients is generally good. Postoperative radioactive iodine therapy is effective in young papillary thyroid cancer patients especially those with distant metastases. Radioactive iodine therapy should be given to all young papillary thyroid cancer patients postoperatively in addition to thyroid hormone administration.

Abstract ML-4

CIRCULATING EPITHELIAL CELLS FOR RECURRENCE OF PAPILLARY THYROID CARCINOMA WITH POSITIVE ANTI-THYROGLOBULIN ANTIBODY YAN-RONG LI Division of Endocrinology and Metabolism, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taiwan

Serum thyroglobulin (Tg) is a routine and useful test to monitor disease status in papillary thyroid carcinoma (PTC) patients after total or near-total thyroidectomy with or without RAI therapy. However, for patients with positive serum anti-thyroglobulin antibody (TgAb), serum Tg cannot be a reliable tumor marker for follow-up of recurrent or persistent disease because of highly false negative rate. Positive serum TgAb are present in around 15% of thyroid cancer patients and an elevated titer of TgAb with or without an increased serum Tg suggests a recurrent disease; on the contrary, a significantly decreased titer of serum TgAb suggests no recurrence. Nevertheless, optimal levels of serum TgAb to define recurrent or persistent PTC is still conflicting currently. Although longitudinal changes in titers of serum TgAb can help physicians in detection of recurrent or persistent disease in progression, considerable time is still needed to observe this trend and this may cause a delayed diagnosis. Therefore, for PTC patients with positive serum TgAb, there remains a critical need to develop new biomarkers to monitor the disease status. Evaluation of circulating epithelial cells (CECs) or circulating tumor cells (CTCs) could be considered as a “liquid biopsy” that can monitor treatment responses and disease status in several types of cancers, such as breast, lung, colorectal and prostate cancers. Because PTC is a tumor of epithelial origin, CECs could be considered as CTCs in a defined population with known PTC. Our preliminary data illustrates that CECs testing could be a potential biomarker to identify recurrences in patients of PTCs with positive serum TgAb and undetectable levels of serum Tg.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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JS1-1

THE LONG TERM OUTCOME OF PRIMARY ALDOSTERONISM VIN-CENT WU Department of internal medicine, National Taiwan University Hospital, Taiwan

Although the role of primary aldosteronism (PA) in increasing cardiovascular risk and the potential of targeted therapy for PA have gained recognition, there exists a great knowledge gap in terms of long-term effects of various surgical and pharmacological treatments on outcomes among PA patients. For instance, it remains unclear whether certain targeted treatments for PA can yield everlasting elimination of high blood pressure and regression of the adverse cardiovascular changes. However, patients with IHA may have a different genotype and phenotype compared to APA, the clinical decision of targeted treatments for APA and long term outcome retained unmet study. Previous studies showed impaired glucose homeostasis and insulin resistance (IR) in PA patients, leading to increased prevalence of metabolic syndrome (MS), which could be improved after adrenalectomy. A cohort study reported a higher risk of cardiometabolic events and death in all PA patients than in essential hypertension counterparts in the follow–up after treatment with a mineralocorticoid receptor antagonist (MRA). In a cohort of PA patients with or without adrenal adenoma, surgical or medical treatment has a compatible cardiovascular outcome in the long term. While we had showed adrenalectomy could decreases long-term all-cause mortality independently from cure from hypertension in all PA patients from a claims database, whether MRA treatment produce a similar effect as adrenalectomy in terms of prevention of cardiovascular events or mortality among APA is unclear.

Abstract JS1-2

ADRENAL VENOUS SAMPLING: TECHNIQUES AND INTERPRETATION CHIN-CHEN CHANG Department of Medical Imaging, National Taiwan University Hospital, Taiwan.

Adrenal venous sampling (AVS) was introduced in late 1960s as a test to distinguish unilateral from bilateral primary aldosteronism (PA). AVS is held to be the “gold standard” diagnostic procedure for assessing lateralization of aldosterone secretion and thereby identifying the surgically curable forms of primary aldosteronism. The successful cannulation of both adrenal veins continues to be challenging clinical issues. Adequate adrenal sampling is based on higher cortisol concentration compared with peripheral sampling. Dyna-CT and on-site quick cortisol assay could be helpful to improve the successful rate. Cortisol is used for AVS data interpretation, but it has several pitfalls, including time- and stressrelated variation, and co-secretion in ipsilateral or contralateral adrenal with hyperaldosteronism. Multiple steroid panels are suggested for stratified PA subtyping and have the potential to circumvent AVS in a subset of patients with PA. We will share our experiences and the recent literature reviews in this speech.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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JS1-3

CLINICAL APPLICATION OF NUCLEAR MEDICINE IN PRIMARY ALDOSTERONISM CHING-CHU LU Department of Nuclear Medicine, National Taiwan University Hospital, Taiwan

Primary aldosteronism (PA), characterized by an excessive production of aldosterone, affects 10% of patients with hypertension. Accurate strategies are needed for the timely diagnosis of PA to allow curability and prevention of excessive cardiovascular events and related damage. Adrenal venous sampling (AVS) is the gold standard for lateralization but it is technically dependent and invasive. Conventional imaging modality such as computed tomography (CT) is widely available and could be used to exclude malignancy. Traditionally CT is considered useless in lateralization since lesion morphology is not correlated with functional status. However, in SPARTACUS trial, treatment based on CT or AVS did not show significant differences in intensity of antihypertensive medication or clinical benefits for patients after 1 year of follow-up. NP-59 adrenal scintigraphy (NP-59) is a molecular imaging evaluating adrenal cortical function based on the activity of cholesterol uptake and transfer. Studies revealed prognostic value of NP-59, but it is commonly considered out-of-date due to low resolution, limited availability and high radiation. Positron emission tomography (PET) using C11-metomidate, which is a CYP11B1 and CYP11B2 inhibitor, showed delicate imaging resolution with some preliminary report of lateralization ability. Specific CYP11B2 PET tracer labelled with fluorine-18 (F18-CDP2230) is currently under investigation in animal model. No steroid suppression is required due to its high affinity to CYP11B2. A novel PET tracer, Ga68-CXCR4 was found uptake by aldosterone-producing adenoma (APA) in human studies. CXCR4 was elevated in APA tissue its expression is closely associated with the expression of CYP11B2. The current review will introduce the history and the future of nuclear medicine in PA.

Abstract JS1-4

AUTONOMOUS CORTISOL SECRETION IN PRIMARY ALDOSTERONISM WAN-CHEN WU Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

Primary aldosteronism (PA) is considered to be the most common reason for secondary hypertension and also recognized as a result of a heterogeneous group of disorders, including aldosterone-producing adenomas (APAs), idiopathic uni- or bilateral adrenal hyperplasia, or from inherited forms of familial hyperaldosteronism (FHA). Among adrenal disorders that lead to PA, the subtype of aldosterone- and cortisol-co-secreting tumors can be recognized separately. A term widely used in the context of adrenal incidentaloma (AI) was “subclinical CS”. However, this terminology has become somewhat obsolete and it is currently more advisable to talk about autonomous cortisol secretion (ACS). This term aims to define AI patients with biochemical evidence of excess of cortisol, but without typical symptoms and signs of CS (mainly the lack of catabolic characteristics such as myopathy and skin fragility). ACS is associated with increased morbidity (diabetes, obesity, hypertension, osteoporosis, and cardiovascular events) and mortality. Concurrent ACS in subjects with PA is reported in an increase number, characterized by a high cardiovascular risk, which reflects the combined damaging effects of the two steroid excess. However, ACS is not easy to diagnose, mainly due to the lack of consensus on its definition and the fact that the detection of “specific” findings of CS is doctor dependent. The dexamethasone suppression test is the most accepted for screening. Low levels of ACTH and DHEA-S and high urinary free cortisol are also associated with ACS, but in isolation they are of little value to establish the diagnosis. Several somatic mutations (KCN5J, ATP1A1, ATP2B3, CACNA1D, CTNNB1) have been showed causative for APAs, and two somatic mutations of PRKACA (catalytic subunit of protein kinase A) and GNAS (guanine nucleotide binding protein α stimulating) have been identified in cortisol-producing adenomas (CPAs). The presence of PRKACA or GNAS mutations in APAs, especially with ACS is not well known.

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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JS1-5 GENETIC AND HISTOPATHOLOGIC CHARACTERIZATION OF SPORADIC PRIMARY ALDOSTERONISM KANG-YUNG PENG Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.

Primary aldosteronism (PA) is a major cause of secondary hypertension characterized by inappropriate secretion of aldosterone from unilateral or bilateral abnormal adrenal glands. The majority cases of PA are sporadic due to a unilateral aldosterone-producing adenoma (APA) or bilateral adrenal hyperplasia (BAH, also known as idiopathic hyperaldosteronism, IHA). During the last ten years, a better knowledge of the pathophysiology of PA came from the discovery of somatic and germline mutations in KCNJ5, ATP1A1, ATP2B3, CACNA1D, CTNNB1, CLCN2 and CACNA1H in sporadic and familial forms of the disease. These genes (except for CTNNB1 which encodes β-catenin) encode ion channels or pumps in adrenal cell membranes, mutations in these genes lead to membrane depolarization, increased calcium influx and activation of calcium signaling which in turn activates aldosterone synthase (CYP11B2) expression and aldosterone production. Histologically, APA has been reported to be mainly composed of clear cells (ZF-like, lipid-rich cells) and compact cells (ZG-like, spherical small cells). Some studies have described APA with KCNJ5 mutations have more ZF-like phenotype with high expression of CYP17A1, while APA with ATP1A1, ATP2B3 and CACNA1D mutations presented more frequently a ZG-like phenotype with high expression of CYP11B2. It is unclear whether somatic mutations completely cause the development of APA, leading to both excessive aldosterone production and nodule formation. Recent studies suggested that APA may derive from aldosterone-producing cell clusters (APCCs), CYP11B2-positive cell foci found in normal adrenal glands, which harbored APA-associated somatic mutations. In addition to APA, APCCs have also been implicated in IHA. The APCC hypothesis is also supported by the description of possible APCC to APA translational lesions (pAATL), which also carry APA-associated somatic mutations. Other studies suggest a two-hit hypothesis, where a specific genetic or epigenetic event stimulates adrenocortical cell proliferation and somatic mutations are secondary events leading to excessive aldosterone secretion. These two hypotheses may coexist, and both contribute to sporadic PA development.

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Abstract AP-1

RISK OF HEART FAILURE IN A POPULATION WITH TYPE 2 DIABETES VERSUS A POPULATION WITHOUT DIABETES WITH AND WITHOUT CORONARY HEART DISEASE 1,2

H-F CHEN, 3C-A HO, 4,5C-Y LI,

Department of Endocrinology, Far Eastern Memorial Hospital, New Taipei City, Taiwan; 2School of Medicine, Fujen Catholic University, New Taipei City, Taiwan; 3Department of Surgery, Catholic Mercy Hospital, Hsinchu County, Taiwan; 4Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City, Taiwan; 5Department of Public Health, College of Public Health, China Medical University, Taichung City, Taiwan

Purpose: To conduct a population-based study comparing age- and sex-specific risk estimates of heart failure (HF) between people with type 2 diabetes and people without diabetes, and to investigate the risks of HF in association with type 2 diabetes in people with various coronary heart diseases (CHDs). Method: We used a nationally representative sample (one million people) selected from Taiwan’s National Health Insurance (NHI) system. A total of 34 291 patients with type 2 diabetes were identified from ambulatory care claims in 2000, and the same number of age- and sex-matched controls were randomly selected from the registry of NHI beneficiaries in the same year. All study subjects were linked to inpatient claims (2000-2013) to identify the possible admissions for HF. Using a Cox proportional hazard regression model, we compared the relative hazards of HF in relation to type 2 diabetes according to various age and sex stratifications. We also compared the relative hazard of HF between type 2 diabetes and controls, with and without histories of various CHDs and coronary revascularization procedures. Result: Compared with absence of diabetes (control group), type 2 diabetes was significantly associated with an increased hazard of HF (adjusted hazard ratio [aHR] 1.47, 95% confidence interval [CI] 1.40-1.54]. In both sexes, those with type 2 diabetes aged < 45 years had the highest increased hazard of HF, with an aHR of 2.54 (95% CI 1.62-3.98) and 4.12 (95% CI 2.35-7.23) for men and women, respectively. Compared with the control subjects without any CHD, people with type 2 diabetes without prior CHD had increased hazards of HF (aHR 1.54, 95% CI 1.41-1.68, in men and aHR 1.56, 95% CI 1.43-1.71, in women), which were similar to the aHRs for people without diabetes who had histories of heart diseases (aHR 1.60 and 1.55 for men and women, respectively). Conclusion: Diabetes mellitus may increase the risk of HF in both men and women, as well as in all age groups, especially in young people. People with type 2 diabetes without CHD had a similarly increased risk of HF to that of control subjects with CHD. Certain coronary revascularization procedures and CHDs, including percutaneous transluminal coronary angiography, coronary artery bypass surgery and acute myocardial infarction, were found to greatly increase risk of HF in people with type 2 diabetes. Conclusions: Increased hepassocin secretion in hyperglycemic crisis might offset the deleterious effects of hyperglycemia on hepatocytes. 101

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AP-2

RACIAL DIFFERENCE IN BIOAVAILABILITY OF ORAL IBANDRONATE BETWEEN CAUCASIAN AND TAIWANESE POSTMENOPAUSAL WOMEN 1,2,3

W-Y CHIU, 4C-J LIN, 1,2W-S YANG, 1,3K-S TSAI, 5J-Y REGINSTER

Department of Internal Medicine, National Taiwan University Hospital , Taipei, Taiwan; 2Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; 3Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan; 4School of Pharmacy, National Taiwan University, Taipei, Taiwan; 5Department of Public Health, Epidemiology and Health Economics, Liège State University, Liège, Belgium

Purpose: Interethnic differences in the pharmacokinetics of oral ibandronate for osteoporosis are unknown. We compared the disposition of oral ibandronate between Caucasian and Taiwanese postmenopausal women. Method: Ibandronate 150 mg was administered to 35 Caucasian and 16 Taiwanese postmenopausal women in two separate phase 1 studies. Interethnic comparisons were performed to assess pharmacokinetic properties, including the area under the concentration-time curve (AUC), peak concentration (Cmax), elimination half-life, urinary drug recovery (Ae%), renal clearance (CLr), apparent total clearance (CL/F), and apparent volume of distribution (Vd/F). Result: The mean AUC, Cmax, and Ae% were 2.41-, 1.69-, and 2.95-fold greater in the Taiwanese than in the Caucasian subjects, and the average CL/F and Vd/F were 2.48- and 2.46-fold smaller. There were no significant differences in mean CLr and half-life between both groups. As bisphosphonates are not biotransformed but are mainly excreted in the urine, the total body clearance is close to the CLr. These results suggested a larger bioavailability in the Taiwanese group which resulted in the differences in the CL/F and Vd/F. Multiple linear regression analysis demonstrated ethnicity influences of the pharmacokinetic properties after adjusting for the other variables. The suppressive effects of ibandronate on the bone turnover markers (sCTX and urinary CTX, NTX corrected by the urinary creatinine concentrations) were all higher in the Taiwanese group compared with the Caucasian cohort. Conclusion: Bioavailability was largely responsible for the interethnic pharmacokinetic differences following oral administration of 150 mg ibandronate, and seemed greater in the Taiwanese compared with the Caucasian subjects. Further dose-ranging studies are warranted to determine the optimal dosages of oral ibandronate in patients of Asian or Taiwanese ethnicity.

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Abstract AP-3

DIABETIC FOOT INFECTION PRESENTING SYSTEMIC INFLAMMATORY RESPONSE SYNDROME: A UNIQUE DISORDER OF SYSTEMIC REACTION FROM INFECTION OF THE MOST DISTAL BODY 1

C-W LIN, 1S-Y HUNG, 1C-H HUANG, 2J-T YEH, 1,3Y-Y HUANG

Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taiwan; 2 Department of Plastic surgery, Chang Gung Memorial Hospital at Linkou, Taiwan; 3 Department of Medical Nutrition Therapy, Chang Gung Memorial Hospital, Taiwan

Purpose: Diabetic foot infection (DFI) is a major complication of diabetic foot that lead to nontraumatic lower-extremity amputation (LEA). Such distal infection of the body having systemic inflammatory response syndrome (SIRS) is rarely reported. This study aimed to further understand the factors that are prone to development of SIRS in patients with DFI and factors affecting its prognosis. Method: Consecutive patients treated for limb-threatening DFI in a major diabetic foot center in Taiwan were analyzed between the years 2014 to 2017. Clinical factors, laboratory data, PEDIS wound score in 519 subjects with grade 3 DFI and 203 presenting SIRS (28.1%) were compared. Major LEA and in-hospital mortality were defined as poor prognosis. Result: Patients presenting SIRS had poor prognosis compared with those with grade 3 DFI (14.3% vs. 6.6% for major LEA and 6.4% vs. 3.5% for in-hospital mortality). Age, wound size and HbA1c were independent risk factors favoring SIRS presentation. Perfusion grade 3 (odds ratio 3.37, P = 0.044) and history of major adverse cardiac events (OR 2.41, P = 0.036) were the independent factors for poor prognosis in treating patients with DFI presenting SIRS. Conclusion: SIRS when presented in patients with DFI is not only limb- but life-threatening as well. Clinicians should be aware of the clinical factors that are prone to develop and those affecting the prognosis in treating patients with limb-threatening foot infections.

