112年度年會論文摘要集

March 18-19, 2023

Floor Plan of Conference Rooms

March 18-19, 2023

Floor Plan of Conference Rooms

08:00-12:00

15 2

March 18, 2023 (Saturday)

12:00-13:00

DAROC-TADE (Room 101) DAROC-TADE Joint Symposium

/

13:10-13:20Opening (Room 101)

13:20-14:05

14:05-14:50

PL1 Plenary Lecture-1 (DM) (Room 101) Management of Hyperglycemia in Type 2 Diabetes: ADA/EASD Consensus Report

Prof. Melanie Davies LIVE QA

PL2 Plenary Lecture-2 (Endocrine) (Room 101) Thyroid Nodule 2023-updates in Interpreting US, Cytology and Molecular Testing

Prof. Susan J. Mandel

14:50-15:20 Break (Poster Stand – 3F Walkway) PD PE

SD1 In Hospital Glucose Management What Changes?

15:20-17:00

Prof. Guillermo Umpierrez

SE1

Thyroid Cytology

SE2 Pituitary

SD2 The Goal 50: Goals and Unmet Needs

SE3 Transgender Endocrinology

17:00-18:00

Meet the ProfessorDiabetes

Prof. Edward Boyko

Meet the ProfessorEndocrine

Prof. Susan J. Mandel

18:00-21:00Welcome Dinner (Conference Room 101)

Endocrine

SD3 Research Symposium & Young Investigator Research Report

08:00-09:40

SE4

Interventional Endocrinology SE5

March 19, 2023 (Sunday)

Adrenal Diseases (Aldosteronism) SD4 Diabetes and Immunization

Daily Program Schedule

New Technology

New Perspectives on Heart Failure in Diabetes

Prof. Roger Chen

Prof. Francis CC Chow LIVE

09:40-10:00Break (Poster Stand – 3 F Walkway)

10:00-10:45 PL3 Plenary Lecture-3(DM) (Room 101) Diabetes and Cancer:Epidemiology and Implications

10:45-12:20 General Assembly (Room 101)

12:20-12:30 Group Picture (1st Floor Square)

12:30-13:30

13:35-14:20 PL4 Plenary Lecture-4 (Endocrine) (Room 101) Prof. Won Bae Kim Active Surveillance of MicroPTC (Papillary Thyroid Carcinoma); Where Are We Now?

14:20-14:40Break (Poster Stand -3 Floor Walkway)

SD7

14:40-16:20

Diabetes and MAFLD Prof. Edward Boyko SE7

Thyroid (Malignancies) SD8 National Diabetes Registries: Do They Make Prof. Katarina Eeg-Olofsson LIVE

16:20-16:30Closing

Diabetes Remission: How Is It Achieved?

Workshop-Endocrine Thyroid Ablation Hand-on Course

Hand on

Plenary

Lecture Prof. Melanie Davies Management of hyperglycemia in type 2 diabetes: ADA/EASD Consensus Report Diabetes and cancer: epidemiology and implications Prof. Edward J. Boyko

Diabetes and MAFLD–the epidemiology of diabetes and body composition Meet the Professor Prof. CHEN, Roger CY from glycemic control to the reduction of diabetic complications; Prof. Francis CC Chow Herpes zoster and herpes zoster vaccination in adult and diabetic patients Prof. Katarina Eeg-Olofsson Sweden Registry experience

理事長致詞

中華民國內分泌暨糖尿病學會 112 年度年會於台大醫院國際會議中心舉行，今 年輪由糖尿病學會來主辦，內分泌學會在這次因台灣疫情減輕、國境開放的同時， 邀請美國 Susan Mandel 教授及韓國 Won-Bae Kim 教授蒞台擔任 Plenary Lecture 的來 賓，Mandel 教授是美國內分泌學會的前任會長，她會帶來 2023 年 thyroid nodule 的

update 以及一場與教授晤談談論甲狀腺亢進與懷孕，Kim 教授是現任 AOTA 會長， 他會講授積極主動監測甲狀腺微小乳突癌。今年的幾場內分泌論壇 Symposium 皆

由秘書長、副秘書長與各委員會主委商討籌劃，計有 SE-1 Thyroid Cytology、SE-2

Pituitary、SE-3 Transgender Endocrinology、SE-4 Interventional Endocrinology、SE-5

Adrenal Disease、SE-6 Obesity、SE-7 Thyroid Malignancy 等七場，節目內容多元又 多彩，會是很豐盛的學術饗宴。而延續 SE-4 的上午課程在下午時段更安排甲狀腺 消融的 Hand-on workshop，也能讓大家各取所需選擇所愛。同時糖尿病學會的滿 堂學術節目、兩會會員的口頭論文報告與壁報展示報告、與藥界同仁安排的 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。

在星期日的會員大會上，我們也要頒發今年度的各項獎項，傑出貢獻獎由曾芬 郁教授獲得，傑出研究獎由王佩文教授獲得，以及四位優秀論文獎得主，分別是吳 婉禎醫師、郭俸志醫師、林嘉鴻醫師、蘇聖強醫師獲得，恭喜他們。

感謝今年負責場地規劃的糖尿病學會，在黃建寧理事長的帶領下圓滿成功，謹 此感謝所有主持人及演講者、糖尿病及內分泌學會兩會的秘書長、副秘書長、秘書、

所有的贊助廠商，更謝謝所有會員對學會的支持，有您們的參予與鼓勵才是我們繼 續走下去的動力，在後疫情時代，讓我們一起同心協力，為台灣的新陳代謝暨內分 泌醫療而努力。

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 2023

Board of Directors

The Endocrine Society of the Republic of China (Taiwan)

President

Standing Executive Board

Executive Board

Standing Control Board

Control Board

Feng Hsuan Liu

Chih-Yuan Wang

Keh-Sung Tsai

Shu-Yi Wang

Annie Lee

Shyang-Rong Shih

Szu-Tah Chen

Horng-Yih Ou

Fen-Yu Tseng

Hong-Da Lin

Hung-Yu Chang

Wai-Kin Chan

Yu-Hsuan Li

He-Jiun Jiang

Jin-Wei Huang

Harn-Shen Chen

Ming-Nan Chien

Chieh-Hua Lu

Chen-Kai Chou

Pei-Lung Chen

Jawl-Shan Hwang

Chieg-Hsiang Lu

Ching-Chung Chang

Chin-Sung Kuo

Kuan-Yu Lin

Szu-chi Chen

The Diabetes Association of the Republic of China (Taiwan)

President

Standing Executive Board

Executive Board

Standing Control Board

Control Board

Secretary

Chien-Ning Huang

Jung-Fu Chen

Shih Te Tu

Hung-Yuan Li

Chin-Hsiao Tseng

Wei-Shiung Yang

Yi-Jen Hung

Chia-Hung Lin

Wayne Huey-Herng Sheu

Lee-Ming Chuang

Low-Tone Ho

Yi-Sun Yang

Feng-Chih Shen

Yi-Ching Shen

Sheng-Chiang Su

Chii-Min Hwu

Shih-Tzer Tsai

Ching-Chu Chen

Ching-Ling Lin

Chien-Hsing Lee

Tien-Jyun Chang

Chih-Hsun Chu

Chewn-Yi Yang

Tong-Yuan Tai

Jeng-Fu Kuo

Kang-Chin Fan

The Endocrine Society and the Diabetes Association of the R.O.C (Taiwan) Would Like to Recongnize the Following for Their Support of the 44th Annual Meeting

The Leader Book Company Ltd.

Orient EuroPharma Co., Ltd.

Taiwan Tanabe Seiyaku Co., Ltd.

Ascensia Diabetes Care Taiwan, Ltd.

Boehringer Ingelheim Taiwan Ltd.

Bayer Taiwan Co., Ltd.

Novo Nordisk Pharma (Taiwan) Ltd.

Novartis (Taiwan) Co., Ltd.

Eli Lilly Company (Taiwan)

evervision instrument company

TSH Biopharm Corporation Ltd

Lotus Pharmaceutical Co., Ltd.

Abbott Laboratories Services Corp. Taiwan Branch

viatris Pharmaceutical company limited

Zuellig Pharma Taiwan

Char Deh Drugs Enterprise Co., Ltd.

AstraZeneca Taiwan Limited

Edward J. Boyko, MD, MPH

Francis CC Chow

MBBS (HK), FRCP (Edin & Lon), FHKCP, FHKAM (Medicine)

Guillermo Umpierrez, MD, CDCES, FACE, MACP

Katarina EegOlofsson, MD PhD

Edward J. Boyko, MD, MPH, is Professor of Medicine and Adjunct Professor

Puget Sound Health Care System in Seattle, USA

Consultant Endocrinologist & Honorary Associate Professor Department of Medicine & Therapeutics

Prince of Wales Hospital

The Chinese University of Hong Kong

Founder & Managing Director, Hong Kong Diabetes Specialist Centre

Hong Kong SAR

Dr. Umpierrez is a professor of medicine in the Division of Endocrinology and Metabolism at Emory University School of Medicine, Atlanta, Georgia. He is the President for Medicine and Science at the American Diabetes Association.

Katarina Eeg-Olofsson is a consultant in diabetes at the Department of Medicine at Sahlgrenska University Hospital in Gothenburg and a researcher at the Sahlgrenska academy the University of Gothenburg. She is the director of the Swedish National diabetes register (NDR) and is working with the NDR-team to support both primary care units and hospital clinics to use the register to improve diabetes care. She has contributed to national guide lines on diabetes as an expert to the National Board of health and welfare in Sweden

Melanie Davies CBE, MB ChB, MD, FRCP, FRCGP, FMedSci

Professor of Diabetes Medicine, University of Leicester

Roger CY Chen, PhD, FRACP, MB BS, ATCL s Hospital, Sydney

Conjoint Professor in Medicine, University of New South Wales Visiting Scientist, Garvan Institute of Medical Research

Susan J. Mandel, M.D., M.P.H

Chief, Division of Endocrinology, Diabetes, and Metabolism

Sylvan H. Eisman Professor of Medicine Perelman School of Medicine, University of Pennsylvania

Won Bae Kim, M.D., Ph.D. Director & Professor, Division of Endocrinology & Metabolism, Department of Internal Medicine, Asan Medical Center, Seoul, Korea President, Asia & Oceania Thyroid Association

( First name )

Moderator & Speaker

March 18, 2023

Room 101

112 3 18-19

DAROC-TADE: Joint Symposium

TimeTopicSpeakerModerator

08:20-08:30 OPENING REMARKS

TADE-1 08:30-08:55 2018

TADE-2 08:55-09:20 2022

TADE-3 09:20-09:50 09:50-10:10

TADE-4 10:10-10:35 - ADCES (BC-ADM®, CDCES)

TADE-5 10:35-11:00 -

TADE-6 11:00-11:2011:20-11:50 11:50-12:00 CLOSING REMARKS

March 18, 2023

Room 101

PL1: Plenary Lecture 1 (Diabetes)

TimeTopicSpeakerModerator

13:10-13:15 OPENING

PL1 13:15-14:05 MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD CONSENSUS REPORT LIVE QA

March 18, 2023

Room 101

Prof. Melanie Davis

PL2: Plenary Lecture 2 (Endocrine)

TimeTopicSpeakerModerator

14:05-14:10 OPENING

PL2 14:10-14:50 THYROID NODULE 2023-UPDATES IN INTERPRETING US, CYTOLOGY AND MOLECULAR TESTING

March 19, 2023

Room 101

Prof. Susan J. Mandel

PL3: Plenary Lecture 3 (Diabetes)

TimeTopicSpeakerModerator

10:00-10:05 OPENING

PL3 10:05-10:45 DIABETIC FOOT: THE GLOBAL STATE OF PLAY

March 19, 2023

Room 101

PL4: Plenary Lecture 4 (Endocrine)

TimeTopicSpeakerModerator

13:35-13:40 OPENING

PL4 13:40-14:20 ACTIVE SURVEILLANCE OF MICROSCOPIC PAPILLARY THYROID CARCINOMA; WHERE ARE WE NOW?

Prof. Won Bae Kim

March 18, 2023 Room 301

MTP-D: Meet the Professor - Diabetes TimeTopicSpeakerModerator

17:00-17:10 OPENING

MTP-D1 17:00-17:10 SURGICAL MANAGEMENT OF THE DIABETIC FOOT: YOUR WOUND, ISCHEMIA AND FOOT INFECTION (WIFI) SETTINGS

MTP-D2 17:25-17:40 ADAVNCED STUDY SHARING AT DIABETES RESEARCH CENTER OF UNIVERSITY OFWASHINGTON IN SEATTLE, USA

17:40-18:00 DISCUSSION AII

March 18, 2023 Room 401

Prof. Edward Boyko

MTP-E: Meet the Professor - Endocrine TimeTopicSpeakerModerator

MTP-E 17:00-18:00 HYPERTHYROIDISM AND PREGNANCY Prof. Susan J. Mandel

March 18, 2023

Room 301

SD1: Symposium-Diabetes 1

TimeTopicSpeakerModerator

15:20-15:25 OPENING

SD1-1 15:25-15:55 MANAGEMENT OF DIABETES AND HYPERGLYCEMIA IN THE HOSPITAL Prof. Guillermo Umpierrez

15:55-16:05 Q&A

SD1-2 16:05-16:30 IN HOSPITAL GLUCOSE MONITORING SYSTEM

SD1-3 16:30-16:55 THE IMPORTANCE OF INPATIENT DIABETES HEALTH EDUCATION FOR GLYCEMIC CONTROL

16:55-17:00 PANEL DISCUSSION All

March 18, 2023

Room 402CD

SD2: Symposium-Diabetes 2

TimeTopicSpeakerModerator

15:20-15:25 OPENING

SD2-1 15:25-15:55 REVIEW AND PROSPECTIVE OF GOAL 50 PROJECT/ GOAL50

SD2-2 15:55-16:25 GOAL50

DM WITH EARLY CKD AND UNMET NEEDS

SD2-3 16:25-16:55 GUIDELINE RECOMMENDATIONS

16:45-17:00 PANEL DISCUSSION All

March 18, 2023

Room 203

SD3: Symposium-Diabetes 3

Research Symposium: Young Investigator Research Report

TimeTopicSpeakerModerator

15:20-15:25 OPENING

SD3-1 15:25-15:55 THERAPEUTIC POTENTIAL OF THERMOGENIC FATS IN OBESITY AND DIABETES

SD3-2 15:55-16:25 ROLE OF HEPASSOCIN IN HYPERTHYROIDISM-INDUCED HEPATIC DYSFUNCTION

SD3-3 16:25-16:55 THE RELATIONSHIP BETWEEN PLASMA APOM-S1P AND INCIDENT DIABETES & OBESITY IN HUMAN

16:55-17:00 PANEL DISCUSSION

March 19, 2023

Room 401

All

SD4: Symposium-Diabetes 4

Diabetes and Immunization

TimeTopicSpeakerModerator

08:00-08:05 OPENING

SD4-1 08:05-08:35 LIFE-COURSE IMMUNIZATION AND ADULT VACCINATION

SD4-2 08:35-09:05 HERPES ZOSTER AND HERPES ZOSTER VACCINATION IN ADULT AND DIABETIC PATIENTS LIVE

SD4-3 09:05-09:35 VACCINATION RECOMMENDATION FROM DAROC FOR DIABETIC PATIENTS

09:35-09:40 PANEL DISCUSSION

Prof. Francis CC Chow

All

March 19, 2023

Room 402AB

SD5: Symposium-Diabetes 5 New technology

TimeTopicSpeakerModerator

08:00-08:05 OPENING

SD5-1 08:05-08:35 CGM : BENEFIT OF CGM : FROM GLYCEMIC CONTROL TO THE REDUCTION OF DIABETIC COMPLICATIONS

SD5-2 08:35-09:05 CSII : THE UPDATE OF ADVANCED HYBRID CLOSED LOOP SYSTEM (AHCL) IN DIABETES MANAGEMENT

SD5-3 09:05-09:25 DIGITAL HEALTH TECHNOLOGY : ARTIFICIAL INTELLIGENCE AND PERSONALIZED DIGITAL TECHNOLOGY: THE NEXT FRONTIER IN DIABETES THERAPY

Prof. Roger Chen

09:25-09:30 PANEL DISCUSSION All

March 19, 2023

Room 203

SD6: Symposium-Diabetes 6 New Perspectives on Heart Function and Failure in Diabetes

TimeTopicSpeakerModerator

08:00-08:05 OPENING

SD6-1 08:05-08:35 HEART FAILURE IN TYPE 2 DIABETES: IS IT ABOUT HFPEF, HFREF OR BOTH?

SD6-2 08:35-09:05 STATUS AND THE NEXT STEP APPROACH RATIONALES?

SD6-3 09:05-09:35 MANAGEMENT OF HF IN TYPE 2 DIABETES

09:35-09:40 PANEL DISCUSSION ALL

March 19, 2023

Room 101

SD7: Symposium-Diabetes 7 Diabetes and MAFLD

TimeTopicSpeakerModerator

14:40-14:55 OPENING

SD7-1 14:55-15:20 DIABETES AND MAFLD – THE EPIDEMIOLOGY OF DIABETES AND BODY COMPOSITION

SD7-2 15:20-15:50 OVERVIEW OF MAFLD/NAFLD AND THE IMPACT OF DM ON MAFLD/NAFLD

SD7-3 15:50-16:15 OVERVIEW OF T2D AND THE IMPACT OF MAFLD/NAFLD ON DM

Prof. Edward Boyko

16:15-16:20 PANEL DISCUSSION All

March 19, 2023

Room 401

SD8: Symposium-Diabetes 8

National Diab etes Registries:

TimeTopicSpeakerModerator

14:40-14:45 OPENING

SD8-1 14:45-15:20 SWEDEN REGISTRY EXPERIENCE LIVE Prof. Katarina Eeg-Olofsson

SD8-2 15:20-15:40 TAIWAN

SD8-3 15:40-16:00 TAIWAN BIOBANK

SD8-3 16:00-16:15 TAIWAN DIABETES REGISTRY

16:15-16:20 PANEL DISCUSSION

All

March 19, 2023

Room 402CD

SD9: Symposium-Diabetes 9

TimeTopicSpeakerModerator

14:40-14:45 OPENING

SD9-1 14:45-15:15 DIABETES REMISSION - HOW IS IT ACHIEVED? (LIFESTYLE)

SD9-2 15:15-15:45 DIABETES REMISSION - HOW IS IT ACHIEVED? (PHARMACOTHERAPY)

SD9-3 15:45-16:15 DIABETES REMISSION - HOW IS IT ACHIEVED? (BARIATRIC SURGERY)

16:15-16:20 PANEL DISCUSSION All

March 18, 2023

Room 401

SE1: Symposium-Endocrine 1 Thyroid Cytology

TimeTopicSpeakerModerator

15:20-15:25 OPENING REMARK

SE1-1 15:25-16:15 CYTOLOGIST'S ROLE IN THYROID NODULE DIAGNOSIS WITH AI

SE1-2 16:15-16:55 COMPUTERIZED ULTRASONOGRAPHY AND CYTOLOGY READING IN THYROID CANCER DIAGNOSIS

16:55-17:00 PANEL DISCUSSION All

March 18, 2023

Room 402AB

SE2: Symposium-Endocrine 2 Pituitary

TimeTopicSpeakerModerator

15:20-15:25 OPENING REMARK

SE2-1 15:25-15:45 PITNETS: WHO CLASSIFICATION UPDATE

SE2-2 15:45-16:05 PITUITARY ADENOMA: DIAGNOSIS, TREATMENT, AND PROGNOSIS

SE2-3 16:05-16:25 SURGEON S PERSPECTIVE

SE2-4 16:25-16:45 (WHO UPDATE ) 16:45-17:00 PANEL DISCUSSION All

March 18, 2023

Room 202

SE3: Symposium-Endocrine 3 Transgender Endocrinology

TimeTopicSpeakerModerator

15:20-15:25 OPENING REMARK

SE3-1 15:25-15:55 PSYCHOSOCIAL ISSUE IN TRANSGENDER

SE3-2 15:55-16:25 HORMONE THERAPY FOR TRANSGENDER

SE3-3 16:25-16:55 TRANSGENDER 16:55-17:00 PANEL DISCUSSION All

March 19, 2023

Room 101

SE4: Symposium-Endocrine 4 Interventional Endocrinology

TimeTopicSpeakerModerator

08:00-08:05 OPENING REMARK

SE4-1 08:05-08:35 UPDATE OF RADIOFREQUENCY ABLATION FOR TREATING BENIGN AND MALIGNANT THYROID NODULAR DISEASE

SE4-2 08:35-09:05 CLINICAL APPLICATION OF MICROWAVE AND HIFU IN THYROID NODULAR DISEASE

SE4-3 09:05-09:35 THYROID ARTERIAL EMBOLIZATION (TAE) AS A ADJUVANT TREATMENT FOR THYROID DISEASE

09:35-09:40 PANEL DISCUSSION All

March 19, 2023

Room 301

SE5: Symposium-Endocrine 5 Adrenal Diseases (Aldosteronism)

TimeTopicSpeakerModerator

08:00-08:05 OPENING REMARK

SE5-1 08:05-08:35 PROGRESS ON GENETIC BASIS OF PRIMARY ALDOSTERONISM

SE5-2 08:35-09:05 AN UPDATE ON ADRENAL HISTOPATHOLOGY IN PRIMARY ALDOSTERONISM

SE5-3 09:05-09:35 PRIMARY ALDOSTERONISM: UPDATING TREATMENT AND COMORBIDITIES DETECTION

09:35-09:40 PANEL DISCUSSION All

March 19, 2023

Room 402CD

SE6: Symposium-Endocrine 6 Obesity

TimeTopicSpeakerModerator

08:00-08:05 OPENING REMARK

SE6-1 08:05-08:35 CURRENT MECHANISM OF OBESITY: BRAIN-ENDOCRINE-GUT INTERACTION

SE6-2 08:35-09:05 THE EFFECT OF OBESITY ON FEMALE REPRODUCTIVE DYSFUNCTION

SE6-3 09:05-09:35 ENDOCRINE DISORDER AND OBESITY: MECHANISM AND DIFFERENTIAL DIAGNOSIS

09:35-09:40 PANEL DISCUSSION All

March 19, 2023

Room 301

SE7: Symposium-Endocrine 7 Symposium –Thyroid (malignancies)

TimeTopicSpeakerModerator

14:40-14:45 OPENING REMARK

SE7-1 14:45-15:15 MEDICAL TREATMENT OF ADVANCED THYROID CANCER

SE7-2 15:15-15:45 THERMAL ABLATION OF THYROID CANCER: OVERVIEW OF CURRENT TECHNIQUE AND EVIDENCE

SE7-3 15:45-16:15 MOLECULAR TESTING AND PRECISION ONCOLOGY IN THYROID CANCERS

16:15-16:20 PANEL DISCUSSION All

March 19, 2023

Room 203

14:40-15:00 15:00-15:10 BREAK( B1)

WE 15:10-17:10 HAND ON (B1 )

March 18-19, 2023

LS: Lunch Symposium

March

LS1 DIABETES AND CHRONIC KIDNEY DISEASE – UPDATED INTERNATIONAL GUIDELINES FOR RAPIDLY EMERGING NEW EVIDENCE

LS2EXPECT TO OPTIMIZE DIABETES MANAGEMENT BY NOVEL BASAL INSULIN THERAPY LS3

LS4 / A PREMIUM JOURNEY FROM PREVENT TO PRESERVE

LS5 DISCOVER BLUE SEA - 3M OSTEOPOROSIS PATIENTS ARE THERE

LS6

(1) WHAT’S NEW IN HYPERTENSION AND LIPID MANAGEMENT IN 2023? ANY DIFFERENCE BETWEEN GUIDELINE AND CLINICAL PRACTICE?

(2) MPROVING QOL FOR YOUR PATIENTS BY OPTIMIZING TREATMENT OF DPNP

Prof. Ian de Boer

March 19, 2023TopicSpeakerModerator

LS7 NONSTEROIDAL MRA – A NEW PILLAR FOR T2D WITH CKD

LS8 HOLISTIC APPROACH TO THE MANAGEMENT OF T2D AND OBESITY

LS9 THE ESSENTIAL ROLE OF EARLY INTENSIFICATION AND BETA CELL PRESERVATION IN ASIA NEW-ONSET DIABETES DURING COVID-19

LS10 ( ) LEARNING FROM AGP, TO DISCLOSE THE PATIENT’S PAIN POINT

LS11 OSTEOPOROSIS PREVENTION AND TREATMENT: MIND THE GAP

LS12 ( ) THE IMPACT OF CONTINUOUS GLUCOSE MONITORING (CGM) AND NUTRITION ON GLYCEMIC MANAGEMENT

Prof. George Bakris

Prof. Roger Chen

March 18, 2023

Room 402CD

OD-1 17:00-17:10 2 SGLT2I

OD-2 17:10-17:20 :

OD-3 17:20-17:30

OD-4 17:30-17:40

OD-5 17:40-17:50 SGLT2 SODIUM-GLUCOSE COTRANSPORTER 2 OD-6 17:50-18:00

March 18, 2023

Room 202

OE-1 17:00-17:10

OE-2 17:10-17:20

OE-3 17:20-17:30 -

OE-4 17:30-17:40

OE- 5 17:40-17:50 :

OE-6 17:50-18:00

March 18-19, 2023

AP: 2022 Award

AP-1 THE ROLE OF MITOCHONDRIA IN THE PATHOGENESIS OF METABOLIC SYNDROME

AP-2 CORTISOL-PRODUCING ADENOMA-RELATED SOMATIC MUTATIONS IN UNILATERAL PRIMARY ALDOSTERONISM WITH CONCURRENT AUTONOMOUS CORTISOL SECRETION: THEIR PREVALENCE AND CLINICAL CHARACTERISTICS

AP-3 ABERRANT OVEREXPRESSION OF HOTAIR INHIBITS ABDOMINAL ADIPOGENESIS THROUGH REMODELLING OF GENOME-WIDE DNA METHYLATION AND TRANSCRIPTION

AP-4 EVALUATION OF DISEASE COMPLICATIONS AMONG ADULTS WITH TYPE 1 DIABETES AND A FAMILY HISTORY OF TYPE 2 DIABETES IN TAIWAN

AP-5 PDIA4, A NOVEL ER STRESS CHAPERONE, MODULATES ADIPONECTIN EXPRESSION AND INFLAMMATION IN ADIPOSE TISSUE

March 18-19, 2023

Poster Presentation-Diabetes

March 18, 2023 14:50-15:20 ( )

March 18-19, 2023 PE: Poster

Presentation- Endocrine

March 18, 2023 14:50-15:20 ( )

March 18-19, 2023 BP 1-7

BP1 TIRZEPATIDE GLP-1 RA

BP2 TIRZEPATIDE

BP3 SURPASS1-4 TIRZEPATIDE

BP4 TIRZEPATIDE

BP5 Semaglutide 2 MACE SUSTAIN 6 PIONEER 6

PL-1

DAROC-TADE-1

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD CONSENSUS REPORT

從 2018 年糖尿病健康促進機構品管調查成果分析看糖尿病與共病 照護

MELANIE DAVIS

劉松臻

Diabetes Medicine, University of Leicester

台北馬偕紀念醫院內分泌暨新陳代謝科主治醫師

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

糖尿病是一種複雜的全身慢性疾病，需要有良好的照護品質來預防各種急慢性併發症的發 生。自 2006 年起在加入了糖尿病預防工作後，把原來的糖尿病人保健推廣機構轉型為糖尿病 健康促進機構。在衛生福利部國民健康署指導與糖尿病衛教學會的積極推動下，截至 2022 年 全國共有 300 家院所經過嚴格審查後，通過健康促進機構的認證資格。

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

糖尿病健康促進機構品管調查針對糖尿病健康促進機構的盡責度與照護結果進行調查，以 作為改善照護品質的參考。此為一項針對糖尿病病人，非介入性的流行病學調查。每家機構依 據糖尿病診治個案數比率分配，收案 50 人到 250 人。糖尿病照護盡責度完成率方面，2018 年 在年度糖化血色素（A1C） 完整追蹤率（94.2%）、年度微量白蛋白檢查率（97.5%）、年度 完整血脂檢查率（88.0%）、年度眼睛視網膜檢查率 (88.8%) 及年度足部檢查率（90.6%） 上 皆比 2006 年與 2011 年時的調查上升。重要指標達成率方面，A1C < 7% 的達標率（44.1%） 與低密度膽固醇 < 100mg/dL（70.9%） 的達標率皆比 2006 年與 2011 年時的調查進步，血壓 < 130/80mmHg 的達標率則由 2011 年時的 37.7% 小幅下降到 36.3%。台灣的糖尿病照護在盡責度 與重要治療目標上大多有持續明顯的進步，我們從調查中也看到需要改進的地方，期望在加強 後讓病人的照護品質能夠不斷提升。

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

李淳權

馬偕紀念醫院

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人 照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為

、

；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

DAROC-TADE-4

從 ADCES 認證制度 (BC-ADM®, CDCES) 從護理師端看糖尿病

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD CONSENSUS REPORT

照護品質提昇

劉秀珍

MELANIE DAVIS

Diabetes Medicine, University of Leicester

臺中榮總糖尿病個管師

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

2020 年 1 月 22 日，美國糖尿病教育工作者協會（American Association of Diabetes Educators, AADE ） 更名為糖尿病護理與教育專家協會 （Association ofDiabetes Care & Education Specialists, ADCES）。糖尿病護理和教育專家扮演的角色，包括臨床管理、教育、預防和支持的整合者， 在 此比較國內外因著國情制度上衛教師資格的取得有其相異之處。

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

中華民國糖尿病衛教學會在 1996 年由首任理事長林瑞祥教授創立，至今已歷經 27 年的時間， 期間積極舉辦各類專業訓練課程、考試及糖尿病衛教實習，截至 2022 年 12 月已培訓出 6,199 位經 由本會認證合格的糖尿病衛教師（Certified Diabetes Educators, CDE），會員人數則達到 11023 人， 其中包括醫師、護理人員、營養師、藥師、醫檢師、社工師、其他專業人員等。除此之外，在衛生 福利部國民健康署委託下，本會更協助各醫院成立並發展「糖尿病健康促進機構」，已達到 300 家， 配合糖尿病共同照護網制度，以提升我國對糖尿病患者的照護品質，機構品質透過糖尿病品質公開 網或排行榜可了解照護之情形。

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

我國在糖尿病疾病管理上，仍然面對著不少挑戰 , 但透過努力提供糖尿病自主管理衛教對照護 是有效益的，因應照護系統及群體需求，發揮更積極角色功能，成為照護團隊的關鍵成員並提供全 人照護，成為社區及群體健康管理者，配合倡導政策及照護系統改變，進而提升提升照護品質 。

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

延伸糖尿病照護觸角 - 以「妊娠糖尿病共同照護」健保倡議為例

未來

李弘元

臺大醫院內科部醫師／臨床教授

李淳權

馬偕紀念醫院

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為

、

；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、

妊娠期糖尿病包括孕前糖尿病與妊娠糖尿病，兩者都會導致孕婦與胎兒周產期併發症發生 的風險升高。此外，孕前糖尿病如果血糖控制不良，會增加胎兒先天性異常的機會與新生兒死 亡率，而妊娠糖尿病史會在產後增加婦女與胎兒發生糖尿病等代謝異常的機會。因此，提升妊 娠期糖尿病的照護品質，將可同時改善婦女與胎兒的健康。

與微量白蛋白尿篩檢率部份，分別為

次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（

、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

在台灣，非孕期時的糖尿病照護，透過糖尿病共同照護網的制度，已經有效的提升糖尿病 照護的品質，並且可減少相關併發症的發生，進而減少醫療支出。然而，妊娠期糖尿病的患者， 在目前的制度下，並無法加入共同照護網接受照顧。因此，我們提出了妊娠糖尿病共同照護的 草案，針對參與資格、收案對象、管理照護項目與支付點數、個案登錄系統必要照護項目欄位、 以及照護、品質與管理指標，草擬出一個版本，並期待各界專家的建議與意見。另一方面，由 於孕前糖尿病在孕期的照護比較複雜，因此將待妊娠糖尿病共同照護形成共識或實行後，再進 一步推動孕前糖尿病共同照護。期待透過這兩個共同照護方案的實行，能夠進一步提升臨床照 護品質，減少周產期併發症的發生，降低孕婦與胎兒產後發生代謝異常的機會，進而減少醫療 上整體著支出。

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

MELANIE DAVIS

Diabetes Medicine, University of Leicester

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

DAROC-TADE-2

PL-2

THYROID NODULE UPDATE: 2023

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

SUSAN J. MANDEL MD MPH

未來

Medicine at the Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine

李淳權

馬偕紀念醫院

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人 照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

、

；

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Thyroid nodules are common in the general population, with higher prevalence in women and with advancing age. Approximately 7-10% of thyroid nodules are malignant and ~85% of these are papillary thyroid cancer. Sonographic imaging characterizes nodule features and leads to classification into tiered categories using an ultrasound risk stratification system (RSS). Each category is associated with a risk of malignancy (ROM). Although there are several RSS in use (e.g. ACR TIRADS, ATA sonographic pattern system), nodule classification among these systems is generally concordant; differences exist for FNA size cutoff recommendations. Once a nodule is selected for FNA, the Bethesda system classifies results into six categories ranging from benign (Bethesda II) to malignant (Bethesda VI). Approximately 40% of cytology results will fall in an indeterminate category (Bethesda III or IV) where the ROM is ~25-30%. When cytology is indeterminate, options include molecular testing to further risk-stratify patients for observation or surgery. Prior to clinical application, molecular testing should be validated in prospective multicenter trials. In areas where molecular testing is not available, diagnostic lobectomy may be performed. Surveillance is indicated for nodules with benign cytology and the surveillance strategy should be determined based upon the nodule’s baseline sonographic category.

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

DIABETES AND CANCER: EPIDEMIOLOGY AND IMPLICATIONS

CONSENSUS REPORT

1,2 C-H TSENG

MELANIE DAVIS

Diabetes Medicine, University of Leicester

1Department of Internal Medicine, National Taiwan University College of Medicine, Taiwan, R.O.C.; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taiwan, R.O.C.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

Epidemiological studies suggest a strong link between diabetes mellitus and cancer, two disease entities that affect a large proportion of the world population. Most studies conducted in the White people suggest that diabetes patients are susceptible to a variety of cancers involving the pancreas, liver, kidney, bladder, colorectal, breast and endometrium. However, a significantly lower risk of prostate cancer is observed in the White diabetes patients.

