OD：Oral Presentation-Diabetes (1-6

OD1 GLYCATED HEMOGLOBIN VARIABILITY, MEAN HBA1C AND HEART FAILURE IN PATIENTS WITH TYPE 2 DIABETES

1YOU-TING LIN,

1WEI-LUN HUANG,

2HUNG-PIN WU,

1CHWEN-TZUEI CHANG,

1CHING-CHU CHEN

1Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung, Taiwan; 2Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung, Taiwan

Aim: To evaluate the association of HbA1c variability and mean HbA1c with heart failure (HF) in patients with type 2 diabetes mellitus (T2DM).

Materials and Methods: Using Diabetes Share Care Program data, patients with T2DM had at least three HbA1c measurements within 12-24 months were included. The cutoffs of mean HbA1c (HbA1c-Mean) were set at <7%, 7-7.9%, and ≥8%. The associated risk of HbA1c-Mean, HbA1c variability (tertiles of HbA1c-SD and HbA1c-adjSD), and HF during 2008-2018 were estimated by using a Cox proportional hazards model.

Results: A total of 3824 patients were included, of whom 315 patients developed HF during the 11.72 years observation period. The associated risk of HF increased with cutoffs of HbA1c-Mean and tertiles of HbA1c variability. In mutually adjusted models, HbA1c-Mean showed a consistent doseresponse association with HF, while the association of HbA1c variability with HF disappeared. Among patients with HbA1c-Mean < 7%, the associated risk of HF in patients with HbA1c variability in tertile 3 was comparable to patients with HbA1c-Mean ≥8%.

Conclusions: Mean HbA1c was an independent predictor of HF and not explained by HbA1c variability. In addition to absolute HbA1c level, targeting on stability of HbA1c in patients with well glycemic control was also important for the development of HF in patients with T2DM.

OD02 THE ASSOCIATIONS BETWEEN NEGATIVE EMOTION, AUTONOMIC ACTIVATION, AND GLYCEMIC CONTROL IN TYPE 2 DIABETES

1KUN-DER LIN, 2I-MEI LIN,

1I-TING LIN, 3SHU-HENG HUANG,

2HUI-JING JI

1Division of Endocrinology and Metabolism, Kaohsiung Medical University Chung-Ho Memorial Hospital 2Department of Psychology, Kaohsiung Medical University 3Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital

Background: Depression decreased autonomic activation in physical illness and mental disorder. The heart rate variability (HRV) was an index of autonomic activation. This study explored the associations between negative emotion, autonomic activation, and glycemic control in patients with Type 2 diabetes.

Methods: A total of 222 patients with Type 2 diabetes were recruited in the outpatient center. The mean age was 62.61 ± 9.98 years with 127 (57.20%) male and 95 (42.80%) females. The Patient Health Questionnaire 9 (PHQ9) and General Anxiety Disorder 7 (GAD7) were used to screening depression and anxiety. A 5-min electrocardiography was measured and transformed into HRV indices. The fasting sugar, hemoglobin A1C (HbA1c), and lipid profiles (cholesterol, triglyceride, low-density lipoprotein [LDL], and high-density lipoprotein [HDL]) were collected for three years from the medical record.

Results: After controlling age, body mass index, lipid profiles, and length of diabetes diagnosis, the positive correlations were found between depression and LF/HF ratio of HRV (r = .145, p = .048). After controlling the demographic data and lipid profiles, the logistic regression showed that higher depression and lower HRV (standard deviation of NN intervals) had poor glycemic control for three years (HbA1c ≥ 7%). The multivariate analysis showed that high sympathetic group (LF/HF ratio ≥ 2.5) had higher cholesterol, LDL, and HbA1c than those low sympathetic group (LF/HF ratio < 2.5) (F

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= 13.14, p < .001, ŋ2 = .070; F = 13.03, p < .001, ŋ2 = .070; F = 5.04, p = .026, ŋ2 = .028).

Conclusions: Depression was related to higher sympathetic activation, and higher sympathetic also related to poor lipid profiles and glycemic control in patients with Type 2 diabetes. Depression and low HRV can also predict poor glycemic control for three years in patients with Type 2 diabetes. Therefore, measures of depression and autonomic activation are needed in the future.