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AP-4

EARLY CARDIOVASCULAR RISK AND ALL-CAUSE MORTALITY FOLLOWING AN INCIDENT OF SEVERE HYPOGLYCEMIA: A POPULATION-BASED COHORT STUDY 1,2

SC LO, 1,2YS YANG, 1,2EDY KORNELIUS, 2,3JY HUANG, 4YR LAI, 1,2CN HUANG, 5 JY CHIOU. 1

Department of Internal Medicine, Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital, Taichung, Taiwan; 2Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan; 3Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan; 4Pharmacy Division, Chung Shan Medical University Hospital, Taichung, Taiwan; 5Department of Health Policy and Management, Chung Shan Medical University, Taichung, Taiwan

Purpose: Severe hypoglycemia is associated with a high risk of cardiovascular events in patient with diabetes. The aim of this study was to clarify the temporal relationship between hypoglycemia and cardiovascular events Method: This observational cohort study was conducted using Taiwan’s Longitudinal Cohort of Diabetes Patients Database, which included 360 000 patients with newly diagnosed diabetes during the period 1999 to 2001. Patients with the first severe hypoglycemia after 2002 served as the study cohort. Each patient in the study cohort was matched with two control patients without severe hypoglycemia, based on a propensity score. A joinpoint regression model was used to determine trends in all-cause mortality and incidence of cardiovascular disease (CVD) events in both cohorts. Result: A total of 10 157 patients with severe hypoglycemia and 20 314 matched controls were recruited. Patients with severe hypoglycemia had a significantly higher risk of CVD (HR, 7.28; 95% CI, 5.19-10.20) and all-cause mortality (HR, 19.92; 95% CI, 13.42-29.56) during the first month compared with those without. In patients with severe hypoglycemia, the incidence of CVDs dropped by 17.29% monthly during the first 4 months and slowly decreased (-0.67%) during subsequent months. All-cause mortality decreased by 16.55% and 3.24% monthly during months 0-6 and months 6-17, respectively. Conclusion: Severe hypoglycemia is associated with a greater risk of cardiovascular events and death, especially during the first month following a hypoglycemic episode. Patients prone to severe hypoglycemia should be made aware of the elevated risk of subsequent cardiovascular events.

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Abstract OE-1

URINARY EXOSOMAL BIOMARKERS IN THYROID CANCER PATIENTS WITH ABLATIVE THERAPY: A PILOT STUDY 1

TSE-YING HUANG, 2,3CHIH-YUAN WANG, 2LI-TING HUANG, 2YI-CHIEH CHUNG

Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taiwan; 3 Department of Internal Medicine, National Taiwan University Hospital, Yunlin Branch,Taiwan

Background: Although thyroid cancers are low-grade endocrine malignancy, most patients usually received thyroidectomy with ablative radioactive iodine therapy. Such patients were followed with thyroid ultrasonography and serial serum thyroglobulin evaluation. Methods: Exosomes are nanovesicles secreted into extracellular environments. Cancer cellderived exosomes could be found in plasma, saliva, urine and other body fluid of patients with cancer. We try to analyze the urinary exosomal proteins, including thyroglobulin and galectin-3, to find the early prognostic biological markers in urine via this prospective study. Results: The trends of urinary thyroglobulin concentrations in patients with post-ablative thyroid cancer were detected in the very first three patients. Importantly, serum thyroglobulin cannot be found in two patients after radioactive I-131 ablation, however, urinary exosomal thyroglobulin still showed an increasing trend. Conclusions: Since expensive recombinant human TSH (rhTSH) is usually needed to stimulate serum thyroglobulin for detecting local recurrence or distant metastasis. The issue of earlier biological markers for predicting prognosis of thyroid cancer should be raised. This pilot study report is the very first one to explore that urinary exosomal thyroglobulin could be a reliable biological marker to substitute for serum thyroglobulin in the future.

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OE-2

COMPARISON OF DIAGNOSTIC METHODS FOR THE DETECTION OF A BRAF MUTATION IN THYROID NEOPLASM 1

YUNG-NIEN CHEN, 2SHUN-CHEN HUANG, 1JUNG-FU CHEN, 1CHEN-KAI CHOU

Division of Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 2Department of Pathology,Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

Background: Papillary thyroid carcinoma (PTC) represents the majority of differentiated thyroid cancers, presenting the V600E activating BRAF mutation in 29–83% of cases. The most accurate and robust method for detecting the BRAF mutation has not yet been determined. BRAF mutational analysis was performed by Sanger DNA sequencing, competitive allele-specific real-time polymerase chain reaction (CasPCR) and digital polymerase chain reaction (dPCR). Methods: To compare sensitivity and accuracy of three methods for detection of BRAF mutation, mixed proportion of BCPAP (BRAF mutant) cells and TPC1 (BRAF-negative) wild type were assessed. DNA extracted from 94 thyroid tumors (30 classical papillary thyroid carcinomas (PTC); 29 follicular PTCs; 15 goiters; 10 Hashimoto’s thyroiditis; 10 Graves’ disease) were also used for detection of BRAF mutations by dPCR. Results: To compare the sensitivity of different methods for detection of BRAF mutation, mutant BRAF DNA samples were tested in diluted mixtures of mutant and wild type. Digital PCR, but not CasPCR(9%) or Sanger sequencing(25%), allowed detection of mutant copies in a mixture 0.4% of DNA from BRAF positive cells with DNA from wild types. In classical PTCs, BRAFV600E was detected from formalin-fixed paraffin-embedded (FFPE) tissue specimens by dPCR in 24/30 (80%). BRAFV600E was not detected in follicular PTCs and other tumors. The BRAF mutation rate of ten classical PTC fine-needle aspiration (FNA) specimens were compared with their FFPE specimens. In 10 aspiration tissue samples, the BRAF mutation was detected in 7 samples (70%) by dPCR and 4 samples(40%) by CasPCR. In 10 FFPE samples, the BRAF mutation was detected in 7 samples (70%) by Roche real-time PCR and was completely matched the dPCR result for their aspiration specimens. The sensitivity and specificity of CasPCR for detecting the BRAF mutation was 57.1% and 100% in FNA samples. Conclusions: Digital PCR could be a more sensitive method to direct Sanger sequencing and CasPCR for BRAF mutation detection of thyroid cancer. Accurate screening for BRAF mutation may contribute to improving the risk stratification of PTC.

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Abstract OE-3

ASM, GRIP STRENGTH AND GAIT SPEED IN MENOPAUSAL WOMEN WITH TOTAL THYROIDECTOMY 1,2

WEI-LUN WEN, 1,3,4,5SZU-CHIA CHEN, 1,2WEI -HAO HSU, 6HUI-CHUN YU, 6,7 JUI-SHENG HSU, 6MING-CHEN SHIH, 2HE-JIUN JIANG, 2,4MEI-YUEH LEE 1

Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 4Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 5Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 6 Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 7Department of Radiology , Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

Background: There has been a growing attention toward sarcopenia not only in worldwide but also in Taiwan. There were several known risk factors including aging, malnutrition, diabetes and even some hormones and osteoporosis involved, but few published papers revealed relationship between thyroidectomy and sarcopenia. As post-thyroidectomy patients were majorly follow-up at our endocrine & metabolic outpatient department, we designed a study to analyze sarcopenia and its risk factors in this specific population. Methods: This prospective, observational, cross-sectional, controlled study involved 50 postmenopausal women with regular visits to the Outpatient Department of Endocrinology and Metabolism, Kaohsiung Medical University Hospital (KMUH) for treatment and follow up after complete removal of thyroid, which included both benign and malignant neoplasms of thyroid on initial diagnosis. We measured their body composition including height-adjusted appendicular skeletal muscle mass (ASM/ht2) and bone mineral density(BMD) via Dual-energy X-ray Absorptiometry (DXA); we then also performed functional testing including handgrip strength and gait speed; Geriatric Nutritional Risk Index(GNRI), a nutrition surrogate marker was calculated by baseline serum albumin level and body weight, as follows: GNRI = [14.89×albumin (g/dL)] + [41.7×(body weight/ideal body weight)]; other comprehensive laboratory survey related to thyroid function, reproductive axis, and mineral metabolism were also collected. Multiple stepwise linear regression analysis was used to identify the factors associated with ASM/height2, handgrip strength and gait speed after multiple adjustments. A p value < 0.05 was considered to be statistically significant. Results: In our study population, the prevalence of sarcopenia was 26%, defined by ASM/ ht2 ≤ 5.67 kg/m2 according to International Working Group on Sarcopenia (IWGS) criteria. The determinants of ASM/height2, handgrip strength, and gait speed using multivariable stepwise linear regression analysis were: Low GNRI, low femoral neck BMD, low TSH, and low thyroglobulin Ab for

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The

low ASM/height2; long menopausal years and low ASM/height2 for low handgrip strength; young age, low GNRI, and high T3 for low gait speed. Conclusions: Age, menopausal duration, BMD, GNRI, thyroid function, and thyroglobulin antibody were significantly associated with sarcopenia or lower functional capacities in menopausal women with total thyroidectomy.

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Abstract OE-4

HYPERTHYROIDISM AND RISK OF SEIZURE: A NATIONAL POPULATION-BASED STUDY 1

HAN-WEN LIU, 1,2TING-I LEE, 3BEN-CHANG SHIA

Division of Endocrinology and Metabolism, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of General Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; 3Research Center of Big Data, College of Management, Taipei Medical University, Taipei, Taiwan

Background: Dysfunction of central nervous system may occur in patients with hyperthyroidism. There are a few case reports of seizure attack in patients with hyperthyroidism. The underlying pathogenesis is not clear. A population-based cohort study was performed to analyze the incidence of seizure among hyperthyroidism patients. Methods: Adult patients who had hyperthyroidism diagnosis and received either antithyroid drugs, thyroidectomy, or radioiodine therapy were identified from Taiwan National Health Insurance Research Database between 2000 to 2013. Patients with history of stroke, brain tumor, or head trauma were excluded. The main outcome was the occurrence of convulsion and epilepsy. The odds ratio (OR) was adjusted by multivariable Cox regression. Results: 9272 patients were identified in the hyperthyroidism group and 27816 patients in control group. The incidence of convulsions was 0.6% in hyperthyroidism group and 0.4% in control group. Crude OR was 1.42 (95% confidence interval 1.04-1.94) and adjusted OR was 1.31 (95% CI 0.951.81). The incidence of epilepsy was 0.6% and 0.4% in each group. Crude OR was 1.42 (95% CI 1.031.97) and adjusted OR was 1.34 (95% CI 0.96-1.87). Conclusions: The risk of seizure seems higher among hyperthyroidism patients. However, the OR was not significant after adjustment. Further research is warranted.

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OE-5

LUNG CANCER WITH RADIOIODINE AVIDITY: A COHORT STUDY OF PATIENTS WITH THYROID CANCER 1

YU-LING LU, 1SZU-TA CHEN, 2TSUNG-YING HO, 3WEN-HUI CHAN, 4CHUEN HSUEH, 1 SHU-FU LIN 1

Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang-Gung Memorial Hospital, Taoyuan, Taiwan; 2Department of Nuclear Medicine, Chang-Gung Memorial Hospital, Taoyuan, Taiwan; 3Department of Medical Imaging and Intervention, Chang-Gung Memorial Hospital, Taoyuan, Taiwan; 4 Department of Pathology, Chang-Gung Memorial Hospital, Taoyuan, Taiwan

Background: We evaluated, in a retrospective cohort, the incidence of lung cancer with radioiodine (RAI) avidity on whole-body scan and the potential mechanism driving RAI uptake. Methods: The incidence of lung cancer with RAI avidity was assessed using our prospectively maintained database of patients with thyroid cancer at a medical center. Immunohistochemistry was performed to determine sodium/iodide symporter (NIS) expression in lung cancer specimens. Results: A total of 4,602 patients with well-differentiated thyroid cancer (WDTC) diagnosed between December 1, 1976 and May 28, 2018 were identified in this database. Among them, 33 patients with papillary thyroid cancer developed lung cancer during follow up of WDTC. Nine of 33 patients exposed to Iodine-131 (131I) within one year prior to the diagnosis of lung cancer were further evaluated. One of 9 (11.1%) lung cancers demonstrated the ability to uptake 131I on RAI scan. Immunohistochemical staining of archived lung cancer specimens revealed NIS expression in 3 of 8 (37.5%) lung cancers. Of these, the one with RAI avidity had the highest level of NIS expression. Conclusions: Our data reveal that a significant proportion of lung cancers have NIS expression. However, only lung cancer with high NIS expression demonstrates RAI avidity.

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Abstract OE-6 IODINE SUPPLEMENTATION AND SOCIOENVIRONMENTAL INFLUENCES ON IODINE NUTRITION STATUS OF PREGNANT WOMEN IN TAIWAN 1

FAN-FEN WANG, 2CHYI-HUEY BAI, 3KAM-TSUN TANG, 2YUN-CHU WANG, 3 CHUN-JUI HUANG 1

Division of Endocrinology and Metabolism, Department of Medicine, Yangming Branch, Taipei City Hospital, Taipei, Taiwan; 2 Department of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; 3Division of Endocrinology and Metabolism, Taipei Veterans General Hospital, Taipei, Taiwan

Background: Iodine deficiency during pregnancy is associated with adverse obstetric outcomes and impaired fetal neurodevelopment. Iodine nutrition of pregnant women from different geographic areas and the impact of socioeconomic status have not previously been evaluated in Taiwan. Methods: The current study is a substudy of Nutrition Survey of Pregnant Women in Taiwan 2017-2019. Multistage cluster sampling was performed based on geographical locations and hospital size. Spot urine was collected for urinary iodine analysis. Dietary iodine intake, including nutritional supplements, was assessed by food frequency questionnaire and 24-h food intake recall. Results: A total of 1502 pregnant women with a mean age of 32.5 ± 4.8 years were enrolled, of whom 77 (5.1%) reported thyroid diseases. The weighted median urinary iodine concentration (MUIC) was 148 μg/L, indicating a borderline iodine insufficiency, and 149 μg/L if women with thyroid disease were excluded. Forty-nine brands of multivitamins were used by the studied population, 38 of which were intended for pregnant women. However, 15 (15/38) of these prenatal multivitamin brands did not contain iodine. The MUIC of pregnant women who used iodine-containing multivitamins was 167 μg/ L, which was significantly higher than that of those who didn’t use iodine-containing multivitamins (126 μg/L, p < 0.001). In the socioenvironmental analysis, lower MUIC was noted in women from the Eastern stratum, with lower educational level (senior high school or less), or lowest quintile of household income. Conclusions: Socioenvironmental inequalities should be taken into account in the evaluation of a population’s iodine status and the development of strategies to achieve optimum iodine nutrition.