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Our studies in Taiwan support a strong link between diabetes mellitus and most cancer types. However, we also observed some discrepancies to what have been seen in the White people. For example, we consistently observed a significantly higher risk of prostate cancer in the diabetes patients in terms of mortality, incidence and prevalence. We were the first to confirm the link between diabetes mellitus and gastric cancer in a study that investigated gastric cancer mortality trends, mortality rate ratios between diabetes patients and the general population and the risk factors of gastric cancer mortality in the diabetes patients. Despite a decreasing trend of gastric cancer mortality in the general population of Taiwan, a positive link between diabetes mellitus and gastric cancer was consistently observed. Our later studies also suggest a higher risk of Helicobacter pylori infection in the diabetes patients which probably explained the increased risk of gastric cancer in the diabetes patients and a potential role of metformin on the prevention of Helicobacter pylori infection and gastric cancer. With regards to non-Hodgkin’s lymphoma (NHL), we were the first to describe an approximately 50% higher risk of in the diabetes patients in terms of prevalence or incidence even though the secular trend of NHL was increasing. A 2-fold higher risk of NHL among diabetes patients who used insulin in terms of prevalence and incidence was also observed.

According to our studies that used the reimbursement database of the Taiwan’s National Health Insurance, metformin seems to play a preventive role in the development of a wide range of solitary tumors. However, metformin exerts an overall null effect on the development of leukemia and a significantly higher risk cannot be excluded in patients who persistently use the drug.

A potential risk of female breast cancer associated with insulin use has been mentioned in the literature. According to our studies, users of insulin for 2 or more years may have such a possibility of getting breast cancer. Furthermore, a significant interaction between insulin and smoking on the risk of mortality from liver, pancreatic and bladder cancer has been observed in the Taiwanese diabetes patients.

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

李淳權

馬偕紀念醫院

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人 照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

、

；

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

The mechanisms linking diabetes and cancer risk might involve general mechanisms (e.g., hyperglycemia or hyperinsulinemia) or site-specific mechanisms. The use of antidiabetic drugs may interact with obesity, insulin resistance, glycemic control and comorbidities and the interplays among these factors may affect, either beneficially or adversely, the development of cancer. Studies evaluating the link between diabetes and cancer risk is complicated by the heterogeneity of both diabetes and cancer involving different organs. Most studies did not differentiate between type 1 and type 2 diabetes and confounding factors such as diabetes duration, metabolic control, drugs used, chronic complications, obesity and oxidative stress etc. are not always considered. The use of the various oral anti-diabetic agents and the emerging insulin analogs makes the conditions more complicated. While the use of metformin is generally linked to a lower risk of cancer, the use of insulin has been noted to increase the risk of cancer in some studies. Therefore, the clinical implications and applications of findings derived from related studies warrant further investigation. Whether screening programs for some specific types of cancer should be implemented or similarly conducted in the diabetes patients and nondiabetic people remains to be answered.

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

ACTIVE SURVEILLANCE OF MICRO-PTC (PAPILLARY THYROID CARCINOMA); WHERE ARE WE NOW?

MELANIE DAVIS

WON BAE KIM, MD, PHD

Diabetes Medicine, University of Leicester

Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

Recent increase in prevalence of papillary thyroid carcinomas (PTC), especially in Korea, ignited a debate on over-diagnosis and over-treatment of PTC worldwide. Most of the recent increase in the incidence of thyroid cancer was mainly caused by the increase in the identification of low-risk microPTM (PTMCs), and a major clinical issue of optimal management of low-risk PTMCs has emerged.

• the review of the interventions

• personalised approach

• approaches for implementation

Recent experiences of aggressive management of patients with PTMCs in our group revealed that distant metastasis occurs extremely rarely, surgery can be safely delayed in most of the patients with PTMC without hampering prognosis of patients, lobectomy with appropriate CND may be adequate in most of the patients, postoperative radioiodine therapy does not benefit the patients, postoperative thyroxine suppression was not helpful.

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

A Japanese study conducting a screening for thyroid cancer using an ultrasound examination and ultrasound-guided fine needle aspiration biopsy (FNAB) on women who visited the authors’ center for a breast cancer screening, and it was reported that thyroid carcinoma was detected in 3.5% of healthy women over 30 years. This incidence was roughly similar to incidences of latent thyroid cancer reported in autopsy studies. Based on these findings, it is apparent that small thyroid carcinomas are very frequent in otherwise healthy adult people, and most of them could be considered harmless.

Based on those findings, active surveillance (AS) of PTMCs had been introduced and conducted in Japan since early 1990’s. They provided a compelling data that AS might be a safe and effective management option for patients with PTMC’s. However, as the duration of application of AS for PTMC’s are not so long in many areas worldwide, we need further studies to justify AS as an effective management option for those patients including oncologic safeties. Most importantly, no clinical feature or molecular characteristics in isolation can reliably differentiate the small numbers of patients destined to develop clinically significant progression from larger numbers of patients destined to have indolent diseases. Moreover, there are many issues to be addressed before we adopt AS as an effective management option in clinical practice.

Recently, we analyzed the follow-up data of a previous multicenter cohort of AS in Korea and evaluated the most relevant predictors of disease progression during AS, especially new cervical LN metastasis. Various tumor and patient factors, including tumor kinetics, were evaluated. We found that TVDT < 5 years is the most relevant predictor of PTMC disease progression in terms of size enlargement and of development of lymph node metastasis during AS. Determination of tumor volume doubling time (TVDT) in the early AS phase may be essential for the prediction of disease progression

DAROC-TADE-2

in terms of tumor enlargement and developing new LN metastasis. I would like to present this data in my lecture.

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

李淳權

馬偕紀念醫院

、

；

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人 照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

Further large cohort prospective studies are warranted to validate our findings. To accomplish this task, recently we launched A Korean Multicenter Prospective cohort study of Active Surveillance or Surgery (KoMPASS) for PTMCs under support of a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea. The aim is to compare clinical outcomes between active surveillance and an immediate lobectomy for low-risk PTMCs. Eleven centers in Korea are participating this project since year 2020 and recruitment of patients will be continued until August 2024. We expect that it could be a milestone study guiding evidence-based approach for management of patients with low risk PTMC. I also would like to briefly introduce the status of this ongoing study during my presentation.

3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（

、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

PL-1

MTP-D1

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

PURSUIT PH.D. DEGREE IN OXFORD: MY PERSONAL EXPERIENCE OF GAIN AND LOSS

MELANIE DAVIS

F-C KUO

Diabetes Medicine, University of Leicester

Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan, R.O.C.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

I will share my personal experience regarding to the application of study abroad, how to get used to the culture/language barriers and the struggling process during my Ph.D. study. I will also describe the difficulties to balance between life, clinical work, and scientific research. Particularly, I will mention the differences between Taiwan and U.K. in turns of the academic environment and attitudes toward research. Hopefully, my personal experience will be useful for our colleagues who are considering study abroad.

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

DAROC-TADE-2

MTP-D2

ADAVNCED STUDY SHARING AT DIABETES RESEARCH CENTER OF UNIVERSITY OFWASHINGTON IN SEATTLE, USA

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

1,2,3CHUN-CHENG LIAO

李淳權

馬偕紀念醫院

1Department of Family Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan, R.O.C.; 2School of Medicine, National Defense Medical Center, Taipei, Taiwan, R.O.C.; 3Department of medical education and research, Taichung Armed Forces General Hospital, Taichung, Taiwan, R.O.C.

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

、

；A1C 檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

With the increasing number of people abroad with diabetes, obesity and metabolic syndrome, Taiwan is currently suffering from the same problem. The proportion of diabetic patients in Taiwan has accounted for more than 11% of the total population, and the rate of overweight plus obesity has also accounted for more than 50% of the total population, and the combined rate of the top ten causes of death caused by metabolic syndrome exceeds the first one (Cancer). Therefore, the morbidity and mortality caused by these three diseases (diabetes, obesity, and metabolic syndrome) must not be ignored in Taiwan's medical treatment today.

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

I sincerely thank Taichung Armed General Hospital and the Military Medical Bureau of the Ministry of National Defense for giving me the opportunity to study at Diabetes Research Center of the University of Washington in Seattle, USA from September 2017 to February 2018. It not only let me learn how different treatment between diabetes, obesity and metabolic syndrome but also let me have more opportunities to learn on diabetes, obesity and metabolic syndrome related research with international masters Prof. Edward Boyko and Prof. Steven Kahn in University of Washington.

Through this speech, I share includes the purpose of advanced study, the preparation process before going abroad, and the advanced training process at Diabetes Research Center of the University of Washington in Seattle. I hope that the sharing at this meeting will be helpful to colleagues in the medical field who want to go abroad in the future.

PL-1

MTP-E

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

HYPERTHYROIDISM AND PREGNANCY

CONSENSUS REPORT

SUSAN J. MANDEL MD MPH

MELANIE DAVIS

Medicine at the Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine

Diabetes Medicine, University of Leicester

Pregnancy represents a dynamic physiologic stress to the thyroid economy and several features of gestational physiology, each with its own onset and duration, stimulate thyroid hormone production. By the end of the first trimester, serum thyroxine binding globulin levels increase by 50%, eventually doubling by 20 weeks gestation. Serum hCG, peaking at the end of the 1st trimester/early 2nd trimester, directly stimulates thyroid hormone production. In addition, alterations in maternal gravid physiology may affect precision of laboratory testing for thyroid hormone. The establishment of gestational normative ranges for thyroid function is prerequisite for diagnosis and treatment thyroid dysfunction during pregnancy.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Gestational thyrotoxicosis refers to the hCG mediated increase in thyroid hormone production and the thyroidal response to hCG depends upon the magnitude of hCG elevation, genetic factors, and individual baseline thyroid parameters. Differentiating this from Graves’ disease relies on physical examination and the lack of a thyroid bruit, a larger goiter or thyroid eye disease. Biochemically, the T3/T4 ratio (ng/mcg) is < 20:1 and thyroid sonography demonstrates lack of the increased vascularity seen in Graves’. This condition generally ameliorates by 15-18 weeks gestation.

Graves’ disease is the most common etiology of maternal hyperthyroidism and if untreated, maternal and fetal complications are increased. Antithyroid drugs are the primary therapy and generally propylthiouracil (PTU) is preferred in the 1st trimester because of the association of methimazole (MMI) with rare, but significant, organogenesis defects. Antithyroid drug therapy may be stopped in the 1st trimester in a subset of women with mild Graves’ disease, without harm to the pregnancy. When administered, MMI or PTU should be titrated to maintain maternal thyroid function at the upper limit of the normal range. TSH Receptor Antibodies (TRAb) are monitored to determine the risk of fetal and neonatal Graves’ disease. Ultrasound examination for fetal growth and assessment of the fetal thyroid is indicated if the TRAb are significantly elevated.

DAROC-TADE-2

SD1-2

IN HOSPITAL GLUCOSE MONITORING SYSTEM

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

YI-JING SHEEN

李淳權

Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan R.O.C.

馬偕紀念醫院

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

The growing number of inpatient hyperglycemic makes the management of hospitalization become a critical issue. Inpatient glycemic control refers to the management of blood glucose levels in hospitalized patients. It is important to maintain adequate glycemic control in the hospital setting to prevent adverse outcomes.

、

、

；

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Insulin therapy is commonly used for inpatient glucose control. The use of insulin in hospitalized patients requires careful monitoring to avoid hypoglycemia. Thus, the quality and safety of glucose management among hospitalized patients are closely dependent on glucose monitoring. An inpatient glucose monitoring system is designed to provide healthcare providers with accurate and realtime glucose readings, allowing for timely adjustments to insulin therapy and the management of hyperglycemia or hypoglycemia.

Bedside point-of-care glucose monitor devices are widely used in hospital settings to monitor blood glucose levels in patients. The use of point-of-care glucose monitor devices can improve the accuracy of blood glucose measurements and reduce the need for laboratory-based testing. However, it's important to note that point-of-care glucose monitor devices are subject to limitations and potential errors. In addition, the point- of care device only provides a snapshot of glucose levels at a particular moment in time. In contrast, Continuous glucose monitoring systems (CGMS) systems provide continuous glucose measurements over a period of time. However, the accuracy was not achieving FDA approval for hospital use. In 2020, the FDA has granted a breakthrough device by issuing an allowance for noninvasive remote monitoring devices to support patient monitoring during the COVID-19 pandemic. The use of CGM integration into inpatient glucose management in the future is just around the corner. In this section, we will discuss the role of the ideal glucose monitoring system in hospitalized glycemic control.

THE IMPORTANCE OF INPATIENT DIABETES HEALTH EDUCATION FOR GLYCEMIC CONTROL

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

HUI-FANG WANG

MELANIE DAVIS

Diabetes Medicine, University of Leicester

Case Management Center of Diabetes, Changhua Christian Hospital

Inpatient Diabetes health education was suggested to be part of the comprehensive discharge plan by Endocrine Society in 2022, including education and certification of survival skills, arrangement of follow-up appointments and visit reservation, and obtainment of diabetic medications and supplies after discharge.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

Ideally, inpatient Diabetes education is provided by certified Diabetes educators. Education of Diabetes survival skills consists of (1) instruction on taking and managing medications, including oral medications and insulin, (2) instruction on the operation of blood glucose meters and self-monitoring of blood glucose (test time, frequency and treatment goals), (3) basic diabetic diet plans provided by the nutritionists, (4) knowledge of the prevention, differentiation and treatment of hypoglycemia and hyperglycemia, and (5) information of contact persons after discharge. Teach-back and phone visits are arranged according to individual needs.

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Due to the limited manpower of Diabetes educators, patients with the risk of readmission, those who are admitted to the hospital because of diabetic related problems, newly diagnosed diabetic patients and initial users of insulin are given priority to receive inpatient Diabetes education.

Inpatient Diabetes health education is beneficial in increasing patient satisfaction, and reducing glycated hemoglobin of diabetic patients and readmission rate. It is expected that patients with diabetes have the best glycemic control after discharge.

DAROC-TADE-2

SD2-1

REVIEW AND PROSPECTIVE OF GOAL 50 PROJECT

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

TIEN-JYUN CHANG

李淳權

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

馬偕紀念醫院

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

；

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Among the patients receiving dialysis, 46% of them had diabetes. Early intervention of diabetes with chronic kidney disease (CKD), including life style modification and first line therapy for ameliorating deterioration of renal function (i.e. SGLT2 inhibitors, metformin, RAS inhibitors, and statin) confers large impact on decelerating the deterioration of renal function. In order to promote the awareness of diabetes patients and enhance the treatment guideline adherence for diabetes with CKD, the Diabetes Association of the Republic of China (DAROC) and Taiwanese Association of Diabetes Educators (TADE) initiated the program of DKD GOAL 50. The targets of DKD GOAL 50 until 2025 are as follows: (1) 50% diabetes patients receive annual microalbuminuria screening (2) Holistic evaluation of comorbidities of diabetes patients and achieve 50% adherence of international treatment guideline (3) 50% diabetes patients are recruited in the integrated diabetes share care & Early-CKD program.

In response to the “DKD GOAL 50” program, the DAROC and TADE held “2021 良程控糖保 腎力 ”competition to attract the attention of the health care providers and diabetes patients to DKD GOAL 50. The inclusion criteria is type 2 diabetes patients have any one of the following conditions: (1) eFGR ≥ 90 ml/min/1.73 m2 and UCAR > 30mg/g (2) 30 ml/min/1.73 m2 ≤ eGFR < 90 ml/min/1.73 m2. The recruitment phase is from Aug 2nd, 2021 to Oct. 31st, 2021. The follow up period is from Jan. 1st, 2022 to Apr. 30th. During the recruitment period, total 6951 diabetes patients with CKD were recruited. Mean age is 65.4 ± 11.2 y/o, BMI is 26.6 ± 4.6 , and the mean diabetes duration is 12.5 ± 8.1 yrs. The other demographic data, biochemistry data, and pharmacological adherence to DKD guideline will be presented.

GOAL50「良程控糖保腎力 : 糖尿病腎病變整合照護 第二階段成果：

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD CONSENSUS REPORT

台灣治療 DM WITH EARLY CKD 現況 AND UNMET NEEDS

楊宜瑱

MELANIE DAVIS

Diabetes Medicine, University of Leicester

中山醫學大學附設醫院 內科部 內分泌新陳代謝科

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

Diabetes is a growing disease with high renal morbidity and mortality. Despite multiple efforts over the last decades to find therapies to halt the progression of renal disease in type 2 diabetes, success remains limited and renal protective guideline therapy remains largely based on inhibition of the reninangiotensin-system (RAS). Recently the renal community was thrilled by the successes of SGLT-2 inhibitors and endothelin antagonist. However, without taking away this success, the unmet need in the population at risk remains extremely high. Patients with type 2 diabetes run a high risk for progressive renal function loss. Many interventions have been tested to reduce the risk, but we are nowadays still confronted with a high unmet need. Are we doing something wrong in our approach to reduce the renal risk in type 2 diabetes? The objective is to achieve “Over 50 percent of patients receiving Diabetes/Chronic Kidney Disease (CKD) joint care of excellence by 2025.” which includes: > 50% of the patients with T2DM in Taiwan complete annual albuminuria tests, comprehensive assessments of comorbidities and achieving 50% of the compliance rate according to international guidelines, and 50% of the patients join the “pay-for-performance program for diabetes” and the early-CKD plan.

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

DAROC-TADE-2

SD2-3

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

GUIDELINE RECOMMENDATIONS FOR THE MANAGEMENT OF CHRONIC KIDNEY DISEASE AND ITS RISKS IN PATIENTS WITH DIABETES MELLITUS

李淳權

1S-C SU

馬偕紀念醫院

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan, R.O.C.

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Chronic kidney disease (CKD) is common in people with both type 1 and type 2 diabetes, and its global prevalence has increased enormously over the past few decades, mostly driven by an increase in the prevalence od diabetes. CKD is characterized with an irreversible damage to kidney structure and function lasting for more than 3 months. Clinically, CKD progression has been shown to positively correlate with declining glomerular filtration rate and proteinuria. When it comes to unmet medical needs in patients with CKD plus diabetes mellitus, both cardiovascular mortality and progression to end-stage renal disease are always warranted. Therefore, the optimal guideline for the management of CKD and its risks in patients with diabetes is imperative to be made. Generally speaking, in patients with diabetes mellitus, primary prevention of kidney disorder, regardless of etiology (diabetic kidney disease (DKD) or nondiabetic kidney disease (NDKD), is essential and includes adequate control of glucose, blood pressure, and body weight and avoidance of nephrotoxic drugs. Furthermore, comprehensive care in which pharmacotherapy that is proven to improve renal and macrovascular outcomes is layered on a foundation of healthy lifestyle. Based on the consensus statements by 2022 American Diabetes Association (ADA) and the Kidney Disease: Improving Global Outcomes (KDIGO), the specific guidance on use of renin-angiotensin system inhibitors, metformin, sodium–glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, and a nonsteroidal mineralocorticoid receptor antagonist was provided. Moreover, the therapeutic recommendation order was rearranged to reflect the appropriate order for clinical interventions aimed at preventing and slowing progression of chronic kidney disease in patients with diabetes by the latest published Standards of Care in Diabetes-2023. Timely referral to a nephrologist was emphasized as well. The optimal guideline for either specific management or comprehensive care in patients with diabetes and CKD in Taiwan may be revised by multidisciplinary discussion in the future.

THERAPEUTIC POTENTIAL OF THERMOGENIC FATS IN OBESITY AND DIABETES

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

MELANIE DAVIS

1C-H WANG, 2M LUNDH, 3R KRISZT, 4TL HUANG, 1C-H WANG, 5MA KIEBISH, 4,6Y-H TSENG

Diabetes Medicine, University of Leicester

1Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan, R.O.C.; 2The Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Denmark; 3Department of Biomedical Engineering, National University of Singapore, Singapore; 4Section on Integrative Physiology and Metabolism, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.; 5BERG, Framingham, MA, USA.; 6Harvard Stem Cell Institute, Harvard University, Cambridge, MA, USA.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

Brown and white fats play crucial roles in systemic energy homeostasis. Brown fat is specific for energy dissipation and has multilocular lipid droplets, while white fat is the main site for storing excess fuel containing unilocular lipid droplets. The activity and amount of brown fat are inversely correlated with body mass index in mammals, making brown fat an appealing target for anti-obesity therapies. Aiming for transforming white fat to brown fat may hold great potential in preventing or treating obesity and obesity-related metabolic disorders, since white fat is more easily reachable and manipulatable considering its abundance and location. Uncoupling protein 1 (UCP1) is uniquely expressed in brown adipocytes and facilitates fuel utilization and energy expenditure. Here, we utilized the CRISPR/Cas9 synergistic activation mediator and specific gRNAs to boost endogenous UCP1 expression in human white adipocytes. The CRISPR/Cas9 engineered human brown fat-like (HUMBLE) cells had acquired human brown fat features when comparing bona fide human brown adipocytes derived from the same individual. Obese mice that received HUMBLE cell transplants showed lower body weight, a sustained improvement in glucose tolerance and insulin sensitivity, as well as increased energy expenditure. Mechanistically, increased arginine/nitric oxide (NO) metabolism in HUMBLE adipocytes promoted the production of NO that was carried by S-nitrosothiols and nitrite in red blood cells to activate endogenous brown fat and improved glucose homeostasis in recipient animals. Taken together, these data demonstrate the utility of using CRISPR/Cas9 technology to engineer human white adipocytes to display brown fat-like phenotypes and may open up cell-based therapeutic opportunities to combat obesity and diabetes.

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

DAROC-TADE-2

SD3-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

ROLE OF HEPASSOCIN IN HYPERTHYROIDISM-INDUCED HEPATIC DYSFUNCTION

未來

李淳權

1CHIH-CHEN WANG, 2CHING-HAN LIN, 2KAI-PI CHENG, 3HUNG-TSUNG WU, AND 2HORNG-YIH OU

馬偕紀念醫院

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為

1 Department of Internal Medicine, National Cheng Kung University Hospital Douliu Branch, College of Medicine, National Cheng Kung University, Taiwan, R.O.C.; 2 Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan, R.O.C.; 3 Department of Internal Medicine, School of Medicine, College of Medicine, National Cheng Kung University, Taiwan, R.O.C.

、

；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標）

與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

、

；

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

OBJECTIVE Impaired liver function is commonly observed in subjects with hyperthyroidism; however, the exact mechanisms still remain obscure. Hepassocin is a hepatokine playing an important role in metabolic diseases. It also exhibited a hepatic protective effect against chemical-induced liver injury. Although the pathophysiological role of hepassocin is well-established, the relationship between hepassocin and hyperthyroidism was still unknown.

METHODS A total of 36 subjects with Graves’ disease was enrolled, and the thyroid and liver functions were recorded throughout the treatment. Serum hepassocin concentrations were determined using enzyme-linked immunosorbent assay. HepG2 hepatocellular carcinoma cell line was used to investigate the possible mechanisms of thyroxine-induced hepassocin expressions by Western blots.

RESULTS The alanine aminotransferase (ALT) levels were significantly decreased, in parallel with the decrement in plasma hepassocin concentrations at six-month after standard treatment in subjects with hyperthyroidism. In order to investigate the causal relationship between hepassocin and hyperthyroidism, HepG2 cells were treated with hepassocin recombinant protein, and we found that hepassocin dose-dependently decreased triiodothyronine-induced ALT and aspartate aminotransferase (AST) elevation. In addition, treatment of hepassocin significantly increased the expression of phosphoenolpyruvate carboxykinase (PEPCK) in a dose-dependent manner. On the other hand, deletion of hepassocin in HepG2 cells reversed the effects of 3,5,3’ Triiodothyronine (T3) on PEPCK expressions. Furthermore, we found that T3 increased the expression of hepassocin through a hepatocyte nuclear factor 1α-dependent pathway.

CONCLUSIONS HPS might have a protective activity in hyperthyroidism-induced hepatic dysfunction. Increased HPS in patients of hyperthyroidism might offset the deleterious effects of thyrotoxicosis-induced hepatotoxicity

THE RELATIONSHIP BETWEEN PLASMA APOM-S1P AND OBESITY

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

IN HUMAN

CONSENSUS REPORT

1KANG-CHIH FAN

MELANIE DAVIS

Diabetes Medicine, University of Leicester

1Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu City, Taiwan, R.O.C.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

Type 2 diabetes mellitus is one of the most common diseases in the world and could lead to multiple complications to the patients such as cardiovascular disease, neuropathy, nephropathy and retinopathy. As we know, insulin resistance is the major pathogenesis in type 2 diabetes mellitus. Obesity is one of the core causes of insulin resistance. In obesity, higher plasma free fatty acid results in the accumulation of ceramide in many tissues of the body. Ectopic deposition of ceramide will lead to the occurrence of insulin resistance and diabetes. The development of metabolon technology in recent years has allowed us to understand the effect of ceramide and its related metabolites in insulin resistance.

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

FFA in tissues is metabolized to ceramide, which has been shown to cause lipotoxicity and further inhibit the insulin signaling pathway and induce pancreatic β-cell death. However, another ceramide-related metabolite, Sphingosin-1-phosphate (S1P), has been found that it has the opposite effect of ceramide to insulin-sensitive tissues and pancreatic β-cells. S1P is produced inside the cell, but can also be secreted out of the cell by systemic circulation and transported into different tissues causing paracrine or endocrine effect. S1P is attached to HDL via apo-lipoprotein M (ApoM), and is believed to cause many pleiotropic effects of HDL, such as anti-apoptosis, anti-inflammatory and vaso-protective effect. Thus, the imbalance between S1P and ceramide in the body will regulate insulin signaling in β cells. As a result, the relationship between plasma ApoM-S1P concentration and obesity, metabolic syndrome & incident diabetes is worth of studying based on our cohort study database.

In the present study, we will use a longitudinal cohort to analyze the relationship between plasma ApoM-S1P level and obesity, metabolic syndrome & new-onset diabetes mellitus. Our cohort, named Taiwan Lifestyle Study, is a community-based study, which enrolled residents from the Yunlin County, Taiwan, aged over 18 years old, who did not report the presence of diabetes during an interview, were invited to join this prospective study from 2006 to 2012. There were 3 visits for this prospective study, separated by 1 to 3 years. Individuals received questionnaire, physical examination including blood pressure, body weight, height, waist circumference, hip circumference by trained nurses. We also conducted blood examination for estimation of biochemical, metabolic and oral glucose tolerance test, TG, high and low density cholesterol, adiponectin, leptin and insulin resistance. Abdominal computed tomography exam was also performed during follow up visit to quantify the abdominal fat tissue.

Diagnosis of metabolic syndrome is according to the definition of Revised NCEP ATP III

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

criteria. In this project, we will measure fasting plasma ApoM-S1P concentration in subjects received abdominal CT to clarity its relationship with metabolic syndrome, obesity and abdominal fat. Pearson’s correlation coefficient will be applied to elucidate the relationship between plasma ApoMS1P concentration and clinical characteristics such as abdominal fat by computed tomography, plasma adiponectin and leptin level.

李淳權

馬偕紀念醫院

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人 照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為

、

；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（

、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

SD4-1

LIFE-COURSE IMMUNIZATION AND ADULT VACCINATION

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

C-H LEE

CONSENSUS REPORT

MELANIE DAVIS

Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Taiwan

Diabetes Medicine, University of Leicester

Vaccines are credited with averting millions of child deaths in the last decade, with most countries offering infants the basic protection of immunization against more than 10 serious diseases. But the risk of infectious disease does not end with childhood: there are clear opportunities to prevent disease throughout life and into old age.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

The benefits are myriad, not only in terms of healthier lives but also the reduced health costs for individuals and society. Despite a commitment to the concept of prevention, most countries have not yet embraced life-course immunization. Barriers include concerns about financing, competing health priorities, the relative complexity of a heterogeneous population, the lack of a universal adult vaccine delivery platform and broad evidence base to support the value of vaccines beyond childhood. However, with a rapidly aging population, it is imperative that the burgeoning conversation around life-course immunization now accelerates and broadens to encompass all countries. In the same way that a global movement coalesced around child vaccines, the time is now right for us to build a cohesive evidence base and call for policies and programs that extend throughout the life-course, especially for older adults.

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

For adult immunization to be adopted and implemented, it is important that policy makers and the public view healthy aging as a priority, understanding the value of protecting older adults from infectious disease. Now is the time to address the immunization measures that form a platform for universal healthcare. Access to vaccines throughout the lifespan is essential – not only for ensuring the health of the individual but also for addressing the indirect impact disease can have on families and societies. Ensuring the health and productivity of the aging adult population makes sense for everyone. Work must begin to build the investment case now – with this fast-growing demographic, we can no longer delay efforts to build a global roadmap for integration of adult immunization into immunization strategy and the decade of healthy aging.

DAROC-TADE-2

SD4-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

HERPES ZOSTER AND HERPES ZOSTER VACCINATION IN ADULT AND DIABETIC PATIENTS

未來

李淳權

FRANCIS CC CHOW, MBBS (HK), FRCP (EDIN & LON), FHKCP, FHKAM (MEDICINE)

馬偕紀念醫院

Consultant Endocrinologist & Honorary Associate Professor, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為

、

；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

Herpes Zoster (HZ) is a painful disease caused by the reactivation of varicella zoster virus (VZV). HZ is characterised by unilateral vesicular rash and excruciating pain. Over 90% of adults aged 40 and above showed serologic evidence of VZV infection, thus the population is at risk for herpes zoster. Worldwide epidemiological data demonstrates a high prevalence of HZ, with one-third of adults developing the disease in their lifetime.

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Age related decline in immunity and weakened immune system are the dominant drivers of herpes zoster. Certain underlying conditions are associated with an additional risk for HZ, including diabetes, chronic pulmonary diseases, renal disease and cardiovascular diseases. Common complications include post-herpetic neuralgia, ophthalmic and neurologic complications. A local study suggested that complications occurred in 23% of zoster admissions.

Prompt treatments with antiviral medications are most effective during the early onset of HZ. However, delay in seeking medical consultation and treatment is often observed. Hence, the role of vaccination is particularly important in preventing the reactivation of the virus and its complications. There are two herpes zoster vaccines available. It has been shown that the new Recombinant Zoster Vaccine (RZV) demonstrated high efficacy in the prevention of herpes zoster and its complications across all study groups ≥ 50 years of age. The safety of the vaccine was extensively studied in subjects aged ≥ 50 years and a broad range immunocompromised patients aged ≥ 18 years. The safety profile of the vaccine in both populations were shown to be acceptable and consistent. Overseas national guidelines including the U.S. and Canada recommend herpes zoster vaccination as part of the routine adult immunization in adults aged 50 years or above.

VACCINATION RECOMMENDATION FROM DAROC FOR PATIENT WITH DIABETES

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

羅仕昌

MELANIE DAVIS

中山醫學大學附設醫院內分泌科

Diabetes Medicine, University of Leicester

People with diabetes are more susceptible to infections due to the alterations of immune response. Hyperglycemia wound lead to decreased T-cell response and neutrophil, monocyte/macrophage, dendritic cell, and natural killer (NK) cell function as well as affect the microbiome. In addition, individuals with diabetes may be at risk for more serious complications from illnesses compared to people without. It is advisable for people with diabetes to get vaccinated to prevent certain diseases. Influenza vaccination in people with diabetes has been found to significantly reduce influenza related hospital admissions and mortality. Annual influenza vaccination is recommended for all individuals more than 6 months of age. People with diabetes are at increased risk for pneumococcal infection and have been reported to have a high risk of nosocomial bacteremia, with a mortality rate as high as 50%. The pneumococcal conjugate vaccines could reduce the hospitalization and severity of infection. There are two type of vaccines available, PPV23 and PCV 13, which are recommended in patient with diabetes. Individuals with diabetes are considered at higher risk for severe illness from COVID-19 and are therefore considered a priority group for vaccination. The bivalent booster protecting against the omicron variant and original strain has now replaced the monovalent booster.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

DAROC-TADE-2

SD5-2

THE UPDATE OF ADVANCED HYBRID CLOSED LOOP SYSTEM (AHCL) IN DIABETES MANAGEMENT

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

CHIA-HUNG LIN1,2

李淳權

馬偕紀念醫院

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan City 33302, Taiwan; 2Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

Insulin pump therapy is the promising paradigm for intensive therapies in diabetes (DM). Through the so called continuous subcutaneous insulin infusion (CSII), 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.

、

、

；

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Most patients with diabetes mellitus who want to maintain good glycemic control need to measure their blood glucose concentrations often. Real-time continuous blood glucose monitoring (CGM) is the device to make a difference view in glucose monitoring. CGM measure the glucose content of interstitial fluid using an electrochemical enzymatic sensor. Interstitial fluid is accessed by a needle sensor inserted subcutaneously. Fluctuation in blood glucose, identified by continuous glucose monitoring, is the new information about DM management besides A1C levels. CGM offers a good way to investigate blood sugars and possible new methods to solve difficult problems in DM management.

The latest advanced hybrid closed loop system (AHCL) 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 as well as correction bolus are the main characteristics of this next-generation insulin pump. Further automatic bolus insulin infusion corresponding to food intake is well developed recently. Manipulating the algorithm between CSII and real-time CGM well is the path to the upcoming artificial pancreas in the near future.

PL-1

SD5-3

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

ARTIFICIAL INTELLIGENCE AND PERSONALIZED DIGITAL TECHNOLOGY: THE NEXT FRONTIER IN DIABETES THERAPY

MELANIE DAVIS

J-T HUANG

Diabetes Medicine, University of Leicester

Institute of Mechatronic Engineering, National Taipei University of Technology, Taiwan, R.O.C.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Through the location-based MESH Internet of Things, wearable devices (a chest attached IMU and a physiological bracelet), CGMS, innovative percutaneous continuous microneedle array sensing patches (glucose, lactic acid, insulin, cortisol, etc.), diet records, etc., AIOT can convert actions into behaviors. Combined with the records of physiological/biochemical signals, real-time personalized life routines can be reconstructed (also become accurate historical health records or real world data), which can be further transformed into interpretations of bad habits and good habits. Through active personalized reminders and detection feedback, based on the smart speaker equipped with chatGPT's powerful dialogue ability, the proposed digital health intervention (DHI) system may increase user adherence, confirm the immediate/short-term/long-term effects of COACH, and finally turn bad habits into good habits, and optimize the health management of diabetic patients. This system will successfully prevent diabetes from becoming an emergency, and it may be possible to prevent the occurrence of diabetes and significantly reduce global medical expenditures.

DAROC-TADE-2

SD6-1

HEART FAILURE IN TYPE 2 DIABETES: IS IT ABOUT HFPEF, HFREF OR BOTH?

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

YU-FANG CHENG

李淳權

Department of endocrinology and Metabolism, ChangHua Christian hospital.

馬偕紀念醫院

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

Complications of type 2 diabetes are well-known, including microvascular and macrovascular complications. Most of the time, we discuss cardiovascular (CV) death, non-fatal myocardial infarction, and non-fatal stroke as the 3-point MACE in macrovascular complications, but we focus less on heart failure as a significant complication of type 2 diabetes. Until 2018, the DECLARE trial was the first oral anti-diabetic cardiovascular outcome trial to include heart failure as the primary endpoint. According to the Taiwan Diabetes Atlas 2019, heart failure is the second most common CV disease and the cause of CV death. It is time to address heart failure, which can decrease the quality of life and increase mortality in patients with type 2 diabetes.