OD03 MITOCHONDRIAL HAPLOGROUPS HAVE A BETTER CORRELATION TO INSULIN REQUIREMENT THAN NUCLEAR GENETIC VARIANTS FOR TYPE 2 DIABETES MELLITUS IN TAIWANESE INDIVIDUALS

1FENG-CHIH SHEN, 1SHAO-WEN WENG, 2MENG-HAN TSAI, 3YU-JIH SU,

1JUNG-FU CHEN,

4YEN-HSIANG CHANG, 2CHIA-WEI LIOU,

2TSU-KUNG LIN,

5JIIN-HAUR CHUANG, 1PEI-WEN WANG

1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 2 Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 3 Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 4 Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 5 Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.

Objective Identifying the diabetes-susceptible genetic variants will help to provide the personalized therapy for type 2 diabetes. Previous studies have reported a genetic risk score (GRS) calculated according to the number of nuclear DNA (nDNA) risk alleles may predict the future requirement of insulin therapy. Although mitochondrial dysfunction has close association with insulin resistance (IR), there are few studies investigate whether genetic variants of mitochondrial DNA (mtDNA) will affect the clinical features of type 2 diabetes.

Research Design and Methods We determined mitochondrial haplogroups using mtDNA whole genome next generation sequencing and 18 single nucleotide polymorphisms (SNPs) in nDNA susceptibility loci of 15 genes in 604 Taiwanese individuals with type 2 diabetes. A genetic risk score (GRS) of nDNA was calculated by summation of the number of risk alleles. We assessed the association between mtDNA haplogroup and the clinical features of type 2 diabetes by logistic regression analysis. The results were compared with the GRS subgroups for the risk of insulin requirement.

Results Mitochondrial haplogroups modulate the clinical features of type 2 diabetes, in which patients harboring haplogroup D4, as compared to those harboring non-D4 haplotypes were less prone to require insulin treatment, after correction for age, sex and diabetes duration. However, there was no association between clinical features and GRS calculated from nuclear genetic variants.

Conclusions Mitochondrial haplogroups, but not GRS constructed by nuclear genetic variants, have a better association with the insulin requirement. Our results highlight the role of mitochondria in the management of common metabolic diseases.

OD04 PROGNOSTIC MODEL FOR CKD REGRESSION AND PROGRESSION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

1,2CHIEN-HSING LEE, 2YAU-JIUNN LEE

1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; 2 Lee's Endocrinologic Clinic, Pingtung, 90000, Taiwan

Background: To investigate the validation of a risk prediction model that has published recently in the prediction of development, progression, and regression of the renal function changes in patients with type 2 diabetes mellitus (T2DM).

Methods: T2DM patients who constitutively managed for at least 12 months were included. Participants were categorized into stable, progression, or regression groups according to their change in estimated glomerular filtration rate and urinary albumin/creatinine ratio. Baseline clinical characters and biochemical data were applied to the model.

Results: 8367 T2DM patients were enrolled in this study and followed-up for a mean of 8.2 years. The score obtained at the baseline of the prediction model was significantly associated with the baseline renal function status. The progression group had the highest score and the regression group had the lowest score. In addition, when patients without clinical evidence of kidney disease, the baseline score we also found to be associated with the newly developed kidney damage.

Conclusions: Our data indicated that the prediction score is a useful clinical tool in evaluating the renal changes of patients with T2DM in clinical practice.

OD05 HYPOGLYCEMIA AND HEART RATE VARIABILITY: SYNCHRONOUS DETECTION BY HOLTER AND CONTINUOUS GLUCOSE MONITORS.

CHIA-JUNG HSU, FENG-HSUAN LIU, SHU-FU LIN

Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan

Background: Hypoglycemia is a notorious diabetic side effect leading to unwanted major vascular events and sudden cardiac death due to change in autonomic cardiac function. Previous studies have reported electrocardiographic (ECG) abnormalities such as QT interval prolongation in patients with hypoglycemia. The aim of this study was to document ECG and heart rate variability (HRV) changes during hypoglycemia, and to explore risk factors that may also affect ECG changes in poor controlled diabetic patients.