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The

OD-1

CARDIOVASCULAR EFFECTIVENESS AND SAFETY OF EMPAGLIFLOZIN IN ROUTINE CARE IN EAST ASIA: RESULTS FROM THE EMPRISE STUDY 1

WAYNE H-H SHEU, 2ELISE CHIA-HUI TAN, 3YUTAKA SEINO, 4DAE JUNG KIM, 5 DAISUKE YABE, 4KYOUNG HWA HA, 6WEI-YU LEI, 7WOOK-JIN CHUNG, 8 ATSUTAKA YASUI, 9RIHO KLEMENT, 10MOE KYAW, 10KIMBERLY G. BRODOVICZ 1

Division of Endocrinology and Metabolism, Taichung Veterans General Hospital, Taichung, Taiwan; National Research Institute of Chinese Medicine, Ministry of Health and Welfare, Taipei, Taiwan, and Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan; 3Kansai Electric Power Medical Research Institute, Kobe, Japan; 4Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea; 5Kansai Electric Power Medical Research Institute, Kobe, Japan, and Department of Diabetes and Endocrinology, Gifu University Graduate School of Medicine, Gifu, Japan; 6Boehringer Ingelheim Taiwan Ltd., Taipei, Taiwan; 7Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Korea; 8Nippon Boehringer Ingelheim Co. Ltd., Tokyo, Japan; 9EPID Research, Tartu, Estonia; 10Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA 2

Background: Empagliflozin reduced the risks of cardiovascular (CV) death and hospitalization for heart failure (HHF) in type 2 diabetes mellitus (T2DM) patients and established CV disease in the EMPA-REG OUTCOME trial. The Empagliflozin Comparative Effectiveness and Safety Study (EMPRISE) is comparing the effectiveness, safety, and healthcare utilization of empagliflozin versus dipeptidyl peptidase-4 inhibitors (DPP-4i) in routine clinical care across the CV risk continuum in Asia, Europe, and the US. Analyses of EMPRISE in the US showed that empagliflozin was associated with a lower risk of CV outcomes. Methods: We analyzed data from three East Asian countries in EMPRISE (Japan, South Korea, and Taiwan) for T2DM patients aged ≥ 18 years before initiated empagliflozin or a DPP-4i. Exclusion criteria included prescription of any SGLT2i/DPP-4i in the prior 12 months, diagnosis of type 1 diabetes mellitus/gestational diabetes at any time, or diagnosis of end-stage renal disease (ESRD) in the prior 12 months. Sub-cohorts of empagliflozin and DPP-4i initiators were identified by propensity score matching (1:1) with > 120 covariates. The meta-analyses were conducted for the primary effectiveness outcomes (HHF, ESRD and all-cause mortality [ACM]). Results: In total, 892,355 patients initiated either empagliflozin or a DPP-4i (Japan 343,329; South Korea 263,524; Taiwan 285,502), with 28,712 matched pairs of patients (Japan 5,592 pairs; South Korea 9,072 pairs; Taiwan 14,048 pairs). Empagliflozin was associated with significant 21% (p-value = 0.023), 36% (p-value < 0.001) and 63% (p-value < 0.001) reductions in the risk of HHFspecific, ACM and ESRD, respectively. Conclusions: The results provide insight into the effectiveness of empagliflozin in routine care of T2DM in East Asia. 112

Abstract OD-2 THE RISK FACTORS OF LATENT TUBERCULOSIS INFECTION IN PATIENTS WITH TYPE 2 DIABETES 1,2

CHING-JUNG HSIEH, 1SUN WU, 1I-CHIN HUANG, 1HSIN-HONG HSIEH, 1CHUN-HUI WU

Department of Internal Medicine, Pao Chien Hospital, Ping Tung, Taiwan; 2Department of Nursing, College of Health and Nursing, Mei Ho University, Ping Tung, Taiwan

Background: There is growing evidence that diabetes mellitus (DM) is an important factor for tuberculosis and might affect disease presentation and treatment response. Otherwise, tuberculosis might induce glucose intolerance and worsen glycemic control in people with diabetes. Adults with diabetes and latent tuberculosis infection (LTBI) are at high risk for progressing to active tuberculosis (TB) disease if they are not treated. Studies have shown that this risk is 2 to 6 times higher than in patients without diabetes. T-cell interferon-γ release assay (IGRA) to test for LTBI at least once after diabetes diagnosis has been recommended. Screening and treatment of LTBI and TB disease could reduce DM associated TB. The aim of this study is to investigate the risk factors of LTBI among patients with type 2 DM in a single institution. Methods: Patients with more than 5 years of type 2 DM under medication control underwent LTBI screening using IGRA testing. TB was investigated by sputum smear, culture and x-ray if positive finding of IGRA. Risk factors measuring from electronic medical record included average and standard deviation (SD) of glycated hemoglobin (HbA1c) between 1 month before and 5 years after IGRA testing. The serum lipid profile, creatinine, urine albumin/creatinine ratio (UACR), and blood pressure were measured before IGRA testing. The duration of diabetes, body weight, and body high were also recorded. Results: Of 90 patients with DM screened, 81 (90%) were eligible and LTBI prevalence was 19.8% (16/81). No active TB was investigated in the patients with LTBI. Patients who had LTBI had longer duration of diabetes (10.6 ± 2.0 vs. 7.3 ± 1.3 years, p = 0.001), higher SD of HbA1cs than control (3.1 ± 0.4 vs. 1.9 ± 0.4 %, p < 0.001) and higher UACR (723.3 ± 605.7 vs.181.8 ± 374.4 mg/ g, p = 0.005) but not average of HbA1cs (8.8 ± 1.0 vs. 8.4 ± 1.4 %, p = 0.065). There were no group differences in gender, body weight, blood pressure, lipid profile, renal function. Conclusion: Patients with longer duration of DM, HbA1cs fluctuation and severe albuminuria may have increased risk of LTBI. Therefore, stable blood glucose control and lower HbA1c oscillation may improve T cell function and prevent LTBI in patients with diabetes. Less HbA1c fluctuation may also decreasing microvascular complication, especially for nephropathy.

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st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

OD-3 SODIUM HYDROSULFIDE RESTORES TUMOR NECROSIS FACTOR-ALPHA-INDUCED MITOCHONDRIAL DYSFUNCTION AND METABOLIC DYSREGULATION IN HL-1 CELLS 1,2,3

T-I LEE, 4,5Y-H KAO, 4L BAIGALMAA, 2,3T-W LEE, 6Y-Y LU LU, 7Y-C CHEN, 8,9Y-J CHEN

Department of General Medicine, School of Medicine, College of Medicine, Taipei Medical University; Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University; 3Division of Endocrinology and Metabolism, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University; 4Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University; 5Department of Medical Education and Research, Wan Fang Hospital, Taipei Medical University; 6Division of Cardiology, Department of Internal Medicine, Sijhih Cathay General Hospital; 7Department of Biomedical Engineering, National Defense Medical Center; 8Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University; 9Cardiovascular Research Center, Wan Fang Hospital, Taipei Medical University Taiwan 2

Background: Tumor necrosis factor (TNF)-alpha induces cardiac metabolic disorder, and mitochondrial dysfunction. Hydrogen sulfide (H2S) contains anti-inflammatory and biological effects in cardiomyocytes. This study investigated whether H2S modulates TNF-alpha-dysregulated mitochondrial function and metabolism in cardiomyocytes. Materials and Methods: HL-1 cells were incubated with TNF-alpha (25 ng/mL) with or without sodium hydrosulfide (NaHS, 0.1 mM) for 24 hours. Cardiac peroxisome proliferator-activated receptor (PPAR) isoforms, proinflammatory cytokines, receptor for advanced glycation end products (RAGE), and fatty acid metabolism were evaluated through Western blotting. The mitochondrial oxygen consumption rate and adenosine triphosphate (ATP) production were investigated using Seahorse XF24 extracellular flux analyzer and bioluminescence assay. Fluorescence intensity using 2′, 7′-dichlorodihydrofluorescein diacetate was used to evaluate mitochondrial oxidative stress. Results: NaHS attenuated the impaired basal and maximal respiration, ATP production, and ATP synthesis, and enhanced mitochondrial oxidative stress in TNF-alpha-treated HL-1 cells. TNFalpha-treated HL-1 cells exhibited lower expression of PPAR-alpha, PPAR-delta, phosphorylated 5′ adenosine monophosphate-activated protein kinase-alpha2, phosphorylated acetyl CoA carboxylase, carnitine palmitoyltransferase-1, PPAR-gamma coactivator 1-alpha, and diacylglycerol acyltransferase 1 protein, but higher expression of interleukin-6 and RAGE protein than control or combined NaHS and TNF-alpha-treated HL-1 cells. Conclusion: NaHS modulates the effects of TNF-alpha on mitochondria and the cardiometabolic system, suggesting its therapeutic potential for inflammation-induced cardiac dysfunction.

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Abstract OD-4

GLP-1 SIGNALING ACTIVATION AND HMB SUPPLEMENTATION ATTENUATE GLUCOLIPOTOXICITY-INDUCED MUSCLE WASTING 1

HSIN-HUA LI, 2CHIH-LI LIN, 3YI-SUN YANG, 3EDY KORNELIUS, 3SHIH-CHANG LO, 4 CHIUNG-HUEI PENG, 2LING-YEN CHIU, 3CHIEN-NING HUANG 1

Clinical Research Center, Chung Shan Medical University Hospital, Taichung, Taiwan; 2Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; 3Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital, Taichung, Taiwan; 4Division of Nursing, Hung Kuang University, Taichung, Taiwan

Background: Type 2 diabetes (T2D) is characterized by a failure to mediate glucose homeostasis, and hence numerous complicated conditions are induced by tissues exposure to high glucose. Although the causes of T2D are multifactorial, nearly 80% of T2D patients suffer obese and insulin resistance simultaneously. Evidence is now revealed that T2D patients typically show high circulating levels of glucose, palmitic and oleic fatty acids (also called as glucolipotoxicity), which can mediate oxidative stress and insulin resistance. Among various complications of diabetes, the continuously loss of muscle is one of the most important adverse effects. Since muscle loss is at high risk for physical disability and mortality in diabetes, the investigation of molecular mechanisms may help developing therapeutic strategies. To this, previous studies have suggested that the supplementation of β-Hydroxy-βmethylbutyrates (HMBs) may be a dietary strategy to minimize diabetic muscle wasting. Interestingly, recent studies have found that GLP-1 agonists appear to slow muscle wasting during T2D. However, the detailed mechanism is still not well understood. Methods: To provide a better understanding the role of GLP-1 signaling, we evaluated whether co-treatment of GLP-1 analogue and HMBs is a workable strategy against glucolipotoxicity-induced muscle wasting. Results: Our results found that activation of GLP-1 signaling protect against glucolipotoxicityinduced muscle damages, including oxidative stress, mitochondria dysfunction, glucose uptake and insulin resistance. Moreover, co-treatment with GLP-1 analogues can better strengthen the above protection mechanisms, and this protection may be effective by activating the AMPK/SIRT1 pathway. Conclusions: These results can confirm and extend the contributing role of GLP-1 signaling and HMBs in glucolipotoxicity-induced oxidative stress and insulin resistance in myotube cells.

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OD-5

SOLUBLE TUMOR NECROSIS FACTOR RECEPTOR TYPE 1 IS ASSOCIATED WITH RENAL OUTCOMES IN CHINESE SUBJECTS WITH TYPE 2 DIABETES MELLITUS 1,2

LIANG-YU LIN, 3,4LI-HSIN CHANG

Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, 2Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, 3Division of Endocrinology and Metabolism, Department of Medicine, Yeezen General Hospital, Taoyuan, Taiwan, 4Department of Nursing, Hsin Sheng Junior College of Medical Care and Management, Taoyuan, Taiwan

Background: Chinese subjects with type 2 diabetes mellitus (T2D) are at higher risk of diabetic kidney disease (DKD) than Caucasian. Soluble tumor necrosis factor receptor type 1(sTNFR1) is associated with advancing of DKD and predicts renal outcomes in the Caucasian but the association has not been validated in Chinese subjects. The purpose of the study is to exam the association of sTNFR1 and renal outcomes in the Chinese cohort with T2D. Methods: Two hundred and eighty three Chinese subjects with T2D were enrolled in the prospectively observational cohort after excluding those with estimating glomerular filtration rate (eGFR) < 30 ml/min/1.73m2. The renal outcomes were composited by more than 30% decline of eGFR or worsening status of albuminuria confirmed by consecutive sampling of blood and urine. Results: sTNFR1 was associated with renal outcomes. sTNFR1 979 pg/mL showed the best area under curve (AUC), sensitivity, and specificity to predict renal outcomes in receiver operating curve (AUC 0.68, p < 0.001; sensitivity 78.3%, specificity 48.9%). The portion of renal events were higher in subjects with sTNFR1 ≥ 979 pg/mL comparing with subjects whose sTNFR1 < 979 pg/mL (29% versus 10%, p < 0.001 by log-rank test). sTNFR1 ≥ 979 pg/mL was associated with renal outcomes after adjusting other covariates (adjusted hazard ratio 2.43, 95% confidence interval 1.18-5.02, p = 0.01) and the association was consistent in all subgroups stratified by age, gender, blood pressure, eGFR, status of albuminuria, and use of blockade of renin-angiotensin system. Conclusions: sTNFR1 was associated with progression of DKD in Chinese subjects with T2D.

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Abstract OD-6

COMPARISON OF THE EFFICACY AND SAFETY OF EMPAGLIFLOZIN AND LINAGLIPTIN ADDED TO PREMIXED INSULIN IN PATIENTS WITH UNCONTROLLED TYPE 2 DIABETES 1

SUNG-CHEN LIU, 1CHUN-CHUAN LEE, 1SHIH-MING CHUANG, 2FANG-JU SUN, 1 YI-HONG ZENG 1

Division of Endocrinology and Metabolism, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; 2Research Assistant, Department of Medical research, Mackay Memorial Hospital, Taipei, Taiwan

Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors and dipeptidyl peptidase 4 (DPP4) inhibitors added to insulin regimen in patients with type 2 diabetes (T2DM) can improve glycemic control. The aim of this study was to compare the efficacy and safety of empagliflozin and linagliptin added to premixed insulin therapy in patients with poorly controlled T2DM. Methods: This was a 24-week, open-label, parallel, randomized controlled trial. Patients with poorly controlled T2DM, who were on premixed insulin were randomized to receive 5 mg linagliptin (n = 53) or 25 mg empagliflozin (n = 53) for 24 weeks. Results: At week 24, the changes in glycated hemoglobin (HbA1c) from baseline were -0.06 ± 0.17 % and -1.01 ± 0.16 % in the linagliptin and empagliflozin groups, respectively. The mean treatment difference in HbA1c was -0.88 % (95 % CI -1.33, -0.43). At week 24, empagliflozin group showed significant reduction compared with linagliptin group in terms of fasting plasma glucose, body weight (p < 0.001), and systolic blood pressure (p = 0.003). Hypoglycemia was reported to be slightly higher but not significantly in the empagliflozin group than in the linagliptin group (30.2 % vs. 22.6 %; p = 0.51). A similar percentage of patients had urinary tract infection in the two groups (1.9 %). Conclusions: In patients with inadequately controlled T2DM on premixed insulin, the addition of empagliflozin over 24 weeks provided better glycemic control and greater reduction in body weight and systolic blood pressure than the addition of linagliptin.

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st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

PE-1 CLINICAL EFFICACY OF SANDOSTATIN LAR 20 MG IN PATIENTS WITH ACROMEGALY AFTER INCOMPLETE SURGERY TZU-CHING HUNG, WAN-CHI CHUANG, WEI-CHENG CHANG, 1CHIH-HSUN CHU Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Veterans General HosPital, Kaohsiung, Taiwan; 1Department of Nursing, School of Nursing, Fooyin University, Kaohsiung, Taiwan.

Background: The objective of this study is to retrospectively survey the efficacy of sandostatin LAR 20mg in patients with acromegaly after incomplete surgery. Methods: From October 2015 to February 2019, there were eleven subjects (4 male, 7 female) who with pituitary adenoma and complicated with acromegaly receiving operation, but the growth hormone level remained above 1 μg/l. The mean age were 55.8 yr (range from 37 to 74 yr), Nine patient (82%) was macroadenoma. There were eight patients (73%) complicated with diabetes, one with prediabetes, only two (18%) without glycemic abnormalities. They were all received sandostatin LAR 20mg injection per month. Results: The mean duration of treatment were 26.2 ± 12.5 months (range from 7 to 47 months). The baseline levels of growth hormone were 3.3 ± 1.8μg/l, IGF-1 were 628.8 ± 197.2 ng/ml. After sandostatin LAR 20mg management, the latest levels of growth hormone decreased to 0.95 ± 0.95μg/ l (∆ 68%, P = 0.001), levels of IGF-1 decreased to 197.2 ± 64.2 ng/ml (∆ 61%, P=0.002). Nine patients (82%) with levels of growth hormone < 1 μg/l. Nine patients (82%) with IGF-1 in normal values. There were seven patients (64%) achieved growth hormone levels < 1 μg/l combined with normalization of IGF-1 values. Conclusion: In patients with acromegaly after incomplete surgery. Sandostatin LAR 20mg injection per month is an effective treatment for most of them.

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Abstract PE-2

THE MORTALITY FACTORS IN RECURRENT PARATHYROID CARCINOMA: A POOLED ANALYSIS FROM 52 YEARS OF MEDICAL LITERATURE WEN-HSUAN TSAI, YI-HONG ZENG, CHUN-CHUAN LEE, MING-CHIEH TSAI Mackay Memorial Hospital

Background: Background: Parathyroid cancer is a rare disease with high recurrence rate. The prognostic factors for recurrent parathyroid cancer are yet to be conclusively determined. We aimed to establish the association between recurrent parathyroid cancer and previously reported prognostic factors. Patients and Methods: We conducted a PubMed search using the keywords ‘parathyroid cancer’, ‘parathyroid neoplasm’, and ‘hypercalcemia’ during 1966–2018 and included 55 studies, 73 patients from 3272 articles. We performed the basic symptoms stratified by serum calcium level and conducted survival analysis by Cox proportional hazard model with 95% confidence interval. Results: For the 73 patients included in the analysis, the mean ± standard deviation age was 44 ± 13.2 years, and 36 of the patients were women (49.3%). During 5236 person-months at risk (mean follow-up 71.7 months, range 3-264), 38 patients died. The incidence of local recurrence, lymph node metastasis, lung metastasis, and bone metastasis was 60.3, 12.3, 56.2, and 24.7, respectively. Bone metastasis, disease-free interval shorter than 1 year, and total surgeries < 3 were significant prognostic factors in univariate analysis (log-rank test P = 0.063, P = 0.0006, P = 0.0056, respectively). In multivariate-adjusted analysis, the mortality risk were significantly increased in bone metastasis with hazard ratio (HR) as 4.83 (95% CI 1.16-20.2; P = 0.03), disease-free interval > 1 year as 0.17 (95% CI 0.05-0.54; P = 0.003) and total surgeries ≥ 3 as 0.09 (95% CI 0.02-0.36; P = 0.001), considering as predictively prognostic factors. Conclusion: Bone metastasis, duration of disease-free interval, and total number of surgeries predict survival in recurrent parathyroid cancer.