In this section, I will discuss the correlation between heart failure and diabetes, as well as the possible pathological mechanisms underlying this connection. Finally, I will address how to detect heart failure earlier and provide common sense guidelines for treating heart failure

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

PL-1

SD6-2

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

STATUS AND THE NEXT STEP APPROACH RATIONALES?

CONSENSUS REPORT

K-M LIAO

Attending physician, Endocrinology and Metabolism, Taipei City Hospital, Zongxiao branch

MELANIE DAVIS

Diabetes Medicine, University of Leicester

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Heart failure (HF) has been recognized as a common complication of diabetes,and increasing incidence rates. Traditionally, the prevention and management of chronic complications in individuals with diabetes have been focused on nephropathy, retinopathy, neuropathy, and atherosclerotic cardiovascular disease. Heart Failure is an underappreciated complication of diabetes. The definition of heart failure changes little in the past 30 years: symptoms and signs pf heart failure caused by caused by a structure or functional cardiac abnormality. However, symptoms and signs were late manifestations of heart failure, and often severe when first recognized. We need new strategy for early diagnosis of heart failure. According to the pathophysiology of heart failure, cardiac congestion seemed to be a common final pathway of heart failure. So, the conceptual basis of new definition of heart failure may be: congestion caused by cardiac dysfunction. And early detection of heart failure by congestion-based biomarkers, such as NT-proBNP or BNP, seemed to be an useful strategy. So, recommendations from ADA consensus report published in 2022 suggest all patients with diabetes should undergo annual biomarker testing to allow early diagnosis of progressive but pre-symptomatic heart failure. And treatment with SGLT-2i should expand among such patients to including everyone with stage B heart failure (pre-symptomatic) or more advanced stages. If we identify the early stage of heart failure, we can implement strategies to prevent transition to symptomatic heart failure.

DAROC-TADE-2

SD6-3

MANAGEMENT OF HF IN TYPE 2 DIABETES

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

KAI-JEN TIEN

未來

Department of Endocrinology and Metabolism, Chi-Mei Medical Center, Tainan, Taiwan

李淳權

馬偕紀念醫院

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人 照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

Both heart failure and diabetes are increasing in prevalence in the world. Type 2 diabetes mellitus (T2DM) is a major risk factor for cardiovascular disease and occurs in ~25% of patients with heart failure (HF). Patients with co-morbid HF and T2DM are at elevated risk of adverse outcomes, making optimization of complementary drug therapies essential. The interrelationship between these two conditions is well known, with conventional heart failure therapies including several newer drug classes providing benefit to subjects with diabetes. Furthermore, several of the more recently introduced medications for type 2 diabetes have resulted in significant cardiovascular morbidity and mortality benefits with a marked improvement in heart failure symptoms and hospital presentations as well as deaths. I will outline current therapies used to treat patients with or at risk for heart failure and their role in subjects with diabetes. Newer therapies, including certain glucose-lowering medications and their benefits in treating heart failure patients with and without diabetes, are also discussed.

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

PL-1

SD7-1

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

DIABETES AND MAFLD – THE EPIDEMIOLOGY OF DIABETES AND BODY COMPOSITION

MELANIE DAVIS

EDWARD J. BOYKO, MD, MPH

Diabetes Medicine, University of Leicester

Professor of Medicine and Adjunct Professor of Epidemiology at the University of Washington and Staff Physician at VA Puget Sound Health Care System in Seattle, USA.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

The type 2 diabetes mellitus epidemic that began in the last century continues into this new millennium with increasing prevalence in all world regions. According to the IDF Atlas 10th Edition, there were an estimated 521 million persons with diabetes mellitus worldwide in 2021. This number is predicted to increase to 783 million by 2045. Overweight and obesity are considered key risk factors driving this epidemic, as excess body weight became a worldwide problem over the same time-period. In addition to body fat quantity, it was also recognized that body fat distribution played an important role in the diabetes epidemic and the development of metabolic syndrome. The fat overflow hypothesis postulates that fat deposited in other than “healthy” subcutaneous depots is related to higher risk of metabolic disorders. Unhealthy depots include, for example, abdominal viscera, liver, epicardium, inter-muscular, and elsewhere. Unhealthy fat overflow usually occurs with excess body weight, but can also be seen in normal weight persons as judged by body mass index criteria. Fat deposition in the liver has been associated with many metabolic abnormalities in addition to liver fibrosis and cirrhosis. Non-alcoholic fatty liver disease (NAFLD) refers to fat deposition in the liver in the absence of other predisposing conditions such as infection or toxic damage. Research is underway to identify effective pharmacologic therapies for treatment of NAFLD. Most evidence supports a nonpharmacologic therapy (reduction in body weight) as the best method to decrease liver fat. A group of experts have recently proposed renaming NAFLD to prioritize its associated metabolic abnormalities as MetabolicAssociated Fatty Liver Disease (MAFLD). In addition to the focus of the new name on metabolic abnormalities, the new definition also would include fatty liver disease associated with other illnesses or toxic exposures, such as viral hepatitis and alcohol use. I will discuss both NAFLD and MAFLD definitions to determine whether the updated version is likely to better promote the recognition of the health consequences of these disorders and facilitate discovery of effective treatments. In addition, I will discuss the potential for recognition and treatment of fatty liver disease in slowing the worldwide diabetes epidemic.

DAROC-TADE-2

SD7-2

OVERVIEW OF MAFLD/NAFLD AND THE IMPACT OF DM ON MAFLD/ NAFLD

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

1,2 J-F

李淳權

HUANG

馬偕紀念醫院

1Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.; 2Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Non-alcoholic fatty liver disease (NAFLD) has been recognized as the most prevalent liver disorder globally, which affects more than quarter of the global population. Asian people are more prone to metabolic syndrome (MetS), type 2 DM (T2DM) and NAFLD than other races. Previous studies from Taiwan clearly demonstrated that the prevalence of NAFLD has been increasing for more than 2 folds within less than 20 years. Recently, metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed as a new definition for patients with fatty liver disease. The diagnosis of MAFLD was initially based on the detection of liver steatosis, either by histology, noninvasive biomarkers, or imaging modalities. Several position consensus statements have recommended the new nomenclature based on the presence of metabolic dysfunction and avoidance of exclusion for clinical diagnosis. The major intent of this steatosis-centered new nomenclature was to shift towards a diagnosis of inclusion based on the presence of metabolic dysfunction and hepatic steatosis.

Although the major cause of mortality in NAFLD patients is cardiovascular disease (CVD), the metabolic liver disorder carries the risk of development of fibrosis, cirrhosis and liver-related deaths.

Metabolic dysfunction, mainly insulin resistance (IR), plays a major role in the pathogenic mechanisms underlying fatty liver disease and its disease progression. The metabolic disorders include abdominal obesity, hypertension, dyslipidemia and IR and further increase the risk of CVD, T2DM and chronic kidney disease (CKD). The elucidation of disease progression in terms of disease course, phenotypes and outcomes is mandatory for clinical management in the aspect of new definition. The scenario of a higher overall mortality due to CVD as compared with controls has made it a critical global issue. Patients with T2M or obesity are the high-risk groups for MAFLD development. Further characterize and stratify MAFLD phenotypes and risk stratification for MAFLD patients are essential steps in a patient-centered approach.

PL-1

SD7-3

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

OVERVIEW OF T2DM AND THE IMPACT OF MAFLD/NAFLD ON DM

CONSENSUS REPORT

HORNG-YIH OU

MELANIE DAVIS

Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng-Kung University Hospital

Diabetes Medicine, University of Leicester

Diabetes and fatty liver are concurrent metabolic diseases. Eighty percent of diabetic patients will have fatty liver. The presence of fatty liver not only lead to diabetes, but also worsens glycemic control in diabetes. In this lecture, we will begin with an overview of the current state of diabetes and addresses the prevalence of diabetic fatty liver. Next, the mechanisms through which fatty liver leads to diabetes will be addressed. Then, we will further explore the impact of fatty liver on the prognosis and treatment of diabetes. Finally, the therapeutic potentials of diabetic medications on fatty liver and the latest clinical practice recommendations of diabetes with fatty liver will be briefly reviewed.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

DAROC-TADE-2

SD8-1

IMPROVEMENT IN QUALITY OF CARE AND OUTCOMES IN DIABETES - EXPERIENCES FROM SWEDEN AND THE SWEDISH

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

NATIONAL DIABETES REGISTER

李淳權

KATARINA EEG-OLOFSSON, MD PHD

馬偕紀念醫院

Diabetes Clinic Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg Gothenburg, Sweden

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

Diabetes is a common chronic disease with impact on the individual, the health care system as well as the society as a whole. There are established national and international guidelines on the management of both type 1 diabetes and type 2 diabetes. The importance of multifactorial risk factor control to minimize risk and progression of diabetes complications is undisputed.

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

The Swedish national diabetes register (the NDR) started in 1996 by dedicated heath care professionals in response to the Saint Vincent declaration on diabetes care with the aim to reduce complications in Diabetes. Today it is an internet-based quality registry covering 90% of all patients with diabetes in Sweden including both primary and secondary care. The goal is at least yearly reports on clinically important variables. Variables are based on national guidelines and include glycaemic measures, cardiovascular risk factors and screening examinations. The NDR is funded by the Swedish health authorities and providers and all data comes from medical records.

Since 2014 the NDR has openly reported the results of diabetes care with the interactive webtool the Button. The Button presents group-level data comparing national, regional and local unit level results. Anybody interested in diabetes care, i.e. health care professionals, patients, regulators and other stakeholders, can access data through the Button. Results can be monitored over time or compared with others. The database is updated nightly.

The NDR is today a widely used tool in diabetes care and has contributed to the improvement seen over time in Sweden by benchmarking public results, inspires discussion on quality improvement at the local level, through patient involvement as well as by register-based research.

PL-1

SD8-2

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

TAIWAN NATIONAL CANCER REGISTRY EXPERIENCE

CONSENSUS REPORT

1 MY LEE

1Taiwan Society of Cancer Registry

MELANIE DAVIS

Diabetes Medicine, University of Leicester

Cancer registration provides core information for cancer surveillance and control. The population-based Taiwan Cancer Registry (TCR) was implemented in 1979. After the Cancer Control Act was promulgated in 2003, the completeness (97%) and data quality of cancer registry database has achieved at an excellent level. Hospitals with 50 or more beds, which provide outpatient and hospitalized cancer care, are recruited to report 20 items of information on all newly diagnosed cancers to the central registry office (called short-form database). The Taiwan Cancer Registry is organized and funded by the Ministry of Health and Welfare. TCR data are high quality in terms of completeness and timeliness.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

The National Taiwan University has been contracted to operate the registry and organized an advisory board to standardize definitions of terminology, coding and procedures of the registry's reporting system since 1996. To monitor the cancer care patterns and evaluate the cancer treatment outcomes, central cancer registry has been reformed since 2002 to include detail items of the stage at diagnosis and the first course of treatment (called long-form database). The accuracy rates of selected 55 major items in the long-form TCR data between 2014 and 2016 with 700 reported cases randomly selected from 25 long-form-reporting hospitals. We calculated the accuracy rates of the reported data by employing a reabstracted chart review. Among the 55 items, the accuracy rates of 38 (69%) were at least 95%, those of 10 (18%) were between 90% and 95%, those of 5 (9%) were between 85% and 90%, and the remaining 2 (4%) wer e between 80% and 85%. This demonstrates a high degree of accuracy in the TCR long-form data.

The Taiwan Cancer Registry has run smoothly for more than 40 years, which provides essential foundation for academic research and cancer control policy in Taiwan.

DAROC-TADE-2

SD8-3

RECENT DEVELOPMENTS AND ACHIEVEMENTS FROM TAIWAN BIOBANK

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

ANN CHEN, MD, PHD

李淳權

Taiwan Biobank, Academia Sinica, Taipei, Taiwan

馬偕紀念醫院

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

The Taiwan Biobank (TWB) is a national scientific infrastructure that provides the biomedical research community with access to biospecimens and information collected from the general population in Taiwan. Through a centralized recruitment and long term follow-up strategy accompanied by comprehensive collection of health, lifestyle, environmental factors and omics information, the TWB aims to improve our understanding of the external and internal factors involved in chronic disease etiology and progression. Our ultimate goal is to improve the health of future generations by facilitating translational research in academic and industry.

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

The composition of Taiwanese population is unique and representative because it includes all subgroups of the Han ethnicity. Currently, more than 180,000 participants have been recruited, about 130,000 participants have undergone whole-genome genotyping, and more than 3,000,000 biospecimens including plasma, urine, and DNA have been collected. In addition, TWB has also established a lot of omics data from biological samples to facilitate the use of researchers and save money.

All participant data and biospecimens collected by TWB have been publicly released. TWB is available as an open release to any bona fide researcher who wishes to use it for their research. In this context, TWB is a resource for data requests from the national and international scientific community. The release of this large-scale population data will greatly benefit human biomedical research. Our goal is to change the future of healthcare with big data.

PL-1

SD8-4

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

TAIWAN DIABETES REGISTRY : PRESENT STATUS AND THE FUTURE

MELANIE DAVIS

1SHIH-YI LIN, 1YI-JING SHEEN, 1HUNG-YUAN LI, 1HARN-SHEN CHEN, 1YI-JEN HUNG, 1CHIH-CHENG HSU, 1SHIH-TE TU, 1CHIH-YUAN WANG,

Diabetes Medicine, University of Leicester

1LEE-MING

CHUANG,

1

CHIEN-NING HUANG, 1WAYNE HUEY HERNG SHEU

1Working Group on Diabetes Epidemiology and Registry, Diabetes Association of R.O.C. (Taiwan)

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

To understand the overall care conditions provided for diabetic patients, many countries have developed registry system for diabetic patients' information for better diabetes managements, including epidemiology, diabetes related complications, medication treatment, and long term outcome. The Diabetes Association of R.O.C. (Taiwan) launched the Taiwan Diabetes Registry (TDR) since 2015, October. The clinical information and various disease-related medical records of the patients at outpatient clinic are registered on the network. The study subjects comprises three patient groups, including those ever participating the quality control study by Taiwan Association of Diabetes Educators in 2006 and 2011 (group 1), type 1 diabetes (group 2), and newly diagnosed type 2 diabetes (group 3). In the web-based platform of TDRS, general characteristics of diabetes, physical examination, blood and urine test reports, diabetic complication evaluation, and medical treatment are recorded. In addition, patients’ health status, and health-related quality of life is surveyed by questionnaires using Patient Health Questionnaire (PHQ-9), and EuroQol five-dimension questionnaire (EQ-5D). Then, follow-up information will be re-registered yearly. At present, the registry system is used at outpatient diabetes clinics of 14 medical centers, and 49 regional and local hospital and 40 primary clinics nationwide, and until Dec 31, 20228, a total of 15013 subjects (2356 in group 1, 2655 in group 2, 9822in group 3) had been enrolled. Besides, based on the registered data in TDR, there are now 15 ongoing studies. In the near future, the forth and fifth registry groups are planned to include diabetic patients with pregnancy and MODY patients. As the data of TDR are continuously expanding, it is expected in the future to become a valuable source to address numerous relevant issues in diabetes management.

DAROC-TADE-2

SD9-1

DIABETES REMISSION - HOW IS IT ACHIEVED? (LIFESTYLE)

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

EDY KORNELIUS MD

未來

Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital

李淳權

馬偕紀念醫院

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

Diabetes remission refers to a state where a person with diabetes is able to achieve and maintain normal blood sugar levels without the use of diabetes medications. This can be achieved through various methods, including lifestyle changes such as diet and exercise, weight loss, and bariatric surgery. The concept of diabetes remission is becoming increasingly important in diabetes management as it can lead to long-term health benefits and reduced risk of complications. However, it should be noted that diabetes remission is not the same as a cure for diabetes and relapses are possible.

、

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

There have been several studies that have been conducted to investigate diabetes remission and the factors that contribute to it. One of the most well-known studies is the Diabetes Remission Clinical Trial (DiRECT), which was conducted in the United Kingdom. The study included 298 adults with Type 2 diabetes who were randomly assigned to either a low-calorie diet (LCD) or a control group. The participants in the LCD group consumed a diet of 850 calories per day for three to five months, and then gradually increased their calorie intake. The study found that almost half of the participants in the LCD group were able to achieve diabetes remission, defined as a HbA1c (a measure of blood sugar control) below 6.5% without the use of diabetes medications. The study also found that weight loss was the main factor associated with diabetes remission, with those who lost the most weight being most likely to achieve remission.

This presentation will focus on the role of lifestyle intervention in achieving diabetes remission. We will explore the various lifestyle changes, such as diet and exercise, that have been shown to be effective in inducing diabetes remission. We will also discuss the mechanisms by which these lifestyle changes lead to diabetes remission and the impact of these changes on overall health. The goal of this presentation is to provide a comprehensive understanding of the role of lifestyle intervention in diabetes remission and the importance of incorporating lifestyle changes in diabetes management.

PL-1

SD9-2

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

DIABETES REMISSION - HOW IS IT ACHIEVED? (PHARMACOTHERAPY)

1YAO-HSIEN TSENG

MELANIE DAVIS

Diabetes Medicine, University of Leicester

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Tungs’ Taichung Metroharbor Hospital

Diabetes "reversed"?

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

The concept of type 2 diabetes remission is gaining popularity and is also referred to as diabetes "reversal," "resolution," and "cure." The 2021 ADA experts came to the conclusion that remission is the most accurate term.

• the review of the interventions

• personalised approach

• approaches for implementation

"Remission" was defined as blood sugar levels below diagnostic criteria for diabetes and absence of diabetes medications for a minimum of three months. However, there are still many unanswered questions, such as how long remission typically lasts and how long the follow-up will be, not only to monitor blood sugar but also to check for diabetes complications. Regarding the effects of diabetes in remission on complications such as the heart and mortality, much remains unknown.

Something worth fighting for or an uncommon occurrence?

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Diabetes places a significant stress on health and the economy. Diabetes remission is not limited to a small population; newly diagnosed type 2 diabetes patients or those who have undergone weight loss surgery with significant weight loss have a greater chance of achieving remission. Almost half participants of the DiRECT trial published in 2018 by Lancet can be alleviated by the weight loss program. One-third of the participants remained in remission at two years, based on a follow-up study, and continued remission was associated with weight loss.

Rather, whether or not a patient is in remission, close monitoring or follow-up is essential. Because the insulin-producing cells are damaged and the underlying genetic factors remain, there is no permanent cure for diabetes. Despite the absence of a cure, diabetes prevention, delaying the onset and progression of the disease, and remission are crucial. Dietary and exercise modifications, as well as bariatric surgery, are crucial to achieving remission from diabetes. Those with newly diagnosed diabetes should receive formal nutritional counseling and lifestyle advice for weight loss and lifestyle enhancement. In terms of diabetes remission, anti-hypoglycemic agents such as AGI, SGLT2i, TZD, metformin and GLP-1 RAs, achieve their potential. In conclusion, remission from diabetes is no longer a myth but a reality. However, long-term research into the efficacy of various mitigation strategies is required.

DAROC-TADE-2

SD9-3

DIABETES REMISSION-HOW IS IT ACHIEVED? (BARIATRIC SURGERY)

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

KEONG CHONG

未來

李淳權

Division of Endocrinology and Metabolism, Department of Internal Medicine, Min-Sheng General Hospital, Taiwan, R.O.C.

馬偕紀念醫院

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為

About 30 years ago, Pories et al. published a seminal article, “Who Would Have Thought It? An Operation Proves to Be the Most Effective Therapy for Adult-Onset Diabetes Mellitus.” This was based on their observation that bariatric surgery rapidly normalized blood glucose levels in obese people with type 2 diabetes mellitus (T2DM), and 10 years later, almost 90% remained diabetes free.

、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

、

；A1C 檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

The Swedish Obese Subjects (SOS) study involved 2010 obese subjects who underwent bariatric surgery [gastric bypass (13%), banding (19%) and vertical banded gastroplasty (68%)] and 2037 contemporaneously matched obese control subjects receiving usual care. The diabetes remission rate 2 years after surgery was 16.4% for control patients and 72.3% for bariatric surgery patients. At 15 years, the diabetes remission rates decreased to 6.5% for control patients and to 30.4% for bariatric surgery patients.

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

The Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE) trial, which randomized 150 participants with unmanaged diabetes to receive either metabolic surgery or medical treatment, found that 29% of those treated with RYGB and 23% treated with VSG achieved A1C of 6.0% or lower after 5 years.

Exceedingly few presurgical predictors of success have been identified, but younger age, shorter duration of diabetes (e.g., < 8 years), and lesser severity of diabetes (better glycemic control, nonuse of insulin) are associated with higher rates of diabetes remission. Greater baseline visceral fat area may also predict improved postoperative outcomes, especially among Asian American people with type 2 diabetes. Lee et al. published ABCD scoring system (age, BMI, C-peptide, and duration of diabetes) to predict the possibility of diabetes remission after bariatric surgery.

The physiological and molecular mechanisms underlying the beneficial glycemic effects of bariatric surgery remain incompletely understood. Caloric restriction, proximal intestinal nutrient exclusion, rapid distal gut nutrient delivery, and the change of gut hormones play key roles. Besides, the changes in bile acid metabolism, GI tract nutrient sensing and glucose utilization, incretins, possible anti-incretin(s), and the intestinal microbiome are implicated. These changes, acting through peripheral and/or central pathways, lead to reduced hepatic glucose production, increased tissue glucose uptake, improved insulin sensitivity, and enhanced beta cell function.

PL-1

SE1-1

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

CYTOLOGIST'S ROLE IN THYROID CANCER DIAGNOSIS WITH ARTIFICIAL INTELLIGENCE

MELANIE DAVIS

I-S JAN

Diabetes Medicine, University of Leicester

Department of Laboratory Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Fine needle aspiration (FNA) cytology of the thyroid gland is a reliable diagnostic tool for the evaluation of patients with thyroid nodules, but morphologic interpretation of the smear is subjective. Therefore, indeterminate diagnostic terminology, such as atypia of undetermined significance, follicular neoplasm, or suspicious for malignancy is reported in the clinical practice. Artificial intelligence (AI) has been applying to cytological imaging for decades, which enables objective quantification of morphologic and chromatic parameters in selected cells on the cytological images. We have developed a computer-aided diagnosis (CAD) software by using the morphologic and chromatic parameters to establish this AI system for years. We took at least 3 digital images of various field views of FNA smear by routine staining. The nuclei and cytoplasm were identified by computer algorithm automatically to compute 22 quantified cytological features, including 16 morphologic and 6 chromatic features. The risk of malignancy proposed by the Bethesda system for reporting thyroid cytopathology was output in this CAD system for each cytological image. In this talk, the morphologic images of FNA cytology for thyroid disease will be shown and the results of CAD interpretation will be illustrated. The discrepancy between these two interpretation methods finally will be verified by the cytologists. We hope CAD scoring system could be an ancillary test of thyroid FNA cytology in challenging situations of indeterminate thyroid FNA cytology.

DAROC-TADE-2

SE1-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

COMPUTERIZED ULTRASONOGRAPHY AND CYTOLOGY READING IN THYROID CANCER DIAGNOSIS - THE ROLE OF ARTIFICIAL INTELLIGENCE

李淳權

1A CHEN, 2I-S JAN, 3P-Y CHAO, 3E SHEN

馬偕紀念醫院

1Industrial Engineering and Mechanical Engineering, National Taiwan University, Taiwan, R.O.C.; 2Department of Laboratory Medicine, National Taiwan University Hospital, Taiwan, R.O.C.; 3AmCad BioMed Corp., Taiwan, R.O.C.

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

In recent years, with the continuous advancement of computing power and machine learning (ML) technologies, artificial intelligence (AI) becomes readily applicable to medical imaging. In particular, Fully Convolutional Networks (FCN or U-Net) have been used for segmentation of objects on medical images. These techniques can be applied to automatic identification and segmentation of thyroid nodules on ultrasound images as well as the cell nucleus and cytoplasm on stain slides for further analysis and diagnosis.

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

In this talk, I first introduce the development and characteristics of various AI technologies, i.e., machine learning methods and the regulatory approval requirement as an AI/ML-based ComputerAssisted Detection (CADe) and Computer-Assisted Diagnosis (CADx) software medical devices. Meanwhile, the recommendation made by the device should also comply to the medical guidelines, such as TIRADS for the thyroid ultrasound imaging and Bethesda systems for the cytology examination, in clinical practice. Conventionally, the ultrasound and cytology readings are performed independently without cross referencing. In this talk, we’ll use five actual cases to demonstrate how the AI/ML-based software can be used to assist physicians in thyroid nodule diagnosis.

Commercialized software devices are used to analyze the computerized ultrasonic and cytomorphometric features of the thyroid nodules and are shown to be valuable for assisting physicians to make final diagnosis. With proper clinical validation and regulatory clearance, artificial intelligence and machine learning technologies are becoming useful tools for clinical diagnosis of thyroid nodules.

PL-1

SE2-1

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

PITNET: WHO CLASSIFICATION UPDATE

CONSENSUS REPORT

S-M JUNG

Department of Pathology, Chang Gung Memorial Hospital, Linkou, Taiwan

MELANIE DAVIS

Diabetes Medicine, University of Leicester

To be pituitary neuroendocrine tumors (PitNET) or not to be PitNET. That is a question.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

The 2022 5th Edition of the WHO Classification of Endocrine and Neuroendocrine Tumors classifies adenohypophyseal tumors as pituitary neuroendocrine tumors (PitNET / adenomas). The ICD-O coding is 8272/3. There is no formal grading system. The terminology metastatic PitNET replaces the terminology pituitary carcinoma.

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

The histological subtyping of a PitNET is based on the tumor cell lineage by use of immunohistochemistry for pituitary transcription factors (PIT1, TPIT, and SF1), hormonal markers (GH, PRL, ACTH, TSH, FSH, and LH), and cytokeratin. Histopathological subtypes include PIT1lineage tumors, TPIT-lineage corticotroph tumors, SF1 gonadotroph tumors, Plurihormonal tumors of PIT1 lineage, and Null cell tumors. Pituitary neuroendocrine tumors of PIT1-lineage include Somatotroph PitNET/adenoma, Mammosomatotroph PitNET/adenoma, Lactotroph PitNET/adenoma, Thyrotroph PitNET/adenoma, Mature plurihormonal PIT1 lineage PitNET/adenoma, Immature PIT1-lineage PitNET/adenoma, Acidophil stem cell PitNET/adenoma, and Mixed somatotrophlactotroph PitNET/adenoma. Pituitary neuroendocrine tumors of TPIT lineage is Corticotroph PitNET/ adenoma. Pituitary neuroendocrine tumors of SF1 lineage is Gonadotroph PitNET/adenoma. Pituitary neuroendocrine tumors without distinct lineage differentiation include Null cell PitNET/adenoma and Plurihormonal PitNET/adenomas. Multiple pituitary neuroendocrine tumors is Multiple synchronous PitNET/adenomas of distinct lineages. Metastatic pituitary neuroendocrine tumors classify as Metastatic PitNET.

In this presentation, the pros and cons of PitNET will be discussed.

DAROC-TADE-2

SE2-2

PITUITARY ADENOMA: DIAGNOSIS, TREATMENT, AND PROGNOSIS

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

SZU-TAH CHEN

未來

李淳權

Consultatnt attending physician, Division of Endocrinology and Metabolism, Department of Internal Medicine, New Taipei Municipal TuCheng Hospital

馬偕紀念醫院

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

Pituitary adenoma (PA) are a group of benign neuroendocrine tumors derived from anterior pituitary gland. Clinical manifestations of PA present a spectrum of endocrinopathies and/or local mass effect determining from their originated cell lineage. PA are classified by histology, phenotypic behavior, and surgical anatomy, each reflecting the multidisciplinary impact and difficulties of clinical management. Overproduction of anterior pituitary hormones may cause overt clinical symptoms such as hyperprolactinemia, acromegaly/gigantism and Cushing’s disease; nevertheless, much complex scenario was found currently under immunohistochemistry study for specific transcription factors.

、

及

；A1C 檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

The majority of PA follow a relatively indolent or even stable course but a subset, approximately 5–10%, may exhibit a more aggressive course with rapid growth or early recurrence following initial treatment. In addition, the current classification of neoplasms of the anterior pituitary does not accurately reflect the clinical spectrum of behavior. Invasion and regrowth of proliferative lesions and persistence of hormone hypersecretion cause significant morbidity and mortality. The International Pituitary Pathology Club thus proposed a new terminology, pituitary neuroendocrine tumor (PitNET) on 2017, which is consistent with that used for other neuroendocrine neoplasms and which recognizes the highly variable impact of these tumors on patients.

First-line treatment includes pituitary surgery, along with medical treatment for specific PitNET subtypes: dopamine agonists for lactotrophs and somatostatin analogs for somatotrophs. Radiotherapy and systemic chemotherapy may also be proposed for recurrent or unresectable tumors. When complete surgery is not achievable, the prognosis of a remaining tumor cannot be established from clinical or pathological data. Histo-prognostic classification of PitNETs is a subject of debate.

Trouillas et al. selected a combination of invasion and proliferation to predict postoperative PA recurrence. Specifically, PA were divided into 4 categories according to invasion (non-invasive, “1”; invasive, “2”) and proliferation (non-proliferative, “a”; proliferative, “b”). The evaluation criterion for invasion was Knosp grades 3–4, while the evaluation criterion for proliferation was the presence of at least 2 of the following 3 proliferation markers: Ki-67 ≥ 3%, p53 staining > 10 strong positive nuclei/10 times high magnification visual field (HPF), and mitosis > 2/10 HPF. The results indicated that invasion and proliferation had a synergistic effect on refractory adenomas and that the effect of invasion on progression-free survival was greater than that of proliferations.

PL-1

SE2-3

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

THE LATEST ENDOSCOPIC ENDONASAL PITUITARY SURGERY

CONSENSUS REPORT

W-H WANG

Department of Neurosurgery, Pituitary and Skull Base Center, Taipei Veterans General Hospital, Taiwan, R.O.C.

MELANIE DAVIS

Diabetes Medicine, University of Leicester

Surgical treatment for pituitary adenoma has been well developed nowadays. With the improvement of the surgical imaging system and techniques, maximal resection of tumor and preservation of pituitary function can be achieved same time in the endoscopic endonasal surgery. The surgical goals including decompression for nonfunctional adenoma and biochemical remission for functional adenoma should be tailored individually. However, successful surgical outcome only can be guaranteed by the experienced surgeon and multidisciplinary team cooperation. According to the 5th WHO classification of endocrine and neuroendocrine tumors, formerly known pituitary adenoma has been classified as pituitary neuroendocrine tumors. This classification is basically defined by the tumor cell lineage, cell type, and related characteristics of tumors. Although there is rarely influence on surgical strategies, the related issues regarding the new classification will be discussed in this session.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

DAROC-TADE-2

SE2-4

IMPACT OF 2022 WHO CLASSIFICATION OF PITUITARY TUMORS

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

UPDATE

未來

HUNG-YU CHANG

李淳權

馬偕紀念醫院

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

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

The most important revision of the latest edition of the WHO classification of pituitary tumors involves preferring the terminology of pituitary neuroendocrine tumor (PitNET) rather than adenoma, emphasis on the biological spectrum of these common endocrine neoplasms. Immunohistochemistry (IHC) examination of pituitary-specific transcription factors (TFs), including PIT1, TPIT, SF-1, GATA2/3, and ERα, is endorsed to determine the tumor cell lineage and to facilitate the classification of PitNET subgroups. TF-negative IHC staining indicates PitNET without distinct cell lineages, including unclassified plurihormonal tumors and null cell tumors. Howover, there is no biomarker that can reliably predict malignancy as defined by metastatic spread(metastatic PitNET).

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

A complete panel of IHC stains for PitNet will increase the cost of pathological examination and it is not fully covered by current national health insurance in Taiwan. The 2022 WHO classification of PitNETs is helpful for developing the follow-up schedule and adjunctive treatment after operation. Among acromegalic patients, it is recognized that sparsely granulated somatotroph tumors are more aggressive than densely granulated ones and have poor response to somatostatin analogue therapy. In patients with hyperprolactinemia, sparsely granulated lactotroph tumors tend to be very indolent and responsive to medical therapy, they can be aggressive in men, whereas the rare densely granulated subtype is generally always aggressive. Patients with pituitary tumor-dependent hyperthyroidism are stratified with immature PIT1-lineage tumors as the most aggressive cause. In patients with Cushing's disease, sparsely granulated corticotroph tumors are more aggressive than densely granulated corticotroph tumors and Crooke cell tumors are exceptionally aggressive. For clinically nonfunctioning tumors, silent corticotroph and silent PIT1-lineage tumors including the non-functional immature PIT1-lineage tumors are more aggressive than the more common silent gonadotroph tumors.

PL-1

SE3-1

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

PSYCHIATRIC ASSESSMENTS FOR THE GENDER DYSPHORIA

CONSENSUS REPORT

C-M LIU

Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan

MELANIE DAVIS

Diabetes Medicine, University of Leicester

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

With the evolution of the times, gender issues are constantly being concerned and discussed. The term “gender identity disorder” was renamed as “gender dysphoria” in the official psychiatric diagnostic systems, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM5). The removal of “disorder” from the new name reduces the psychiatric medicalization and avoid unnecessary labeling and stigmatization. I will introduce the psychiatric diagnosis and evaluation for gender dysphoria cases, their common psychosexual development, and their maladaptive and adaptive process. The psychiatrists help gender dysphoria cases reduce the disturbance for their inconsistency between biological and psychological gender identity. The psychiatrists also play some roles in the evaluation of gender dysphoria cases receiving hormone replacement therapy from endocrinologists, plastic surgeries and sexual re-arrangement surgeries from surgeons. We formed an integrated team in our hospital for years, including psychiatrists, endocrinologists, obstetrician and gynecologist, urologists, plastic surgeons, clinical psychologists and social workers to evaluate gender dysphoria cases, to help them change to a relatively idealized gender status, to reduce their stress for adjustment, and to enhance their life quality and wellbeing.

DAROC-TADE-2

SE3-2

HORMONE THERAPY FOR TRANSGENDER

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

YU-FANG CHENG

未來

Department of endocrinology and Metabolism, ChangHua Christian hospital.

李淳權

馬偕紀念醫院

、

；

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人 照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

In this section, we will introduce gender-affirming hormone therapy (GAHT), which is considered medically necessary to achieve changes consistent with an individual's gender identity. The content of this discussion is primarily based on the "Standards of Care for the Health of Transgender and Gender Diverse People Version 8." We will discuss how to assess adults who are willing to receive hormone therapy for gender transition, as well as the criteria for initiating hormone therapy. We will also cover the benefits and side effects of hormone therapy.