Methods: Seventeen participants including twelve poor controlled type 2 diabetes, four type 1 diabetes and one suspected nesidioblastosis were enrolled in this study. There were eleven females and six males, aged from 37 to 77 (mean 50.3 ± 12.0) years old, with self-reported duration of diabetes from 6 to 33 (mean 20.8 ± 8.7) years. The mean HbA1c was 8.3 ± 1.4 % on the time of the examination. We used Holter monitor (VitalSigns) and continuous glucose monitor (Medtronic) to record ECG waveform, heart rate variability and glucose level with synchronization of time for a duration of seven days.

Results: Three of the seventeen participants did not experience hypoglycemia (≤ 70 mg/dL). The other participants who experienced hypoglycemia revealed, as a whole, a trend of correlation between blood glucose, corrected QT Interval (QTc), heart rate (HR) and low frequency/ high frequency (LF/ HF) ratio. When the participants experienced hypoglycemia were sub-divided into response and nonresponse groups according to the appearance of QTc prolongation, significant negative correlations were found between the length of QTc interval as well as LF/HF ratio and glucose levels in the response group. In contrast, no significant correlation was found between glucose levels and QTc length as well as LF/HF ratio in the non-response group. It was also interestingly to find that the nonresponse group of participants are mostly type 1 diabetic patient.

Conclusions: We found that the appearance of QTc prolongation and LF/HF ratio elevation during hypoglycemia was quite different in our patients with poor sugar control, and the cause of the heterogenecity may be due to individual difference of autonomic dysfunction, glycemic variability and/or mean absolute glucose change per unit time.

OD06 INFORMATION SYSTEM INITIATED ACTIVE CONSULTATION FOR IN-PATIENTS WITH HYPERGLYCEMIA COULD IMPROVE MEDICAL CARE QUALITY

1,2CHING JUNG HSIEH

1 寶建醫療社團法人寶建醫院內科部、 2 美和科技大學 護理學系

Background Many studies have shown that hyperglycemia correlates with mortality and morbidity in patients in hospital. Well glycemic control could decrease healthcare resource utilisation including length of stay (LOS) in hospital, hospital mortality, and 30-day readmission rate in critically and non-critically ill patients regardless of the presence or absence of diabetes. In our previous study, we also found high glucose variability increases 30-day readmission rates in patients with type 2 diabetes hospitalized in department of surgery. In another our ten-years’ study, early short-term intensive multidisciplinary diabetes care could decrease coronary artery disease and nephropathy progression. In this study, we want to investigate whether proactive and intensive intervention with multidisciplinary diabetes care for in-hospital patients could reduce healthcare resource utilisation and glucose variability.

Methods We used our automatic information systems to inform doctor of Endocrine &Metabolism to make immediately recommendation for in-hospital patients with first sequential 2 times of blood glucose levels more than 250 mg/dL measured after admission, then initiated multidisciplinary diabetes care. In charged attending could decide receiving autonomic consultation or not. The patients not receiving proactive multidisciplinary diabetes care were as control group. Outcome measure included average and standard deviation (SD) of blood glucose and health care cost during admission, glycated hemoglobin (HbA1c), lipid profile and urine albumin/ creatinine ratio(UACR), changes of medication for DM after discharge 3-6 month , LOS, readmission within 30 days, and mortality rate. Discharge diagnosis, in-charged subspecialist and number of ED/office visits were also recorded.

Results There are 505 patients who had received active consultation system had lower readmission rate within 30 days after discharge (3.4% vs 6.8%), health care cost (23,3253 ± 10,5325 NTD vs. 26,7462 ± 10,4228 NTD, p < 0.001), mortality rate (2.2% vs.3.4%) and LOS (7.0 ± 1.8 days vs 9.0 ± 1.6 days, p = 0.010) than 610 patients as control. Comparing to control group, the study group also had lower HbA1c (7.7 ± 2.2% vs. 8.5 ± 2.3% p = 0.015) after discharge and less blood glucose fluctuation during admission (75.7 ± 20.5 mg/dL vs. 99.1 ± 26.5 mg/dL, p = 0.088). The SD of blood glucose level was apparent correlated with HbA1c after discharge and health care cost. There were no group differences in in-charged subspecialist, number of ED/office visits, medication amount for DM,

lipid profile, UACR and discharge diagnosis.

Conclusion Intensive early intervention by active consultation system and multidisciplinary diabetes care may decrease blood glucose fluctuation, healthcare resource utilisation including decrease the LOS, hospital mortality, total cost of care and 30-day readmission rate.