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st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

PE-3 A CASE REPORT : PHEOCHROMOCYTOMA IN A 69 YEAR-OLD WOMAN PRESENTED AS RECURRENT SYNCOPE 1

YAN-YU LIN, 1,2CHUNG-HUEI HSU, 1CHEN-LING HUANG, 1SHUEN-FU WENG, 1 YU-PEI LIN 1

Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; 2Department of Nuclear Medicine, Taipei Medical University Hospital, Taipei, Taiwan

Introduction: Pheochromocytomas are rare neuroendocrine chromaffin-derived tumors that arise within the adrenal medulla. They are usually benign, but if not diagnosed or if left untreated, they can have devastating consequences. Case Report: This 69-year-old woman had underlying disease of type 2 diabetes mellitus, hypertension, and old left cerebellar infarction. She was just discharged from other hospital due to recurrent syncope episodes. However, recurrent syncope which happened more than three times in one week still occurred that she was admitted in our hospital for survey . After admission acute left cerebral infarction over posterior cerebral artery (PCA) territory was diagnosed. However, severe hypertension with fluctuated blood pressure was noted. Serum ACTH, cortisol, renin, aldosterone and 24 hr urine VMA, catecholamine were checked for secondary hypertension survey. Abnormal findings showed urine VMA 25.63mg/24hr, urine epinephrine 170.7 μg/24hr, and urine norepinephrine 780.8μg/24hr. Adrenal MRI was arranged which presented as a left adrenal mass, size up to 3.8 cm, with T2 heterogeneous intensity and post contrast enhancement, suggest clinical correlation the possibility of pheochromocytoma. After consulting urologist and discussing with her family, they decided to receive operation. Alpha blocker was used then, and prepared for surgery until blood pressure became stable. Discussion: The typical symptoms of pheochromocytoma are paroxysmal hypertension, chest pain (or headache), palpitation, perspiration, pallor. Although most patients have either sustained or paroxysmal hypertension, some patients present with hypotension. The management of hypertension with pheochromocytoma is well-established. However, it is difficult to stabilize blood pressure in patients presenting with hypotension. Excess epinephrine and volume depletion may be the cause. Beta blocker seemed effectively reduced syncopal attacks and hypotension. Propranolol and large volume of infusion could stabilize the blood pressure. The therapeutic treatment of pheochromocytoma is operation; however, stabilize the blood pressure and control the activity of the tumor is a very important issue before the surgery.

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Abstract PE-4 EXOSOMAL PROTEINS IN URINE: BRAND NEW BIOMARKERS IN POST-OPERATIVE FOLLOW-UP OF THYROID CANCER 1,2

CHIH-YUAN WANG, 3TSE-YING HUANG, 1LI-TING HUANG, 1YI-CHIEH CHUNG

Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taiwan; 2Department of Internal Medicine, National Taiwan University Hospital, Yunlin Branch,Taiwan; 3 Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan

Background: Thyroid cancer is the commonest malignancy in endocrine disease category. Postoperative follow-up in well-differentiated thyroid cancer usually depends on image studies and serum thyroglobulin levels for decades.The aim of our study tried to find new biomarkers instead of serum thyroglobulin. Methods: Urinary exosome precipitation was performed. All reagents were ACS grade or higher. All solvents used, including water, were liquid chromatography (LC)/mass spectrometry (MS) grade. Standard peptides were synthesized. Multiple reaction monitor was performed and urine analysis of the samples was performed with acquisition methods containing three verified ion-pair transitions per target peptide to ensure the detection of any minor sample-specific signals. The calculated concentration is reported in μM of urine and can be defined in ng/mL when the weight of the entire processed protein is taken into account. Results: Eleven peptides were synthesized and prepared for detecting urine exosomal protein concentrations. The concentrations of such peptide in urine exosomal level were measured. Several peptides were noted with statistically difference before and after operation, and could be stratified in various staging. Conclusions: We found a brand new tumor biomarkers in urine exosomes; and we hope these peptides could be effective in patients of thyroid cancer, without intervention of human recombinant TSH/withdrawal of thyroid hormone replacement, and without interference of thyroid auto-antibodies.

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st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

PE-5 TRANSTUBULAR POTASSIUM GRADIENT PREDICTS END ORGAN DAMAGE IN PRIMARY ALDOSTSERONISM 1

HUNG-WEI LIAO, 2VIN-CENT WU

Chinru clinic 2Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

Background: End organ damage could occur in primary aldosteronism (PA). However, kidney impairment could be concealed by relative hyperfiltration but emerge after treatment. We assumed transtubular gradient potassium gradient (TTKG), a kidney aldosterone bioactivity indicator, could forecast chronic kidney disease manifestation after adrenalectomy and correlate to end organ damage. Methods: In the present nonconcurrent prospective study, we enrolled PA patients who underwent adrenalectomy in the Taiwan Primary Aldosteronism Investigation (TAIPAI) registry from 2010 to 2018. The clinical outcome was chronic kidney disease (CKD) status, defined as estimated glomerular filtration rate (eGFR) 50 mg/g (OR = 2.42; 95 % CI, 1.07 – 5.47; p = 0.034) and left ventricular mass (B = 20.10; p = 0.018). Multivariate logistic regression analysis demonstrated that TTKG ≥ 4.9 could predict subsequent CKD (OR = 5.42; 95% CI, 1.48 – 19.85; p = 0.011), 20% decrease of eGFR (OR = 2.55; 95% CI, 1.11 – 5.88; p = 0.028) at 12 months after adrenalectomy. Conclusions: TTKG could predict emerged CKD in PA patients after adrenalectomy. TTKG as an adverse surrogate of aldosterone and hypokalemia correlated with pre-operative end organ damage in terms of high proteinuria and cardiac hypertrophy. TTKG could help us predict who may have concealed organ injury and treat these patients more actively to prevent further complication from PA.

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Abstract PE-6 THE SIZE DOES MATTER: MANAGEMENT OF RUPTURE OF THYROID NODULE AFTER RADIOFREQUENCY ABLATION AND LITERATURE REVIEW 1

WEN-CHIEH CHEN, 2KAI-LUN CHENG, 3WEI-CHE LIN

Division of Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 2Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan;3Departments of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

Background: Radiofrequency ablation (RFA) is a safe and well-tolerated way for the management of thyroid nodules. Careful follow-up and monitor of complications are essential. We aim to evaluate the clinical manifestations, imaging features, and management of patients with thyroid nodule rupture after RFA in Taiwan. Methods: We presented 9 patients with nodule rupture after RFA at 2 medical centers between 2017 and 2019. The nodules were confirmed benign on at least 2 fine needle aspirations or core needle biopsy prior to RFA. Data including baseline characteristics, initial symptoms of rupture, imaging, management, and prognosis were reviewed. The localization of rupture was classified into anterior, posterolateral, and medial types. Results: 9 patients (7 females and 2 males, with mean age 38.9±7.3 years) experienced nodule rupture after RFA. The complication rate of nodule rupture was 1.1% (9/791). There were 4 patients received RFA twice. The volume reduction rate (VRR) was 83.6±5.8%. The ruptured nodules were all with predominantly solid content (mean volume 73.9 ml and the maximum one was 198ml). The most common symptoms of post-RFA nodule rupture were sudden neck bulging and erythema. The anterior type was the most common type of rupture (8/9, 89%). 7 patients (78%) received antibiotics treatment initially, and 6 of who required followed invasive procedures, including aspiration, incision and drainage (I&D) and debridement. 4 patients needed hospitalization (duration 7-20 days). All patients recovered completely after longitudinal management. Conclusion: Anterior type is the most common type of thyroid nodule rupture after RFA. Though thyroid nodule ruptures after RFA can be managed conservatively, the larger goiter may require aggressive management including I&D or debridement, and was not necessarily related to delayed nodule bleeding. Understanding these clinical and imaging features can help physicians make the correct diagnosis and treatment in time.

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st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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PE-7 URINARY SODIUM POTASSIUM RATIO ASSOCIATES WITH CLINICAL SUCCESS AFTER ADRENALECTOMY IN UNILATERAL PRIMARY ALDOSTERONISM 1

MING JSE LEE, 2CHIAO YIN SUN, 2HENG CHIH PENG, 3VIN CENT WU

Division of Nephrology, Ten Chan General Hospital, Taoyuan, Taiwan 2Division of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan 3 Division of Nephrology, National Taiwan University Hospital, Taipei, Taiwan

Background: Urinary sodium-potassium ratios not only correlated with dietary sodium and potassium intake and blood pressure but also represented the activity of aldosterone. In this study, we evaluated the value of the urinary sodium-potassium ratio in predicting the surgical outcome of primary aldosteronism (PA) patients. Methods: This non-concurrent prospective cohort study was conducted from 2011 to 2017 and included 241 PA patients who had undergone adrenalectomy and been followed at least one year. Demographic and laboratory data were collected. Predictors of successful clinical outcomes were analyzed using logistic regression. Results: Among the 241 PA patients, 197 patients (81.7%) achieved clinical success. The clinical success group had higher systolic blood pressure (154.5 ± 20.3 vs 146.8 ± 14.3; P = 0.011), diastolic blood pressure (92.2 ± 14.1vs 87.1 ± 11.2; P 0.013), aldosterone level (56.8 ± 35.4 vs 56.8 ± 35.4 ng/ dL; P = 0.037), log ARR ratio (2.39 ± 0.78 vs 2.13 ± 0.85; P = 0.019), better renal function (estimated glomerular filtration rate: 96.6 ± 20.4 vs 83.8 ± 20.5 mL/min/1.73m2; P = 0.001), but lower renin (0.88 ± 3.41 vs 1.70 ± 4.84 ng/dL; P = 0.037) than absent clinical success group. Urinary sodium potassium ratio less than 3 (OR:2.5; 95% CI:1.2-5.4; P=0.015), body mass index less than 25 (OR = 2.82; 95% CI: 1.31-6.06; P = 0.008), renin less than 1 (OR = 2.51; 95% CI: 1.01-6.21; P = 0.047) and mean blood pressure more than 115 mmHg (OR = 5.02; 95% CI: 2.10-11.97; P < 0.001) could predict clinical success after adrenalectomy. Furthermore, log urine NaK ratio was correlated with serum C- reactive protein (β value = 2.326; 95% CI 0.029-4.623; P = 0.047) Conclusion: Patients with low urinary NaK ratio, in term of hyperaldsoterone, low potassium together with low dietary salt intake, were more likely to have clinical success after surgery. PA patients with lower urinary NaK ratio were associated with less severe inflammatory status.

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Abstract PE-8 DISSOCIATION OF BONE MINERAL DENSITY BETWEEN LUMBER SPINE AND HIP JOINT IN A CASE OF PROSTATE CANCER WITH BONE METASTASIS 1

SU-CHIN CHEN, 2FU-SHUN KO, 1WAN-SHIH HUANG, 3AI-HUNG LIU, 1,4HONG-DA LIN

Section of Endocrinology and Metabolism, Department of Medicine, Central Clinic and Hospital, Taipei, Taiwan; 2Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 3Section of Endocrinology and Metabolism, Department of Medicine, Chung Shan Hospital, Taipei, Taiwan; 4Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

Advanced prostate cancer is frequently accompanied with bone metastasis. High prevalence of bone metastasis in prostate cancer were osteoblastic change with high bone density. Among the patients with prostate cancer, the values of bone mineral density (BMD) in the lumbar vertebrae were significantly higher in patients with osseous metastasis than in those without metastasis. Androgen deprivation therapy is commonly used in patients with prostate cancer and associated with bone loss and fractures. Patients should have assessment of skeletal integrity with bone mineral density or x-ray of the hip and spine. We report a case of 79-years old male with history of diabetes mellitus over 15 years under oral anti-diabetes drugs and basal insulin treatment. He also had history of prostate cancer with surgery at other hospital. A routine DEXA checkup he was found high BMD over lumbar spine (average T-score 4.4, Figure 1) but low BMD over hip joint (average T-score -1.2, Figure 1). Plain spine X-ray showed multiple osteoblastic metastasis lesion over L-spine (Figure 2). In case of high BMD over lumbar spine but osteopenia in hip joint, physicians should remain alert that this may be correlated with bone metastasis in prostate cancer. Early management may help improve quality of life and decrease potential osteoporosis or fracture risk among these patients

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PE-9 HYPERTHYROIDISM INDUCED BY MOLAR PREGNANCY: A CASE REPORT 1

KUAN-HUA CHEN, 2KUNG-YANG WANG, 1TING-CHU CHEN, 1CHUAN-TAI CHIU, 1 SHYANG-RONG SHIH 1

Division of Metabolism and Endocrinology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; 2Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

A 29-year-old woman received treatment for infertility in a local hospital in March 2019. The doctor provided stimulant for ovulation followed by progesterone, and soon she was pregnant. The last date of her menstrual period was 2019/03/05. However, vaginal bleeding developed in April 2019, and the amount increased gradually. In addition, she suffered from excessive vomiting, dyspnea on exertion and palpitation. She visited the hospital again, where twin pregnancy was confirmed. Unfortunately, one of the fetuses did not have heartbeats and multiple cystic lesions were noticed in the uterus. The patient was referred to National Taiwan University Hospital (NTUH) for further management. In NTUH, abdominal and pelvic computed tomography detected an intrauterine contrast-enhanced mass. Under the impression of molar pregnancy, therapeutic dilatation and curettage (D&C) was performed on 2019/05/16. The pathological report confirmed a complete mole. However, palpitation and exertional dyspnea still persisted after the operation. Laboratory tests revealed elevated thyroxine, undetectable thyroid-stimulating hormone (TSH) and very high beta-human chorionic gonadotropin (β-HCG) levels; while anti-thyroglobulin antibody, TSH receptor antibody, and anti-thyroid peroxidase antibody were all undetectable. Thyroid sonography did not show any evidence of autoimmune thyroid disease. Carbimazole was prescribed for hyperthyroidism. One week later, thyroid function normalized, carbimazole was discontinued and the patient was then discharged. Hyperthyroidism did not recur for the next seven months of follow-up. Discussion: β-HCG and TSH share the same alpha subunits. A very high level of β-HCG thus will induce hyperthyroidism. Compared with partial molar pregnancy, complete mole tends to induce higher β-HCG levels and therefore brings higher risk of hyperthyroidism. Therapeutic D&C is the main treatment option.

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Abstract PE-10 THE IMPACT OF BISPHOSPHONATES ON MORTALITY AND CARDIOVASCULAR RISK AMONG OSTEOPOROSIS PATIENTS AFTER CARDIOVASCULAR DISEASE 1

SHU-TING WU, 1JUNG-FU CHEN, 1CHIA-JEN TSAI

Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.

Purpose: Bisphosphonates (BPs) impact on the survival and cardiovascular safety of osteoporosis patients after acute coronary syndrome (ACS) or acute ischemic stroke (AIS) was evaluated. Methods: A nationwide epidemiological study was conducted using the Taiwan National Health Insurance Research Database from 2000 to 2010. From the 1,456 osteoporosis patients with previous ACS or AIS, mortality and cardiovascular safety was compared between 464 patients who used BPs and 464 patients who did not. Primary outcomes included all-cause mortality, and major adverse cardiovascular events. Results: The BPs group had a lower risk of all-cause mortality than the control group. All-cause mortality after the 8-year follow-up was 13.8% (n = 64) and 21.1% (n = 98) in the BPs and control groups, respectively (HR, 0.64; 95% CI, 0.46-0.88; P = 0.006). The risks of myocardial infarction, ischemic stroke, cardiovascular death, hospitalization for heart failure or other causes of mortality were similar across groups. However, there was a higher risk of hospitalization for atrial fibrillation in the BPs group than the control group (HR, 1.76; 95% CI, 1.26-2.46; P = 0.001). Conclusion: Among osteoporosis patients after ACS or AIS, BPs use was associated with a reduced risk of all-cause mortality. However, patients with previous cardiovascular disease who received BP treatment should be careful about the risk of atrial fibrillation. Keywords: Bisphosphonate, Osteoporosis, Cardiovascular outcome, Mortality risk, Atrial fibrillation

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PE-11 NODAL OR DISTANT METASTATIC THYROID CARCINOMA AS INITIAL PRESENTATION WITHOUT DETECTABLE PRIMARY THYROID LESIONCASE SERIES AND LITERATURE REVIEW 1

LAY SAN LIM, 1JUNG-FU CHEN, 1CHEN-KAI CHOU

Division of Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.