、

3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（

、

、

、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

PL-1

SE3-3

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

TRANSGENDER OPERATION

CONSENSUS REPORT

1,2SHYUE-YIH HORNG, 1,2PO-CHENG HUANG

MELANIE DAVIS

1Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital, Taiwan, R.O.C.; 2NTUH Sex Reassignment Surgical Team

Diabetes Medicine, University of Leicester

Transgender operation can be divided into transwomen and transman operation. Generally, the transwomen surgical procedure is included:

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

1.Vaginoplasty (penile disassembly and inverted vaginoplasty or intestinal vaginoplasty). 2. Facial feminization surgery

• the overall approaches to care

• the review of the interventions

3. Thyroid chondroplasty

• personalised approach

4. Breast augmentation

• approaches for implementation

5. Body contouring surgery

6. Orchiectomy

7. Clitoplsty

8. Labiaplasty.

We will present our clinical experience and introduce special procedure of transwomen surgery especially in female genital reconstruction including vaginoplasty and clitoris-labiaplasty.

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

DAROC-TADE-2

SE4-1

UPDATE OF RADIOFREQUENCY ABLATION FOR TREATING BENIGN AND MALIGNANT THYROID NODULAR DISEASE

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

李淳權

HE-JIUN JIANG

馬偕紀念醫院

Division of Endocrinology and Metabolism, Department of Internal Medicine, E-Da Dachang Hospital

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

；

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Radiofrequency ablation (RFA) is a minimally invasive method for treating thyroid nodules, which has become increasingly popular in recent years. RFA is used as an alternative therapy to traditional surgery for benign thyroid nodules and is widely employed due to its effectiveness and good tolerability. For functional thyroid adenomas, RFA is an effective and safe treatment method, but multiple RFA sessions maybe needed for durable functional control. For parathyroid adenomas, RFA can effectively restore normal parathyroid function. However, in secondary hyperparathyroidism, compensatory hyperplasia of unablated parathyroid tissue can occur, leading to transient effects. In recent years, there is mounting evidence supporting the feasibility of using RFA in the treatment of thyroid cancer, local recurrence, and lymph node metastasis. Therefore, this presentation will focus on the above-mentioned thyroid diseases and provide an overview based on recent literature and evidence.

PL-1

SE4-2

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

CLINICAL APPLICATION OF MICROWAVE AND HIFU IN THYROID NODULAR DISEASE

1,2 K-L CHENG

MELANIE DAVIS

Diabetes Medicine, University of Leicester

1Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan; 2School of Medicine, Chung Shan Medical University, Taichung, Taiwan;

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

Thyroid nodules continue to be a common condition. Minimally invasive techniques have become increasingly common treatments for thyroid nodules. In addition to radiofrequency ablation (RFA), other percutaneous ablative techniques, such as microwave ablation (MWA) or high-intensity focused ultrasound (HIFU), have been introduced in Taiwan. However, compared to RFA, MWA and HIFU are still in their infancy in the treatment of thyroid nodules. In this presentation, therapeutic efficacy, safety and possible complications of MWA and HIFU will be introduced.

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

DAROC-TADE-2

SE4-3

THYROID ARTERIAL EMBOLIZATION (TAE) AS AN ADJUVANT TREATMENT FOR THYROID DISEASE.

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

1CHENG-KANG WANG, 1WEI-CHE LIN

李淳權

馬偕紀念醫院

1Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

、

；

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Previous reports suggest transcatheter arterial embolization (TAE) cloud be an adjuvant treatment for different thyroid disease since 2002. The main indication includes large benign thyroid nodules (BTNs) and toxic diffuse goiter (Graves disease). After embolization, marked volume reduction ratio (VRR) of thyroid lesions in more than two-thirds of patients with large BTNs or Graves disease. It allowed elimination or resolving of compression symptoms. Permanent embolizer, such as embosphere, would be used for TAE of thyroid arteries. The artery was embolized with 300–500μm embosphere until obviously decreased blood flow. Smaller particles may increase probability of too distal or nontarget embolization, therefore medium size of particles was preferred to smaller particles. To ensure optimal embolization, the proximal part of the feeding arteries was occluded with coils. Based on the angiography results, embolization of nodular-side superior and inferior thyroid arteries was performed. Preservation of one-side inferior thyroid artery should be considered to avoid the potential risk of hypoparathyroidism if patient presented bilateral thyroid nodules. Completed procedure was until optimally embolized the target arteries.

The serum levels of T3, free T4, and TSH were elevated than before embolization what did not affect clinical condition of most patients. After embolization, thyroid functions will return to normal range 12 weeks later. Neck pain and swelling are the most common complications after thyroid TAE. TAE not only reduces the thyroid volume substantially but also normalizes or improves thyroid hormone levels without causing hypothyroidism. Selective embolization of the thyroid gland has an outcome similar to the subtotal thyroidectomy. Embolization of the majority of the thyroid gland arteries is associated with good therapeutic effect.

PL-1

SE5-1

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

PROGRESS ON GENETIC BASIS OF PRIMARY ALDOSTERONISM

CONSENSUS REPORT

1,2 VIN-CENT WU

1National Taiwan University Hospital, Primary Aldosteronism Center; 2Taiwan Primary Aldosteronism Investigators

MELANIE DAVIS

Diabetes Medicine, University of Leicester

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Among hypertensive patients, the prevalence of endocrine hypertension (HT) reaches up to 10%. Primary aldosteronism (PA) is characterized by excessive aldosterone production, and affects 5–20% of hypertensive patients. The mechanisms causing excessive aldosterone production have been explored via identification of somatic and germline mutations in PA patients. Studies have identified somatic mutations in the majority of aldosterone-producing adenomas (APAs). Mutations in the selectivity filter of the potassium channel GIRK4 (encoded by KCNJ5) abolish potassium selectivity, and increase sodium entry and membrane depolarization. Somatic mutations in a L-type voltagegated Ca 2+ -channel subunit, Cav1.3 (encoded by CACNA1D), and two ATPases (Na+/K+ ATPase Alpha-1 Subunit and Ca2+ ATPase 3, encoded by ATP1A1 and ATP2B3, respectively) were also identified to increase aldosterone secretion. Over the past years, genomic and genetic studies have allowed improving our knowledge on the molecular mechanisms of endocrine HT. Those discoveries have opened new windows to translate knowledge to clinical practice for better diagnosis and specific treatment of affected patients. Several genetic defects in the germline or somatic state have been found in PA. Understanding how these molecular abnormalities lead to excess aldosterone contributes significantly to the elucidation of the pathophysiology of low-renin hypertension. It may also lead to new and more effective strategies for this disease acting at the molecular significance. In this mean time, I will describe the physiology of adrenal hormone biosynthesis and action, the clinical and biochemical characteristics of different forms of endocrine HT, and their underlying genetic defects. The impact of these discoveries on diagnosis and management of patients, as well as new perspectives related to the use of new biomarkers for improved patient care will be discussed .

DAROC-TADE-2

SE5-2

AN UPDATE ON ADRENAL HISTOPATHOLOGY IN PRIMARY ALDOSTERONISM

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

W-Y CHUANG

李淳權

Department of Pathology, Chang Gung University and Chang Gung Memorial Hospital, Taoyuan, Taiwan.

馬偕紀念醫院

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人 照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Aldosterone overproduction could be either bilateral or unilateral. Bilateral primary aldosteronism is most commonly due to aldosterone-producing diffuse hyperplasia or nodules/micronodules. For unilateral primary aldosteronism, the HISTALDO (histopathology of primary aldosteronism) classification combining CYP11B2 (aldosterone synthase) immunohistochemistry and morphologic findings is useful for defining clinically relevant diagnostic categories, including aldosteroneproducing adrenocortical carcinoma (APACC), aldosterone-producing adenoma (APA), aldosteroneproducing nodule (APN), aldosterone-producing micronodule (APM), multiple aldosterone-producing nodules or micronodules (MAPN or MAPM), and aldosterone-producing diffuse hyperplasia (APDH). In a resected adrenal gland of unilateral primary aldosteronism, the presence of a solitary APA or a dominant APN is considered classical histology. Non-classical histology in unilateral primary aldosteronism is associated with a higher incidence of post-surgical disease persistence and increased aldosterone production from the unresected adrenal gland.

PL-1

SE5-3

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

PRIMARY ALDOSTERONISM: UPDATING TREATMENT AND COMORBIDITIES DETECTION

MELANIE DAVIS

YA-HUI HU

Diabetes Medicine, University of Leicester

Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

Primary aldosteronism is the most frequent cause of secondary hypertension. Early diagnosis and treatment of primary aldosteronism are improtent to prevent organ damage. The prevalence of primary aldosteronism approaches 5-10% of all hypertensive patients, and up to 20% in those with treatment-resistant hypertension. Recently primary aldosteronism is increasingly recognized, but still underdiagnosed.

• the review of the interventions

• personalised approach

• approaches for implementation

Patients with documented unilateral PA (i.e. APA or unilateral adrenal hyperplasia ) should be treated with unilateral adrenalectomy. However, if the patient is unable or unwilling to undergo surgery, it is recommended that the patient receives medical treatment with a MR antagonist as same as bilateral adrenal hyperplasia. The autosomal dominant glucocorticoid-remediable hyperaldosteronism (GRA) can be treated medically with a glucocorticoid +/- a MR antagonist.

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

DAROC-TADE-2

SE6-1

THE BRAIN-GUT AXIS IN THE HOMEOSTASIS OF WEIGHT AND COMORBIDITIES OF OBESITY

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

CHUANG HAI-HUA

李淳權

長庚紀念醫院北院區 家庭醫學部副科主任

馬偕紀念醫院

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人 照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

；

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

The word “globesity” refers to the alarming global increase of obesity in both its prevalence and impact. The bi-directional “brain-gut axis” in the development and progression of obesity has raised attention in the advance of neuroscience and microbiome research. The homeostasis of energy and weight for human bodies are controlled by the central nervous system. On the other hand, the gut consequently sends feedback signals via multiple pathways including hormones, in which the gut microbiota and its metabolites may also have a considerable role. Previous evidences have indicated shifts in the abundancy and diversity of gut microbiome in non-communicable conditions such as obesity and its comorbidities. This presentation reviews the brain-gut axis in the homeostasis of weight and comorbidities of obesity.

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

PL-1

SE6-2

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

THE EFFECT OF OBESITY IN FEMALE REPRODUCTIVE DYSFUNCTION

CONSENSUS REPORT

MEI-JOU CHEN

Department of Obstetrics and Gynecology, National Taiwan University Hospital

MELANIE DAVIS

Diabetes Medicine, University of Leicester

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Obesity not only contributes to the increase risk of cardiometabolic disorders, but also has been recognized as a risk factor of ovarian dysfunction. It has distinctive pattern of ovarian hormone profile levels and can directly induce ovarian inflammation to reduce oocyte quality. In our previous study, we have observed a negative association between high body mass index (BMI) and ovarian reserve which represented by anti-Mullerian hormone (AMH) levels, ovarian antral follicle counts and ovarian volume in women with PCOS. Further studies have proved the harmful effect of obesity, insulin resistance and metabolic disturbances on AMH levels and ovarian function; also appear in women without PCOS and with normal menstruation period. Although obesity is not a necessary criterion for polycystic ovary syndrome (PCOS), while visceral adiposity has proved to amplify and worsen all metabolic and reproductive outcomes for women with PCOS and it’s interaction with androgen excess has been considered to be involved in the major pathogenesis of PCOS. The pathological roles of obesity including increases insulin resistance and compensatory hyperinsulinemia, which in turn increases adipogenesis and decreases lipolysis. Besides, obesity sensitizes thecal cells to LH stimulation and amplifies functional ovarian hyperandrogenism by upregulating ovarian androgen production. We have previously reported that the obesogenic induced abdominal obesity can affect granulosa cell function and ovarian folliculogenesis by in vivo and in vitro models, which further substantiate the hypothesis that the abdominal adiposity can destroy the ovarian function independently.

.

DAROC-TADE-2

SE6-3

ENDOCRINE DISORDER OR ENDOCRINE DYSREGULATION? THE MECHANISM AND DIFFERENTIAL DIAGNOSIS OF OBESITY.

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

1MING-CHIEH TSAI

李淳權

Chen’s Clinic, Kaohsiung, Taiwan

馬偕紀念醫院

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

Patients have a high rate of obesity in the Department of Endocrinology. However, some patients don't understand how they gained weight. They come to the clinic with the chief complaint of "endocrine dysregulation." They believe they are suffering from a disease which makes them obese. It is a task for an endocrinologist to help these patients determine an appropriate diagnosis.

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

、

；

The use of certain medication could result in weight gain. The clues can be found in a detailed history taking and in the cloud-based medical record of National Health Insurance. There are also certain endocrine disorders that would cause weight gain, such as hypothyroidism, Cushing's syndrome, and polycystic ovary syndrome. We can make a differential diagnosis through history taking, physical examination, and blood tests.

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Nevertheless, how much weight did they gain from an endocrine disease? Can the body weight be restored after proper treatment of the disorder? Among those patients who gained weight, what percentage is associated with endocrine disorders? What kind of laboratory tests or medical imaging should be performed? These subjects are rarely discussed.

After excluding endocrine disorders, weight gain is primarily resulted from an unhealthy lifestyle. However, some patients have no idea of this. Lifestyle modification, rational use of weight loss medications, and bariatric surgery are all effective prescriptions for weight reduction. Shared decision making should be conducted by patients and physicians to find out the most suitable solution.

PL-1

SE7-1

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

MEDICAL TREATMENT OF ADVANCED THYROID CANCER

CONSENSUS REPORT

K-Y LIN

MELANIE DAVIS

Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Taiwan, R.O.C.

Diabetes Medicine, University of Leicester

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

The definition of advanced thyroid cancer, as recently defined by International Thyroid Oncology Group, included structural/surgical, biochemical, histological/molecular features, and clinician prerogative. All anaplastic thyroid cancer, and advanced differentiated thyroid cancer (DTC) should be considered for molecular profiling. Several kinase inhibitors had been developed for driver mutations and fusions in thyroid cancer. There are hierarchies of treatment for advanced thyroid cancer. For potentially curable patients, surgical excision of loco-regional diseases is recommended. Other local therapies include external beam radiation, cryoablation and embolization. Radioactive iodine (RAI) therapy should be given for RAI-sensitive DTC. Currently there’s no recommendations about the superiority of dosimetric approach over empiric fixed dose radioiodine. Bone remodeling agents may be considered in patients with bone metastases, in addition to radioiodine therapy and local therapy. Radiotherapy and surgery are mainstay treatments for brain metastases before starting systemic therapy. For patients with stable or slowly progressive asymptomatic diseases, a period of observation with TSH-suppressive thyroid hormone therapy may be sufficient. The kinase inhibitors are reserved for patients who have failed other non-systemic therapies, who are radioiodine refractory, and had imminently threatening disease progression, symptomatic diseases or diffuse disease progression.

The kinase inhibitors could be classified into anti-angiogenic drugs and mutation/fusion-directed drugs. The former exerts anti-tumoral effects by targeting VEGFRs. Detailed history taking and shared decision making are necessary before initiating anti-angiogenic drugs considering their common side effects, especially when relative contraindications are present. FDA approved mutation/fusion-directed drugs included pralsetinib and selpercatinib for RET fusion/mutations, larotrectinib and entrectinib for NTRK fusions, dabrafenib plus trametinib for BRAF-mutated RAI-resistant DTC. Targeting with BRAF and MEK inhibitors could suppress MAPK pathway, restore the expression of sodium-iodine symporter (NIS) and ability to uptake RAI in RAI-refractory DTC. These so-called redifferentiation therapy had been shown to be partial responsive in some of the patients. In conclusion, in the new era of thyroid cancer treatment, clinicians should be familiar with molecular testing of tumors and differences between kinase inhibitors as well as their side effect profiles. Meanwhile, multidisciplinary approach and good communications between endocrinologist, oncologist, nuclear radiologists and surgeon were utmost important.

DAROC-TADE-2

THERMAL ABLATION OF THYROID CANCER: OVERVIEW OF CURRENT TECHNIQUE AND EVIDENCE

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

WEN-CHIEH CHEN

李淳權

馬偕紀念醫院

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

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人 照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為

、

、

、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

Thermal ablation such as radiofrequency ablation (RFA) and microwave is indicated for patients with locally recurrent thyroid cancers or neck LN metastases, especially for those presenting with high surgical risk or refusal of surgery. Effective management of lesions at critical locations, such as abutting the trachea, with limited complications is noted. Application on PTMC or even primary thyroid cancer above the T1b stage is explored. In 2021, the ETA/CIRSE first co-published the clinical practice guidelines for the use of minimally invasive treatments for thyroid malignant lesions. In addition to the control of local recurrence, RFA has the potential to decrease the risk of subsequent surgery and as a combination therapy.

In this section, the current evidence and the technique specific to malignancy are introduced summarily. We also present the single-center experience of RFA for the treatment of locoregional recurrent thyroid cancer and PTMC.

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

PL-1

SE7-3

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

MOLECULAR TESTING FOR PRECISION ONCOLOGY IN THYROID CANCER

MELANIE DAVIS

J-F HANG

Diabetes Medicine, University of Leicester

Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

Thyroid cancer is a common malignancy, and its prevalence has increased rapidly in recent years in Taiwan. In the 2020 Cancer Registration Annual Report from Health Promotion Administration, Ministry of Health and Welfare, thyroid carcinoma accounts for the eighth highest incidence of malignancy, and the increased number of cases is ranked the first place, 10.96% higher than last year. Due to the extensive studies of the molecular pathogenesis of thyroid cancer and the advance of clinical trials for targeted therapeutic agents, there are more and more targeted therapeutic agents available for the treatment of thyroid carcinomas, such as BRAF inhibitors, NTRK inhibitors, ALK inhibitors, RET inhibitors, etc. In this presentation, I will overview the genetics of thyroid cancer, demonstrate a couple of real-world thyroid cancer cases with algorithmic testing approach, and summarize the current recommendations for molecular testing in thyroid cancer.

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

DAROC-TADE-2

CARDIOVASCULAR OUTCOMES OF PATIENTS WITH TYPE 2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

DIABETES COMPLICATED WITH URINARY TRACT INFECTION POST

SODIUM-GLUCOSE COTRANSPORTER 2 INHIBITORS TREATMENT

李淳權

1TSE-LUN HSU, 1CHIA-HUNG LIN

馬偕紀念醫院

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taiwan, R.O.C.

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標）

與微量白蛋白尿篩檢率部份，分別為 51.6、

Background: Urinary tract infection (UTI) is recognized as a common adverse effect of sodiumglucose cotransporter 2 inhibitors (SGLT2i). But the impact on cardiovascular outcomes of patients with type 2 diabetes (T2D) is unclear.

、

、

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

Method: This multi-center retrospective observational study included diabetes patients receiving SGLT2i at 7 branches of Chang Gung Memorial Hospitals in Taiwan from 2016 January -2019 April. The major adverse cardiovascular event (MACE) outcomes were compared between patients furtherly complicated with UTI and those without UTI.

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Result: We retrospectively reviewed 8862 diabetes patients treated with SGLT2i. 550 patients were identified with urinary tract infection and require antibiotics after SGLT2i treatment. The was significant difference in age(65.94 vs 60.70, p < 0.0001), female sex (64.91% vs 37.5%, p < 0.0001), hypertension rate (41.27% vs 28.2%, p < 0.0001), heart failure rate (8.36% vs 4.38%, p < 0.0001), estimated glomerular filtration rate (eGFR, ml/min/1.73 m2) (80.26 vs 89.32, p < 0.0001), and median urinary albumin-to-creatinine ratio (64.90 vs 46.6, p = 0.0092) between UTI group and non-UTI group. There was no significant difference in baseline HbA1c, Body-mass index, cerebrovascular accident, or coronary artery disease between the two groups.

As to medication use, there was significant difference in use of insulin (27.82% vs 18.15%, p < 0.0001), loop diuretics (18.91% vs 8.61%, p < 0.0001), aldosterone antagonist (7.27% vs 4.52%, p = 0.0032), beta blocker (41.82% vs 37.27%, p = 0.0330), calcium channel blocker (23.64% vs 16.10%, p < 0.0001) between two groups. There was no difference in use of angiotensin converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), and other oral anti-diabetes agent including dipeptidyl peptidase-4 inhibitor (DPP-4 inhibitor), metformin, glucagon-like peptide 1 agonists (GLP1), and sulfonylurea.

We followed up cardiovascular outcome in a period of 30 months after UTI event. UTI group had shown increased risk of heart failure [hazard ratio (HR) = 1.51, 95% confidence interval (CI) 1.211.87; P = 0.0003], stroke [HR = 1.43, 95%CI 1.09-1.86, P = 0.0095], MACE [HR = 2.16, 95%CI 1.732.70, P < 0.0001], and all-cause mortality[HR = 3.18, 95%CI 2.54-3.98, P < 0.0001] .

Conclusion: UTI in patients with T2D post SLGT2i therapy is related with increased risk of MACE up to 30 months. The risk factors included hypertension, heart failure, old age, lower eGFR, and proteinuria.

THE STATUS OF DEPRESSION WAS ASSOCIATED WITH MICROAND MACRO-VASCULAR COMORBIDITIES IN PATIENTS WITH LONG-DURATION TYPE 2 DIABETES: THE TAIWAN DIABETES REGISTRY (TDR)

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

MELANIE DAVIS

Diabetes

Medicine,

University of Leicester

JHIH-SYUAN LIU, CHIEH-HUA LU, FENG-CHIH KUO

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan, R.O.C

• the overall approaches to care

• the review of the interventions

Background: Psychologic distress such depression is a common problem in patients with type 2 diabetes mellitus (T2DM). However, whether long duration of diabetes with associated macro- or micro-vascular complications may aggravate the severity of depression is still uncertain.

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Methods: A total of 1187 long-duration T2DM patients (mean age 65.9 ± 11.4 years; mean diabetes duration 14.0 ± 8.5 years) and 3289 newly diagnosed T2DM patients (mean age 54.6 ± 13.6 years) from the Taiwan Diabetes Registry (TDR) were analyzed. The cross-sectional self-report Patient Health Questionnaire-9 (PHQ-9) was used to stratify the depression status as minimal (score 1-4), mild (score 5-9), and moderate to severe (score ≥ 10). Diabetes associated macro- and micro-vascular complications were carefully evaluated via reviewing the medical records with physical examination during registry and their associations with the severity of depression were further assessed using logistic regression analysis.

Results: In the patients with long-duration T2DM, the severity of depression was positively associated with cardiovascular disease, peripheral arterial occlusion disease (PAOD) and neuropathy (p value of 0.002, 0.025 and 0.003, respectively). After adjusting multiple variable factors, having cardiovascular disease was associated with increased risk for both mild and moderate to severe depression, with an odds ratio (OR) of 1.75 (95% confidence interval [CI]: 1.05 to 2.91) and 2.67 (95% CI: 1.35 to 5.29), respectively. PAOD also significantly increased the risk of moderate to severe depression (OR of 2.75, 95% CI: 1.20 to 6.33), and polyneuropathy considerably increased the risk of mild depression (OR of 1.82, 95% CI: 1.21 to 2.76). Whereas, in patients with newly diagnosed T2DM, there is decreased prevalence of depression and the status of macro- and micro-vascular comorbidities does not meaningfully increase the risk of depression.

Conclusions: Longer duration of type 2 diabetes with the development of cardiovascular disease, PAOD or polyneuropathy may exacerbate the depression, which will require more attention in the clinical practice.

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

INVESTIGATION OF THE EFFECTS OF SUCRALOSE CONSUMPTION ON INSULIN SENSITIVITY

未來

1MENG-JIE

李淳權

馬偕紀念醫院

TSAI, 2HSIU-LING PAI, 1,3HORNG-YIH OU, 3HUNG-TSUNG WU

1Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.; 2Graduated Institute of Metabolism and Obesity Science, College of Nutrition, Taipei Medical University, Taipei City, Taiwan.; 3Department of Internal Medicine, School of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

、

；

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

Background: Although it is recommended that subjects with diabetes or obesity may use these sugar substitutes to control their body weight and glycemic status, previous studies indicated that consumption of artificial sweeteners exerted adverse effects on glycemic homeostasis. Sucralose is one of the widely used sweeteners in food products. However, the effects and detail mechanisms of sucralose on insulin sensitivity remains unclear.

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Methods: Eight-week-old male C57BL/6 mice were randomly divided into three groups, fed with chow diet (Chow group), high-fat diet (HFD group) and HFD supplemented with 0.06% sucralose (HFSUC group), and each group of the mice was received the diet for two-week. Oral glucose tolerance test and insulin tolerance test were used to determine effects of sucralose supplement on insulin sensitivity. Western blot was used to investigate the mechanisms.

Results: Bolus administration of sucralose increased insulin secretion to decrease plasm glucose level in mice. However, supplement of sucralose augmented HFD-induced insulin resistance and glucose intolerance. In addition, sucralose decreased insulin sensitivity by interfering insulin signal transduction through MAPK/ERK pathway in HepG2 cells. Inhibition of IRE1α and taste receptor type 1 member 3 (T1R3) reversed sucralose-induced insulin resistance in HepG2 cells.

Conclusions: Sucralose augments HFD-induced insulin resistance in mice, and interrupts insulin signal transduction through MAPK/ERK pathway in HepG2 cells. Sucralose activates T1R3 and induces ER stress, thus contributes to the development of insulin resistance.

INTERVENTION OF CONTINUOUS GLUCOSE MONITORING CAN IMPROVE GLYCEMIC CONTROL IN PATIENTS WITH TYPE 1 DIABETES

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

MELANIE DAVIS

Diabetes Medicine, University of Leicester

1WEI-YU CHEN, 1,2CHEN-KAI CHOU, 1,2JUNG-FU CHEN, 1,2FENG-CHIH SHEN

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Taiwan; 2College of Medicine, Chang Gung University, Taoyuan, Taiwan

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

INTRODUCTION: The use of continuous glucose monitoring (CGM) is known to be an efficient tool for type 1 diabetes (T1D) management. As CGM has become more accurate and the technology has evolved, previous research has demonstrated CGM can improve glycemic control. The objective of the current study was to assess the effects of CGM on glycemic control in patients with T1D.

• personalised approach

• approaches for implementation

METHODS: Patients with T1DM (aged 16–78 years) who has received CGM from June, 2017 to August, 2021 in Kaohsiung Chang Gung Memorial Hospital were recruited. The values of HbA1c at the time of performing CGM and 3 and 6 months after CGM were recorded for analysis. In addition, the glycemic control parameters of CGM such as time in range (TIR), time above range (TAR) and time below range (TBR) were obtained.

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

RESULTS: A total of 73 patients (age 42.1 ± 13.9 years) with T1DM were included for analysis. A significant improvement of HbA1c was obtained at 3 and 6 months after each CGM intervention (MeanHbA1c at baseline vs. 3 months vs 6 months, 8.6% vs. 8.3% vs. 8.4%, ptrend = 0.017). Among these study patients, 57 of them had received one time of CGM, 12 patients for 2 times, and 4 patients for 3 times, respectively. For patients with 2 times of CGM, the TIR of the 2nd intervention was nonsignificantly increased as compared to the first intervention (45.3 ± 6.0% vs. 39.8 ± 5.1% , p = 0.238). Likewise, the TAR and TBR revealed non-significantly changed. For patients with 3 times of CGM, a significant improvement of TIR (18.5 ± 5.7% vs. 27.3 ± 3.2% vs. 55.5% ± 2.6%, p trend < 0.001) and TAR (74.8 ± 3.3% vs. 70.5 ± 3.1% vs. 39.2 ± 4.6%, p trend < 0.001) was obtained at the 3rd intervention.

CONCLUSION: Among the patients with poorly control T1DM, use of CGM resulted in significantly lower HbA1c levels at 3 months after intervention. In addition, a significant improvement of glycemic control parameters (TIR and TAR) can be obtained in patients receiving 3 times of CGM but not 2 times.

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

INVESTIGATE THE ROLES OF SGLT2 (SODIUM-GLUCOSE COTRANSPORTER 2) ON THE CELLULAR BIOLOGY OF REGIONAL ADIPOSE TISSUE

李淳權

1YU-CIAN HUANG, 2FENG-CHIH KUO, 1,2CHIEN-HSING LEE

馬偕紀念醫院

1Department and Graduate Institute of Biochemistry, National Defense Medical Center, Taipei, Taiwan; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為

、

；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Background: Increasing body mass index (BMI) and fat content are associated with a higher risk of cardiometabolic disease in those overweight and obese subjects. Recent studies have pointed out that the gain of regional adipose tissue is more highly correlated with cardiometabolic diseases than BMI. Subcutaneous fat in the human body is mainly distributed in two parts, namely the subcutaneous fat tissue of the abdomen and the subcutaneous fat tissue of the gluteus. Current studies have found that the functions of these two subcutaneous fat tissues are significantly different. A recent study has revealed that after correcting for total fat mass, subcutaneous fat mass in the gluteus is negatively correlated with insulin resistance and dyslipidemia. Dapagliflozin is an SGLT2 inhibitor is to inhibits the renal tubular reabsorption of glucose to lower blood glucose and improve body weight. Recent literature indicated that SGLT2 inhibitor also plays an important role in adipocytes. However, research on the function of SGLT2 and its inhibitor in regional adipose tissue is still lacking.

Methods: We utilized the paired immortalized abdominal and gluteal preadipocytes to explore the changes of SGLT2 expression in the differentiation process and free fatty acids and Dapagliflozinmediated detrimental and differential impacts on both abdominal and gluteal fat depots.

Results: The results showed that Oil Red O staining, PPARγand C/EBPα were significantly enhanced during adipocyte differentiation. In addition, the expression of SGLT2 in both cells decreased significantly with the differentiation time. We further disclosed the Oil Red O staining, SGLT2 expression, and possible downstream signaling (pIRS1, pAKT, pAMPK) were changed after adding free fatty acid. However, it showed different trends in the two adipocytes. Further SGLT2 knockdown and the addition of Dapagliflozin will be used to detect the changes in the above functions.

Conclusions: Our results initially provide the role of SGLT2 in local adipocyte biology, and further study will elucidate the effect of SGLT2 and its inhibitor on local adipocyte functions.

HLA-DQA1 AND TYPE 1 DIABETES IN CHILDREN

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

1,2,3,4YJ LEE, 1CI CHAN, 6,7FS LO, 1,3,5WH TING, 1,3,5CY HUANG, 8CH LIN, 1LT WANG, 8BW CHENG, 9YL WU, 2CL LIN, 2WS LIN, 2CC CHU, 2M LIN, 2YP LIEN

MELANIE DAVIS

Diabetes Medicine, University of Leicester

1Pediatric Endocrinology, MacKay Children's Hospital; 2Medical Research, MacKay Memorial Hospital Tamsui District; 3Medicine, Mackay Medical College; 4Pediatrics, School of Medicine, College of Medicine, Taipei Medical University; 5MacKay Junior College of Medicine, Nursing, and Management; 6Pediatrics, Chang Gung Memorial Hospital; 7College of Medicine, Chang Gung University; 8Pediatrics, Mackay Memorial Hospital HsinChu Branch; 9Pediatric Endocrinology and Metabolism, Chuanghua Christian Children's Hospital

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

Background: Type 1 diabetes (T1D) is characterized by T cell-mediated destruction of β cells and genetic clustering. HLA complex contributes up to 50% of genetic susceptibility. The susceptibility might be determined by the DQ locus. Therefore we investigated the DQA1 gene in Han Chinese living in Taiwan.

• approaches for implementation

Patients and controls: The patients were 814 unrelated children (376 boys, 438 girls) with T1D. Their mean age at diagnosis was 8.1 ± 4.2 (range, 0.8– 18.0) years. The control subjects were 558 adults (221 men, 337 women).

Methods: HLA-DQA1 genotypes were typed with sequence-based typing.

Results: DQA1*03, *05, and *01:02 were the 3 most frequent alleles in controls and accounted for 30.9%, 20.7%, and 17.3%, respectively. Allele DQA1*05 was significantly more frequent in patients than in controls and conferred a risk of T1D (OR (95% CI) = 2.43 (2.04-2.89), Pc = 7.91E23). So was *03 (OR = 2.33 (1.99-2.73), Pc = 1.96E-24). Whereas *06:01 was significantly less frequent in patients than in controls and rendered protection against T1D (OR = 0.10 (0.06-0.15), Pc = 4.79E-27). So were *01:03 (OR = 0.13 (0.08-0.20), Pc = 5.27E-19), *01:01 (OR = 0.14 (0.09-0.20), Pc = 4.63E-22), and *01:02 (OR = 0.19 (0.14-0.25), Pc = 1.02E-31). DQA1*03/*05:01, *01:02/*03, and *03/*03 were the 3 most frequent genotypes in controls and significantly associated with T1D. DQA1*03/*05:01, *03/*03, and *05:01/*05:01 conferred risk of T1D.

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Conclusion: DQA1 was associated with T1D in Han Chinese in Taiwan. DQA1*05 and *03 conferred susceptibility to T1D while *06:01, *01, *01:02, and *01:03 rendered protection against T1D. Genotype *03/*05, *05/*05, and *03/*03 conferred risk of T1D.

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

COMPARISONS BETWEEN DIFFERENT ANTI-OSTEOPOROSIS MEDICATIONS ON POSTFRACTURE MORTALITY: A POPULATIONBASED STUDY

李淳權

馬偕紀念醫院

1,2,3CHIH-HSING WU, 2,4CHIA-CHUN LI, 5YU-HSUAN HSU, 6FU-WEN LIANG, 3YIN-FAN

CHANG, 7JAWL-SHAN HWANG

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為

、

；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標）

與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

；

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

1Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 2Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 3Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 4Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 5Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 6Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan; 7Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Chang Gung University, Taiwan

Background: Osteoporosis is becoming a global epidemic in aging societies. Anti-osteoporotic medications (AOMs) can prevent fractures, and their pleiotropic effect on mortality is interesting but not well elucidated. To provide real-world evidence on the pleiotropic effect of different antiosteoporotic medications on all-cause mortality, stratified by fracture site, sex, and age.

Methods: This was a longitudinal population-based cohort study of the 23 million people in Taiwan. Subjects ≥ 40 years old with osteoporotic fracture who used AOMs were recognized in Taiwan's National Health Insurance Research Database (NHIRD) from 2009 to 2017 and followed until 2018. A Multivariate Cox proportional hazards model adjusted for immortal time bias was used to evaluate the association between fracture sites and all-cause mortality.

Results: A total of 46,729 subjects with an average age of 74.45 years old (80.0% female) and a mean follow-up of 4.73 years were enrolled. In the total fracture group, compared with raloxifene and bazedoxifene, alendronate/risedronate (HR 0.83 [0.79-0.88]), denosumab (HR 0.86 [0.81-0.91]), and zoledronic acid (HR 0.78 [0.73-0.84]) resulted in significantly lower mortality according to a Cox regression model, and similar trends were observed in the hip, vertebral or nonhip/nonvertebral fracture groups. Subjects receiving long-acting zoledronic acid showed the lowest mortality in the subanalysis according to sex or age over 65 y/o.

Conclusions: This real-world mega data study suggests that the usage of osteoporotic medication, especially the long-acting regimen, may result in lower postfracture mortality.