Introduction: The incidence of metastasis from differentiated thyroid carcinoma ranges between 10% and 20%, of which most are identified at the time of the primary tumor diagnosed. Nodal or distant metastasis is rarely the initial presentation of thyroid carcinoma in patients without detectable primary thyroid tumor. Methods: We reported 4 cases of nodal or distant metastasis without detectable primary thyroid lesion in Kaohsiung Chang Gung Memorial Hospital between 2013 and 2018. Results: Case 1: A 72-year-old female presented with enlarged left neck level II lymph node and biopsy revealed metastatic papillary thyroid carcinoma(MPTC). CT showed multiple metastatic lung nodules. She underwent total thyroidectomy and left extended radical neck dissection. Pathology revealed bilateral nodular goiter and nodal mPTC. However, recurrent left neck nodule was detected and pathology confirmed MPTC. Intracranial and bony metastasis developed later. Case 2: A 37-year-old female with history of follicular adenoma status post left total thyroidectomy had left neck mass. MRI showed a left cervical level II cystic lesion, suspected 2nd branchial cleft cyst. Left neck lesion was surgically removed and pathology showed nodal MPTC. Right total thyroidectomy and left modified radical neck dissection were performed. Final pathology report confirmed nodular goiter without metastatic nodal lesions. Case 3: A 32-year-old female with history of nodular goiter status post right total thyroidectomy complained of right supraclavicular nodule. She received excision of tumor and pathology revealed metastatic follicular thyroid carcinoma (MFTC). She then received left total thyroidectomy and pathology turned out nodular goiter. Case 4: A 66-year-old female with hepatoma post op and chemotherapy. T3 bony metastases was noted and biopsy showed MFTC. She received bilateral total thyroidectomy 2 years ago and pathology turned out left nodular goiter with a follicular adenoma and right nodular goiter. Conclusions: Nodal or distant metastasis of thyroid carcinoma without detectable primary tumor is rare but exists in our practice. Greater awareness of this unusual initial presentation is important to avoid mistaking metastatic thyroid carcinoma for benign lesion in the setting of neck mass. Besides, long-term follow-up might be necessary in these cases because of the possible association of unusual presentation and worse prognosis. Keywords: thyroid carcinoma, distant metastasis, lymph node metastasis 128

Abstract PE-12 TUBERCULAR HYPOPHYSITIS MIMICKING AUTOIMMUNE HYPOPHYSITIS: A CASE REPORT 1

CHEN TING-CHUN, 1SIA HON-KE, 1TU SHIH-TE, 1WANG SHU-YI

Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Changhua County, Taiwan

Introduction: Hypophysitis is an inflammation of pituitary gland with various clinical symptoms including hypopituitarism, diabetes insipidus, amenorrhea, and mass effect. Hypophysitis is rare and not fully understood until nowadays. It may have an underlying autoimmune etiology or secondary to tumor and infection. Isolated hypophysitis due to Mycobacterium tuberculosis infection is extremely rare in Taiwan. We reported a young woman having tubercular hypophysitis mimicking autoimmune hypophysitis initially, and with hypothalamus involvement in the later course. Case report: A 26-year-old woman presented with polydipsia and polyuria for one month. She had body weight lose from 46kg to 41 kg and ceased menstruation. Central diabetes insipidus (DI) was diagnosed by water deprivation test. Pituitary function test showed normal cortisol, freeT4/TSH, but hyperprolactinemia (Prolactin: 80.07ng/mL), and hypogonadotropic hypogonadism. Pituitary MRI revealed thickness and good enhancement of the pituitary stalk and enlargement of pituitary gland, which indicated hypophysitis, especially lymphocytic hypophysitis also known as autoimmune hypophysitis, or sarcoidosis, adenoma. The neurosurgeon suggested conservative treatment. She was treated with cabergoline, desmopressin and a course of methyl-prednisolone. Follow-up pituitary function showed declined prolactin levels and stable pituitary size in MRI images for two years. Prolactin level elevated again and pituitary MRI showed the mass lesion became larger with suprasellar extension and involved hypothalamus, optic chiasm and optic tracts. Stereotactic biopsy of hypothalamus was performed. Pathology reported granulomatous inflammation and acid-fast stain positive microorganism, Mycobacterium tuberculosis. Panhypopituitarism occurred after biopsy. Sex hormone replacement and anti-tubercular treatment were initiated. After complete treatment of anti-tuberculosis, brain MRI showed disappearance of the suprasellar mass lesion. Nonetheless, panhypopituitarism still presented. Discussion: Tuberculosis of the central nervous system is seldom in these days, especially in young people without immunocompromised conditions or special contact history. In our case, this healthy young woman presented with secondary amenorrhea, hyperprolactinemia and DI compatible with the pituitary MRI finding of suprasellar lesion suggested autoimmune hypophysitis, which is not the candidate of surgery. Nonetheless, when conservative treatment failed, prompt surgical intervention is warranted since biopsy is the only means of accurate diagnosis. The typical radiological appearance of granulomatous 129

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hypophysitis, such as tubercular hypophysitis, is similar to that of lymphocytic hypophysitis, but the treatment is different. No standard regimen of tubercular hypophysitis was established till now, but it seems reasonable to treat as tubercular meningitis. Conclusion: We presented a case of tubercular hypophysitis mimics autoimmune hypophysitis, the former is difficult to be differentiated by clinical symptoms, laboratory tests and pituitary MRI. Biopsy or surgery should be performed promptly if medical treatment failed.

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Abstract PE-13 TREATMENT EFFICACY AND SAFETY OF ULTRASOUND-GUIDED PERCUTANEOUS RADIOFREQUENCY ABLATION FOR PTMC: TAIWAN EXPERIENCE 1

WEI-CHE LIN, 2KAI LUN CHEN, 3CHEN-KAI CHOU, 4CHENG-CHIAO HUANG, 5 SHENG-DEAN LUO, 6SHUN-YU CHI, 7YEN-HSIANG CHANG, 7PEI-WEN WANG 1

Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital; 2Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan; 3Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; 4Departments of Surgery, Taipei Medical University Hospital, Taipei, Taiwan; 5Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital; 6Departments of Surgery, Kaohsiung Chang Gung Memorial Hospital; 7Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital

Background: To evaluate the therapeutic efficacy and safety of ultrasound-guided percutaneous radiofrequency ablation (RFA) of papillary thyroid microcarcinoma (PTMC). Methods: From February 2018 to August 2019, we enrolled 16 patients (12 female, 4 male, mean age 52.6 ± 10.6 years) with 18 PTMC for single session of ultrasound-guided percutaneous RFA. All nodules were confirmed by at least two time ultrasound-guided aspiration, and all the patients had normal thyroid functions. The maximum diameter and volume of all nodules were recorded before treatment and during 1, 3, 6 and 12 months follow-up. Results: The RFA procedures were completed with a mean time of 45.3 ± 28.1 min. The procedures were tolerated well in all the patients. The baseline maximum diameter and volume of nodules were 0.85 ± 0.18 cm and 0.35 ± 0.71 cc, respectively. Compared to baseline condition, significant regression of the maximum diameter (0.78 ± 0.30, p = 0.027) and volume (0.21 ± 0.42, p = 0.043) of nodules were noted in 12 months follow-up after RFA. Two PTMCs experienced complete disappear one year after RFA. During follow‐up, no patient experienced local tumor recurrence or distant metastasis. No patients had lymph node metastasis or new PTMC development. Conclusion: Thermal ablation is an excellent local tumor control method in patients with low‐ risk PTMCs. Strict inclusion criteria and technical expertise are required to obtain favorable results.

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PE-14 TREATMENT RESPONSE AND OUTCOME OF R2 RESECTION IN DIFFERENTIATED THYROID CANCER - A RETROSPECTIVE ANALYSIS 1

YVONNE EE WERN CHIEW, 1JUNG-FU CHEN, 1CHEN-KAI CHOU

Division of Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

Background: Majority of differentiated thyroid cancer has favorable outcome, even in patient with advanced disease. Surgical resection with the possible adjunction of radioiodine therapy is recommended for treating differentiated thyroid cancer. The aim of this study is to analyze whether R2 resection affects the treatment response and outcome of differentiated thyroid cancer by using the institutional database of our hospital. Methods: We reviewed our institutional database of 1247 patients with thyroid cancer operated between January 2013 and July 2018, follow up until December 2019. A total of 252 patients with differentiated thyroid cancer had tumor extension beyond the thyroid capsule. They were grouped into patients with either negative surgical or microscopically positive margin(R0/R1), or with gross residual disease(R2) after surgical resection of thyroid cancer. The parameter and outcome of the two groups (R0/R1 versus R2) were assessed and analyzed. Results: The median age of the 252 patients with tumor extension beyond the thyroid capsule was 54 years (range 13–87 years). 192 patients (76.2%) were female. Among the 252 patients, 211(83.7%) patients underwent surgery with R0 or R1 tumor resection, 41(16.3%) patients received R2 tumor resection. 205(97.2%) of patients with R0 or R1 resection had thyroid cancer stage I/II, and 6(2.8%) patients has thyroid cancer stage III/IV. 20(48.8%) and 21(51.2%) patients of R2 group had thyroid cancer stage I/II and stage III/IV, respectively. The treatment response when stratified by excellent/ biochemical incomplete/structural incomplete/indeterminate, was 69.4%, 20.6%, 8.6% and 1.6% respectively in R0/R1 group. In patients with R2 resection, 46.3% of them had excellent response, 34.1% was biochemically incomplete and 19.5% was structurally incomplete. The recurrence rate was 8.5% in R0/R1 group and 24.4% in R2 group. Among the R2 group, 87.5% of them had T4a or T4b tumor, 12.5% had T3b tumor. The 2 groups had similar median age. However, higher percentage of patients with T3b tumor achieved excellent response (87.5%) compared to T4a or T4b patients (36.4%). None of the R2 resected patients with T3b tumor had structurally incomplete treatment. All the recurrence and distant metastasis cases in R2 group were patients with T4a or T4b tumor. Conclusion: Patient with gross residual disease(R2), especially those with advanced stages, T4a or T4b tumor, are more likely to have structural or biochemically incomplete treatment and higher recurrence incidence. A more rigorous follow up with detailed examination were suggested in these patients. Keywords: Differentiated thyroid cancer, Tumor resection, Recurrence 132

Abstract PE-15 RIEDEL’S THYROIDITIS MASQUERADING AS THYROID MALIGNANCY ON ULTRASOUND: A CASE REPORT 1

YOU-TING LIN, 1CHING-CHU CHEN, 1CHING-CHUNG CHANG, 1CHWEN-TZUEI CHANG, 1 RONG-HSHING CHEN, 1TZU-YUAN WANG, 1WEI-LUN HUANG, 1SHENG-PANG HSU 1

Division of Endocrinology and Metabolism, Department of Internal Medicine, China Medical Hospital, China Medical University, Taiwan,

Background: It has been recently suggested that Riedel’s thyroiditis is to be a part of IgG4RD spectrum. Many clinicians are convinced that the thyroid would be diffusely involved and enlarged while considering its inflammatory background of Riedel’s thyroiditis, but rarely reported as a masquerading malignant mass. We herein introduce a case of Riedel’s thyroiditis, a probable histological features of IgG4-related disease, mimicking thyroid malignancy on ultrasound. Case report: A 66-year-old woman presented to our endocrine out-patient clinic for consulting whether or not to continue taking the levothyroxine prescribed at local clinic for unknown entity of right thyroid nodule for years. Initial physical examination of the neck disclosed a symmetric thyroid gland with no palpable bilateral lobes. Laboratory investigations after she discontinued levothyroxine by herself for four consecutive weeks demonstrated serum thyroid-stimulating hormone level, serum free T4 level and serum thyroid peroxidase antibody level were within normal reference laboratory values, but an elevated anti-Thyroglobulin antibody level at 1521 IU/mL (reference range <40 IU/ mL). Preoperative neck ultrasound scan disclosed an ill-defined, solid, hypoechoic nodule 12x10x10 mm with microcalcifications and extrathyroid extension. Histological examination after right total and left subtotal thyroidectomy revealed the thyroid follicles were obliterated by extensive dense fibrous tissue with storiform, keloid-like hyalinzing fibrosis, which also infiltrated adjacent skeletal muscles. The number of IgG4-positive cells were up to 15 per high power field and the IgG4 to IgG ratio was less than 40%. Riedel thyroiditis, a probable histological features of IgG4-related disease, should be considered. Discussion: Riedel thyroiditis (RT), a rare inflammatory disorder of uncertain etiology and characterized by fibrotic replacement of thyroid tissue with vascular obliteration, is suggested to be a part of IgG4-RD spectrum. RT can demonstrate either a homogenegous hypoechoic texture and pseudonodular appearance due to fibrous tissue or a hypoechoic mass with irregular delimitation, even involves adjacent tissues under ultrasound scan. It is important for clinicians to be aware of this clinicopathological and unusual ultrasonic manifestation of Riedel’s thyroiditis.

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PE-16 IODINE NUTRITIONAL STATUS OF BREASTFEEDING WOMEN IN NORTHERN TAIWAN 2019 1

CHUN-JUI HUANG, 2FAN-FENG WANG

Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taiwan; 2 Department of Medicine, Yangming Branch, Taipei City Hospital, Taipei, Taiwan

Background: Pregnant and lactating women are vulnerable to iodine deficiency. Our survey of pregnant women in 2018 revealed sufficient iodine status in an urban area of Northern Taiwan, but the condition in lactating women is unknown. This study was conducted to evaluate the iodine nutritional status of lactating women residing in and around Taipei metropolitan area. Methods: A total of 198 subjects were recruited from Taipei Veterans General Hospital in 2019. Random spot urine samples were collected and a simple food frequency questionnaire was completed by the participants. Urinary iodine concentration (UIC) was measured by inductively coupled plasma mass-spectrometry. Results: The median UIC of the total surveyed population was 120 μg/L, which indicated sufficient iodine status. The distribution of UIC was as follows: 3.0% with UIC < 20 μg/L, 14.6% with UIC within 20-49 μg/L, 22.7% with UIC within 50-99 μg/L, 29.3% with UIC within 100-199 μg/ L, 14.6% with UIC within 200-299 μg/L, and 15.7% with UIC ≥ 300 μg/L. Postpartum nourishment diet was very common in Taiwan and 74.7% (n = 148) of the surveyed population was under specially designed diet for postpartum care. Conclusions: The results suggest that the iodine status in lactating women in an urban area of Northern Taiwan is adequate.

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Abstract PE-17 METHIMAZOLE INDUCED CHOLESTATIC JAUNDICE: A CASE REPORT 1

FONG-JUI KUO, 2, 3TON-HO YANG, 1, 2, 4CHING-CHIEH SU

Division of Endocrinology and Metabolism, Department of Internal Medicine, Cardinal Tien Hospital, New Taipei City, Taiwan; 2School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; 3Division of Gastroenterology & Hpatology, Department of Internal Medicine, Cardinal Tien Hospital, New Taipei City, Taiwan; 4Graduate institute of Applied Science and engineering, Fu Jen Catholic University, Taipei, Taiwan

Background: Hepatic dysfunction and jaundice are sometimes present in patients with hyperthyroidism. They can be clinical manifestations of the disease or the adverse effect of antithyroid medications. Methimazole is widely prescribed for patients with hyperthyroidism. However, cholestatic jaundice is one of the rare but serious adverse events of methimazole therapy. Methods: We reported a case of cholestatic jaundice after a few weeks of methimazole use. Results: This 52-year-old women with Graves’ hyperthyroidism had developed cholestatic hepatitis after a one-month course of methimazole treatment. Clinical workup revealed hyperbilirubinemia as well as impaired liver function. Concomitant liver diseases, such as viral hepatitis (A, B, C) or CMV viral infection, autoimmune hepatitis, IgG4 disease, primary biliary cirrhosis and calculus of bile duct, were excluded by blood tests and imaging studies. Liver enzyme levels returned to normal after discontinuing methimazole followed by glucocorticoid administration. Conclusions: In this case, methimazole caused severe but reversible cholestatic jaundice. It is indeed rare, but physicians and patients should be aware of this serious adverse effect. To the best of our knowledge, this is the first reported case of methimazole induced cholestatic jaundice in Taiwan.

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PE-18 SUCCESSFUL GESTATION AFTER REMOVAL OF PITUITARY TSH PRODUCING TUMOR IN A INFERTILE FEMALE PATIENT 1

CHIATE WU, 2JING SHAN HUANG, 3TSUNG HSUAN LAI, 1CHING-LING LIN

Division of Endocrinology and Metabolism, Department of Internal Medicine, Cathey General Hospital, Taiwan; Division of Neurosurgery, Department of Surgery, Cathey General Hospital, Taiwan; 3Division of Obstetrics & Gynecology, Cathey General Hospital, Taiwan

This is a 36 years old female seeking help at Infertility Department. Elevated TSH and fT4 were noted therefore transferred to the Endocrinology department due to the discrepancy of the result. Pituitary MRI was arranged after the patient’s In vitro fertilization treatment had failed for the second time and one nearly 0.8 cm less contrast-enhancing nodular shadow over the right side of the pituitary gland just medial to the siphon segment of right ICA and mild suprasellar extension was found. Pituitary microadenoma was impressed, favored TSH-secreting tumor, rule out thyroxine resistance syndrome based on her clinical manifestation. Admitted into the endocrinology ward for complete pituitary study with Insulin Stress Test, GnRH Test, and TRH Test. Result favored ThyroxineSecreting Pituitary adenoma. Symptoms of Hyperthyroidism with palpitation developed afterward and Endoscopic Endonasal Trans-sphenoidal Hypophysectomy/ adenomectomy (Naviagation system (BRAINLAB) assisstence) was done by the neurosurgeon. Hyperthyroidism symptoms relieved after the surgery and follow up thyroid function falls back within the normal range. The patient underwent 3rd round of In vitro fertilization treatment however miscarriage occurred due to habitual abortion. 4th round of In vitro fertilization treatment was successful after 6 months of hormonal therapy at the Obstetrics and Gynaecology department and the patient gave birth to a preterm baby at 30+2 gestation week with Placenta previa and preterm pre-labor rupture of the membrane via cesarean section.

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Abstract PE-19 METHIMAZOLE-INDUCED ANCA AND ANTI-GBM-ANITBODY POSITIVE RPGN IN A PATIENT WITH GRAVE’S DISEASE: A CASE REPORT 1

WEI-CHANG CHEN, 2CHING-LING LIN, 3MING-TSO YAN

Division of Endocrinology and Metabolism, Department of Internal Medicine, Cathay General Hospital, Taiwan, Division of Endocrinology and Metabolism, Department of Internal Medicine, Cathay General Hospital, Taiwan, 3 Division of Nephrology, Department of Internal Medicine, Cathay General Hospital, Taiwan 2

Anti-neutrophil cytoplasmic antibody(ANCA)-associated vasculitis may cause symptoms or signs with multisystem involvement such as renal failure, pulmonary hemorrhage, gastrointestinal dysfunction and peripheral neuropathy. Patient with Grave’s disease who was treated with antithyroid drugs may suffer from rare but severe adverse effect such as agranulocytosis, thrombocytopenia and ANCA-positive vasculitis, especially propylthiouracil. Here we reported a case of methimazoleinduced pauci-immune and anti-glomerular basement membrane(GBM) rapidly progressive crescentic glomerulonephritis in a 55 years old Taiwanese woman with Grave’s disease who was treated with Methimazole for 6 years. Initial clinical presentation as dyspnea, decreased urine output, general edema and painful sensation over lower extremities without muscle weakness. Antithyroid drug was stopped, steroid pulse therapy and oral immunosuppression therapy with Mycophenolate were used as impression of ANCA-positive vasculitis related glomerulonephritis, pleuritis, pericarditis and peripheral neuropathy. The kidney biopsy showed diffuse extra-capillary proliferative(crescentic) glomerulonephritis which is compatible with pauci-immune type(type III) glomerulonephritis. However, anti-GBM disease could not be totally excluded because of linear IgG staining of GBM in immunofluorescent study. Serum testing for anti-GBM, p-ANCA and anti-myeloperoxidase(MPO) antibody were all positive. Plasmapheresis was performed immediately and follow-up serum testing for anti-GBM and anti-MPO showed negative after plasmapheresis for six times. Unfortunately, oligouria persisted after above treatment and she received regular hemodialysis thereafter. Anti-thyroid drugs related adverse effect varies and may cause severe clinical manifestation such as renal failure which may need steroid therapy, immunosuppression therapy, plasmapheresis and eventually renal replacement therapy. Here described a rare, may be the first case of methimazole-induced ANCA and anti-GBM RPGN. The patient also a victim of permanent renal replacement therapy despite steroid, immunosuppression therapy and plasmapheresis.

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PD-1

A BETTER QUALITY OF DIABETES CARE BASED ON A SPECIALIST OF ENDOCRINOLOGY AND METABOLISM CHIN-CHOU YANG Division of General Medicine, Department of General Psychiatry, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan1

Background: Diabetes is prevalent in many countries and its costs of medical care are increasing. The proportion of diabetes is higher in psychiatric patients than that of general population, and the difficulties of treatment also raises significantly. Most studies about integrated diabetes care were focused on non-psychiatric patients. Our study will analyze the glycemic change in chronic psychiatric patients with type 2 diabetes in a psychiatric center, after a full-time specialist of endocrinology and metabolism participated in the long-term-care team and directly involved in the integrated care. Methods: Our retrospective study included 56 resident patients in the chronic psychiatric wards. The specialist of endocrinology and metabolism was engaged in the integrated care team since January 2018. We first used paired-t test to analyze the glycemic change between 2016 and 2017 before our interventional care, and then analyze the glycemic change between 2017 and 2018 after our interventional care. Results: The results showed that this care model has positive impacts on the patient’s eating habits and activity habits. Chi-square test analysis showed significant relationship between the improvement of eating habits and average glycated hemoglobin (HbA1c) level (X2 = 4.487, p = 0.034), and also between the improvement of activity habits and average HbA1c level (X2 = 11.864, p = 0.001). The average HbA1c and fasting blood glucose (AC) of all patients were both significantly improved (p0.05). For male patients, the average HbA1c was significantly improved, but there was no significant change found in average AC (P > 0.05). Conclusions: To our best knowledge, this is the first study of diabetes care based on a full-time specialist of endocrinology and metabolism, who was directly involved in the long-term care team in a psychiatric center. The results showed that this care model has positive impacts on the patient’s eating habits and activity habits. The average HbA1c and AC were both significantly improved after our intervention. This study not only provides a positive and feasible approach to medical systems of longterm care, but also setup a health promotion measure that deserves attention and should be actively implemented and promoted.

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Abstract PD-2

CLINICAL EFFICACY AND SAFETY OF CANAGLIFLOZIN IN THE TREATMENT OF TYPE 2 DIABETES UNCONTROLLED WITH MULTIPLE DAILY INSULIN INJECTION THERAPY CHENG-HAN HAN, WAN-CHI CHUANG, WEI-CHENG CHANG, 1CHIH-HSUN CHU Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; 1Department of Nursing, School of Nursing, Fooyin University, Kaohsiung, Taiwan.

Background. The objective of this study is to investigate the efficacy and safety of canagliflozin in patients with type 2 diabetes uncontrolled with multiple daily insulin injection therapy. Methods. subjects (aged 20-80 years old) who meet the criteria after screening period will start 12 weeks treatment of canagliflozin. At the screening period, HbA1C test was performed and those who have inadequate glycemic control (7.0% < HbA1C < 11.0%) was considered as eligible. All eligible subjects were assigned to canagliflozin with fixed dosage for 12 weeks study treatment. Results. Total of 25 type 2 diabetic subjects (21 male, 5 female) were enrolled in the study. The mean age were 60.1 yr, body weight were 76.6 ± 11.0 kg with BMI 27.3 ± 4.3 kg/m2. All subjects were controlled with premixed insulin. After a period of 12-week treatment of canagliflozin management in those subjects. The mean HbA1c decreased from 8.9 ± 1.0% to 7.9 ± 0.9%, with a difference of -1.0% (P < 0.001). The mean FPG decreased from 167.8 ± 57.0 mg/dl to 129.1 ± 30.5 mg/dl, with a difference of -38.7 mg/dl (P = 0.005). By weight were significantly decreased of 1.2 kg (p < 0.001). The hemoglobin increased significantly. However, the eGFR was not changed. The lipid panel, liver panel were also not changed. No serious adverse event was reported during the study period Conclusion. The addition of canagliflozin in type 2 diabetes who uncontrolled with multiple daily insulin injection therapy is effective in term of glycemia and body weight reduction. There is no safety concern in liver or renal function and no serious adverse event occurred.

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st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

PD-3

FULMINANT AND PROLONGED HYPOGLYCEMIA IN A PATIENT WITH INSULIN GLARGINE U-300 OVERDOSE - A CASE REPORT 1

WEI-LIN CHEN, 1CHIA-FEN WANG, 2CHIH-HSUN CHU

Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; 2Department of Nursing, School of Nursing, Fooyin University, Kaohsiung, Taiwan.

Background. This case is a 48-year-old woman with a history of major depression who injected a large dose (1,800 units) of insulin glargine U-300. Results. The patient presented with only mild hypoglycemia symptoms, such as slow response and dizzy while the blood glucose was 33mg/dl. Continuous 10% glucose solution infusion plus frequent 50% glucose bolus injection, however hypoglycemia episodes persisted at emergency department. During hospitalization, 50% glucose solution was continuously given via central line. Besides, dexamethasone was prescribed hope to prevent further hypoglycemia. However, bolus injection of 50% glucose was still needed due to marked hypoglycemia episodes. A total of 7 days intensive management, the blood glucose was eventually stable without hypoglycemia episode. Conclusion. The case report demonstrates a prolonged hypoglycemic effect with a large dosage of insulin glargine U-300.

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Abstract PD-4

FAMILIAL CHYLOMICRONEMIA SYNDROME: A CASE REPORT OF 10-YEARS FOLLOW UP 1

EDY KORNELIUS, SHIH-CHANG LO, CHIEN-NING HUANG, YI-SUN YANG

Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung Shan Medical University Hospital, Chung Shan Medical University, Taiwan

This 46-year-old Taiwanese female was first diagnosed with hypertriglyceridemia at age 37 years when she had the first episode of acute pancreatitis. She was diagnosed with diabetes in the same year, and further developed ischemic stroke at age 44 years. She did not drink alcohol, and there was no history of biliary tract disease, hypothyroidism, or prescription of oral contraceptive pills. Her body mass index (BMI) was 22.7 kg/m2. She did not have acanthosis nigricans or xanthomas but had lipemia retinalis on fundoscopic examination. Otherwise, she had severe hepatomegaly and splenomegaly. Her first record of lipid profile was triglyceride: 7389 mg/dl, total cholesterol 930 mg/dl, high-density lipoprotein (HDL): 18 mg/dl, and low-density lipoprotein (LDL): 86 mg/dl. She had experienced recurrent abdominal pain with referring pain to the back area and had numerous hospitalizations because of acute pancreatitis. She mentioned that her abdominal pain was unpredictable and worsening after fat-diet intake. She had been taking fenofibrate and combination with niacin, omega-3, and statin alternatively. However, the effects were negligible. Her serum triglyceride levels were ranged around 5,000~15,000 mg/dl. Genetic testing was not performed due to not available in our institution. She had a history of diabetes with severe insulin resistance. She had been taking a basal-bolus insulin regimen with a total daily dose of 2.5 unit/kg and pioglitazone 30 mg/day. Her average HbA1c was 7.5%. None of her family members has similar symptoms to this patient. However, her mother has type 2 diabetes mellitus, hypertension, and an old cerebrovascular accident. Her mother’s lipid profile was triglyceride: 356 mg/dl, total cholesterol 144 mg/dl, LDL: 54 mg/dl, and HDL: 28.7 mg/dl. Throughout her clinical course, she has difficulty to remained compliant with her dietary fat restriction. Her renal, liver, and heart function remained stable.

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st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

PD-5

ASSOCIATION OF EXERCISE WITH ALL-CAUSE MORTALITY IN THE ELDERLY TAIPEI RESIDENTS 1

YUN-JU LAI, 2YUNG-FENG YEN, 3LI-JUNG CHEN, 4PO-WEN KU, 5CHU-CHIEH CHEN, 6 YU-KAI LIN 1

Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan; 2Section of Infectious Diseases, Taipei City Hospital, Taipei City Government, Taipei, Taiwan; 3Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan; 4 Graduate Institute of Sports and Health, National Changhua University of Education, Changhua, Taiwan; 5 Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; 6Department of Health and Welfare, College of City Management, University of Taipei, Taiwan

Background: Human life expectancy has increased rapidly in recent decades. Regular exercise can promote health, but the effect of exercise on mortality is not yet well understood. Methods: We used data from annual health check-ups of the elderly citizens of Taipei in 2006. Participants were interviewed by trained nurses using a structured questionnaire to collect data on demographics and lifestyle behaviors. Overnight fasting blood was collected for measuring blood glucose, liver and renal function, and lipid profiles. Exercise frequency was categorized into no exercise, 1-2 times in a week, and more than 3-5 times in a week. All-cause mortality was ascertained from the National Registration of Death. All participants were followed up until death or December 31 2012, whichever came first. Kaplan-Meier curves and Cox proportional hazard analysis were used to investigate the association between exercise and all-cause mortality. Results: In total, 42,047 elderly people were analyzed; 22,838 (54.32%) were male and with a mean (SD) age of 74.58 (6.32) years. Kaplan-Meier curves of all-cause mortality stratified by exercise frequency demonstrated significant findings (Log-rank P < 0.01). Multivariate Cox regression analysis showed that elderly people with higher exercise levels had a significantly decreased risk of mortality (moderate exercise HR = 0.74, 95% CI: 0.68-0.81, high exercise HR = 0.65, 95% CI: 0.59-0.70) after adjusting for potential confounders, with a significant trend (P for trend < 0.01). Conclusions: Elderly people with increased exercise levels had a significantly decreased risk of all-cause mortality.

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Abstract PD-6

A CASE REPORT OF SECUKINUMAB RELATED DIABETIC KETOACIDOSIS JUI-HSIANG LI, SU-HUEY LO Division of Endocrinology and Metabolism, Department of Internal Medicine Tao-Yuan General Hospital

Introduction: Diabetic ketoacidosis (DKA) is hyperglycemia crisis. It occurred mainly in patients with T1D but also affects in T2D. Common causes of DKA by frequency included infection, inadequate insulin treatment or drug noncompliance, newly-onset diabetes, cardiovascular disease, particularly myocardial infarction, selected drug and other causes. Drug related DKA, such as corticosteroid, FK506, interferon and antipsychotic drug was sometimes happened in diabetes. We reported a case with DKA due to secukinumab (cosentyx). Case report: A 48-year-old male has history of Type 2 DM under insulin control for 15 years with toujeo 8u qhs+ novorspid 5u tid ac+ livalo 1# qhs and psoriasis regularly follow up in TaoYuan General Hospital and Chang Gung Memory Hospital respectively. His blood glucose control is good. (108-1-23 ac:121mg/dl, a1c:5.5%, 108-4-12 ac:133mg/dl, a1c:6.0%). Since April 2019, he received cosentyx for psoriasis according to treatment ptotocol. He noted blood sugar progressively slow elevation (108-7-23 ac:136mg/dl, a1c:6.2%). On October 10, 2019, he was presented to the emergency room because of dizziness and high blood sugar (SMBG pc:510 mg/dl). The lab data showed sugar:426 mg/dl, Na:135mmol/L , serum ketone:3.7mmol/L, urine analysis ketone 4+,aterial blood gass (PH/CO2/ HCO3 /O2/ O2sat/ Be:7.35 /32.7/17.8/63/ 90.3/-6.6), anion Gap:15. This is compatible with DKA. We gave intravenous fluid hydration and intravenous insulin . After these treatment, metabolic acidosis improved. He started insulin therapy with novorapid 16u tidac+ Toujeo 24u qhs. The blood sugar control was good within 100~200mg/dl. He felt better and discharged on 3rd admission day Discussion: Secukinumab (cosentyx), a human immunoglobulin G1-kappa monoclonal antibody that directly inhibits interleukin (IL)-17A, has been shown to have efficacy in the treatment of psoriasis. We searched FDA reports about Cosentyx and Hyperglycemia by eHealthMe on December 1 2019. There are some reports about cosentyx related hyperglycemia. The frequency of hyperglycemia found among people who take Cosentyx is about 0.05% (24/51846) especially taking the drug for 1 - 6 months. Age and portion of people who have Hyperglycemia when taking Cosentyx is 3039: 7.69 %, 40-49: 15.38 %, 50-59: 23.08 %, 60+: 53.85 %. From this report, we highly suspected secukinumab related DKA in this male. Therefore, we should keep in mind about Secukinumab related hyperglycemia.