ASSESSMENT OF EARLY-TRIMESTER MATERNAL THYROID FUNCTION AND IODINE NUTRITIONAL STATUS OF PREGNANT WOMEN IN NORTHERN TAIWAN

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

MELANIE DAVIS

Diabetes Medicine, University of Leicester

1GUAN-YU SU, 4,5,6CHANG-CHING YEH, 2,3,7,8CHEN-CHANG YANG, 1,2CHII-MIN HWU, 1,2HARN-SHEN CHEN, 1,9FAN-FEN

WANG, 1,2,3CHUN-JUI HUANG

1Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 2Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 3Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 4Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; 5Department of Obstetrics & Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; 6Department of Obstetrics and Gynecology, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 7Institute of Environmental & Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 8Division of Clinical Toxicology & Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 9Department of Medicine, Yangming Branch, Taipei City Hospital, Taipei, Taiwan

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Background: The American Thyroid Association (ATA) has proposed to lower the earlytrimester upper limit of the TSH reference interval to become 0.5 mIU/L less than the non-pregnant value. However, this may not be appropriate in Taiwan and local-regional reference intervals are needed. The aim of the study is to evaluate the early-trimester thyroid function and iodine nutritional status of pregnant women in Taiwan.

Methods: Women aged 20 years and above who were in the early trimester (gestation 8 to 15 weeks) of pregnancy were recruited in Taipei Veterans General Hospital from March 2019 to July 2022. Thyroid function and antibodies, including TSH, free T4, free T3, total T4, total T3, antithyroglobulin antibody (aTG) and anti-thyroidperoxidase antibody (aTPO), TSH receptor antibody, were measured. The gestation-specific thyroid function reference range was derived from the 2.5th and 97.5th percentiles of the studied women. Random spot urine sample was collected and urinary iodine concentration was checked by inductively coupled plasma mass spectrometry. A simple food frequency questionnaire was also completed.

Results: A total of 211 women were enrolled and the derived early-trimester upper limit of serum TSH (median: 0.92 [0.007-3.08] uIU/mL) was lower than the value provided by the manufacturer (0.27-4.2 uIU/mL), while the upper limit of free T4 (median: 1.28 [0.93-2.15] ng/dL) and free T3 (3.00 [2.30-5.10]ng/dL) were both higher than the non-pregnant value (0.93-1.7 ng/dL and 2.0-4.4 ng/ dL, respectively). The range of total T4 (median: 9.90 [6.39-15.36] ng/dL) and total T3 (median: 136 [89.50-223.20] ng/dL) in the studied women were similar to the non-pregnant range (5.1-14.1 ng/dL and 80-200 ng/dL, respectively). The positivity rate of aTG & aTPO were 8.6%. Two patients with mild Graves’ disease and three patients with subclinical hypothyroidism were incidentally detected

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

李淳權

馬偕紀念醫院

and treated. The positive predictive value for detecting thyroid dysfunction using the non-pregnant reference interval was only 15.9% because subclinical hyperthyroidism (18.2%, n = 37) would be over-diagnosed and subclinical hypothyroidism (1.0%, n = 2) would be under-diagnosed. The overall median UIC was 160.9 μg/L, indicating a sufficient iodine status. Dairy products were the most commonly consumed iodine-containing food type with 71.8% of the pregnant women ingesting dairy products ≥ 3 days/week. The median intake frequency for seaweed, fish, and seafood were one day per week. Approximately 34.0% of the women took multivitamin every day, but 58.4% of the women never took multivitamin.

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人 照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為

、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

Conclusions: Our results indicate that the iodine nutritional status in the early trimester of pregnancy is adequate and that the upper limit of serum TSH was approximately 1.12 uIU/mL lower than the upper limit provided by the manufacturer. Gestation-specific thyroid function reference intervals are needed for correct diagnosis of thyroid dysfunction in pregnancy.

、

、

3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

CUSHING SYNDROME IS ASSOCIATED WITH A HIGHER RISK OF CANCERS - A NATIONWIDE STUDY

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

1WAN-CHEN WU, 1TIEN-SHANG HUANG, 2CHUNG-YI LI,

MELANIE DAVIS

Diabetes

Medicine, University of Leicester

1HUNG-YUAN LI

1Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; 2Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

Background: If patients with endogenous Cushing syndrome (CS) have a higher incidence and mortality of cancers remains unknown.This study is to investigate if endogenous CS is associated with increased cancer incidence and mortality.

• personalised approach

• approaches for implementation

Methods: This is a nationwide cohort study and we analyze the records of the National Health Insurance (NHI) program in 2006-2017. Between 2006-2017, 1278 patients with newly diagnosed endogenous CS were identified from the Taiwan NHI program. We depicted the biannual secular trend in the incidence rate and the demographic characteristics of endogenous CS. Among them, 1246 patients with endogenous CS but without a history of malignancy were enrolled from the same program. We calculated incidence rate, age-sex-calendar year standardized incidence ratio, and standardized mortality ratio for all-cause cancers in these patients.

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Results: The age- and sex-standardized incidences of CS decreased from 4.84 to 3.77 per million person-years between 2006-2017. Average age at diagnosis of CS was 44.92 ± 14.72 years and 80.1% were female. Among these patients, 35.4% of them had Cushing disease and 64.6% of them had adrenal CS. The incidence of all-cause cancers in patients with CS was 7.77 (95% CI: 5.84-10.14) per 1000 person-years and the age-sex-calendar year standardized incidence ratio of all-cause cancers was 2.08 (95% CI:1.54-2.75). The top three cancer types were liver (27.7%), kidney (16.7%), and lung (13.0%). The standardized mortality ratio of cancer mortality in patients with CS was 1.56 (95% CI: 0.94-2.43).

Conclusions: Patients with endogenous CS have a higher risk of all-cause cancers.

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

VISCERAL ADIPOSITY PREDICTS THE RISK OF NEW-ONSET DIABETES IN PRIMARY ALDOSTERONISM

李淳權

1LEAY KIAW ER, 2CHIN-CHEN CHANG, 3JIN-YING LU, 4WAN-CHEN WU, 5YAO-CHOU TSAI, 6YEN-HUNG LIN

馬偕紀念醫院

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Tzu-Chi Hospital; 2National Taiwan University; 3National Taiwan University; 4National Taiwan University; 5Taipei Tzu-Chi Hospital; 6National Taiwan University

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、

；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

Background: There is high prevalence of diabetes mellitus (DM) in patients with primary aldosteronism (PA). However, it remains unclear whether a relationship between visceral adiposity and new-onset diabetes mellitus (NODM) in patients with PA.

、

3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

Methods: Patients aged > 18 years who had been diagnosed with PA were prospectively recruited between 2010 and 2020. We used a self-developed CT-based software program to quantify the abdominal adiposity indexes, including visceral adipose tissue (VAT) area, VAT ratio, subcutaneous adipose tissue (SAT) area and SAT ratio.

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Results: The risk of NODM in PA after targeted treatment was examined in 342 patients with PA (197 with bilateral and 145 with unilateral PA). There were 35 patients (10.2%) with PA had NODM after a mean 7.4 years of follow-up. Generalized additive model showed a positive nonlinear relationship between the risk on NODM against Log (VAT Ratio) ≥ -0.72 (High-VAT group). The high-VAT group (hazard ratio (HR), 5.31, p = 0.01) was an independent risk of NODM by COX proportional hazard model among PA patients after targeted treatments. Older age, higher BMI, higher waist-to- hip ratio, lower baseline aldosterone, higher diastolic BP and lower systolic BP were the risk for high VAT by logistic regression.

Conclusion: There were 10.2% patients of PA developed NODM after a mean 7.41 years of follow-up. We demonstrated high VAT increased the risk of NODM in patients with PA. Baseline visceral adiposity remained the pivotal role in the development of NODM after targeted treatments.

CLINICAL CHARACTERISTICS OF NEUTROPENIC PATIENTS

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

UNDER ANTI-THYROID DRUG: A RETROSPECTIVE COHORT STUDY IN TAIWAN

MELANIE DAVIS

Diabetes Medicine, University of Leicester

1CHIH-HSUEH TSENG, 2,3CHI-LUNG TSENG, 2,4HARN-SHEN CHEN, 2,4,5CHUN-JUI

HUANG

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

1Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 2Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; 3Division of Gastroenterology, Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan; 4Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 5Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

Background: Thionamide-induced agranulocytosis (TiA), is a rare adverse event with a reported incidence of around 0.1-1.75%. To reduce mortality, prompt recognition is critical but the differential diagnosis of TiA cases from non-TiA neutropenia can be challenging as other causes of neutropenia, such as concomitant chemotherapy, liver dysfunction or infection, may simultaneously exist. The present study aimed at investigating the possible factors associated with the development of TiA.

Method: This is a retrospective cohort study of patients treated with anti-thyroid drugs (ATDs) in Taipei Veterans General Hospital from 2006-2018. Patients who developed a neutropenic event under treatment of ATDs were identified from the medical records. TiA was defined as (1) development of neutropenia under treatment or within 7 days of previous exposure to the same ATDs; (2) total recovery of neutropenia within one month after discontinuation of the culprit drug with absolute neutrophil count > 1500/μL; (3) exclusion of other causes for neutropenia. The incidence and risk factors for developing TiA were analyzed and compared to those with non-TiA neutropenia.

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Results: Among 6644 patients treated with ATDs, 66 (mean age, 53 ± 15 years; 16.2% men) developed a neutropenic event and 20 were diagnosed with TiA (incidence: 0.3%). In univariate analysis, TiA was associated with shorter treatment duration, lesser cumulative ATD dosage, higher ATDs dosage, higher absolute neutrophil count and higher free T4 level at the time of the neutropenic event, compared to non-TiA neutropenia. After accounting for age, gender and time to neutropenia, ATDs dosage at the time of neutropenic event [odds ratio (OR) and 95% confident intervals (CIs): 635.47, 1.88-214562.36], free T4 level (OR and 95% CIs: 17.23, 1.02-290.58), and absolute neutrophil count (OR and 95% CIs: 1.00, 1.00-1.01) were still independently associated with TiA in multivariable logistic regression.

Conclusions: TiA patients were more likely to have higher free T4 level, higher absolute neutrophil count at the time of neutropenic event and had received higher dosage of ATDs, compared to non-TiA cases.

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

DUAL-TARGETED THERAPY IN RADIOACTIVE IODINE REFRACTORY DIFFERENTIATED THYROID CANCER: REAL-WORLD EXPERIENCE

未來

李淳權

CHIA-JUNG HSU, MIAW-JENE LIOU

馬偕紀念醫院

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

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為

、

；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

Background: Differentiated thyroid cancer patients who are refractory to radioactive iodine therapy (rrDTC) should consider kinase inhibitor therapy according to ATA guidelines. In Taiwan, there are two drugs reimbursed by government health insurance for rrDTC currently: sorafenib and lenvatinib. We report the efficacy and safety of this group of patients treated with dabrafenib plus trametinib.

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Methods: Patients with differentiated thyroid tumors harboring BRAFV600E mutation were evaluated. The inclusion criteria were (1) rrDTC, (2) intolerable to sorafenib or lenvatinib therapy, or (3) progressive disease after sorafenib and/ or lenvatinib use. They received dabrafenib plus trametinib until unacceptable toxicity, disease progression, or death. Progression-free survival, overall survival, and safety were evaluated.

Results: Twenty-eight patients had received dual-targeted therapy, male and female were evenly divided. The median age at initial diagnosis was 60.0 years old (IQR, 52.5,74.5). Fifteen patients (54%) received sorafenib and/ or lenvatinib before. The median cumulative dose of radioactive iodine during treatment was 355 millicurie (IQR, 110,560). The median duration of dual-targeted therapy was 15.9 months (IQR, 6.2, 18.9) with twenty-five patients (89 %) achieved progression free. The median progression free survival was 22.9 months (IQR, 11.16,-) and the median overall survival was 24.1 months (IQR, 18.94, -). Common adverse events were pyrexia (46%), nausea/ vomiting (25%) and bleeding (11%). No grade 3 or grade 4 adverse effects were detected.

Conclusion: For rrDTC patients with BRAF V600E mutation, dabrafenib plus trametinib may be considered as second line regimen.

THE INTERPLAY OF MITOCHONDRIAL QUALITY CONTROL AND META-INFLAMMATION

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

PEI-WEN WANG

MELANIE DAVIS

Diabetes Medicine, University of Leicester

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

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

The ancient path of human migration is from Africa to the Asian Pacific region. The evolution of the human mitochondrial genome is characterized by the emergence of ethnically distinct lineages or haplogroups. Mitochondrial haplogroups (MtHp) are drivers of evolutionary adaptation and disease susceptibility, and may determine the chronic low-grade inflammation in the innate immune system through nuclear genetic control in nutrient excess-induced metabolic disorders

• the review of the interventions

• personalised approach

• approaches for implementation

In Taiwan, the major haplogroups are B, D, F, and M. Our previous studies have found that subjects harboring the MtHp B4 have significant association with diabetes (OR, 1.54; P = 0.002), while subjects harboring D4 have resistance against diabetes (OR, 0.68; P = 0.02). We then successfully created the cybrid cells harboring the different mtDNA haplogroups for studying the impact of human mtDNA variant on cellular physiological performances, including (1) MtHp play an independent role in the pathogenesis of insulin resistance (IR) (2) diabetessusceptible MtHp B4 promotes meta-inflammation (3) MtHp affects mitochondrial dynamics and mitochondrial unfolded protein response (mtUPR). Recently, we demonstrated that MtHp have a better correlation to insulin requirement than nuclear genetic variants for T2DM in Taiwanese individuals.

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

C57BL/6J mice fed high fat diet (HFD) developed increased fat mass, cell size, inflammation, ROS expression, oxidative damage and mitochondrial biogenesis in visceral adipose tissue, as well as mitigating systemic glucose intolerance, IR and cellular senescence. ROS-scavenger NAC is able to ameliorate nutrient excess-induced metabolic aberration. This action is likely better expressed through early intervention.

Toll like receptor 4 (TLR4) knockout mice demonstrates higher nutrient storage in subcutaneous fat than visceral fat, reduced inflammation, ROS expression, and oxidative damage of visceral adipose tissue, as well as mitigating systemic glucose intolerance and IR. This data highlighted that the role of innate immune response in fat distribution and development of IR.

In our observation, T2DM patients have higher levels of serum mtUPR than controls, and there is an association between the trend of increasing microvascular complication and serum HSP60. Recently, using transgenic mice overexpressing Hsp60 (Hsp60-Tg), and human HepG2 cells transfected with Hsp60 cDNA or with Hsp60 siRNA, we revealed that mitochondrial HSP60 promotes fatty acid oxidation while repressing mitochondrial stress and inflammation to ameliorate the development of non-alcoholic fatty liver disease. This study reveals the hepatoprotective effects of HSP60 and indicates that HSP60 could play a fundamental role in the development of therapeutics for meta-inflammation.

DAROC-TADE-2

AP-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

李淳權

CORTISOL-PRODUCING ADENOMA-RELATED SOMATIC MUTATIONS IN UNILATERAL PRIMARY ALDOSTERONISM WITH CONCURRENT AUTONOMOUS CORTISOL SECRETION: THEIR PREVALENCE AND CLINICAL CHARACTERISTICS.

馬偕紀念醫院

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為

1WAN-CHEN WU, 2KANG-YUNG PENG, 1JIN-YING LU, 3CHIEH-KAI CHAN, 1CHIH-YUAN WANG, 1FEN-YU TSENG, 1WEI-SHIUNG YANG, 4YEN-HUNG LIN, 4PO-CHIH LIN, 5TING-CHU CHEN, 6KUO-HOW HUANG, 6,7JEFF S CHUEH AND 8VIN-CENT WU

、

；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

、

；

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

1Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.; 2Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.; 3Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, HsinChu Branch, Hsinchu City, Taiwan.; 4Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.; 5Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu City, Taiwan.; 6Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.; 7Department of Urology, College of Medicine, National Taiwan University, Taipei, Taiwan; and 8Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

Objective: Concurrent autonomous cortisol secretion (ACS) in patients with primary aldosteronism (PA) is being reported more frequently. Several somatic mutations including PRKACA, GNAS, and CTNNB1 were identified in cortisol-producing adenomas (CPAs). The presence of these mutations in unilateral PA (uPA) patients concurrent with ACS (uPA/ACS) is not well known. This study aimed to investigate the prevalence of these mutations and their clinical vs. pathological characteristics in uPA/ ACS.

Methods: Totally 98 uPA patients from the Taiwan Primary Aldosteronism Investigation registry having overnight 1-mg dexamethasone suppression test (DST) and adrenalectomy from 2016 to 2018 were enrolled. Their adrenal tumors were tested for PRKACA, GNAS, and CTNNB1 mutations.

Results: 11 patients had CPA-related mutations (7 PRKACA and 4 GNAS). The patients carrying these mutations had higher post-DST cortisol (5.6 vs. 2.6 μg/dL, P = 0.003) and larger adenoma (2.2 ± 0.3 vs. 1.9 ± 0.7 cm, P = 0.025). Adenomas with these mutations had a higher prevalence of nonclassical uPA (72.7% vs. 26.3%, P = 0.014). Numerically, slightly more complete clinical success of uPA patients with these mutations was noticed after adrenalectomy, although it was statistically nonsignificant. Post-DST cortisol levels, adenoma size >1.9 cm, and the interaction of adenoma size > 1.9 cm with potassium level were found to be associated with the presence of these mutations.

Conclusion: Our study showed that CPA-related mutations were detected in 36.7% of uPA/ ACS adenomas. The presence of these mutations was associated with higher post-DST cortisol levels,

PL-1

larger adenoma sizes, and a high percentage of non-classical uPA. However, these mutations did not significantly affect the clinical and biochemical outcomes after adrenalectomy of uPA/ACS patients, but they showed a better trend.

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

MELANIE DAVIS

Diabetes Medicine, University of Leicester

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

ABERRANT OVEREXPRESSION OF HOTAIR INHIBITS ABDOMINAL ADIPOGENESIS THROUGH REMODELLING OF GENOME-WIDE DNA METHYLATION AND TRANSCRIPTION

李淳權

馬偕紀念醫院

1F-C KUO, 2,3,4Y-C HUANG, 2M-R YEN, 1C-H LEE, 5K-F HSU, 6H-Y YANG, 7,8L-W WU, 1C-H LU, 9Y-J HSU, 2,3P-Y CHEN

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

、

及

；A1C 檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.; 2Institute of Plant and Microbial Biology, Academia Sinica, Taipei, Taiwan.; 3Bioinformatics Program, Taiwan International Graduate Program, National Taiwan University, Taipei, Taiwan.; 4Bioinformatics Program, Institute of Information Science, Taiwan International Graduate Program, Academia Sinica, Taipei, Taiwan.; 5Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.; 6Division of Cardiovascular Surgery, Department of Surgery, TriService General Hospital, National Defense Medical Center, Taipei, Taiwan.; 7Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.; 8Health Management Center, Department of Family and Community Medicine, Tri-Service General Hospital, National Defense, Medical Center, Taipei, Taiwan.; 9Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

Purpose: Abdominal adiposity is strongly associated with diabetic and cardiovascular comorbidities. The long noncoding RNA HOTAIR (HOX Transcript Antisense Intergenic RNA) is an important epigenetic regulator with fat depot-specific expression. Its functional roles and epigenetic regulation in abdominal adipogenesis remain uncertain.

Methods: We collected different fat depots from healthy, severely obese, and uraemic subjects to measure fat-depot specific gene expression and quantify regional adiposity via dual-energy X-ray absorptiometry (DXA). HOTAIR was overexpressed to evaluate its functional roles. Reduced representation bisulfite sequencing (RRBS), RNA-sequencing, real-time qPCR and RNA/chromatin immunoprecipitation were performed to analyse HOTAIR-mediated epigenetic regulation.

Results: A negative correlation between adipose tissue HOTAIR expression (arm or abdominal subcutaneous fat depots) and regional adiposity under the status of severe obesity or uraemia was observed. HOTAIR overexpression using human immortalized abdominal preadipocytes further revealed its anti-adipogenic effects. Integrative analysis of genome-wide DNA methylation by reduced representation bisulfite sequencing (RRBS) and gene expression was performed. Overall, the differentially methylated genes were functionally enriched for nervous system development, suggesting that HOTAIR may be epigenetically associated with cell lineage commitment. We specifically found that HOTAIR-mediated genes showed strong changes in both DNA methylation and gene expression during abdominal adipogenesis. We observed that two HOTAIR -repressed genes, SLITRK4 and PITPNC1, present an obesity-driven fat-depot specific expression pattern that is positively correlated with the central body fat distribution.

PL-1

Conclusions: Our study indicated that HOTAIR is a key regulator of abdominal adipogenesis via intricate DNA methylation and is likely to be associated with the transcriptional regulation of genes involved in nervous system development and lipid metabolism, such as SLITRK4 and PITPNC1.

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD CONSENSUS REPORT

MELANIE DAVIS

Diabetes Medicine, University of Leicester

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

EVALUATION OF DISEASE COMPLICATIONS AMONG ADULTS WITH TYPE 1 DIABETES AND A FAMILY HISTORY OF TYPE 2 DIABETES IN TAIWAN

李淳權

馬偕紀念醫院

1,2CHIA-HUNG LIN, 3FU-SUNG LO, 1YU-YAO HUANG, 1JUI-HUNG SUN, 1SZU-TAH CHEN, 4,5CHANG-FU KUO, 4MEI-YUN HSIEH, 1SHENG-HWU HSIEH

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為

、

；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan.; 2Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.; 3Division of Pediatric Endocrinology and Genetics, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan.; 4Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Linkou, Taiwan.; 5Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom.

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Patients with type 1 diabetes (T1D) and a family history of type 2 diabetes (T2D) appear to be at a high risk of diabetes complications and other cardiovascular diseases. However, estimates of individual risks in patients in Taiwan are largely unavailable or unreliable. A population-based cohort study used the Taiwan National Health Insurance Research Database. Participants included all individuals registered in that database on December 31, 2017, and followed up since March 1, 1995. The data were analyzed from December 6, 2018, to December 5, 2019. Patients with T1D and a family history of T2D were evaluated.

Of 27 370 965 individuals included in the database, 11 237 (mean [SD] age, 22.7 [14.4] years; 54% were female) had T1D. The crude prevalence of T1D was 0.04%, with a female to male ratio of 1.22: 1. The adjusted HRs in individuals who had a first-degree relative with T2D were 2.61 (95% CI, 1.325.16) for MACEs at an age at diagnosis of less than 20 years. Adjusted HRs were 1.44 (95% CI, 1.271.64) for diabetic nephropathy, 1.28 (95% CI, 1.12-1.47) for retinopathy, and 1.24 (95% CI, 1.06-1.47) for neuropathy at all ages of diagnosis.

In this study of patients in Taiwan with T1D, having relatives with T2D was associated with an increase in the individual risks of developing diabetes complications. Patients with T1D and a family history of T2D might have more complications and require close management.

Keywords: Type 1 diabetes, family history, Type 2 diabetes, major adverse cardiovascular events, complication

PDIA4, A NOVEL ER STRESS CHAPERONE, MODULATES ADIPONECTIN EXPRESSION AND INFLAMMATION IN ADIPOSE TISSUE

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

MELANIE DAVIS

Diabetes Medicine, University of Leicester

1SHENG-CHIANG SU, 2CHU-YEN CHIEN, 2YING-CHEN CHEN, 2CHI-FU CHIANG, 3FU-HUANG LIN, 1FENG-CHIH KUO,1 CHIA-LUEN HUANG, 1PENG-FEI LI, 1JHIH-SYUAN LIU, 1CHIEH-HUA LU, 1LI-JU HO, 1CHANG-HSUN HSIEH, 1,4YI-JEN HUNG, 1,2,4YI-SHING SHIEH, 1,4CHIEN-HSING LEE

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.; 2School of Dentistry, National Defense Medical Center, Taipei, Taiwan.; 3School of Public Health, National Defense Medical Center, Taipei, Taiwan.; 4Department and Graduate Institute of Biochemistry, National Defense Medical Center, Taipei, Taiwan.

• the review of the interventions

• personalised approach

• approaches for implementation

Purpose: Increasing evidence supporting a causal link between obesity and endoplasmic reticulum (ER) stress in adipose tissue is being reported. Protein disulfide isomerase 4 (PDIA4) is a novel ER chaperone involved in the pancreatic β-cells pathogenesis in diabetes. However, the role of PDIA4 in obesity progression remains poorly understood.

Method: To assess the relationship between PDIA4, adiponectin, and metformin, we used the palmitate-induced inflammation in hypertrophic adipocytes and the high-fat diet-induced obesity mouse model.

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Result: Our results revealed that palmitate-induced hypertrophic adipocytes exhibit obesityassociated conditions such as increased lipid accumulation, inflammation, and reduced glucose uptake. Pharmacological and genetic inhibition of PDIA4 significantly reverses these obesity-associated conditions in adipocytes. PDIA4 mechanistically promotes obesity progression via adiponectin downregulation. Furthermore, metformin modulates PDIA4 and adiponectin expression and improves obesity-associated conditions in both in vitro adipocytes and in vivo mouse models. Serum PDIA4 concentrations are also associated with body mass index, adiponectin, triglycerides, and inflammatory cytokines in humans.

Conclusion: This is the first study demonstrating that PDIA4 modulates adipocytes by downregulating adiponectin. Moreover, metformin may serve as a potential therapeutic for preventing obesity via PDIA4-targeting.

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

A RARE SERIOUS SKIN REACTION FOUND IN A HHS PATIENT USING DAPAGLIFLOZIN

1CHE-CHIEH LIAO, 1SHIH-TING TSENG, 1,2,3YUAN-HORNG YAN

李淳權

馬偕紀念醫院

1Department of Endocrinology and Metabolism, Kuang Tien General Hospital, Taichung, Taiwan; 2Department of Healthcare Administration, Asia University, Taichung, Taiwan; 3Department of Medical Research, Kuang Tien General Hospital, Taichung, Taiwan

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

Background: Dapagliflozin (Forxiga ®) is a highly potent, reversible and selective sodiumglucose cotransporter-2 inhibitor that improves glycemic control and gives a relative safety profile for patients with type 2 diabetes mellitus (T2DM).

、

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

Case report: We reported an unusual case of a male, diabetic patient that presented with hyperglycemic hyperosmolar state(HHS) and lactate acidosis in the emergency room with progressive dyspnea. The patient was subsequently diagnosed with Stevens-Johnson syndrome due to whole body toxic epidermal necrolysis.After reviewing all his drug history, Dapaglifloxin is doubted as the cause of serious skin rashes.

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Discussion/Conclusion: The drug relationship and clinic presentation exclude other drugs leading to the epidermal toxicity. Such acute eruption of drug reactions, although rare, can drastically impact patient care and may warrant increased provider consideration when choosing to prescribe Dapaglifloxin.

THE ASSOCIATION AMONG ATTITUDE, INTENTION, PERCEIVED USEFULNESS, EASE OF USE, SUBJECTIVE NORM, AND PERCEIVED FINANCIAL CONTROL FOR PEOPLE WITH T2DM IN ADOPTING AN INNOVATIVE SMART DIABETIC FOOT SCREENING SYSTEM

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

MELANIE DAVIS

Diabetes Medicine, University of Leicester

1TING-TING YEH, 2MIAO-YU LIAO, 2I-FENG

HSU, 2CHIA-CHIH CHANG

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

1Master Degree Program in Healthcare Industry, Chang Gung University, Taiwan, R.O.C.; 2Department of Physical Therapy, Chang Gung University, Taiwan, R.O.C.

• the overall approaches to care

• the review of the interventions

• personalised approach

Background: Diabetes Mellitus (DM) is a pressing global issue. Diabetic foot ulcer (DFU) is one of the most devastating complications of DM. Foot disease affects nearly 6% of people living with type 2 diabetes mellitus (T2DM) with a global recurrence rate of approximately 22.1% per personyear. The application of digital technology in healthcare is becoming a common practice and trend globally. While digital technology has become an important aspect of healthcare, its adoption of some of the digital health interventions in diabetic foot monitoring is lagging. The aim of the study was to investigate the association among Attitude, Intention, Perceived usefulness, Ease of use, Subjective norm, and Perceived financial control for people with T2DM in adopting an innovative smart diabetic foot screening system.

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Methods: One hundred people with T2DM completed an online version of a self-developed Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire. Structural equation modeling (SEM) analysis was used to determine the hypothesized model.

Results: One hundred people with T2DM (male = 46, female = 54) completed the online UTAUT questionnaire. Structural equation modeling (SEM) analysis revealed that people with T2DM who perceived higher Perceived usefulness and Ease of use had a positive and significant effect on Attitude and were more likely to adopt an innovative smart diabetic foot screening system.

Conclusions: This study confirmed the importance of the effectiveness and ease of use of the new technology in promoting people with T2DM to conduct home-based foot monitoring behaviors. The result of the study provides novel insights for medical device manufacturers in developing selfmonitoring DM foot monitoring systems.

DAROC-TADE-2

PD03

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

INSULIN INITIATION FOR PATIENTS WITH POORLY CONTROLLED TYPE 2 DIABETES MELLITUS

1HSIN-AN CHEN, 2CHIA-HUNG LIN, 2FENG-HSUAN LIU

李淳權

馬偕紀念醫院

1School of Medicine, Chang Gung University, Taoyuan, Taiwan, R.O.C.; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan, R.O.C

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

Background: The changes of initiating insulin therapy in poorly controlled type 2 diabetes (T2D) needs further study in Taiwan. Our study aims to study the glycemic responses and compare risk factors between patients with better and worse glycemic outcomes.

、

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

Methods: Patients with T2D starting first insulin therapy were analyzed. Glycemic data were followed up for six months. We analyzed the (1) effects of insulin initiation, (2) patients that responded better and worse to insulin, and (3) patients that responded more and less drastically to insulin.

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Results: Significant decreases of HbA1c and fasting blood glucose levels were noted by 3 months of therapy and continued to decrease after 6 months of therapy. Patients that responded better to insulin were statistically indistinguishable from worse responsive counterparts in either baseline glycemic profiles, age, sex, BMI, or diabetes history, but patients that responded better to insulin had lower HbA1c levels by as early as 3 months of therapy. Patients that responded more drastically to insulin had higher baseline HbA1c and fasting blood glucose levels than their less drastically responding counterparts, but not significantly different in either age, sex, BMI, or diabetes history.

Conclusions: The improvement of HbA1c can be achieved as early as 3 months after the initiation of insulin therapy in patients with poorly controlled T2D. Those that have higher baseline glycemic profiles may have more drastic responses to first insulin therapy.

A CASE REPORT OF SEVERE HYPERNATREMIA IN A PATIENT TREATED WITH JARDIACE

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

MELANIE DAVIS

JUI-HSIANG LI, SU-HUEY LO

Diabetes Medicine, University of Leicester

Division of Endocrinology and Metabolism, Department of Internal Medicine Tao-Yuan General Hospital

The patient is a 75-year-old female has dementia, Hypertension and Diabetes mellitus regular follow-up at our clinics with medication, Exelon Patch(10) 1pc qd, Neuroquel (25mg) 1# qhs, Diovan(160mg) 0.5# qhs, Zanidipine 1# qd, Jardiance (25mg) 1# qd, sennoside 2# qhs. This time, consciousness drowsiness with slower reaction was noted for 2 weeks before admission. One week before admission, she fall down twice when going to toilet in the night. She went to our clinic for help. Brain CT was performed. The result showed no ICH, IVH, brain atrophy. She came back. However, stupor and slow reaction gradually got worsen. She ate and drunk less. She was brought to ER for further evaluation. Physical exam showed E2V3M2, stable vital sign, no other active finding. Whole body CT showed "Cortical atrophy, no ICH. Urine analysis showed glucosuria (4+). Lab data showed hyperglycemia (sugar:579), Acute kidney injury(BUN/Cr:68.3/1.96), hypernatremia (Na:180), hyperosmolarity (osmolarity:400 ), ketonemia (1.60), leukocytosis (WBC:12360), metabolic acidosis (vein blood gas: pH/ HCO3-/PCO2/PO2:7.301/20.70/43/54, BE:-5.5, O2sat:83.5%), high lactate (2.45). IV insulin (100u in N/S100) and GIK solution was given. Flumarin was also given for R/O sepsis. Under the impression of 1.DM poor control with impending DKA and HHS 2. Hypernatremia 3. AKI due to dehydration 4.Suspect UTI, the patient was admitted. We kept IV insulin treatment ( RI 50u in N/S500) and adequate hydration (D5W500+RI 4u+ 20meqKCl). Her consciousness recovered after Na slowly dropped to 166 mg/dl. We change GIK solution to 0.45% NaCl. The Na finally was dropped to 148mg/dl. The blood sugar was around 89~200mg/dl under toujeo 14u qhs+ apidra 8u tidac. Other survey revealed a1c = 8.1, Urine Na = 84mmol/L, urine osmolarity = 791 mosm/kgH20. Purse her medical history, only jardiance was related with diuresis. There were 2 case report about SGLT-2i related hypernatremia in literature review. In this care-dependent outpatient, who lost the ability to replace water autonomously because of dementia and lethargy, continuous administration of empagliflozin caused persistent glucosuria and contributed to progressive volume depletion. In patients who were dementia or depend on support from others in daily tasks, including fluid intake, may be at particular risk of dehydration under SGLT2 inhibitor therapy. Therefore, SGLT2 inhibitor therapy should not be initiated in patients with an impaired sense of thirst or lost the ability to communicate thirst.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

ABNORMAL WAIST CIRCUMFERENCE INDICATOR IN METABOLIC SYNDROME INCREASES THE HIGHEST RISK WITH HYPOGONADISM IN TAIWANESE OVERWEIGHT AND OBESE MALE ADULTS

李淳權

1,2,3CHUN-CHENG LIAO, 1PO-SHENG HSU, 3CHIA-LIEN HUNG, 3,4DENG-HO YANG

馬偕紀念醫院

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

1Department of Family Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan, R.O.C.; 2School of Medicine, National Defense Medical Center, Taipei, Taiwan, R.O.C.; 3Department of medical education and research, Taichung Armed Forces General Hospital, Taichung, Taiwan, R.O.C.; 4Division of Rheumatology, Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan, R.O.C.

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標）

與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

、

及

；A1C 檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Background: Overweight and obesity that confer high-risk of diabetes and cardiovascular disease, even hypogonadism in male. So do metabolic syndrome (MetS) patients. But not knowing which MetS related parameters is the crucial risk factor with hypogonadism with overweight and obesity male adult. This study is aimed to assess which MetS related parameters are associated with hypogonadism in Taiwanese overweight and obesity male adults.

Methods: We conducted a retrospective cohort study by using database of MJ Health Research Foundation which contained 7,133 male adults who receive health check-ups in MJ health screening center from 2009-2017. Basic patient characteristics with relevant MetS parameters were obtained, including waist circumference (WC), HDL, TG, FBS and BP and hypogonadism defined as total testosterone T < 300 ng/dL in men. The chi-square test was used for categorical variables. Independent Sample t test was applied for comparing hypogonadism and without hypogonadism groups. The logistic regression model was applied for analyze the relationship between those with or without hypogonadism and the MetS parameters after adjusting for age in the different BMI groups (overweight and obese). Two-sided p < 0.05 was taken to indicate statistical significance. All statistical analyses were performed using SPSS software, Version 22.0 (IBM Corp., Armonk, NY, USA).

Results: A total 7,133 participants were recruited in this study, including 6,352 participants without hypogonadism and 781 participants with hypogonadism. The distribution of item following MS criteria was significantly different between participants with and without hypogonadism (p < 0.001). In stepwise logistic regression model, we found abnormal WC of MetS parameters was crucial risk factor for hypogonadism (OR, 3.437; 95% CI, 2.939-4.018, p < 0.001) and still most important risk factor for hypogonadism after adjusting for TG, HDL, FBS and BP (OR, 2.610; 95% CI, 2.213-3.078, p < 0.001). Finally, in logistic regression model, abnormal WC of MetS parameters was a crucial risk factor for hypogonadism in overweight and obesity male (OR, 2.200; 95% CI, 1.850-2.616, p < 0.001).

Conclusions: Abnormal WC of Metabolic syndrome parameters increases the risk with hypogonadism in Taiwanese overweight and obesity male adults. So, we might to test total testosterone on overweight and obese Taiwanese male with abnormal WC and found out whether these men had hypogonadism or not as soon as possible to reduce the serious complications of hypogonadism.

A CASE REPORT OF FULMINANT TYPE 1 DIABETES

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

JUI-HSIANG LI, SU-HUEY

CONSENSUS REPORT

LO

Division of Endocrinology and Metabolism, Department of Internal Medicine Tao-Yuan General Hospital

MELANIE DAVIS

Diabetes Medicine, University of Leicester

This 32 year old male denied any systemic disease before. He is a worker working in the night. He received three dose covid-19 vaccine and denied covid-19 infection. He denied any bad habitus such as drinking, smoking and Betel nuts chewing. He experienced Intermittent abdominal pain when walking about two weeks and Intermittent dizziness with headache for one week before this admission. He did not pay much attention to it. One day before admission, he suffered from frequent vomiting after meals. He went to LMD for help but in vain. The next day, due to symptoms of URI and vomiting, he went to our ER for help. At ER, vital sign recorded tachycardia (HR: 118/min). Physical examination revealed negative finding. Lab exam showed hyperglycemia (sugar:494mg/ dl) and metabolic acidosis (VBG:PH:7.155, PCO2/PO2/HCO3-:30.5/43.4/10.5mmHg), ketonemia (ketone:5.3mmol/L), hyperosmolarity (serum osmolarity:323mOsm/kgH2O), acute kidney injury (Cr:1.95mg/dl), DKA was impressed and he was admission. Normal saline hydration and IV insulin was given. The sugar level was control around 200mg/dl. Metabolic acidosis and keteonemia improvement. Purse his medical history, he denied weight loss, dietary habit change, recent trauma history, drug abuser or taking Chinese medicine. Further examination revealed C-peptide: 0.16ng/ ml, Glutamic acid decarboxylase antibody:54 (normal range < 10IU/ml), a1c = 6.2. He discharged with insulin therapy ( toujeo 14u qhs+ apidra 7u tidac). According to Report of the Committee of the Japan Diabetes Society on the Research of Fulminant and Acute-onset Type 1 Diabetes Mellitus (2012), Fulminant type 1 diabetes mellitus is confirmed when all the following three findings are present:(1) Occurrence of diabetic ketosis or ketoacidosis soon (approximately 7 days) after the onset of hyperglycemic symptoms (2) Plasma glucose level ≥ 288 mg/dL and glycated hemoglobin level < 8.7% at first visit (3) Urinary C-peptide excretion < 10 μg/day or fasting serum C-peptide level < 0.3 ng/mL ( < 0.10 nmol/L) and < 0.5 ng/mL ( < 0.17 nmol/L) after intravenous glucagon (or after meal) load at onset. Fulminant T1D was highly suspected for this male. All medical practitioners must remember that fulminant type 1diabetes—an extremely rapidly progressing type of diabetes—does exist and they must pay special attention not to overlook this disease.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

INVESTIGATION OF THE EFFECTS OF ENDOGENOUS SORBITOL INCREMENTS ON HEPATIC INSULIN SENSITIVITY IN HYPERGLYCEMIC CRISIS

李淳權

1YU-CHENG

馬偕紀念醫院

LIANG, 2YING-JU LIN, 1,3HORNG-YIH OU, 3HUNG-TSUNG WU

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

1Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, R.O.C.; 2Graduated Institute of Metabolism and Obesity Science, College of Nutrition, Taipei Medical University, Taipei City, Taiwan, R.O.C.; 3Department of Internal Medicine, School of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan, R.O.C.

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

、

及

；A1C 檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

Background: Hyperglycemia activates polyol pathway to increase the production of endogenous sorbitol, and increment in sorbitol is associated with many diabetic complications. However, the effects and detail mechanisms of endogenous sorbitol increments on insulin sensitivity in hyperglycemic crisis remain obscure.

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Methods: A total of 29 subjects with hyperglycemic crises was enrolled and the blood samples were collected for biochemistry test and determination of sorbitol levels. Hepatic sorbitol levels of streptozotocin (STZ)-induced diabetic mice were analyzed by triple quadrupole liquid chromatograph/ mass spectrometer system. HepG2 cells were treated with sorbitol to investigate molecular mechanisms by western blot analyses.

Results: The serum sorbitol concentrations were significantly decreased in subjects with hyperglycemic crises after correction of hyperglycemia, and were positively correlated with alanine transaminase. Similarly, both serum and hepatic sorbitol levels of sorbitol were significantly increased in STZ-induced diabetic mice. In addition, treatment of sorbitol in HepG2 cells generated reactive oxygen species (ROS), and increased phosphorylation of extracellular signal regulated kinase (ERK) 1/2 to induce insulin resistance and gluconeogenesis through sweet taste receptors (STR). Moreover, we found that treatment of STR inhibitors significantly improved hyperglycemia-induced insulin resistance and gluconeogenesis in STZ-induced diabetic mice.

Conclusions: Endogenous sorbitol activates STR and then facilitates ROS production. These effects further activate ERK 1/2 pathway to develop hepatic insulin resistance in hyperglycemia.

SPIKE PROTEIN 1 (S1) OF SARS-COV-2 LINKS WITH AMYLOID Β

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

AGGREGATION TO INTENSIFY RENIN-ANGIOTENSIN SYSTEM IN HGH FAT DIET

MELANIE DAVIS

Diabetes Medicine, University of Leicester

1PI-CHEN LIN, 1,2KUAN-HSUAN CHEN, 1,2HSING-YI HUANG, 3CHAO-HUNG CHEN

1Division of Endocrinology and Metabolism, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 2Department of Internal Medicine, Kaohsiung Municipal TaTung Hospital, Kaohsiung Medical University; 3General Research Service Center, National Pingtung University of Science and Technology, Pingtung, Taiwanrsity, Kaohsiung.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

Background: In clinic, SARS-CoV-2 infection can increase the severity of COVID-19 in diabetes, obesity leading aggravation of pre-existing cardiovascular (CV) diseases or acute-onset of new complications. However, the molecular mechanism how SARS-CoV-2 involves renin-angiotensin system (RAS) has been researched. Currently, the amyloid β (Aβ) has been considered risks of metabolic syndrome-associated complications, especially in vascular system. Therefore, this study tried to investigate linkages of COVID-19 renin-angiotensin system in vivo study

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Methods: SARS-CoV-2 pseudovirus, rVSV-ΔG-spike S1+S2 and rVSV-spike S2 were vein-injected to chow or high fat diet (HFD) hamster (once a day) for 14 days for mimicking acute SARS-CoV-2 infection. Blood was sampled twice in a week for analyzing renin, Aβ. ACE (angiotensin-converting enzyme), ACE2 (angiotensin-converting enzyme 2), angiotensin II (AngII), Angiotensinogen (AGT). Especially, Aβ-rVSV-ΔG-spike or ACE2-Aβ-rVSV-ΔG-spike, or ACE2rVSV-ΔG-spike were detected in serum by immunoprecipitation.

Results: At HFD condition, the renin, Aβ. ACE, AngII, and AGT were significant increase in rVSV-ΔG-spike S1+S2 injected group compared with rVSV-ΔG-spike S2 injected group. At chow diet These biochemical data were not significant changes between rVSV-ΔG-spike S1+S2-injected or rVSV-ΔG-spike S2 injected chow hamsters. At rVSV-ΔG-spike S1+S2 injection, immunoprecipitation showed that Aβ-rVSV-ΔG-spike S1+S2 is significant expression in HFD hamsters compared with chow hamsters. At rVSV-ΔG-spike S2 injection, Aβ-rVSV-ΔG-spike S2 did not expression in HFD and chow hamsters.

At rVSV-ΔG-spike S1+S2 injection ACE2-rVSV-ΔG-spike S1+S2 complexes significantly expressed in HFD hamsters compared with chow hamster. At rVSV-ΔG-spike S2 injection, ACE2rVSV-ΔG-spike S2 complexes did not expressed in HFD and chow hamster.

Conclusions: Above results showed that S1 protein of SRAS-CoV2 could bind to Aβ for higher affinity to ACE2 resulted in activation of RAS, suggesting preliminary mechanism about SARS-CoV-2 involving renin-angiotensin system (RAS). This mechanism might be a cause of acute-onset of new complications in cardiovascular system of COVID-19 with metabolic syndrome.

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

VITAMIN D REGULATES SERUM LIPID LEVELS DISCREPANTLY IN ADULTS WITH AND WITHOUT DYSLIPIDEMIA

未來

李淳權

1YING-LIEN CHENG

1TING-I

LEE,

1YU-MEI CHIEN, 2YI-JEN CHEN, 1TING-WEI LEE

,

馬偕紀念醫院

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 2Cardiovascular Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為

、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

Background: Vitamin D deficiency is associated with hyperlipidemia, but it remains unclear whether vitamin D supplementation reduces serum lipid levels. The aims of this study were to investigate the associations between increased serum 25-hydroxyvitamin D (25(OH)D) concentrations and lipid levels, and identify the patient characteristics with or without lipid reduction associated with increased 25(OH)D levels.

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Methods: A total of 118 individuals (53 men; mean age, 54.4 +- 10.6 years) were retrospectively included. Biochemistry data and patient characteristics were collected. The associations of increased 25(OH)D levels and serum lipid levels were assessed through t tests and logistic regression analysis was performed to evaluate the independent biomarkers. Excel 2013 spreadsheet was used as research tool and SPSS 22.0 was performed for statistical analysis.

Results: Patients exhibited significantly increased levels of 25(OH)D were associated with decreased levels of triglycerides (TG). The individuals who responded to vitamin D ( ≥ 10% reduction in TG or total cholesterol (TC) levels) exhibited significantly higher baseline TG and TC levels than did those who did not. Only patients with hyperlipidemia at baseline exhibited significantly reduced TG and TC levels at follow-up. However, increasing serum 25(OH)D concentrations were significantly correlated with decreasing lipid levels in individuals with baseline 25(OH)D levels of < 30 ng/mL, in men (not in women), and in individuals aged 50–65 years (not in patients younger than 50 years or older than 65 years).

Conclusions: Vitamin D supplementation is particularly helpful for the treatment of hyperlipidemia in middle-aged men with vitamin D deficiency.

Keywords: age; cholesterol; lipid; triglycerides; vitamin D

THE RISK FACTORS OF SUDOMOTOR DYSFUNCTION IN PATIENTS WITH TYPE 2 DIABETES

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

MELANIE DAVIS

1JHENG JIA WU, 1YUN SHING PENG, 1CHEN HO, 1PAO YIN CHEN, 1HSIAO YUN YEH, 1CHIA PEI CHEN, 1HSING JUNG HUANG, 1YUNG HSIANG LIN

Diabetes Medicine, University of Leicester

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Taiwan, R.O.C.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

Background: Many clinical parameters were reported to have relationship with electrophysiological diagnosed peripheral sensorimotor nerve dysfunction in patients with type 2 diabetes. Nevertheless, research for risk factors of sudomotor dysfunction (SD) remains limited.

• the review of the interventions

• personalised approach

• approaches for implementation

Methods: In this retrospective study, patients with type 2 diabetes (age 62.4 ± 11.5 years) received both Sudoscan and ankle-brachial index examinations in 2022 at Chiayi Chang Gung Memorial Hospital. Patients were divided into SD group (all limbs electrochemical skin conductance (ESC) 60 microseconds). Student’s t test and χsquare test were used to compare parameters between groups and then multivariate logistic regression was performed to find independent risk factors

Results: Ninety-three patients met the criteria of SD group and 248 patients were included in control group. Patients in SD group were older, tend to have longer duration of diabetes, higher glycated hemoglobin level, lower body mass index, higher systolic pressure, lower ankle-brachial index, higher pulse pressure and higher pulse wave velocity. Multivariate logistic regression analysis showed age, diabetes duration, and pulse wave velocity were independent risk factors.

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Conclusions: It is reasonable to perform Sudoscan examination in type 2 diabetes patients with older age, longer disease duration, and higher pulse wave velocity for early diabetic peripheral neuropathy detection.

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

TRADITIONAL CHINESE MEDICINE ATTENUATES RISK OF FRACTURE SURGERY, INPATIENT AND MORTALITY IN DIABETIC PATIENTS WITH OSTEOPOROSIS IN TAIWAN

李淳權

馬偕紀念醫院

1,2CHIEH-HUA LU, 3,4CHI-HSIANG CHUNG, 5CHIEN-JUNG LIN, 1SHENG-CHIANG SU, 1FENG-CHIH KUO, 1JHIH-SYUAN LIU, 1PENG-FEI LI, 1CHIA-LUEN HUANG, 1LI-JU HO, 2,3WU-CHIEN CHIEN

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標）

與微量白蛋白尿篩檢率部份，分別為 51.6、

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital; 2Department of Medical Research, National Defense Medical Center; 3School of Public Health, National Defense Medical Center; 4Taiwanese Injury Prevention and Safety Promotion Association; 5Department of Chinese Medicine, Tri-Service General Hospital

、

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Background: Diabetes is often accompanied by chronic complications, one of which is osteoporosis, and increases the risk of fracture surgery. Traditional Chinese medicine (TCM) treatment is becoming more common in Taiwan, often as an adjunct to chronic diseases. The purpose of this study was to investigate whether diabetes combined with osteoporosis combined with TCM treatment could reduce the risk of related fracture surgery, hospitalization, and death using the Taiwan National Health Insurance Research Database (TNHIRD).

Methods: 3131 patients with diabetes and osteoporosis who received TCM treatment and 3131 patients who did not receive TCM treatment were selected from the TNHIRD as the control group, with a 1:1 matching of gender, age, and index year as the control group. Cox proportional hazards analysis was performed to compare fracture surgery, hospitalization, and mortality during a mean follow-up period of 15 years.

Results: There were 433 (13.83%) patients with diabetes and osteoporosis who received TCM treatment who received surgery for fractures, and 617 (19.71%) who did not receive surgery due to fractures (p < 0.001). 624 (19.93%) were hospitalized for treatment, 835 (26.67%) were not admitted (p < 0.001), and all-caused mortality was 318 (10.16%) patients with diabetes and osteoporosis who were treated with TCM, 390 (12.46%) did not accept (p = 0.004). Kaplan-Meier analysis showed that patients with diabetes and osteoporosis who received TCM had lower surgery, hospitalization and mortality rates for fractures than those who did not receive TCM, and there were statistically significant ( all log-rank p < 0.001).

Conclusion: This is a study to explore the relationship between the treatment of diabetes and osteoporosis patients with TCM combined with relatively low fracture surgery, hospitalization and mortality. A prospective study design may be needed to confirm our preliminary findings, promote the combined application of TCM in patients with diabetes and osteoporosis those have a better prognosis.

SPIKE PROTEIN OF SARS-COV-2 BINDING TO NEUROPILIN-1

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

ENHANCES INSULIN RESISTANCE IN ADIPOSE TISSUE

1PI-CHEN LIN, 1,2KUAN-HSUAN CHEN, 3CHAO-HUNG CHEN

MELANIE DAVIS

Diabetes Medicine, University of Leicester

1Division of Endocrinology and Metabolism, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 2Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University; 3General Research Service Center, National Pingtung University of Science and Technology, Pingtung, Taiwanrsity, Kaohsiung.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

Background: Uncontrolled hyperglycemia is has been considered as the deterioration of the COVID-19. Insulin resistance (IR) of plays a central role in pathogenesis of acute hyperglycemia in COVID-19. In addition, functions of adipose has been known as crucial regulator of glucose homeostasis. Recently, co-receptor of SARS-CoV-2 is identified as Neuropilin-1 (Nrp1) for facilitating the binding of SARS-CoV-2 to ACE2. However, role of Nrp1 has been investigated in IR of COVID-19.

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Methods: In vitro, control-siRNA transfected 3T3-L1 (human adipocytes), or Nrp1 siRNA transfected 3T3-L1 were cultured in medium containing 50 µg/ml SARS-CoV-2 pseudovirus (rVSVΔG-spike-D614G), 5µg/ml insulin, and 10 mM glucose for detecting insulin signaling (IRS-PI3k-Akt). In vivo, Nrp1 inhibitor (EG01377) or PBS (as control) were pre-injected into hamster once a day for 1 week. At 8th day, rVSV-ΔG-spike-D614G were injected mice with PBS or EG03117 (once a day) for a weeks for investigating insulin resistance in adipose tissue.

Results: In vitro, immuneprecipitation showed rVSV-ΔG-spike-D614G binding to ACE2 in control and Nrp1 siRNA-transfected 3T3-L1 cells. However, rVSV-ΔG-spike-D614G did not binding to Nrp1 in Nrp1-siRNA transfected 3T3-L1 cells. In addition, Nrp1 siRNA transfection significantly expressed phosphorylation of IRS, ,PI3K, and Akt in 3T3-L1 compared with control siRNA. In vivo adipose tissue, Nrp1 inhibitor also significantly presented phosphorylation of IRS, ,PI3K, and Akt; decreased rVSV-ΔG-spike-D614G binding to Nrp1 and ACE2.

Conclusion: Above results showed Nrp1 might be a positive regulator of SARS-CoV-2 coreceptor for IR, suggesting preliminary mechanism of hyperglycemia or of d deteriorated diabetes under acute phase of COVID-19.

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

PERIPHERAL ARTERY DISEASE IS NOT A RISK FACTOR OF MAJOR ADVERSE CARDIOVASCULAR EVENTS IN THYROXINE USING DIABETIC PATIENTS: A RETROSPECTIVE STUDY

李淳權

1CHIH-WEI HSU, 1CHIA-HUNG LIN, 1,2YI-HSUAN LIN

馬偕紀念醫院

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; 2Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為

、

；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

Aims: This retrospective study investigated the occurrence of major adverse cardiovascular events (MACE) in thyroxine using diabetic patients and compared the risk factors between the MACE and non-MACE groups.

3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

Methods: We used longitudinal claims data from 2008 to 2017 from the Chang Gung Research Database. Diabetic patients who used thyroxine were included. The primary outcome was the occurrence of MACE. The secondary outcomes were the differences between the two groups (MACE vs. no MACE)

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Results: After 1:1 group matching by propensity score between MACE and non-MACE group by sex, age, the interval of using thyroxine, there were 416 patients in each group. Patients with worse renal function (eGFR < 45 ml/min/1.73 m2), hypertension, history of diabetic microvascular complications, end stage renal disease (ESRD), coronary heart disease (CHD), heart failure, cerebrovascular accident (CVA) and diabetic foot infection had a higher risk of experiencing MACE. Free T4 had weak positive correlation with HDL, and TSH had weak positive correlation with LDL and negative correlation with HDL (correlation coefficient, p value: 0.131, 0.022; 0.124, 0.016; -0.157, 0.003, respectively). There’s no optimal cutoff points according to the Receiver operating characteristic (ROC) curve analysis of the best discrimination point between TSH/free T4/LDL and MACE attack.

Conclusions: In thyroxine using diabetic patients, patients with worse renal function, hypertension, history of diabetic microvascular complications, ESRD, CHD, heart failure, CVA and diabetic foot infection had a higher risk of experiencing MACE, but peripheral artery disease (PAD) was not a significant risk of MACE.

EVALUATION OF GLYCEMIC FLUCTUATIONS IN PATIENTS WITH DIABETES MELLITUS ON DIALYSIS THROUGH CONTINUOUS GLUCOSE MONITORING

1

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

MELANIE DAVIS

Diabetes Medicine, University of Leicester

LI-YU KAO, 1,2TING-WEI LEE, 1,2TING-I LEE

1Division of Endocrinology and Metabolism, Wan Fang Hospital, Taipei Medical University, Taiwan, R.O.C.;

2Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taiwan, R.O.C.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

Background: Optimal glycemic control in patients with renal failure can be challenging since marked glucose fluctuations. The use of continuous glucose monitoring (CGM) provides a comprehensive glycemic evaluation in patients with diabetes mellitus (DM). This study analyzed the blood glucose fluctuations in patients with DM receiving dialysis through CGM.

• approaches for implementation

Methods: Medtronic iPro2 professional system was used for CGM in dialysis patients. The patients’ basic characteristics, biochemical data, medications, as well as CGM diary recording times of dialysis, meals and exercises were retrospectively reviewed.

Results: A total of 10 DM patients receiving dialysis (7 men, mean age 66 years) were enrolled for analysis. 6 patients have taken oral antidiabetes drugs (linagliptin and repaglinide), and 5 patients have insulin therapy (insulin aspart, insulin degludec, insulin aspart + protaminated insulin aspart) for glycemic control. Among 10 patients with renal failure, 9 patients were on hemodialysis, and only 1 patient was on peritoneal dialysis. None of patients were found to have hypoglycemia during hemodialysis. We observed that two patients experienced hyperglycemia (blood sugar levels greater than 180 mg/dL) during the intervals between hemodialysis treatments. However, their blood sugar levels were less than 180 mg/dL during hemodialysis sessions. After the completion of hemodialysis, their blood sugar levels increased. These patients’ hyperglycemia persisted until the next hemodialysis session. We also found that the blood glucose fluctuations were associated with the type of peritoneal dialysis fluid (Dianeal, Nutrineal, or Extraneal) used.

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Conclusions: CGM may be a valuable tool in managing blood sugar levels in patients with DM undergoing dialysis.

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

SERUM PROTEOMIC ANALYSIS OF A PATIENT WITH TYPE 1 DIABETES WITH UNEXPLAINED RECURRENT HYPOGLYCEMIC EPISODES

李淳權

1CHIN-FANG CHEN, 2YEN-YIN CHOU, 3HUNG-TSUNG WU, 1,3HORNG-YIH OU

馬偕紀念醫院

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

1Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 2Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 3Department of Internal Medicine, School of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

Objective: To explore possible serum causative proteins in a 22-year-old female patient with type 1 diabetes suffering from frequent severe hypoglycemia episodes after COVID-19 infection.

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Methods: In addition to regular clinical assessment, including laboratory studies and abdominal contrast-enhanced computed tomography (CECT), the glycemic profile of this patient was determined using continuous glucose monitoring. After a 72-hr fast, both blood samples in euglycemic and hypoglycemic episodes were collected to survey possible etiologies by proteomic analysis using isobaric tags for relative and absolute quantitation (iTRAQ). Furthermore, serum insulin-like growth factor (IGF)-2 concentrations were measured using a commercialized ELISA kit.

Results: During a 72-hr fasting test, low c-peptide (0.13 ng/mL) and low insulin level (2.45 μU/ ml) were noted at the occurrence of severe hypoglycemia (37 mg/dL). Abdominal CECT showed no overt pancreatic lesion. Tests for both antinuclear antibody profile and immunoglobulins showed negative results. The levels of growth hormone, IGF-1, IGF-2, free T4, thyrotropin, reproductive hormones, and cortisol were all within normal limits. Although the above findings were unremarkable, we found a total of thirteen serum proteins were changed significantly during hypoglycemic episodes by proteomic analysis. Most of these serum proteins belonged to the S100 protein family, which was associated with inflammation, and two of them were involved in the regulation of Akt activity.

Conclusion: By proteomic analysis of serum from this patient, we found a total of thirteen serum proteins were significantly changed during the hypoglycemia episode. Among these proteins, two of them were involved in the regulation of Akt activity, which might explain hypoglycemia episodes in this patient.

PD16

HBA1C AND SYSTOLIC BLOOD PRESSURE VARIATION TO PREDICT

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

ALL-CAUSE MORTALITY IN PATIENTS WITH TYPE 2 DIABETES

MELANIE DAVIS

1YUN-CHI LEE, 1CHWEN-TZUEI CHANG, 1RONG-HSING CHEN, 1TZU-YUAN WANG, 1CHING-CHU CHEN

Diabetes Medicine, University of Leicester

1Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung 40447, Taiwan

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

Aim: To investigate the associated risk between HbA1c and systolic blood pressure (SBP) variation and all-cause mortality in patients with type 2 diabetes.

• the review of the interventions

• personalised approach

• approaches for implementation

Materials and Methods: Patients with type 2 diabetes who had at least three HbA1c, SBP measurements within 12-24 months during 2001-2007 were included. Coefficient of variation (CV) was used to evaluate variation. The 75th percentile of HbA1c-CV and SBP-CV were set as a cutoff to define high and low variation. Hazard ratios (HRs) for all-cause mortality during 2007-2016 were estimated using Cox proportional hazard models.

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Results: A total of 2744 patients were included, of whom 769 died during the 11.7 observation years. The associated risk (HRs) of all-cause mortality were 1.22 [1.01 - 1.48], P = 0.044 for low HbA1c-CV & high SBP-CV, 1.28 [1.04 - 1.57], P = 0.020 for high HbA1c-CV & low SBP-CV and 1.68 [1.31 - 2.17], P < 0.001 for high HbA1c-CV & high SBP-CV.

Conclusions: Both HbA1c and SBP variation were significant predictors of all-cause mortality in patients with type 2 diabetes. The combined effect of variation on all-cause mortality was higher than either alone.

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

URINARY FRACTIONAL EXCRETION OF ACROLEIN IS POSITIVELY ASSOCIATED WITH DIABETIC PERIPHERAL NEUROPATHY IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

李淳權

馬偕紀念醫院

1TSUNG-HUI WU, 1GUAN-YU SU, 2TSUNG-YUN LIU, 2,3,4HSIANG-TSUI WANG, 1,5CHII-MIN HWU

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

1Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 2Institute of Food Safety and Health Risk Assessment, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; 3Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; 4PhD Program in Toxicology, Kaohsiung Medical University, Kaohsiung, Taiwan; 5Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

Background: Acrolein is a highly reactive α,β-unsaturated aldehyde and involves in the pathophysiology of neurodegenerative diseases. The effects of acrolein on peripheral neuropathy are less well known. The aim of this study was to examine the association between acrolein and diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes.

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Methods: A total of 152 ambulatory patients with type 2 diabetes were recruited. The participants underwent evaluation of Michigan Neuropathy Screening Instrument (MNSI) and SUDOSCAN. The definition of DPN was MNSI-Questionnaire score ≥ 4, or MNSI-Physical Examination score ≥ 2.5, or feet electrochemical skin conductance ≤ 60 μS by SUDOSCAN. Urine and serum levels of acrolein were obtained to calculate urinary fractional excretion of acrolein (FEACRO).

Results: Patients with DPN had greater FEACRO than patients without DPN (0.11, 95% CI: 0.083-0.14 vs. 0.058, 95% CI: 0.041-0.082, P = 0.005). In univariate logistic analysis, logarithmic transformation of FEACRO was positively associated with DPN, and the association kept significant in multivariate analysis (OR = 2.35, 95% CI: 1.07-5.17, p = 0.033).

Conclusions: FEACRO may be a biomarker for identification of patients with type 2 diabetes mellitus at high risk for DPN. Further studies are needed to explore the involvement of acrolein in the pathogenesis of DPN.

PD18

TRENDS OF PATIENT CHARACTERISTICS OF NEWLY-DIAGNOSED

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

TYPE 2 DIABETES IN 2003 TO 2021: RESULTS FROM THE PAY-FORPERFORMANCE PROGRAM AT ONE MEDICAL CENTER FROM SOUTHERN TAIWAN

MELANIE DAVIS

Diabetes Medicine, University of Leicester

1,2TZ-WEN LU, 2YU-HSUN CHEN, 2CHUN-YANG HUANG, 2I-HUA CHEN, 2SHUO-WEI HUANG, 2HSIU-CHU LIN, 1,3SHANG-JYH HWANG, 1,3YI-WEN CHIU, 3MING-YEN LIN, 2WEI-WEN HUNG

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

1Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan, R.O.C.; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan, R.O.C.; 3Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan, R.O.C.

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Background: The Taiwan Pay-for-Performance(P4P) Program for diabetes care is the national policy designed to improve the quality of care for patients with diabetes. The program aims to incentivize certified diabetic educators, including doctors, nurses, and dieticians, to provide highquality care by linking their payments to the achievement of specific performance targets. These targets may include indexes like optimal controls of blood sugar, blood pressure, and lipids, and other measures of good diabetes management such as receiving regular diabetic educations and complication survey. Understanding changes of patient characteristics over time may be useful on care resources arrangements. Thus, we analyzed the trends about patient characteristics of newly diagnosed type 2 diabetes.

Methods: The data were extracted from the diabetes care P4P database in a single medical center from 2003 to 2021. We defined the newly-diagnosed diabetes by patients with type 2 diabetes having the same visiting year as the diabetes onset year recorded in the P4P database. The trend of patient characteristics were evaluated and compared by appropriate statistical tests.

Results: In 2003-2021, there were totally 4117 newly-diagnosed type 2 diabetes enrolled into the P4P program in the medical center. The number of newly-diagnosed type 2 diabetes increased year by year by an average of 11.3% per year, except in 2008. The average age at diagnosis had a rising trend, which was not higher than 56 years before 2014 and then increased to between 56 and 59 years after 2015. The average HbA1C at diagnosis significantly decreased from 7.9% (6.5-10.1%) in 2003 to 6.7% (6.2-8.5%) in 2021.

Conclusion: During 2003 to 2021, the HbA1C at diagnosis of type 2 diabetes had a decreasing trend in this medical center in south Taiwan. This might implicate that as the Taiwan P4P Program started, citizens might become more aware of their health status and seek medical consultants earlier to diagnose type 2 diabetes before dramatic elevations of HbA1C. Further statistical analysis is needed to elucidate if lower HbA1C at diagnosis would lead to better overall outcomes in our study.

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

CORRELATIONS BETWEEN INSULIN RESISTANCE INDEX AND GLYCEMIC STATUS OF NEWLY- DIAGNOSED TYPE 2 DIABETES

李淳權

ENROLLED IN THE PAY-FOR-PERFORMANCE PROGRAM FROM 2003 TO 2021 AT ONE MEDICAL CENTER OF SOUTHERN TAIWAN

馬偕紀念醫院

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

1YU-HSUN CHEN, 1,2TZ-WEN LU, 1CHUN-YANG HUANG, 1I-HUA CHEN, 1SHUO-WEI HUANG, 1SHU-PING SUE, 1HSIU-LING LIANG, 1,3SHANG-JY HWANG, 3MING-YEN LIN, 1WEI-WEN HUNG

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan, R.O.C.; 2 Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan, R.O.C.; 3Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan, R.O.C.

、

、

及

；A1C 檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Background: The triglyceride glucose-body mass index(TyG-BMI) has been recognized as one of the insulin resistance indexes. To the authors’ knowledge, there were no available reports about the TyG-BMI in newly-diagnosed type 2 diabetes in Taiwan. We analyzed the Taiwan Pay-forPerformance (P4P) Program database from 2003 to 2021 at one medical center of southern Taiwan to focus on the relationships of patient characteristics and TyG-BMI in newly diagnosed type 2 diabetes.

Method: The data were extracted from the diabetes care P4P database in a single medical center from 2003 to 2021. We defined the newly-diagnosed type 2 diabetes by subjects having type 2 diabetes with the same visiting year as the diabetes onset year recorded in the database. Correlations between various indexes of patient characteristics were analyzed by appropriate statistical tests. Estimated glomerular filtration rate (eGFR) was calculated by the Equation of Chronic Kidney Disease Epidemiology Collaboration. The formula of triglyceride glucose-body mass index (TyG-BMI) was: Ln [triglyceride (TG) (mg/dL) × fasting plasma glucose (FPG) (mg/dL)]/2 × body mass index (BMI).

Results: From 2003 to 2021, there were 4117 newly-diagnosed type 2 diabetes enrolled into the P4P program. We found negative correlations between age and HbA1c (Pearson = -0.186, P = < 0.001), and not surprisingly age and estimated glomerular filtration rate (eGFR) (Pearson = -0.639, P = < 0.001). There was no significant correlation between body mass index (BMI) and HbA1c in our study (Pearson = -0.03, P = 0.06). The average TyG-BMI at diagnosis significantly increased from 130.2 (92175) in 2003 to 137.2 (78-284) in 2021. We also discovered that fasting glucose, fasting triglyceride, and TyG-BMI were positively correlated with HbA1c (Pearson’s r: 0.631, P < 0.001; Pearson’s r: 0.146, P < 0.001; Pearson’s r: 0.125, P < 0.001, respectively).

Conclusion: Our study yielded a trend of increasing age along with decreasing HbA1C from 2003 to 2021. As young-onset type 2 diabetes is known to be associated with higher all-cause mortality, further longitudinal analysis in our database should be performed to compare newly-

PL-1

diagnosed type 2 diabetes onset before and after 40-year-old. In addition, our study demonstrated for the first time about the TyG-BMI having positive correlations with HbA1C in newly-diagnosed type 2 diabetes in Southern Taiwan. The results of our database study might be applied clinically to use TyGBMI as the index to represent the levels of insulin resistance associated with glycemic status in newlydiagnosed type 2 diabetes.

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

MELANIE DAVIS

Diabetes Medicine, University of Leicester

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

DAROC-TADE-2

PD20

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

ULCERATIVE COLITIS WITH TYPE 1 DIABETES MELLITUS: CASE REPORT AND LITERATURE REVIEW

李淳權

PIN-CHUN HUANG, SHU-YI WANG, SZU-HAN LIN

馬偕紀念醫院

Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital,Taiwan, R.O.C.

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

Background: Type 1 diabetes mellitus (T1DM) is often complicated with some other autoimmune disorders. The complication of various autoimmune disorders is known as autoimmune polyglandular syndrome (APS). The diagnosis of APS is established in the presence of at least 2 or more organ specific endocrine or non-endocrine autoimmune diseases.

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Methods: We report the case of a 54-year-old man, who has no history of systemic disease before. Father has T2DM, denied other family history. He was hospitalized with severe dehydration and clinical signs of ketoacidosis. Increased blood glucose (HbA1C = 8.5%), ketosis and metabolic acidosis indicated the possibility of type 1 diabetes mellitus. No anti-GAD Ab elevation(1.42 u/ mL). Glucagon stimulation test was arranged (Glucose AC: 164 mg/dL ; C-peptide: 0.384ng/mL → 0.628ng/mL) and diagnosis of type 1 diabetes mellitus was established. At the same time, bowel habit change with body weight reduction (3~4 kg/ 1-2 weeks) had developed. Stool OB showed positive. Colonoscopy was arranged which revealed ulcerative colitis. We also screened the thyroid function and cortisol level, but no autoimmune thyroid disorders or adrenal insufficiency were found.