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st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

PD-7

EFFECT OF LOW-DOSE PIOGLITAZONE ON NONALCOHOLIC STEATOHEPATITIS: A CASE REPORT 1

HSUAN-WEN CHOU, 1YE-FONG DU, 1HAO-CHANG HUNG, 1KAI-PI CHENG, 1 HORNG-YIH OU 1

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

Background: Nonalcoholic fatty liver disease (NAFLD) is common worldwide currently with the prevalence estimated to be 25% in the general population, and that of nonalcoholic steatohepatitis (NASH) about 3% to 5%. NASH may progress to cirrhosis and even liver cancer. Pioglitazone has been proved to improve liver histology in patients with biopsy-proven NASH. The dose of pioglitazone in most of the trials was 30 mg once daily. However, the efficacy of low-dose pioglitazone on NASH remains unclear. Methods: Here, we report a case of NAFLD successfully treated with low-dose pioglitazone. Results: A 61-year-old woman with a history of dyslipidemia, atorvastatin-related hepatitis, and prediabetes presented to our out-patient department for dyslipidemia (LDL-cholesterol: 228 mg/dL) and elevated alanine transaminase (ALT) level (269 U/L). The patient reported no habitus of alcohol-drinking. Abdominal sonography showed moderate fatty liver. After excluding other etiology of hepatitis including hepatitis B virus infection, hepatitis C virus infection, Wilson’s disease, hemochromatosis and autoimmune hepatitis, pioglitazone 15 mg once daily was prescribed due to suspected NASH. ALT level decreased to 65 U/L after treatment, but increased again after ceasing pioglitazone due to lower leg edema. Improvement in aminotransferase levels was noted again after adding back pioglitazone at very low dose of 15 mg for alternative day use. Conclusions: Low-dose pioglitazone may be beneficial for the patients with NAFLD with less side effects. Long-term therapy may be needed to sustain the improvements of inflammation in patients with NASH. However, potential adverse effects should be taken into consideration during therapy.

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Abstract PD-8

A CASE OF HYPERGLYCEMIC EMERGENCY PRESENTED AS BILATERAL CORTICAL BLINDNESS AND REVIEW OF LITERATURE MIN-TSUN CHIU, CHEWN-YI YANG, KAI-JEN TIEN, MEI-CHEN YEH, NAI-CHENG YEH, SHANG-GYU LEE Division of Endocrinology and Metabolism, Department of Internal medicine, Chi Mei Medical Center, Tainan, Taiwan

Background: There is high prevalence of type 2 diabetes mellitus. Diabetic emergencies commonly presented as diabetic ketosis and hyperosmotic hyperglycemic state. Fewer patients presented as hyperglycemic chorea. In chronic complications, visual problems including retinopathies are common, but it is fewer in acute presentation. Here we present a case of previously well controlled diabetes (HbA1c 5.9%) with bilateral cortical blindness, and review the differential diagnosis and treatment option for this condition. Methods: In this article, one case of previously well controlled diabetes (HbA1c 5.9%) was reviewd. A 63-year-old female was presented to emergent department due to dysarthria, general weakness, and severe impaired visual acuity. Around 3~5 days before arrival, there had been dizziness and then progressively blurred vision of both eyes. Laboratory study showed glucose level 812 mg/dL, but there was negative findings in brain computed tomography and ophthalmology exam. This patient admitted for further treatment under the impression of bilateral cortical blindness. Results: Basal bolus insulin regimen was given since the acute hyperglycemia with neurologic complications. During admission, neurology surveillance including brain magnetic resonance imaging and nerve conduction velocity showed no abnormal findings but mild polyneuropathy. Her vision gradually recovered after the control of sugar level. After the stabilized of sugar level. There was good recovery in vision while discharged. Conclusions: It is uncommon presentation of acute hyperglycemia as acute visual impairment without macroscopic structural ophthalmologic abnormal findings (e.g. vitreous hemorrhage, retinal detachment). What ever the causes of acute visual impairment, regain sugar control in patients with hyperglycemia remains important.

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st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

PD-9

THE EFFICACY OF GROUP EDUCATION PROGRAMS ON SGLT-2 INHIBITORS IN PATIENTS WITH TYPE 2 DIABETES 1

TING-YU CHEN, 1CHUN-SING LIN, 1YA-CHUN LI, 1MAN-NI LU, 1JIA-MEI CHEN, 1 BAO-MEI LIN, 1FANG-TING HUANG, 1FANG-YU CHEN, 1CHONG-HUEI WU 1

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

Background: SGLT-2 inhibitors inhibit reabsorption of glucose in proximal tubule of the kidney. As a result, SGLT-2 inhibitors have been shown to be effective at lowering hemoglobin HbA1c levels, improving weight loss and lowering blood pressure. But the most common side effects are reproductive and urinary tract infections that make patients afraid of taking medicine. Therefore, We conducted the Group Education Programs to increase the willingness of patients. Methods: There were 60 volunteers who took SGLT-2 inhibitor for first time introduced to participate this study. We designed “Group Education Programs” as intervention including TheraBand exercise, introducing the mechanism of SGLT-2 and reminding precautions when taking SGLT2 inhibitor. Participants also can share their experience. Each participants’ body composition including visceral fat, whole body fat percentage and skeletal muscle percentage were measured by Karada Scan 701, OMRON before and after intervention. Other measurements included the fasting glucose, HbA1c and body weight were collected before and after study. The outcomes were evaluated after 8-12weeks. Kolmogorov-Smirnov test was applied for statistical analysis. Results: Two male had itching and peeling of the Penis. One female had urinary tract infections. One participant was afraid of eating drugs because body weight droped too fast. After sharing experience of all symptoms after SGLT-2 inhibitor and more knowledge of SGLT-2 inhibitor, the participants were more willing to continue the medication. There is a significant reduction in HbA1c level and body weight compared with baseline. HbA1c level was decreased from 9.1 ± 1.5% to7.3 ± 1.0% after intervention, body weight was 75.6 ± 16.3kg to 71.6 ± 15.3kg, respectively (Decreased p-value < 0.05). There were 23 participants completed the measurement of body composition and showed a significant reduction in visceral fat was observed (15.2 ± 6.6% before intervention and 14.3 ± 6.0%, Decreased p-value = 0.039). Whole Body fat percentage decreased 0.7%, and skeletal muscle percentage increased 0.3%. Conclusion: Group Education Programs have positive effect on maintaining the medication adherence and motivation. SGLT-2 inhibitor with this intervention programs significantly reduced HbA1c level, body weight and visceral fat.

146

Abstract PD-10

EFFECTS OF GLP-1RAS INJECTION FOR GLYCEMIC CONTROL AND BODY COMPOSITION IN TYPE 2 DIABETIC PATIENTS 1

MAN-NI LU, 1CHUN-SING LIN, 1YA-CHUN LI, 1TING-YU CHEN, 1JIA-MEI CHEN, 1 BAO-MEI LIN, 1FANG-TING HUANG, 1FANG-YU CHEN, 1CHONG-HUEI WU 1

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

Background: 2018 American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) stated that one important goal of management of type 2 diabetes is to prevent and delay cardiovascular events. Glucagon like peptide-1 receptor analogues ( GLP-1 RA) have been proved by showing cardiovascular benefit. Throughing GLP-1 RAs injection to change body composition and glycemic control of the Type 2 Diabetic patients. Methods: This program analysed data from outpatient clinic of Taipei Veterans General Hospital Metabolism Department from April 1, 2019 to July 30,2019. There were included total of 40 type 2 diabetes mellitus patients having poor glycemic control by oral hypoglycemic agents alone.We prescribed GLP-1 RA injection after collection of their base line characteristic such as body weight, neck and waist circumference,blood pressure, glycated hemoglobin, body fat composition ( using Omron body fat machine: Karada Scan 701, OMRON).Self monitoring of blood glucose and proper injection way were also explained to them. After that, we performed regular phone calling to every patient and confirmed drugs compliance and any injection problems. After eight to twelve weeks of GLP-1 RA injection, we performed post-tests data. Results: Glycated hemoglobin was reduced 1.9 ± 1.7%, overall weight was -2.9 ± 3.9kg, neck circumference : -0.9 ± 2.7cm, and waist circumferences: -2.3 ± 5.0cm, all of which had significant differences (P < 0.05).Among them, the average value of trunk fat difference before and after completing body composition decrease -2.8 ± 7.1%, the average value of thigh muscle difference was -0.2 ± 3.4%, and the average value of subcutaneous fat difference was -1.4 ± 3.9%.(P < 0.05). Conclusions: Our study showed that although GLP-1 RAs significantly decreased body weight, neck circumference and waist circumference. They have high percentage of 15 % due to their gastrointestinal side effects such as nausea, vomiting and discomfort.

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st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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PD-11

A CASE REPORT OF METFORMIN-ASSOCIATED LACTIC ACIDOSIS JUI-HSIANG LI, SU-HUEY LO Division of Endocrinology and Metabolism, Department of Internal Medicine Tao-Yuan General Hospital

Introduction: Metformin is currently the most commonly prescribed oral antihyperglycemia agent in the world and recommended as first-line medication in the guideline of many area such as United States and Taiwan. It is considered cost effective and less hypoglycemia side effect. But lactic acidosis is recognized as rare complication with estimated incidence 6.3 per 100,000 patient-years and high mortality rate around 50%. We presented a case with metformin associated lactic acidosis. He successfully treated and fully recovered. Case presentation: A 68-year-old man has history of hypertension and diabetes mellitus with medication control in a local medical clinic, Glimet (Glimepiride/Metformin(2/500)) 1# po bid, Diabecon (Pioglitazone/Metformin (15/850)) 1# po bid. The biochemistry study on July 9 2019 was Cr:1.1 mg/dl, A1C:6.6%. Acute onset of short of breath and urine amount decrease was noted after strenuous exercise and this condtion lasted for one week. He was sent to our emergent department. The lab. exam showed acute renal failure (Bun/Cr: 70/11.5 mg/dl), severe metabolic acidosis (pH/pCO2/ HCO3/BE:6.782/23.9/3.5/31.1), lactic acid:26.1 mmol/L, leukocytosis (WBC:21690m/mm3) and hypoglycemia (sugar:29mg/dl). After admission, emergent continuous venovenous hemofiltration (CVVH) was performed due to ACKD with metabolic acidosis and shock. Emergent intubation was performed on 1st admission day due to severe short of breath. Cr recovered and urine output increased after CVVH. We performed extubation on September 17 2017. We changed diabetic therapy to novorapid 14u tid/ac sc and toujeo 18u hs sc. The blood sugar was around 100~200mg/dl. He discharged on 13th admission days with insulin therapy and shifted to oral hypoglycemic agent (amaryl 1# qd+ trajenta 1#qd) in OPD. Discussion: Development of metformin associated lactic acidosis involves a combination of lactate overproduction and drug accumulation. Risk factors predisposing to metformin associated lactic acidosis are common, such as hypoxemia, sepsis, alcohol abuse, renal injury, shock and medications such as ACEi or and ARB. Timely diagnosis allows correct treatment that is life saving and every one should keep in mind.

148

Abstract PD-12

CAUSES OF IN-HOSPITAL DEATH IN TYPE 2 DIABETIC PATIENTS WITH MICROVASCULAR COMPLICATION IN TAIWAN 1

CHING-LING TU, 1HSING-YI HUANG, 1,2WEI-HAO HSU, 1,2WEI-LUN WEN, 1,3 NAI-WEI SHEU, 1,3SHU-HENG HUANG, 1KUAN-HSUAN CHEN, 1I-TING LIN, 1 MEI-YUEH LEE 1

Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital; 2Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital; 3Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital

Background: Diabetes mellitus (DM) has become a major cause of death worldwide; it is also the fifth major cause of death in Taiwan in recent three years. We aimed to investigate the causes of inhospital death of type 2 diabetic patients, especially with microvascular complication. Methods: This case-control study followed 36,477 (12,159 type 2 diabetic patients matched to 24,318 non-diabetic patients) identified from Taiwan National Health Insurance Research Database (NHIRD) from year 1998 to 2013. Results: The deaths from acute respiratory failure, pneumonia, acute renal failure and septicemia increased in both male and female diabetic patients compared to non-diabetic patients. The disease with the highest risk of in-hospital death in diabetic patients was acute renal failure, with adjusted odds ratio (AOR) of 8.44 (95% confidence interval [CI] 3.35-21.30), 9.07 (95% CI, 1.86-44.22), and 8.10 (95% CI, 2.59-25.35) in total population, male and female, respectively. In diabetic patients with microvascular diseases, the disease with the highest risk of in-hospital death was aspiration pneumonitis (AOR 2.78, 95% CI 1.00-7.71). There was no significant difference of the length of hospitalization between diabetic and non-diabetic patients. Conclusions: Acute illness such as pneumonia caused septicemia, acute respiratory failure and renal failure and led to in-hospital death in diabetic subjects.

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st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

PD-13

ASSOCIATION OF ASPIRIN AND DIPYRIDAMOLE THERAPY WITH RISK OF HEPATOCELLULAR CARCINOMA IN TYPE 2 DIABETES MELLITUS 1

HSING-YI HUANG, 1CHING-LING TU, 1,2WEI-HAO HSU, 1,2WEI-LUN WEN, 1,3 NAI-WEI SHEU, 1,3SHU-HENG HUANG, 1KUAN-HSUAN CHEN, 1I-TING LIN, 1,4 MEI-YUEH LEE 1

Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 2Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 4Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

Background: Studies have shown diabetes mellitus increase cancer risk in liver, pancreas, colon, bladder, endometrial, breast, and non-Hodgkin’s lymphoma. There are also studies have shown aspirin can decrease risk of cancers in esophagus, liver, pancreas, stomach, colon, lung and leukemia, but only few evidence reported the association of aspirin and cancer risk in diabetic population. In this study, we aim to investigate whether aspirin and dipyridamole can decrease the risk of cancer in type 2 diabetic patients. Methods: A total of 5,308 type 2 diabetic patients were identified from the National Health Insurance from 1998 to 2000 and followed up until 2013. The demographic characteristics between patients using aspirin and dipyridamole were analyzed using the χ(2) test. Cox proportional hazard regression models were used to determine the independent effects of aspirin and dipyridamole in the risks of cancer. Results: After adjustment with multiple covariates, aspirin decrease risk of lymphoma, liver and any types of cancer with risk ratios of 0.11 (95% confidence interval [CI], 0.01-0.96), 0.46 (95% CI, 0.31-0.69),and 0.72 (95% CI, 0.59-0.89) respectively. Dipyridamole decrease risk of liver cancer with risk ratio of 0.51 (95% CI, 0.32-0.80).Both low and high doses of aspirin and dipyridamole decrease liver cancer with risk ratios of 0.56 (95% CI, 0.37-0.83), 0.14 (95% CI, 0.05-0.39), 0.61 (95% CI, 0.38-0.99) and 0.28 (95% CI, 0.12-0.66) respectively. Conclusions: Therefore, we conclude both low and high doses of aspirin and dipyridamole decrease risk of liver cancer in type 2 diabetic patients.

150

Abstract PD-14

IMPROVING GLUCOSE CONTROL OF INPATIENTS WITH INTELLIGENT INFORMATION SYSTEM 1

CHIA-LIN CHU, 1LI-CHI HUANG

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

Background: During hospitalization, diabetic patients often have high and low blood glucose fluctuations due to unadjusted drugs and dietary treatments. It will be increased the length of hospital stay due to the difficulty in controlling blood sugar especially for treatment of hypoglycemia. Therefore, our diabetes team hopes to give the more immediate and effective intervention for blood glucose control in hospitalized patients. Methods: The intervention object is “patients with diabetes who have high and low blood glucose levels within 72 hours (hypoglycemia: 250mg/dl), and treated with insulin”, so that the patient’s blood glucose can be stably controlled before discharge. The information system searches for patients who meet the criteria and the diabetes educators take the initiative to visit the patient in the ward, and builds a file in the system to synchronize the team. Our team members (Physician, personal administrator, nutritionist, pharmacist) will provide interventional care. Results: 1. After using the blood glucose management prompting mechanism for inpatients, 405 in-patients with diabetes were consulted in 2019, and 81 in-patients with the team’s acceptance criteria, an increase of 2.09 times compared with last year. 2. The patient’s blood glucose was stable before discharge and no hypoglycemia occurred again. 3. Compared with the past, the time spent is reduced from about 72 minutes per day to less than 1 minute. Conclusions: From the care of inter-professional practice, designing a more comprehensive information system can allow a better and timely interaction and communication mechanism between teams.