Results: Inflammatory bowel diseases are rather rare associated with APS. APS with Type 1 diabetes mellitus usually present with autoimmune thyroid disease and/or autoimmune adrenal insufficiency (APS type 3A or type 2). In our case, combination of Type 1 DM with ulcerative colitis classified into type 4 APS which is a rare subtype.

Conclusions: Many studies have reported a strong linkage between T1DM and IBD including UC. It has been suggested that these two diseases share similar immune-mediated pathogenesis. When T1DM was newly diagnosed, we should be alerted about the possible presence of other immunemediated diseases, not only autoimmune thyroid disease or autoimmune adrenal insufficiency.

EFFECTS OF THE DIABETES PAY-FOR-PERFORMANCE CARE

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

PROGRAM ON METABOLIC PROFILES AND GLYCEMIC CONTROL

IN PEDIATRIC PATIENTS WITH TYPE 1 DIABETES

MELANIE DAVIS

Diabetes Medicine, University of Leicester

1CHUN-YANG HUANG, 1,2TZ-WEN LU, 1I-HUA CHEN, 1SHUO-WEI HUANG,

1MAN-CHIA HSU, 1CHIN-WEI TSENG, 2,3SHANG-JYH HWANG, 3MING-YEN LIN,

1WEI-WEN HUNG

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan, R.O.C.; 2Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan, R.O.C.; 3Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan, R.O.C.

• the review of the interventions

• personalised approach

• approaches for implementation

Background: Although the prevalence of type 1 diabetes (T1D) is less than 1% in Taiwan, the age of onset peaks at 10 to 14 years, and lifelong insulin administration is required. The diabetes payfor-performance program (P4P) program started in our hospital since 2003 and patients were enrolled in the outpatient department (OPD) mainly at daytime. Starting in 2021, certified diabetic educators (CDEs) initiated the P4P care program for patients with T1D in the pediatric OPD at nighttime. This study aims to evaluate the changes in metabolic profiles and glycemic control after the P4P program enrollment in pediatric patients with T1D.

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Methods: We analyzed the database of the diabetes P4P program in our hospital from 2003 to 2022. The annual prevalence of T1D in the program was calculated. We selected T1D in the database since Jan 2021 when the CDEs started to enroll T1D of the pediatric nighttime OPD into the P4P program and followed various metabolic parameters in the database until May 2022 as currently available. We compared metabolic profiles and glycemic control before and after the P4P program enrollment through appropriate statistical tests.

Results: From January 2021 to May 2022, there were totally 112 T1D in the database, among which 85 subjects were enrolled via pediatric nighttime OPD, with an average age of 19.6 years and 50.6% male gender. The mean HbA1c at the enrollment was 8.71%, with the mean fasting serum glucose level 178mg/dL, the mean total cholesterol 193.75 mg/dL, the mean triglyceride 89.99 mg/ dL, the mean HDL-C 61.37mg/dL, and the mean LDL 105.90 mg/dL. After the enrollment, 62 subjects had completed at least twice quarterly follow-ups. We further excluded patients with baseline HbA1c < = 7 or with T1D for more than 20 years and there were 46 subjects for final analysis. The mean HbA1c was 9.15%, and the mean duration of diabetes was 7.6 years. However, there were no significant differences in the metabolic profiles and glycemic control when comparing the second or the third quarterly follow-up with the initial enrollment.

Conclusion: We showed that the glycemic control of pediatric T1D did not improve after

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

enrolling in the P4P program with three quarterly follow-ups, but the small sample size and short follow-up periods might underestimate the effects of P4P program. To have a more comprehensive understanding of improving the care of pediatric T1D, a large-scale, more extended follow-up study to evaluate the P4P program effects is needed.

李淳權

馬偕紀念醫院

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人 照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為

、

；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（

、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

PD22

MASSIVE INSULIN OVERDOSE WITH FORTUITOUS INSULIN

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

RESCUE EFFECT: CASE REPORT

1XIN NING NG, 1WEI-CHENG LIAN, 1PIN-FAN CHEN

MELANIE DAVIS

Diabetes Medicine, University of Leicester

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Taiwan.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

A 54-year-old woman with bipolar disorder and 5-year history of type 2 diabetes mellitus, presented with dizziness after deliberately being administered 1500 units of long-acting insulin

• the overall approaches to care

• the review of the interventions

• personalised approach

Glargine U100 (5 vials) and 40 tablets of Zolpidem. At the emergency department, her blood glucose was found to be 37 mg/dl and the insulin level was 134 uIU/ml. Glasgow Coma Score was 15/15. 80 ml of 50% dextrose was administered, followed by a total of 665g parenteral glucose continuous infusions for the next 111 hours.

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Reviewing her glycemic regimen, she was initially on glyburide/metformin (5/500mg) 0.5# BID starting from Dec 2009 when her A1c was 9.8%, and reached an A1c of 6.3% during 6-months follow-up. First course of basal insulin rescue therapy was initiated from Oct 2011 till April 2012, as sulphonylurea treatment failed with an A1c level of 8.7%. Her regimen was shifted back to metformin 1000mg daily when her two consecutive A1c levels were back to around 6.5%. Second course of basal insulin was given in Aug 2013 when her A1c was up to 9%. After this suicide attempt, vildaglptin/ metformin (5/500mg) was given after discharge, 18 hours after discontinuation of intravenous dextrose infusion. The patient had an excellent glycemic control on follow-up 15 months, with her HbA1c levels ranging from 5.3-6.3% under vildagliptin/metformin (5/500mg) use.

Higher concentration and more daily amounts of dextrose continuous infusions may be required in providing timely action to save patients’ lives. Her fair glycemia on short term after attempting suicide might be due to very intensive insulin treatment, as supported by the results in previous insulin rescue trials.

DAROC-TADE-2

A RARE CASE OF HEPATIC PARAGANGLIOMA

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

1CHIA YUAN CHANG, 1MING-CHIEH TSAI, 1,2TZU-YING CHEN

李淳權

馬偕紀念醫院

1Division of Endocrinology and Metabolism, Department of Internal Medicine, MacKay Memorial Hospital, 10449, No. 92, Section 2, Zhongshan North Road; 2Department of Internal Medicine, MacKay Memorial Hospital, 10449, No. 92, Section 2, Zhongshan North Road

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標）

與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

Background: Catecholamine tumors can be classified as pheochromocytoma and paraganglioma (PPGL). Pheochromocytomas are located within the adrenal glands, whereas PPGL are located outside the adrenal glands near vessels or elsewhere. Cases of hepatic PPGL are especially rare. The imaging features of hepatic PPGL (HPGL) of the liver mimic those of hemangioma. Here we report the rare case of a 60-year-old woman with HPGL but without any clinical signs or symptoms.

；

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

Methods: We summarized demographic information, manifestations, treatment, and prognosis reported cases of hepatic paraganglioma. We also performed diagnose of hepatic paraganglioma correctly owing to its various manifestations and the fact that its radiological findings can mimic hemangioma or hepatic carcinoma.

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Results: According to our review, patients no pre-operative biochemical data were available due to the patient’s incidental diagnosis and asymptomatic clinical course. Due to the lack of data about hepatic paraganglioma , we were unable to postulate the patient’s future prognosis. However, we will do our best to continue collecting laboratory data and hope to have more complete information about HPGL in the future.

Conclusions: Catecholamine-producing tumors can be asymptomatic for years. We summarized the case between 2014-2020 years of all hepatic paraganglioma case report. It is difficult to diagnose hepatic paraganglioma correctly owing to its various manifestations and the fact that its radiological findings can mimic hemangioma or hepatic carcinoma. In this case report, we presented one case of hepatic paraganglioma We described the patient’s clinical presentation, radiological and pathological image features, treatment and prognosis. Because hepatic paraganglioma has similar radiological features with hepatic angioma and hepatocellular carcinoma, diagnosing hepatic paraganglioma remains a challenge for physicians, radiologists. Pathology may be still necessary for diagnosing this rare disease.

HETEROGENEOUS AND MILDLY HYPERDENSE RETROPERITONEAL SCHWANNOMA MASKED AS PHEOCHROMOCYTOMA: A CASE REPORT

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

MELANIE DAVIS

Diabetes Medicine, University of Leicester

1LI-HSIN PAN, 1GUAN-YU SU, 1YUN-KAI YEH, 1PEI-CHUAN LEE, 1LIANG-YU LIN

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

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

Background: An adrenal tumor with degenerative changes on abdominal image often leads to consideration of pheochromocytoma, adrenocortical carcinoma or adrenal hemorrhage. However, schwannoma should be placed in differential diagnoses if the tumor is slowly growing over years.

• the review of the interventions

• personalised approach

• approaches for implementation

Methods: We reported a case with heterogeneous and mildly hyperdense retroperitoneal schwannoma mistaken as pheochromocytoma.

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Results: A 54-year-old man had membranous nephropathy and chronic kidney disease in stage G3bA3. He had poor compliance with medications and poorly controlled hypertension for 3 years. The magnetic resonance angiography of renal vessels revealed a 2.7cm nodule with restricted diffusion and high signal intensity on T2-weighted image at the left adrenal gland. The Hounsfield unit (HU) was 12.7 on the non-contrast computed tomography (CT). Pheochromocytoma was suspected. However, the patient did not have headache, palpitation and sweating. The 24-hour urine VMA and catecholamine were both within normal range. He underwent left adrenalectomy. The pathology reported the nodule as schwannoma.

Conclusions: Pre-operative diagnosis of schwannoma is challenging. There may be hemorrhagic, cystic or calcific component in retroperitoneal schwannoma with mean unenhanced attenuation value about 30-40 HU and delayed progressive enhancement on CT scans. The imaging characteristics resembles those of pheochromocytoma and other malignancy. Pathology remains the gold standard of diagnosis.

DAROC-TADE-2

PE03

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

URINARY CORTISOL LEVEL IN EXCLUSION AUTONOMOUS CORTISOL SECRETION IN THE PATIENT OF PRIMARY ALDOSTERONISM

未來

1

李淳權

WEN-KAI CHU

馬偕紀念醫院

, 1

CHIH-YUAN WANG, 1WAN-CHEN WU, 1VIN-CENT WU, 2TAIPAI

1Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; 2TAIPAI, Taiwan Primary Aldosteronism Investigation (TAIPAI) Study Group

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

Background: Serum cortisol level after 1-mg overnight dexamethasone suppression test (1-mg DST) below 1.8 ug/dL was a diagnostic criterion for having autonomous cortisol secretion (ACS), whether the cut-off point in 24-hour urine-free cortisol (24-h UFC) for the patient suspecting with primary aldosteronism (PA) concomitant ACS is unclear.

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

Methods: This prospective observational study enrolled 274 patients diagnosed with PA from January 2017 to January 2020 (male, 42.3%; mean age, 55.9 ± 11.7 years). Serum cortisol level after 1 mg DST over 1.8 ug/dL was a diagnostic criterion for ACS, confirmed with a second repeated test.

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Results: Of the 274 PA patients, 74 patients (27%) with PA had concomitant ACS while the other 200 patients were not. Logistic regression analysis showed patients with PA concomitant ACS were associated with higher 24-h UFC (OR, 1.91 [95% CI, 1.06–3.41], P = 0.03), older age (OR, 1.04 [95% CI, 1.01–1.07], P = 0.008), and diabetes mellitus (OR, 2.4 [95% CI, 1.12–5.12], P = 0.025). The generalized additive model (GAM) for urinary cortisol and ACS showed the 24-h UFC above 36 μg, concurrent with the positive predictive value of 32.6% and negative predictive value of 77.9% could be a factor predicting a higher possibility of ACS.

Conclusions: More than a quarter of PA patients concomitant ACS. Our study suggested the 24-h UFC less than 36 μg as a cut-off point in exclusion of the patient with PA concomitant ACS. Additionally, older age and diabetes mellitus were also risk factors for predicting patients with PA concomitant ACS.

EGFR-DIP RATIO AFTER MEDICAL TARGET THERAPY ASSOCIATED WITH INCREASED MORTALITY AND CARDIOVASCULAR EVENTS IN PATIENTS WITH PRIMARY ALDOSTERONISM

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

MELANIE DAVIS

Diabetes Medicine, University of Leicester

1JIA-YUH SHEU, 2SHUO-MENG WANG, 3VIN-CENT WU, 2KUO-HOW HUANG,

2CHI-SHIN TSENG, 2YUAN-JU LEE, 4YAO-CHOU TSAI, 5YEN-HUNG LIN,

2JEFF S. CHUEH, 6TAIPAI

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

1Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan; 2Department of Urology, National Taiwan University Hospital, Taipei, Taiwan; 3Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; 4Division of Urology, Department of Surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; 5Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; 6TAIPAI, Taiwan Primary Aldosteronism Investigation (TAIPAI) Study Group

• personalised approach

• approaches for implementation

Background: The correlation of estimated glomerular filtration rate (eGFR) change with long-term cardiovascular complications in patients with primary aldosteronism (PA) following mineralocorticoid receptor antagonists (MRA) treatment remains ambiguous.

Methods: This prospective study aims to determine factors associated with all-cause mortality and de novo cardiovascular events of PA patients against the eGFR-dip ratio. A total of 208 newly diagnosed PA patients were enrolled from January 2007 to January 2019. MRA was administered with at least a 12-month follow-up. The ‘eGFR-dip ratio’ worse than -12% (defined as the difference between eGFR at 6 months after MRA treatment and respective baseline eGFR divided by the baseline eGFR) was detected in 99 (47.6%) of the 208 patients.

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Results: After a mean 5.7 years follow-up, a splines plot identified the eGFR-dip ratio worse than -12% was a significant independent risk factor predicting composite outcomes, including all-cause mortality, de-novo 3-point major adverse cardiovascular (CV) events, and/or congestive heart failure. Multivariable logistic regression showed that age (odds ratio (OR), 0.94; p = 0.003), pre-treatment plasma aldosterone concentration (PAC; OR, 0.98; p = 0.004), and initial eGFR (OR, 0.97; p < 0.001) had a negative linkage with the eGFR-dip ratio worse than -12%.

Conclusions: In conclusion, nearly half of PA patients had an eGFR-dip ratio worse than -12% after six months of MRA treatment. They had a higher incidence of all-cause mortality and de novo adverse CV events. The presence of an elder age, higher pre-treatment PAC, or higher initial eGFR could be associated with an elevated risk of an eGFR-dip ratio worse than -12%.

DAROC-TADE-2

PE05

CASE REPORT: PITUITARY APOPLEXY AFTER COVID-19

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

1HOK WENG LO, 1CHING-LING LIN

李淳權

1Division of Endocrinology & Metabolism, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan

馬偕紀念醫院

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

Pituitary apoplexy is a rare clinical syndrome, with an infarction or hemorrhage of the pituitary gland. Recently, some cases of pituitary apoplexy after COVID-19 have been reported. We described a case of pituitary apoplexy after COVID-19.

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Sudden onset severe headache with unsteady gait, nausea, and vomiting after COVID-19 13 days later. No ophthalmological findings but abnormal endocrinological consequences were found. Brain magnetic resonance imaging revealed a pituitary gland tumor about 2.3x1.3x1.7cm at the anterior lobe of the pituitary gland, favoring pituitary macroadenoma and differential diagnosis with craniopharyngioma, and the optic chiasm is compressed by this tumor. Hydrocortisone was administered and intermittent headache was still mentioned. Operation with uninostril endoscopic transsphenoidal hypophysectomy was performed and the pathology showed hemorrhagic necrosis, consistent with pituitary apoplexy. After the surgery, cortisone and thyroxine were continued to use and the headache and neurological symptoms improved.

The reason of pituitary apoplexy may related to the virus directly acting on angiotensinconverting enzyme 2 receptor at the pituitary gland, cytokine storm, and hemodynamic unstable. Moreover, the clinical spectrum of pituitary apoplexy is similar to COVID-19 such as headache, nausea, vomiting, and fatigue.

It’s easy to misdiagnose pituitary apoplexy and must be kept in mind for the diagnosis.

TWO CASES OF CUSHING’S DISEASE PRESENTED WITH CYCLIC HYPERCORTISOLISM

1

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

YUN-KAI YEH, 1LI-HSIN PAN, 1GUAN-YU SU, 1PEI-CHUAN LEE, 1LIANG-YU LIN

MELANIE DAVIS

Diabetes Medicine, University of Leicester

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan, R.O.C

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

Background: Cyclic Cushing's syndrome is often overlooked and it is challenging for clinical physician to diagnosis. If the result of initial screening for Cushing’s syndrome is negative but clinical suspicion remains strong, cyclic Cushing’s syndrome should be taken into consideration. Repeated evaluation should be performed for long-term monitoring.

• the review of the interventions

• personalised approach

• approaches for implementation

Methods: We reported two cases with periodical hypercortisolism which were found accidentally during survey for Cushing’s syndrome. Both cases were confirmed pituitary corticotroph adenoma with presentation with cyclic Cushing’s disease.

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Results: Case 1: A 61 year-old man had history of type 2 diabetes mellitus. Elevated fasting blood sugar was noticed and further survey revealed hypercortisolism with elevated ACTH. Magnetic Resonance Imaging (MRI) showed 2cm pituitary macroadenoma. Periodic hypercortisolism was noticed during survey and bilateral inferior petrosal sinus sampling (BIPSS) confirmed centralization. Operation was performed by neurosurgeon and further pathological report confirmed corticotroph adenoma. Cyclic Cushing’s disease was diagnosed.

Case 2: A 30 year-old woman suffered from headache with double vision and 2.7cm pituitary macroadenoma was found incidentally during MRI survey for headache. Pituitary function survey revealed elevated cortisol with ACTH level. Periodical hypercortisolism was recorded after survey. BIPSS was performed and centralization was confirmed. Cyclic Cushing’s disease was diagnosed finally after operation.

Conclusions: Cyclic Cushing’s syndrome was considered to be at least 8% of Cushing syndrome, but the prevalence might be underestimated because cyclic Cushing’s syndrome was often overlooked. Repeated measurement and long-term monitoring should be considered. Late night salivary cortisol was recommended as the initial screening for cyclic Cushing’s syndrome.

DAROC-TADE-2

PE07

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

PRIMARY THYROID EXTRANODAL MARGINAL ZONE LYMPHOMA OF MUCOSA-ASSOCIATED LYMPHOID TISSUE (MALT)

李淳權

JIA-PEI WU, CHAI-CHUN CHEN, CHUNG-ZE WU, JIUNN-DIANN LIN, CHIH-TSUENG HE, ANNE CHANG

馬偕紀念醫院

Division of Endocrinology and Metabolism, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taiwan, R.O.C.

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為

Case report--Abstract

、

；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

A 63-year-old male was referred from the local clinics to the Division of Endocrinology of Shuang Ho hospital with an initial presentation of a painless left neck mass for 2 months. There was no known history of thyroid radiotherapy or family history of thyroid cancer. Laboratory tests showed an elevated TSH serum level (6.124 uIU/mL), a free T4 level within normal range (0.81 ng/ dL) and a positive serum anti-microsomal Ab. The thyroid ultrasound revealed multiple nodules over both lobes, and the largest one, measured about 2.93x2.41x4.61 cm in size, was in the left lobe. Fine needle aspiration biopsy cytology of the left thyroid nodule showed some lymphocytes and follicular cells, and lymphocytic thyroiditis was impressed. However, as the nodule was too huge, and low-grade lymphoma was unable to be completely excluded by the results of the cytology, the patient was referred to endocrine surgical unit for tissue proof, and finally, the patient received left thyroid lobectomy. The histology was determined as extranodal marginal zone lymphoma of mucosaassociated lymphoid tissue (MALT lymphoma), and the immunohistochemistry stain displayed the presence of B cell markers, including CD20 and immunoglobulin superfamily receptor translocationassociated 1 protein. The subsequent Positron Emission Tomography scan and bone marrow (BM) biopsy showed no other lymph node and BM involvement, respectively. Patient was scheduled to be followed up 3 months later without further treatment.

PRIMARY ADRENAL DIFFUSE LARGE B-CELL LYMPHOMA: A CASE REPORT

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

1SU GUAN YU, 1,2HWU CHII-MIN

MELANIE DAVIS

Diabetes Medicine, University of Leicester

1Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, 2Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

Background: Primary adrenal lymphoma [PAL], a rare form of adrenal mass, predominantly affects elderly men and involves in bilateral adrenal gland. Due to its rarity, the clinical features and therapeutic options of PAL have not been defined in detail, leading to the difficulty in diagnosis and management.

• the review of the interventions

• personalised approach

• approaches for implementation

Methods: In this article, we reported a male patient with primary adrenal diffuse large B-cell lymphoma, which is the most common histologic type of PAL.

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Results: The 67 year-old Taiwanese man with type 2 diabetes mellitus and hyperlipidemia experienced malaise and easily sweating two months ago. His laboratory data showed elevated concentration of serum adrenocorticotropic hormone [ACTH] (8 am 59.1 pg/mL) with normal level of serum cortisol (8 am 10.8 ug/dL), and the abdominal magnetic resonance imaging [MRI] revealed bilateral heterogeneous adrenal tumors measured larger than 4 cm, in suspicious of pheochromocytoma, metastasis or lymphoma. The high dose ACTH stimulation test supported the possibility of adrenal insufficiency, but the clonidine suppression test reported the suppressed result of serum epinephrine and norepinephrine. Bone marrow biopsy only showed erythroid hyperplasia without other specific finding. To confirm the diagnosis, the patient underwent the laparoscopic left adrenoectomy and the pathology report indicated left adrenal diffuse large B cell lymphoma [DLBCL]. He then started chemotherapy and the tumor size shrink after treatment.

Conclusions: Patients with PAL have the poor prognosis and may develop adrenal insufficiency, especially those with bilateral lesions. Endocrine evaluation and appropriate therapy is required to improve the outcomes of this malignant disease.

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

ADVANCED ADRENOCORTICAL CARCINOMA COMPLICATED WITH CUSHING SYNDROME

未來

1CHIAO-YA CHAN, 2WEI-CHIN CHANG, 3YI-HONG ZENG

李淳權

馬偕紀念醫院

1Division of Endocrinology and Metabolism, Department of Internal Medicine, MacKay Memorial Hospital, Taiwan, R.O.C.; 2Division of Pathology, MacKay Memorial Hospital, Taiwan, R.O.C.; 3Division of Endocrinology and Metabolism, Department of Internal Medicine, Taitung MacKay Memorial Hospital, Taiwan, R.O.C.

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

Introduction: Adrenocortical carcinoma (ACC) is a rare disease with poor prognosis. We here presented a case of advanced ACC with acute Cushing syndrome (CS) and its consequent complications.

、

、

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Case presentation: A 64-year-old female presented to emergency room with initial presentation of septic shock. After infection under control, the patient had refractory hypokalemia and resistant hypertension. Serial survey including overnight dexamethasone suppression test (ONDST) was done and CS was confirmed. One 7 cm left adrenal tumor, two pulmonary tumors and one hepatic tumor were noted in Computed tomography (CT) scan. We performed biopsy of metastatic pulmonary tumor and the pathology pattern with immunoprofile showed metastatic tumor from endocrine origin. The patient was diagnosed with ACC with lung metastases and possible liver metastases, complicated with CS. We then prescribed etomidate for hypercortisolism treatment and meanwhile applicated for mitotane. Unfortunately, the patient had progressive infection and finally expired.

Discussion: Glucocorticoid suppress immune function and therefore contribute to increased risk of infections. Our patient had hypercortisolism and went through multiple opportunistic infections such as cytomegalovirus (CMV), Pneumocystis jirovecii pneumonia (PJP) and Candidiasis. Etomidate was an effective medication for acute CS and could be lifesaving while waiting for surgical or radioactive treatment. If the diagnosis of ACC was made earlier while the patient was relatively suitable for surgery, it would surely lead to different outcome.

Conclusion: When confronting refractory hypertension and unusual opportunistic infections, one should always think of the possibility of CS. Timely diagnosis will benefit survival.

CARCINOID TUMOR OF CHEST PRESENTING WITH ECTOPIC ACTH SYNDROME AND HYPOKALEMIA

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

CHAI-CHUN CHEN

MELANIE DAVIS

, JIA-PEI WU, CHUNG-ZE

WU, JIUNN-DIANN

LIN, CHIH-TSUENG HE, ANNE CHANG

Diabetes Medicine, University of Leicester

Division of Endocrinology and Metabolism, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taiwan, R.O.C

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

A 41-year-old woman without systemic diseases, except for uterine myoma, visited for general weakness and leg edema. Hypokalemia (serum potassium 1.6 mmol/L) was found in the local clinic during an episode of weakness. Plasma aldosterone concentration showed 12.1 ng/dL, Plasma renin activity showed 0.12ng/mL/hr. High level of aldosterone to renin ratio was noted. Urine potassium 53.6 mmol/L, serum potassium 3.7 mmol/L, urine osmolality 506 mOsm/kgH2O, serum osmolality 294 mOsm/kgH2O, TTKG calculation revealed 8. However, saline loading test showed plasma aldosterone concentration was 3.9 ng/dL, which was negative. 24-hour urine cortisol excretion revealed 3257.3 μg/24hrs. The overnight dexamethasone suppression test showed cortisol 15.6 ug/dL, which suspected Cushing’s syndrome. Brain MRI of sella revealed right lateral pituitary microadenoma (0.4 cm). Inferior petrosal sinus sampling showed no obvious increasing ACTH levels. Low-dose dexamethasone suppression tests showed cortisol 21.41 ug/dL. High-dose dexamethasone suppression tests showed cortisol 51.86 ug/dL. Both tests revealed non-suppressible cortisol levels. Ectopic ACTH syndrome was impressed, but its source should be determined. However, the whole body scan showed no scintigraphic evidence of malignancy. She visited other hospital and received CT scan of chest, which showed a tumor of lung, right upper lobe. After receiving wedge resection for right upper lung, pathology showed atypical carcinoid tumor. The final diagnosis was atypical carcinoid tumor of lung with ectopic ACTH syndrome, initially presenting with hypokalemia.

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

DAROC-TADE-2

PE11

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

A CASE OF THYROID-ASSOCIATED ORBITOPATHY WITH ELEVATED TPO ANTIBODIES AND NEGATIVE TRAB

1TING-YU YEH, 2POH-SHIOW YEH, 3MEI-CHEN YEH

李淳權

馬偕紀念醫院

1Department of Family Medicine, Chimei Medical Center, Tainan, Taiwan; 2Department of Neurology, Chimei Medical Center, Tainan, Taiwan; 3Department of Endocrinology & Metabolism, Chimei Medical Center, Tainan, Taiwan

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

Case presentation:

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

A 53-year-old woman presented to the neurologic outpatient department, suffered from blurred vision while gazing to the left side and bilateral ophthalmoplegia with more severity on over her left eye for 3 weeks. She was afebrile, the pulse was 70 beats per minute, the blood pressure was 110/66 mm Hg. Her body weight was measured 41.7 kg.

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Blood test of renal function, liver function and infection were all within normal limits. Thyroid related lab test showed normal thyroid-stimulating hormone(TSH), T3 and free T4. The thyroid stimulating hormone receptor antibodies (TRAb) was also within normal limit. However, there were apparent elevated anti-thyroglobulin antibodies and antithyroid peroxidase antibody (Anti-TPO) noted (Anti-TPO:267.3 IU/mL). Brain magnetic resonance imaging revealed swelling and increased enhancement of her left medial rectus muscle, left inferior rectus muscle, left superior oblique muscle and right superior rectus muscle with sparing of the tendinous insertion sites. Therefore, the thyroid ophthalmopathy was highly suspected.

She then visited my endocrinology department. High dose intravenous steroid use with methylprednisolone 400mg was given once, however, patient refused intravenous steroid for personal reason and the steroid was shifted to oral form. The oral form steroid was given and I tapered it down gradually, and then was discontinued. The patient tolerated well and the symptoms gradually relieved.

Discussion: Thyroid-associated orbitopathy is usually considered as Graves’ orbitopathy and it could occur in hyperthyrioid, euthyroid and even hypothyroid status. Those patient usually have positive result for TRAb. There are only a few case reports with Hashimoto’s thyroiditis associated orbitopathy with negative TRAb up to now. Further standard treatment protocol should be established for these patients.

OUR FIRST EXPERIENCE OF TRANSCATHETER THYROID ARTERIAL EMBOLIZATION ON A HUGE THYROID NODULE: A CASE REPORT

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

MELANIE DAVIS

1PO-YIN LAI, 2JYUN-YAN LIOU, 1WEI-FU HUANG, 1PO-TSANG CHENG, 1KAI-JEN TIEN, 1CHEWN-YI YANG, 1MEI-CHEN YEH

Diabetes Medicine, University of Leicester

1Department of Endocrinology & Metabolism, Chimei Medical Center, Tainan, Taiwan; 2The Department of Diagnostic Imaging, Chimei Medical Center, Tainan, Taiwan

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

Case Presentation:

• the overall approaches to care

• the review of the interventions

This 63-year-old woman has epilepsy, schizophrenia and a thyroid nodule with regular followup in another hospital. However, the size of the nodule was increasing. There was mild difficulty in swallowing and severe compressive symptoms and operation was suggested. However, the patient was concerned about the risk of anesthesia and permanent hypothyroidism and prefered conservative treatment. So she came to our hospital for second opinion. Lab revealed normal Free T4 and TSH. Sonography showed one huge nodule in the left lobe with size 5.8 cm with trachea deviation to the right side, and the cytology was benign. Due to the large size of the nodule, we suggested transcatheter arterial embolization (TAE) followed by rradiofrequent ablation(RFA). CTA-carotid revealed left thyroid mass (5.8*4.2*5.8 cm) with vascular supply from left superior thyroid artery. TAE was performed by our radiologist with embolic agent, Embosphere. Prophylactic antibiotic, steroid and Acetaminophen were prescribed.

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Hours after the procedure, the patient had nausea and vomiting. Contrast-related adverse effect was the impression. Nausea and vomiting persisted for about a week. Mild fever (37.6 ˚C) was also noted the next day. One month later, thyroid ultrasound showed significant shrinkage of left thyroid mass (3.5x2.5x4.5 cm). The nodule volume reduced from 70.64 mL to 19.69 mL, a reduction of 72.13% and thyroid function test was still normal. The compressive symptoms improved significantly according to the patient and there was no sequelae from the contrast-related adverse effect. RFA may not be necessary since patient is already satisfied with the outcome.

Discussion: Standard treatment for symptomatic huge nodule goiter is hemithyroidectomy or total thyroidectomy. However, less invasive approach such as thyroid TAE only or TAE plus subsequent RFA can also be considered. RFA without TAE might be less effective in large nodules with volume > 30 mL. Therefore, for single huge thyroid nodules or nodular goiters, TAE was shown to be a safe and effective alternative treatment.

Conclusion: Thyroid artery embolization is an emerging technique. It may be a good and safe alternative to surgery. We demontrate our first experience in our hospital.

DAROC-TADE-2

PE13

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

CARDIOVASCULAR DEATH AND CARDIOVASCULAR DISEASE IN PRIMARY HYPERPARATHYROIDISM: A SYSTEMIC REVIEW AND META-ANALYSIS

李淳權

SIANG-KE

馬偕紀念醫院

KONG, MING-CHIEH TSAI, CHUN-LIN YEH, YU-CHENG TSAI, WEN-HSUAN TSAI

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Mackay Memorial Hospital; 2Department of Medicine, Mackay Medical Collage; 3Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University

、

；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

Background: Elevated parathyroid hormone is associated with increased risk of cardiovascular disease (CVD). Our aim is to evaluate the correlation between primary hyperparathyroidism (PHPT) and CVD or cardiovascular death (CV death).

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Method: Literature research was conducted via PubMed and Embase on November 21st, 2022. The keywords were "cardiovascular disease" and "primary hyperparathyroidism". A total of 8 cohort studies were included in our analysis. CVD and CV death were primary outcomes. Patients with PHPT were compared to general population. We also compare patients that had received parathyroidectomy (PTx) to those without parathyroidectomy. The variables were pooled as hazard ratios or standard mortality ratios, and a meta-analysis using random-effects model was performed.

Result: Of the 8 studies included, there were 250,476 PHPT patients with or without PTX, of which 185,261 were women (73.9%). The average of mean ages reported in 5 studies available was 66.0 years. PHPT was associated with higher risk of CV death when compared to general population (RR 1.55 [95% confidence interval (CI) 1.38-1.74); however, there was no significant difference of CVD risk between patients with PHPT and general population (RR 1.73 [95% CI 0.87-3.47]. When compared to patients without PTx, PTx had lower risk of CV death (RR 0.75 [95% CI 0.71-0.80]) and CVD (RR 0.92 [95% CI 0.90-0.94]).

Conclusions: PHPT had higher risk of CV death than general population, and PTX reduced the risk of CV death and CVD.

RISK OF SECOND PRIMARY MALIGNANCIES IN PATIENTS WITH THYROID CANCER TREATED WITH RADIOIODINE

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

1,2,4YU-LING LU

3

MELANIE DAVIS

,

YU-TUNG HUANG, 3CHIA-LING WU, 1,2,4SHU-FU LIN

Diabetes Medicine, University of Leicester

1Division of Endocrinology and Metabolism, Department of Internal Medicine Chang Gung Memorial Hospital, Taoyuan, Taiwan, 2Division of Endocrinology and Metabolism, Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, 3Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou, 4Chang Gung University, Taoyuan, Taiwan

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

Background: Radioactive iodine (RAI) therapy was used for thyroid cancer ablation. Previous studies have shown that RAI therapy increases the risk of second primary malignancies (SPM) and leukemia. We investigated whether RAI therapy increases the risk of SPM in Taiwanese thyroid cancer patients during long-term follow-up.

• personalised approach

• approaches for implementation

Methods: We conducted a retrospective study using data from the Taiwan’s national health insurance research database (NHIRD). From 2001-2017, the study included 33,002 patients. Of these thyroid cancer patients, 32.4% (10694/33002) were treated with RAI therapy. Patients who received RAI therapy were compared with the general population and patients who did not receive RAI therapy, and the cumulative doses of RAI and risk of SPM were also analyzed.

Result: A total of 33,002 Taiwanese patients diagnosed with thyroid cancer from 2001 to 2017, of whom 78.2% (25,794/33,002) were women, the median follow-up time was 6.1 (3.3-10.1) years, and the median age was 47 (38-56) years old. Of these thyroid cancer patients, 32.4% (10694/33002) had received RAI therapy.

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Thyroid cancer patients (n = 33002) were compared with the general population. SPM developed in 1351 patients, SIR 1.03 (0.97-1.08). When comparing the risk of SPM in patients with thyroid cancer who received and did not receive RAI therapy, there was no increased risk of SPM in patients receiving RAI therapy, IRR 0.95 (0.86-1.05).