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st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

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PD-15

CLINICAL CHARACTERISTICS AND PROGNOSTIC FACTORS OF GERIATRIC TYPE 2 DIABETIC PATIENTS WITH DKA 1

WEN-HSUAN TSAI, 1CHUN-CHUAN LEE, 1CHUN-TA HUANG

Division of Endocrinology and Metabolism, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan

Background: Diabetic ketoacidosis (DKA) crisis is a severe, acute metabolic decompensations of diabetic mellitus (DM). Although DKA tends to developed in younger patients with type 1 DM, it can affect type 2 diabetic patients of any age as well. The number of DKA-related hospitalization continues to rise in all age groups but few studies have focused on geriatric population. The aim of this study is to investigate the clinical characteristics, outcomes and prognostic factors of elderly type 2 diabetic patients hospitalized for DKA. Method: The current study is a sub-study of our SPRING (Structured Protocol for Rapid Inhospital Glycemic Control) Program. Briefly, we conducted a retrospective review of medical records of patients aged 65 or more, who admitted to Mackay Memorial Hospital between January 2016 and December 2019. We used discharge diagnosis to identify subjects admitted primarily for type 2 DM with DKA. Data were retrieved for each patient during the index hospitalization, and only those fulfilling DKA diagnostic criteria proposed by American Diabetic Association (ADA) will then be analyzed. If the same patient is admitted for DKA more than once, only the first event will be included. Our outcome of interest is in-hospital mortality and length of hospital stay. Statistical analysis was done using Mann Whitney U test, X2 or Fisher’s exact test, and binary logistic regression with level of α set at 0.05. Statistical significance was considered for variables with p < 0.05. Result: Over a three-year period, there were 153 admissions of DKA in 138 patients. After excluding repeated cases, complete data was available in 51 patients. Mean age of patients was 73 ± 6.5 years with slightly more males (54.9%). Infection was the most common precipitating factor (51%), followed by poor compliance (23.5%). The median length of hospital stay was 9 days and only 16 (36.4%) patients could be discharged with 7 days. In-hospital mortality occurred in 7 (13.7%) cases with significant higher probability to occur in those having pre-existing ischemic heart disease, stroke or malignancy. Initial tachycardia (OR = 1.142, CI:1.014-1.285, p = 0.028) was an independent mortality predictor and mortality declined with higher GCS (OR = 0.59, CI:0.367-0.949, p = 0.029). Age, gender, BMI, glucose, pH, osmolality and blood pressure showed no significant efficacy in predicting mortality. Conclusion: Infection and non-compliance with drug were the most common precipitants for DKA in geriatric type 2 diabetic patients. Length of hospital stay and mortality were high. Our study showed that initial heart rate and coma scale were prognostic factors for elderly patients with DKA. 152

Abstract PD-16

THE EFFECT OF COMBINED GLP-1 ANALOGUE INJECTION THERAPY WITH GROUP EXERCISE COURSES IN PATIENTS OF TYPE 2 DIABETES 1

SHI-YU CHEN, 1EI SO, 1TSUNG-LIN HSIEH, 1SU-CHIUNG LIN, 1AI-RU CHEN, 1 CHIEH-HUA LU, 1CHANG-HSUN HSIEH 1

Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital

Background: Achieving optimal glycemic control requires medications, diet control, as well as exercise. Research has shown that healthcare providers were often out of practice about exercise guidelines for type 2 diabetic patients, especially with group exercise. Thus, the present study is to evaluate the efficacy of group exercise courses in patients of inadequately controlled T2DM receiving GLP-1 analogue injection therapy. Methods: In 2018, we included 40 patients receiving GLP-1 analogue injection therapy as control group whereas another group of 40 patients were enrolled in 2019 as experimental group which received GLP-1 analogue injection therapy in collaboration with exercise intervention. GLP1 analogue injection skill and regular group exercise every month intervention were introduced. Health education leaflets with QR code video play about diabetic care were also issued. Biochemical examinations glycemic indices, muscle mass and body fat measurements using Bioimpedance Analysis were collected before and 3 months after therapy. Results: In this case-control design study, a total of 80 T2DM patients were recruited. The glycated hemoglobin, fasting blood glucose, body weight, body fat, waist and neck circumferences of patients received group exercise courses were decreased significantly in compare with the control group (p < 0.01). Furthermore, the average muscle weight in experimental group increased by 0.4 kg, while it decreased by 0.5 kg in the control group, with significant difference. Conclusions: Collaborate with group exercise courses with GLP-1 analogue treated patients with poor controlled T2DM, should improve glycemic control and reduced body fat, as well as gaining lean body mass.

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st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

PD-17

A SURVEY OF TREATMENT AND COMPLICATIONS OF TYPE 2 DIABETES PATIENTS IN TAIWAN CLINIC 1

TSAI KUN-YUAN, 2CHEN MIN-LING, 3CHEN SAMUEL, 4CHOU CHIEN-WEN, 5 TZENG THING-FONG, 6LEE YAU-JIUNN 1

重心診所、2 陳敏玲內科診所、3 陳宏麟診所、4 周劍文診所、5 曾競鋒診所、6 李氏聯合診所

Diabetes is a chronic major disease increasing socio-economic burden in Taiwan. More and more people receive treatment for their diabetes in the clinic. Hence, it is necessary to know the quality of treatment in local clinics. In this study, we evaluated the status of diabetes control in 7200 diabetes subjects among 43 local clinics in Taiwan. The mean age was 62.6 ± 11.9 years (mean ± SD). Male to female ratio was 1:1.016. 60% subjects had obesity and 19.7% subjects were overweight, which based on the definition of WHOAsia Pacific. The percentage of subjects having comorbidity of hypertension and dyslipidemia was 67% and 84%. The percentages of subjects who smoked and have quitted smoking were 17.1% and 4.7%. The percentage of subjects having HbA1c levels met ADA goals(< 7%) were 52.5%. The percentages with both SBP and DBP less than 130/80 mmHg were 40.9%. The percentages with LDL cholesterol levels less than 100 mg/dl were 79.7%. Therefore, we found only 18.3% of subjects reached all ABC goals.

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Abstract PD-18

INFLUENCE ON HBA1C AND WEIGHT BY BASELINE BMI WITH ONCE WEEKLY DULAGLUTIDE IN CHINESE T2DM PATIENTS 1

YONG QUAN SHI, 2BIN ZHANG, 2HAI YA WU, 3THOMAS LEW (NON-AUTHOR PRESENTER)

Department of Endocrinology and Metabolism, Changzheng Hospital, Shanghai, China. 2Lilly Suzhou Pharmaceutical Co. Ltd., Shanghai, China. 3Lilly USA, Indianapolis, USA

Objective: To evaluate the efficacy of dulaglutide (1.5mg, 0.75mg) in Chinese T2DM patients with baseline BMI < 25 kg/m2 or ≥ 25 kg/m2, a post-hoc analysis was conducted on two randomized trials at week 26. Methods: Patients in the dulaglutide versus glimepiride study (AWARD-CHN1, NCT01644500; n = 555) were treatment-naive or discontinued from oral monotherapy; those in the dulaglutide versus glargine study (AWARD-CHN2, NCT01648582; n = 591) continued on metformin and/or sulfonylurea. Analyses were conducted based on mixed-model repeated measures using modified intent-to-treat analysis set with only Chinese population. Changes of HbA1c and weight from baseline were analyzed by individual study. Results: 45.6% of patients in AWARD-CHN1 and 42.8% in AWARD-CHN2 had a baseline BMI < 25 kg/m2. In patients with BMI < 25 kg/m2 or ≥ 25 kg/m2 of AWARD-CHN1, both doses of dulaglutide were superior to glimepiride for HbA1c reduction from baseline with a least squares mean difference of -0.55% or -0.53% for dulaglutide 1.5mg (both P < 0.001) and -0.32% or -0.35% for dulaglutide 0.75mg (both P < 0.05), while compared to glimepiride, both doses of dulaglutide showed significant weight reduction from baseline with a least squares mean difference of -2.09 kg or -2.75 kg for dulaglutide 1.5mg (both P < 0.001) and -1.76 kg or -1.92 kg for dulaglutide 0.75mg (both P < 0.001). In AWARDCHN2, dulaglutide 1.5mg was superior to glargine for HbA1c reduction from baseline with a least squares mean difference of -0.58% or -0.55% in patients with BMI < 25 kg/m2 or ≥25 kg/m2 of (both P < 0.001), while dulaglutide 0.75mg was superior to glargine for HbA1c reduction from baseline with that difference of -0.29% in patients with BMI < 25 kg/m2 (P < 0.05), but non-inferior to glargine for HbA1c reduction from baseline with that difference of -0.16% in patients with BMI ≥ 25 kg/m2. Besides, in patients with BMI < 25 kg/m2 or ≥ 25 kg/m2 of AWARD-CHN2, compared to glargine, both doses of dulaglutide showed significant weight reduction from baseline with a least squares mean difference of -2.46 kg or -2.17 kg for dulaglutide 1.5mg (both P < 0.001) and -2.34 kg or -1.51 kg for dulaglutide 0.75mg (both P < 0.001). Conclusions: Irrespective of baseline BMI, Dulaglutide showed effective reduction of HbA1c and weight in Chinese T2DM patients compared with glimepiride and glargine. For higher BMI patients treated with oral anti-hyperglycemia medicine, dulaglutide 1.5mg could be a better clinical choice. 155

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

PD-19

ADHERENCE AND PERSISTENCE FOR DULAGLUTIDE(DU) VS. BASAL INSULIN(BI) IN INJECTION-NAÏVE PATIENTS WITH TYPE 2 DIABETES(T2D): THE DISPELTM STUDY 1

REEMA MODY; 2QING HUANG; 3MARIA YU; 2LIYA WANG; 2XIAN ZHANG; 2 MICHAEL GRABNER 1HIREN PATEL, 1THOMAS LEW (NON-AUTHOR PRESENTER) 1

Eli Lilly and Company, Indianapolis, IN, USA, 2HealthCore, Inc., Wilmington, DE, USA, 3Eli Lilly and Company, Toronto, ON, Canada

Purpose of the study: Adherence and persistence are key considerations in patient-centric treatment selection for T2D management. The objective of this retrospective real-world study was to assess 1-year adherence and persistence using different measures among injection-naïve patients with T2D initiating DU vs. BI. Methods: A US claims database was used to identify patients with T2D initiating DU or BI between Nov’14–Apr’17 (index date=earliest fill date). Patients ≥ 18 years, with no claim for any antidiabetic injectable in the 6 months pre-index period (baseline), continuous enrollment and ≥ 1 HbA1c result at baseline and 1-year post-index were included. Two widely used measures for assessing persistence of injectables in the real-world were implemented. DU users were propensity-matched 1:1 to BI users. Summary of the results: Matched cohorts (903 pairs) were balanced in baseline patient characteristics with mean age of 54 years. At 1-year follow-up, DU patients were significantly more likely to be adherent [PDC ≥ 80%, n (%)] than BI patients [516 (57.1%) vs. 262 (29%); p < .001). When measuring persistence as no gap between fills > 45 days [n (%)], more BI [605 (67.0%)] vs. DU [367 (40.6%)] patients discontinued their therapy but more BI [422 (69.8%)] vs. DU [141 (38.4%)] patients restarted their index therapy. More DU [519 (57.5%)] vs. BI [317 (35.1%)] patients discontinued based on the 90th percentile measure, and more DU [320 (61.7%)] vs. BI [126 (39.7%)] patients restarted their index therapy. Conclusions: In this real-world study, DU demonstrated higher adherence than BI. Given the results, the most appropriate persistence measure may vary for different classes of antidiabetic injectables.

156

Abstract PD-20

DULAGLUTIDE HAS BETTER GLYCEMIC EFFECTIEVNESS VERSUS BASAL INSULIN IN INJECTION-NAÏVE PATIENTS WITH TYPE 2 DIABETES: THE DISPELTM STUDY 1

REEMA MODY, 2QING HUANG, 3MARIA YU, 2XIAN ZHANG, 2LIYA WANG, 2 MICHAEL GRABNER, 1HIREN PATEL, 1THOMAS LEW (NON-AUTHOR PRESENTER) 1

Eli Lilly and Company, Indianapolis, IN, USA. 2HealthCore, Inc., Wilmington, DE, USA. 3Eli Lilly and Company, Toronto, ON, Canada

Background/objectives: 2018 ADA-EASD consensus report recommends GLP-1 RAs over basal insulin (BI) as the first injectable medication in most patients with type 2 diabetes (T2D). Objective of this US retrospective observational study was to compare 1-year real-world glycemic effectiveness among patients with T2D initiating dulaglutide (DU) vs BI. Design and methods: Patients ≥ 18 years with T2D initiating DU or BI between Nov’14–Apr’17 (index date = earliest fill date), and no claim for any antidiabetic injectable in 6 months pre-index period (baseline), continuous enrollment and ≥ 1 HbA1c result 6 months pre-index and 1-year postindex were identified from a US claims database. DU users were propensity-matched 1:1 to BI users. Results: Pre-matching mean baseline HbA1c for DU cohort (n = 1,103) was 8.4% vs 9.9% for BI cohort (n = 3,193). Matched cohorts (903 pairs) were balanced in baseline characteristics with mean HbA1c~8.6%, mean age = 54 years, SGLT2 inhibitor use: 24% and DPP-4 inhibitor use~38%. 1-year post-index, 11% of DU cohort used BI and 10% of BI cohort used GLP-1 RAs; DU patients used less rapid-acting insulin (2% vs 16%) and DPP-4 inhibitors (24% vs 39%) and more SGLT2 inhibitors (34% vs 23%) vs BI patients. For the matched cohorts, change (mean; SE) in HbA1c levels from baseline was significantly greater in the DU (-1.12; 0.05) vs the BI cohort (-0.51; 0.05) (p < 0.01). HbA1c level was reduced by ≥ 1% or decreased to < 7% in significantly more number of patients in the DU (65.6%) vs the BI cohort (45.3%) (p < 0.01). Among patients with baseline HbA1c > 9%, change (mean; SE) in HbA1c levels was significantly greater in the DU -2.11; 0.10) vs the BI cohort (-1.52; 0.10) (p < 0.01). Similar observations were made in patients aged ≥ 65 years. Conclusions: This real-world study, patients with T2D initiating DU demonstrated significantly greater and clinically meaningful HbA1c reduction compared to those initiating BI.

157

st Annual Meeting of September 5-6, 2020 the Endocrine Society and the Diabetes Association of the R.O.C. (Taiwan)

The

PD-21

CHRONIC KIDNEY DISEASE OUTCOMES WITH DULAGLUTIDE VERSUS INSULIN GLARGINE IN TYPE 2 DIABETES AND MODERATETO-SEVERE CHRONIC KIDNEY DISEASE BY ALBUMINURIA STATUS: AWARD-7 1

KATHERINE R. TUTTLE, 2BRIAN RAYNER, 3MARK C. LAKSHMANAN, 3 D. BRADLEY WOODWARD, 3ANITA KWAN, 3MANIGE KONIG, 3FADY T. BOTROS; 3 THOMAS LEW (NON-AUTHOR PRESENTER) 1

Providence Health Care, University of Washington, Spokane, WA, USA; 2Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa; 3Eli Lilly and Company, Indianapolis, IN, USA

Background/objectives: In this study, conducted in type 2 diabetes (T2D) and moderate-tosevere chronic kidney disease (CKD), dulaglutide (DU) treatment was associated with slower decline in estimated glomerular filtration rate (eGFR) versus insulin glargine (IG). DU = 1.5mg weekly (1yr treatment) was associated with fewer CKD outcomes, including eGFR decline ≥ 40% or end-stage renal disease (ESRD), versus IG at similar levels of glycemic control and blood pressure. Aim now is to determine risk of CKD outcomes between treatments in albuminuria subgroups. Design and methods: Participants with T2D and CKD stages 3-4 were randomized (1:1:1) to DU = 0.75mg/DU = 1.5mg weekly versus titrated IG daily, added on to titrated insulin lispro, for 1yr. Composite outcome of eGFR decline ≥ 40% or ESRD was compared between treatments (Coxproportional hazards model time-to-first-event analysis). Results: At baseline, treatment groups had similar eGFR by albuminuria subgroups; majority of events occurred in macroalbuminuria patients (Table). Compared to IG, incidence rate of composite endpoint was significantly lower for DU = 1.5mg in overall study and macroalbuminuria population. Conclusions: Risk of ≥ 40% eGFR decline or ESRD outcomes was reduced by > half for DU = 1.5mg versus IG, particularly in macroalbuminuric subgroup.

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Notes

109年年會論文摘要集

Articles inside

PD：Poster Presentation- Diabetes (1-21

PE：Poster Presentation-Endocrine (1-19

OE：Oral presentation-Endocrine (1-6

OD：Oral presentation-Diabetes (1-6

AP：2020 Award

JS-1：ESROC-TSA Joint Symposium

PL：Plenary Lecture (1-4

DAROC : DAROC 40th Anniversary DAROC – AASD Joint Symposium

Board of Directors

ML：Memorial of Prof. Jen-Der Lin

Moderator & Speaker

SD：Symposium-Diabetes (1-8

SE：Symposium-Endocrine (1-8

ESROC : ESROC 40th Anniversary Special Symposium