We compared patients with cumulative RAI doses of 0-29mCi (N = 22,334) and cumulative RAI doses of 30-99mCi (N = 610), 100-149mCi (N = 5,029) and more than 150mCi (N = 5,029), to access the risk of SPM. The results showed that the risk of SPM did not increase with cumulative dose of RAI.

Conclusion: RAI therapy in patient with thyroid cancer dose not increase the risk of SPM and leukemia.

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

WIDESPREAD METASTATIC FOLLICULAR THYROID CARCINOMA FROM UNCERTAIN PRIMARY THYROID LESION IN THYROID GLAIND

未來

1

李淳權

MIN-CHUN

馬偕紀念醫院

YEH, 1CHUNG-HUEI HSU

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

、

；

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Introduction: Follicular thyroid carcinoma(FTC) is the second most common differentiated thyroid cancer and tends to be more common in areas with iodine deficiency. The most common clinical presentation of FTC is a painless thyroid nodule with or without background nodularity. Clinically evident cervical lymphadenopathy is rare(2-8%) at presentation. Distant metastasis at presentation is between 15% and 27%. The most common sites for metastasis are lung and bone. Herein, we describe a case report of widespread metastatic follicular thyroid carcinoma from uncertain primary thyroid lesion in thyroid glaind.

Case summary: A 82-year-old woman who has right thyroid goiter for more than ten years. The fine-needle aspiration for right thyroid goiter showed absence of abnormal change. Right lobectomy was performed on 2017-11-03 and the pathology result was nodular hyperplasia. On 2021-03-31, she visited emergency room due to chest tightness. Chest computed tomography showed diffuse multiple various-sized nodules in bilateral lungs. CT-guided biopsy for left lower lung nodular lesion showed metastatic follicular thyroid carcinoma. 3mCi diagnostic I-131 scan showed tumor at neck, with bilateral diffuse lung metastases and multifocal bone metastases. On 2021-06-10, she received left thyroid lobectomy and the pathology result was nodular hyperplasia.

Discussion: This case report and literature review investigated: 1. the possible primary site of FTC of this patient 2. the crux and accessory diagnostic method for FTC.

PRIMAY THYROID LYMPHOMA: A CASE REPORT

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

1PEI-CHUAN LEE, 1LI-HSIN PAN, 1KUAN-YU SU, 1YUN-KAI YEH, 2LIANG-TSAI HSIAO, 1CHIN-SUNG KUO

MELANIE DAVIS

Diabetes Medicine, University of Leicester

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.; 2Division of Hematology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

Background: Primary thyroid lymphoma is rare in the thyroid malignancies. Here, we reported a rare case of primary thyroid lymphoma who presented with rapidly neck mass growth and compressive symptoms.

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

Methods: A 61-year-old male without systemic disease, presented with acute enlargement of left neck mass in four weeks and hoarseness in one week. On physical examination, 8x10cm neck mass was noted on the left side of the thyroid with trachea deviation to the right side.

Results: Neck CT scanning showed a 10.3cm hypodense lesion at the left middle and lower neck with airway displacement to right side. The cytology of fine needle aspiration revealed suspected malignant B cell lymphoma. The pathology of incisional biopsy revealed diffuse large B cell lymphoma, germinal center type. The patient then undergone chemotherapy with good response.

Conclusions: The differential diagnosis of thyroid lymphoma may be considered in patients presented with rapidly growth of thyroid mass and tissue biopsy helps for the confirmation of diagnosis.

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

DAROC-TADE-2

PE17

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

SUCCESSFUL LAPAROSCOPIC PARTIAL ADRENALECTOMY FOR BILATERAL CORTISOL-SECRETING ADENOMAS

李淳權

1YING-YU TSENG

2CHI-REI YANG, 3TSUNG-CHUN HUANG, 1TZU-YUAN WANG

,

馬偕紀念醫院

1Division of Endocrinology and Metabolism, Department of Internal Medicine,China Medical University Hospital, Taiwan, R.O.C.; 2Department of Urology, China Medical University Hospital , Taiwan, R.O.C. 3Department of Plastic Surgey , China Medical University Hospital , Taiwan, R.O.C.

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為

、

；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

Adrenocorticotropic hormone (ACTH)-independent Cushing’s syndrome (CS) is mostly due to unilateral adrenal adenoma. Bilateral adenomas causing ACTH-independent CS are very rare. Adrenal venous sampling (AVS) is the gold standard procedure to differentiate the unilateral from the bilateral form in patients with CS. However, it is an invasive and difficult technique. NP-59 SPECT/CT may be a alternate method when AVS failed.

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

Method: We report a rare case of bilateral cortisol-secreting adenomas causing CS, which was diagnosed by NP-59 SPECT/CT before successful laparoscopic bilateral partial adrenalectomy

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Results: A 40-year-old woman with a history of type 2 diabetes and obesity was admitted to our hospital because of poor wound healing for about half year after a car accident. Cushingoid appearance were found during hospitalization . Lab data revealed no circadian rhythm of cortisol, elevated 24-hour urinary free cortisol (1676 ug/24hour),low ACTH level ( < 5pg/mL) and no suppression of 1 mg overnight dexamethasone test. Adrenal computed tomography showed bilateral adrenal masses. Adrenal venous sampling was performed, but failed cannulation of the right adrenal vein. NP-59 SPECT/CT favored bilateral functional adenomas. She underwent laparoscopic partial left adrenalectomy first. The pathology report showed adrenocortical adenoma. Cortisol was still high after surgery. One month later , she accepted another laparoscopic partial right adrenalectomy .The pathology report was adrenocortical adenoma. After second time operation, Her cushingoid appearance markedly improved and DM was well controlled only with diet.

Conclusions: The diagnosis of patients with CS due to bilateral adenomas is challenging for correct localization of the functional lesions.NP-59 SPECT/CT are useful diagnostic test for Cushing’s syndrome presenting with bilateral adrenal adenomas. Laparoscopic bilateral partial adrenalectomy is effective and safe in CS with bilateral functional adenomas.

A RARE CASE OF LYMPHOCYTIC HYPOPHYSITIS PRESENTING AS

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

POSTPARTUM DEPRESSION

MELANIE DAVIS

YI-TING CHIU, TZU-YUAN WANG, CHING-CHU CHEN, RONG-HSING CHEN, CHWEN-TZUEI CHANG

Diabetes

Medicine, University of Leicester

Division of Endocrinology and Metabolism, Department of Internal Medicine, China Medical University Hospital, Taiwan, R.O.C.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

Introduction: Postpartum depression occurs in about 10% to 20% of women. It is important that health care professionals strive for early identification and treatment of postpartum depression. Lymphocytic hypophysitis (LH) is the most common form of hypophysitis and is more frequently observed in women during pregnancy or postpartum. LH patients typically present with severe headaches, visual disturbances due to chiasmal compression, and symptoms of adrenal insufficiency. Here, we report a rare case of LH presenting as postpartum depression due to adrenal insufficiency

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Case report: A 35-year-old woman gravida 1, para 1 with a history of infertility with heterozygotic twin pregnancy via In Vitro Fertilization, delivered at 36 weeks with malpresentation and placenta accreta, status post Cesarean section and perioperative blood loss of 850 ml was reported and received massive fluid replacement of 3700 ml, leading to anemia with a drop in hemoglobin from 11.0 g/dL to 7.3 g/dL. No hemodynamic instability was recorded after treatment. She was discharged on fifth day of hospitalization. After discharge, she started complaining of decreased oral intake, fatigue, and depressive mood for one month. She ever visited Psychiatric Clinic and received medication treatment, but in vain. Afterwards, she was readmitted to the hospital for evaluation. She denied of headache, dizziness, fever, chills, abdominal pain, diarrhea, or constipation. No suicide ideation nor plans, no delusions, no hallucinations, no psychotic symptoms. Physical examination disclosed temperature of 37.3'C, blood pressure of 118/77 mmHg, heart rate of 98 beat per minute, respiration rate of 20 per minutes, and oxygen saturation of 99% on room air. She was awake but confused in verbal response. There were no diplopia, visual field defect, extraocular muscle restriction, focal motor or sensory deficits. Laboratory tests showed anterior pituitary hormone deficiencies Cortisol AM: 5.59 ug/dL (6.7-22.6), ACTH AM: 17.6 pg/mL (7.2-63.3), Estradiol: 31 pg/mL (49-291), Progesterone: 0.82 ng/mL (5.2-18.6), LH: 0.35 mIU/mL (2.1-10.9), FSH: 3.71 mIU/mL (4.5-22.5), TSH: 0.147 uIU/mL (0.34-5.60), Free T4: 0.97 ng/dL (0.54-1.40) and hyperprolactinemia Prolactin: 102.46 ng/mL (3.3-26.7). MRI of Sella turcica showed slightly thickened and deviated pituitary stalk. LH with adrenal insufficiency was highly suspected based on image finding and hormone data. After prescribing intravenous hydrocortisone 200 mg for one dose, symptoms of depressive mood dramatically improved.

Conclusion: LH should be kept in consideration as a differential diagnosis in women with postpartum depression. Early diagnosis and treatment with steroid may prevent serious morbidity.

DAROC-TADE-2

PE19

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

PHEOCHROMOCYTOMA PRESENTING AS HYPOTENSION IN A 12 YEAR OLD GIRL

李淳權

1YU-CHING HUNAG, 1TZU-YUAN WANG, 1CHING-CHU CHEN, 1RONG-HSING CHEN, 1CHWEN-TZUEI CHANG

馬偕紀念醫院

1Division of Endocrinology and Metabolism, Department of Internal Medicine,China Medical University Hospital, Taiwan, R.O.C1

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、

；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

Background: Pheochromocytoma in tweens is uncommon. The classical presentation of pheochromocytoma are hypertension with the triad of palpitations, sweating and headaches. However, many patients lack these typical features. Pheochromocytoma occurs in tweens who develop hypotension as the first manifestation are extremely rare.

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

Methods: We report a young girl of pheochromocytoma presenting with hypotension and acute heart failure.

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Results: A 12-year-old girl presented to the emergency department with progressive shortness of breath. Initially hypotension (SBP: 70mmHg) was noted at local clinic. She was referred to our hospital for suspected congestive heart failure due to virus myocarditis. The chest X-ray reveal enlarged cardiac pericardial silhouette and pulmonary edema. The echocardiogram demonstrated remarkable left ventricle dilation and decrease contractility with left ventricular ejection fraction (LVEF) of 45%. She was treated for congestive heart failure with diuresis and after load reduction. After admission, severe hypertension developed despite nitroprusside, capoten, minipress and lasix used. Sudden collapse with high fever (40'C) were noted during hospitalization and she underwent defibrillation for ventricular tachycardia. She was place on an artificial respirator afterward. A hypoechoic lesion was found in the right adrenal gland incidentally on renal ultrasonography which was ordered due to acute urinary retention. Pheochromocytoma was highly suspected and subsequent 24-hour urine metanephrine, norepinephrine, epinephrine and dopamine were elevated. Abdomen computed tomography (CT) showed an inhomogeneous right adrenal mass. I-131 MIBG scan was negative finding. Once the patient was stabilized, she was transferred to the urology department and successfully underwent laparoscopic right adrenalectomy. Pathology result confirmed the diagnosis of pheochromocytoma. After surgery, regression of dilated left ventricle was noted and LVEF improved to 54%. Urine metanephrine, norepinephrine, epinephrine and dopamine were return to normal range. This case highlights that pheochromocytomas secrete excessive levels of catecholamine may lead to myocardial dysfunction and heart failure subsequent present with hypotension or even fatal arrhythmia

Conclusions: Pheochromocytoma should be kept in mind when a tweens patient having unexplained hypotension with congestive heart failure. Early diagnosis and treatment may prevent serious morbidity and mortality.

ACUTE KIDNEY INJURY AND HYPERKALEMIA IN A PATIENT WITH PRIMARY ALDOSTERONISM POST ADRENALECTOMY

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

MELANIE DAVIS

1EN-TZU LIN, 1TZU-YUAN WANG, 1CHING-CHU CHEN, 1RONG-HSING CHEN, 1CHWEN-TZUEI CHANG

Diabetes

Medicine,

University of Leicester

1Division of Endocrinology and Metabolism, Department of Internal Medicine,China Medical University Hospital, Taiwan, R.O.C

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

Background: Primary aldosteronism (PA) is the most common cause of secondary hypertension, Idiopathic bilateral adrenal hyperplasia (IHA) and aldosterone-producing adrenal adenoma (APA), are the leading causes of primary aldosteronism. Surgery is the treatment of choice in patients with APA. Unilateral adrenalectomy cures hypertension in 30-70% of patients with APA and improves hypertension, normalize hypokalemia in all patient. Post adrenalectomy acute kidney injury(AKI) with hyperkalemia has never seen in our hospital.

Methods: we report a case of APA associated with persistent postoperative hyperkalemia and AKI.

Results: A 59-year-old man with a history of hypertension and chronic renal failure visit our outpatient department (OPD) because of hyperkalemia and acute kidney injury post adrenalectomy. He had hypertension for 10 years. High blood pressure developed in the recent 3 years, even with triple antihypertensive therapy. The aldosterone renin ratio was 30.88 and creatine 3.2 mg/dl. Abdominal CT showed a 2cm right adrenal mass. Primary aldosteronism due to right APA was diagnosed after a series of examinations. He underwent right adrenalectomy smoothly. At 4 weeks post-operative follow up, her blood pressure was 120/80 mmHg, serum potassium 5.7 mmol/L, creatinine 4.33 mg/dl and BUN 60 mmol/L. Treatment at nephrology OPD was initiated with sodium bicarbonate 1.2g three times and calcium polystyrene sulfonate 3 pack three times daily. However, his potassium level remains 4.7-5.9 mmol/L for the four following months. Due to persistent hyperkalemia. He called on metabolism OPD and fludrocortisone 0.1 mg once daily was prescribed. After 1 week follow up, his serum potassium reduced to 4.1 mmol/L, and maintained normal on subsequent visits.

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Conclusions: Serum potassium and creatine should be closely monitored in APA after adrenalectomy to avoid potentially dangerous complications, especially in patient with long duration of hypertension, older age and impaired renal function. Management should be tailored to patient characteristics. Fludrocortisone, sodium bicarbonate, loop diuretics and potassium binders can be used for treatment.

DAROC-TADE-2

PE21

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

A CASE OF PRIMARY BILATERAL MACRONODULAR HYPERPLASIA AFTER RECEIVING UNILATERAL ADRENALECMY

未來

李淳權

YI-CHING TSAI, TZU-YUAN WANG, CHING-CHU CHEN, RONG-HSING CHEN, CHWEN-TZUEI CHANG

馬偕紀念醫院

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

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為

、

；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Background: Primary bilateral macronodular hyperplasia refers to adrenal hyperplasia with multiple bilateral macronodules ( > 10mm). The adrenal hyperplasia may lead to different degrees of adrenal hormone secretion. The clinical presentation ranges from asymptomatic to signs of Cushing syndrome according to the level of cortisol excess and rarely associated with autonomous aldosterone or androgen secretion. Metabolic signs and symptoms with hypertension, diabetes and obesity are frequently found. Surgery with unilateral adrenalectomy on larger side is often chosed for hypercortisolism control. Here, we present a case that presented with subclinical Cushing syndrome and hyperaldosteronism and she had resolved of the comorbidites after receiving unilateral adrenalectomy.

Case: This 50 years old woman with a history of adenomyosis status post laparotomy total hysterectomy and bilateral salpinectomy presented to our clinic with high blood pressure for 2 months. Secondary hypertension survey was done and showed adrenal hypercortisolisim with suppressed ACTH [Cortisol AM: 20.92 ug/dL (6.7-22.6), ACTH AM: 61 ug/dL and aldosterone 111.3 ng/dL; from inferior vena cava showed cortisol 12.21 ug/dL and aldosterone 7.23 ng/dL. The selectivity index for right and levt adrenal vein is 0.69 and 5.00 respectively. There is only adequacy of cannulation of the left adrenal vein. Ipsilateral ratio of left side (ACRdominat adrenal vein/ACRinferoir vena cava) was 3.13. The result of adrenal vein sampling indicated dominant hypersecretion of left adrenal tumor but failure of right adrenal vein cannulation. The patient received left laparoscopic adrenalectomy a year later due to CT showed enlarging left adrenal tumor. The left adrenal tumor was grossly 8cm x 4cm x 3.5cm in size with multiple nodules. The pathology showed adrenal cortical macronodular hyperplasia. During follow up, the patient had remission of diabetes mellitus 6 months after the operation with HbA1c 5.5% without anti-diabetic agents. She is also free from anti-hypertensive medication. Overt hypercortisolism subsided with Cortisol AM: 9.30 ug/dL, Cortisol PM: 5.70 ,ug/dL, ACTH AM: 5.63 pg/mL, though 1 mg dexamethasone test is still non-suppressed.

Conclusions: Unilateral adrenalectomy of primary bilateral macronodular hyperplasia may lead to clinical remission and may improve comorbidity of hypercortisolism despite subclinical cushing syndrome may still exist. Comparing to bilateral adrenalectomy, unilateral adrenalectomy may provide the patient a better life quality owing to avoidance of life-long adrenal hormone supplement. Closely monitoring for recurrence is needed due to contralateral pathologic structure still persists.

A CASE OF 33-YEAR-OLD WOMAN WITH PAPILLARY THYROID CARCINOMA IN STRUMA OVARII

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

MELANIE DAVIS

YU-CHING LIAO, YAN-YU LIN, CHUNG-HUEI HSU

Diabetes

Medicine,

University of Leicester

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

A 33-year-old woman presented to the gynaecology outpatient department of our hospital experienced abnormal vaginal bleeding for several months. Vaginal ultrasound showed the presence of uterine mass, suspected to be myoma and a left-side ovarian cyst (12.8x8.9x8.8 cm in size). Both serum tumor marker CA-125 and Hemoglobin (Hb) indicated normal levels. During regular followup in the gynaecology department, a decreased size ( < 10cm) of the ovarian cyst was found. After one year, a growing cyst (10.4x7.7x10.7 cm) and myoma were discovered. Serum tumor markers CA125, CA153, CA199, β-HCG were within normal limits. A computed tomography scan of the pelvis was scheduled to identify the mass, which revealed a 10 cm large cystic lesion in the left adnexa, with mural nodule appearance, thus the possibility of ovarian cancer should be considered. No fluid, ascites or enlarged lymph nodes were observed in the pelvic space. A laparoscopic left-side cystectomy was performed. The pathologic report of the removed mass confirmed the existence of struma ovarii with a focus of papillary thyroid microcarcinoma. After surgery, ultrasonography of the thyroid showed no abnormalities. Thyroid stimulating hormone (TSH) and thyroxine (T4) were within normal limits, autoantibody was absent. No abnormal uptake was found in thyroid scintigraphy. Additional laparoscopic assisted staging surgery (left-side salpingo-oophorectomy, bilateral lymph node dissection and washing cytology) was performed. Pathologic report revealed left ovarian serous cystadenoma and a follicle cyst, without lymph node involvement. After a two year follow-up, the woman is well with no evidence of recurrence.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

DAROC-TADE-2

PE23

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

A CASE OF OPHTHALMOPATHY IN TENTATIVE HYPOTHYROID GRAVES’ DISEASE

1YU-XUAN CAI, 2SZU-TAH CHEN, 4YUEH-JU TSAI, 1,3FENG-HSUAN LIU

李淳權

馬偕紀念醫院

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation); 3Chang Gung University, Taoyuan City, Taiwan; 4Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標）

與微量白蛋白尿篩檢率部份，分別為 51.6、

Objective: Graves’ ophthalmopathy (GO) is commonly associated with hyperthyroidism secondary to Graves’ disease (GD). It is rare in GD patients with hypothyroidism. Here we describe a case of GO developed in a hypothyroid patient suffering from possible both GD and Hashimoto’s thyroiditis and eventually successfully treated with block and replace therapy.

、

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Method: [case report] A 60-year-old man presented for the first time in our endocrine clinic with left exophthalmos and lethargy for 6 months, accompanied by body weight gain 8 kg in one year. The patient had smoke history. The patient had no history of thyroid related diseases, nor any history of chronic diseases and medications. There’s also no thyroid disease in his family history. Laboratory examinations revealed primary hypothyroidism with free T4: 0.40 ng/dl (0.70-1.48), thyroid stimulating hormone (TSH): 193.745 μIU/mL (0.35-4.94). His TSH receptor Antibody (TSH-R Ab) 34.8 IU/L (normal: 1000 IU/ml (normal: < 5.6 IU/ml) were both strongly positive.

While ultrasonogram of the thyroid revealed diffusely enlarged hypoechoic gland, 99mTc pertechnetate scan showed diffuse low uptake of radiocontrast in the thyroid. At the beginning, we used levothyroxine 0.1 mg/day to treat primary hypothyroidism. He was later referred by an ophthalmologist for exophthalmos, vision loss and suspected dysthyroid optic neuropathy. Computed tomography of the orbits showed typical findings of GO. Repeated methylprednisolone pulse therapy was started, and his vision improved initially but worsened later. After orbital decompression surgery, his vision improved slightly but it still did not return to normal. The patient complained of aggravated eye swelling and discomfort after levothyroxine despite euthyroid status. Block-and-replace therapy was then prescribed for the high titer of TSH-R antibody. Finally, methimazole 10mg and levothyroxine 0.15mg/day were used to maintain normal thyroid function and TSH-R antibody gradually declined to 4.6 IU/L. The patient underwent surgery to adjust the oculomotor muscles, improving diplopia and is currently in stable condition.

Discussion: GO is a rare condition to come across in patients with primary hypothyroidism secondary to GD and Hashimoto’s thyroiditis, and is being successfully treated with methylprednisolone pulse therapy, orbital decompression surgery, and block-and-replace regimen.

Conclusion: The management of Graves’ ophthalmopathy is multidisciplinary. It requires close collaboration between endocrinologists and ophthalmologists.

ANALYTICAL VALIDATION OF AN INDUCTIVELY COUPLED PLASMA MASS SPECTROMETRY METHOD FOR MEASURING IODINE

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

CONTENT IN BREAST MILK

MELANIE DAVIS

1,2JIA-ZHEN LI, 1,2LIN-HSUAN

Diabetes Medicine, University of Leicester

LEE, 2,3FAN-FEN WANG, 4,5,6CHEN-CHANG YANG, 2,6CHUN-JUI HUANG

1Department of Food Safety and Health Risk Assessment Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan; 2Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 3Division of Endocrinology and Metabolism, Department of Internal Medicine, Yangming Branch, Taipei City Hospital, Taipei, Taiwan; 4Division of Clinical Toxicology & Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 5Institute of Environmental & Occupational Health Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; 6Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

Background: Adequate iodine status in lactating women is defined by a maternal median urinary iodine concentration (UIC) above 100 μg/L. However, the current standard does not account for the secretion of iodine into breastmilk and could not truly reflect the amount of iodine delivered to the infants. Measuring breastmilk median iodine concentration (BMIC) is of crucial importance but the method to measure BMIC has not been developed and validated in Taiwan.

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Methods: We adopted the ammonia dilution method without prior sample digestion to measure BMIC by inductively coupled plasma mass spectrometry (ICP-MS). Samples and iodine calibrators were prepared into an aqueous solution containing Triton X-100, 0.5% ammonia solution and tellurium (128Te) as the internal standard. Precision, accuracy, serial dilution, and recovery tests were performed for method validation.

Results: The intra-assay and inter-assay coef fi cient of variations for the four human breast milk samples with different iodine concentrations ranged from 3.2% to 4.7% and 2.3% to 5.5%, respectively. The standard NIST 1549 milk powder was prepared into three different concentrations of 50 μg/L, 100 μg/L and 200 μg/L to assess accuracy and the biases were < 5%. A recovery of 95–105% was achieved for four human breast milk samples spiked with sodium iodide solution. The serial dilution test confirmed linearity up to 500 μg/L. The limit for detection and quantification was 0.73 μg/ L and 2.19 μg/L, respectively.

Conclusions: The results of the current study confirmed that this ICP-MS method is accurate and reliable in measuring BMIC.

DAROC-TADE-2

PE25

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

THYROID MALTOMA: A RARE TYPE OF THYROID MALIGNANCY ON A 61-YEAR-OLD FEMALE

未來

1SHU-MING CHOU, 1CHUNG-HUEI HSU

李淳權

馬偕紀念醫院

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taiwan, R.O.C.

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Introduction: Primary thyroid lymphoma is a rare cause of thyroid malignancy, accounting for only about 5% of cases, and the annual estimated incidence is only 2 per 1 million. Most cases are diagnosed at their 60’s to 70’s, while females are at higher risk than male. Extranodal marginal zone lymphoma (MALToma) is the second common subtype, which accounts for 10%~23% of all primary thyroid lymphoma. The nature of thyroid MALToma is relatively indolent with a 5-year survival of about 96%. The actual pathophysiology of thyroid MALToma is not clearly established, but most cases (60%~90%) of primary thyroid lymphoma do arise in a background of thyroiditis.

Case Description: We present a case of a 61-year-old Taiwanese female with underlying disease of Hashimoto’s thyroiditis for about 1 year under levothyroxine supplement 75 mcg per day. Due to thyroid nodule found by palpation at outpatient department, thyroid sonography was performed and a 1.71 cm x 0.77 cm left thyroid nodule was found. Fine needle aspiration cytology was done, which revealed atypical cellular change. Left total thyroidectomy was arranged, and the pathology showed extranodal marginal zone lymphoma (MALToma). Tumor survey was given and PET scan revealed involvement at left axilla, right neck, mediastinum and suspiciously right thyroid lobe. The initial staging is Ann-Arbor stage IIE. Cyclophosphamide 50mg QOD and regular head, neck, and chest CT scan follow-up were given. Recurrence at right thyroid and mediastinum was noted about 4 years after the initial diagnosis, and Cyclophosphamide was given again.

Discussion: This case report demonstrated the treatment and management of thyroid MALToma on a female in her 60’s with Hashimoto’s thyroiditis. Although recurrence still occurred years after the initial treatment, the course is still compatible with the indolent nature of the disease.

A PATIENT WITH PRIMARY BILATERAL MACRONODULAR ADRENAL HYPERPLASIA (PBMAH) PRESENTING AS ADRENAL INCIDENTALOMA AND AUTONOMOUS CORTISOL SECRETION - A CASE REPORT

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

MELANIE DAVIS

Diabetes Medicine, University of Leicester

1YUN-CHI LEE, 1RONG-HSING CHEN

1Division of Endocrinology and Metabolism, Department of Internal Medicine, China Medical University Hospital

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

Introduction: A rare and diverse condition known as primary bilateral macronodular adrenal hyperplasia (PBMAH) is characterized by bilateral benign adrenal macronodules ( > 1 cm) that may be the cause of varying degrees of cortisol excess. The majority of patients do not initially present with particular indications of cortisol excess but are diagnosed after the analysis of incidentally detected bilateral adrenal tumors on abdominal imaging. We present a patient with PBMAH who was found incidentally and did not present with typical signs of Cushing’s syndrome and was thereafter received laparoscopic left adrenalectomy.

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Case presentation: A 71-year-old female with history of hypertension and chronic hepatits C, s/ p direct-acting antiviral treatment, sought assistance from the endocrine out-patient department due to incidentally discovered bilateral adrenal masses on abdominal computed tomography (CT), which showed left adrenal gland mass 7 cm in diameter and right adrenal gland mass 3.5 cm in diameter, with attenuation value of 25 Hounsfield units on an unenhanced scanning.

The patient has no discomfort other than hypertension that has been being treated with Exforge HCT. Her height was 152.5 cm and weight was 55.8 kg, with no typical clinical manifestations of Cushing’s syndrome, such as facial plethora, central obesity, or dorsocervical fat pad. Hormonal assessment revealed 8 am serum cortisol 26.16 ug/dL (normal range (NR): 6.7-22.6), ACTH < 5.00 pg/mL (NR < 46), aldosterone 19.08 ng/dL (NR: 6.8-17.3 ng/dL), plasma renin activity 27.61 ng/mL/hr (NR: 0.32-1.84), 24 hour urine vanillyl mandelic acid 3.86 mg/day (NR: 1-7.5), dehydroepiandrosterone sulfate 3.7 ug/dL (NR: 4.6-285 ug/dL), and 17α-OH progesterone 0.55 ng/ mL (NR: 0.55-1.99). Her fasting blood glucose was 116 mg/dl(NR < 100) and HbA1c was 5.5%(NR: 4.0~5.6). 1-mg overnight dexamethasone suppression test (1 mg-ONDST) revealed non-suppressed serum cortisol with a level of 15.94 ug/dL (NR: < 5). Standard low-dse and high-dose dexamethasone suppression test showed serum cortisol level 13.57 ug/dL and 15.9 ug/dL, respectively (NR: < 5). Dual-energy X-ray absorption test showed T-score for the L1 through L4 vertebrae -4.5. A diagnosis of osteoporosis was made.

The patient was admitted to the urology ward for a laparoscopic left adrenalectomy. During the procedure, the left adrenal gland was discovered to have many nodules, and the largest nodule was yellowish brown in color (Figure 2). The left adrenal specimen has dimensions of 8.0 x 4.5 x 3.0 cm,

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

weighed 59.0 gm. One 7.5 × 4.5 cm multinodular yellow and elastic tumor, practically filling the entire specimen, is present. Microscopically, the sections of the adrenal tumor show proliferation of round to polygonal tumor cells with clear cytoplasm and minimal to mild nuclear atypia with occasional small nucleoli arranged in trabecular or nest patterns.

李淳權

Two weeks after the surgery, hormonal assessment showed plasma cortisol 8 am was 22.20 ug/dL (N: 6.7-22.6), ACTH was 9.88 pg/mL (N < 46), and 1mg-ONDST was 5.55 ug/dL (N: < 5).

馬偕紀念醫院

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人 照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為

、

Three months after the surgery, a follow-up hormonal assessment showed plasma cortisol 8 am was 15.90 ug/dL (Normal: 6.7-22.6), ACTH was 16.30 pg/mL (N < 46), and 1mg-ONDST was 5.23 ug/dL (N: < 5). Her hypertension gradually improved, so Exforge HCT was withdrawn. The patient received weekly doses of self-paid Fosamax Plus 70mg/5600IU/tab for osteoporosis along with routine follow-up visits to the Endocrine OPD.

；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（

、

、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

EPIDEMIOLOGICAL STUDY OF THYROID NODULE IN HEALTH EXAMINATION CASES

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

1SHU-YI WANG, 1PEI-YUNG LIAO, 1SHIH-TE TU

MELANIE DAVIS

Diabetes

Medicine,

University of Leicester

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Taiwan, R.O.C

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

Background: According to statistics, approximately 19%-68% of healthy adults have asymptomatic thyroid nodules, most of which are benign. Thyroid ultrasound is the most common examination of thyroid morphology. Common features of malignant nodules include solid, hypoechoic appearance, taller than wide, dot calcifications, irregular or unclear margins, abnormal cervical lymphadenopathy, etc. Thyroid fine needle aspiration cytology is recommended for nodules larger than 1 cm in diameter or small nodules larger than 0.5 cm with malignant features to check for malignant changes. In this study, we aimed to compare the malignancy risk stratification of thyroid nodules using the ATA 2015, EU-TIRADS 2017, KSThR 2016 and ACR TIRADS 2017

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

Methods: Health examination cases with thyroid ultrasound scan were collected and analyzed between April 2018 to May 2019. The ultrasound characteristics of all nodules were analyzed. Four ultrasound classification systems, ATA 2015, EU-TIRADS 2017, KSThR 2016 and ACR TIRADS 2017 were applied to the ultrasound findings. Fine needle aspiration for cytology were performed if the nodules were suspicious according to the physician.

Results: Among the 1087 cases of health examination, 519 cases were female and 568 were male. 32.0% (578/1827) cases had nodules. The average size of the nodules were 0.63 ± 0.44 cm in females and 0.59 ± 0.40 cm in males (p = 0.0081). Among the cases, the average age of cases with nodules is higher than those without nodules (53.65 ± 11.62 vs 48.21 ± 11.59 in male, p < 0.0001; 51.87 ± 11.08 vs 45.16 ± 11.28, p < 0.0001). Among ultrasound classification systems, 156 cases (5.73%) fine needle aspiration cytology (FNAC) was suggested for the ACR system, 151 cases (5.54%) for the ATA system, 232 cases (8.52%) for the EU-TIRADS, and 275 cases (10.10%) for the KSThR guideline.

Conclusions: Medical guidelines play an important role for FNAC. Size is a critical factor in FNAC recommendation. ACR2017 has the highest specificity and diagnostic odds ratio and has only 5.73% FNAC recommendation rate. KSThR 2016 has the highest FNAC recommendation rate (10.10%).

DAROC-TADE-2

PE28

PRIMAY THYROID LYMPHOMA: A CASE REPORT

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

PEI-CHUAN LEE, LI-HSIN PAN, KUAN-YU SU, YUN-KAI YEH, LIANG-TSAI HSIAO, CHIN-SUNG KUO

李淳權

馬偕紀念醫院

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.; 2Division of Hematology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.; 3School of Medicine, National Yang Ming Chiao Tung University

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

Background: Primary thyroid lymphoma is rare in the thyroid cancers. Here, we reported a case of primary thyroid lymphoma who presented with a rapid-growing neck mass and compressive symptoms.

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

、

；

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

Methods: A 61-year-old male without systemic disease, presented with an acutely enlarged mass over left neck in four weeks and hoarseness in one week. On physical examination, 8x10cm neck mass was noted on the left side of the thyroid with trachea deviation to the right side.

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Results: The neck computed tomography scan showed a 10.3cm hypodense lesion at the left middle and lower neck with airway displacement to right side. The fine-needle aspiration cytology revealed suspected malignant B cell lymphoma. The pathology of incisional biopsy revealed diffuse large B cell lymphoma, germinal center type. The patient then underwent chemotherapy and obtained good response.

Conclusions: Primary thyroid lymphoma may be considered in the differential diagnosis of patients presenting with a rapid-growing thyroid mass. It is necessary for thyroid biopsy to make the diagnosis.

CASE REPORT: SUCCESSFUL IMPROVEMENT BY DOPAMINE

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

AGONIST IN A FEMALE PATIENT WITH MACROPROLACTINOMA

1YU-LING LIN

MELANIE DAVIS

Diabetes Medicine, University of Leicester

1Feng Yuan Hospital, Ministry of Health and Welfare

Prolactinoma is the most common of all pituitary adenomas. Up to 80% is presented as microadenoma. Females seek medical advice earlier due to hyperprolactinemia causing inhibition of gonadotropins leading to menstrual irregularities, galactorrhea or infertility. Medical therapy with dopamine agonists is highly effective in the majority of cases and represents the mainstay of therapy except few challenging situations. Here we report a case of 25-year-old female patient with initial presentation of sparromenorrhea, mild obesity, galactorrhea and headache without blurred vision. Hormonal evaluation revealed an extreme hyperprolactinemia (PRL = 1469 ng/ ml) and hypogonadotropic hypogonadism. MRI revealed a 18.2 mm height and cystic lesion with upward bulging displacing optic chiasm and sellar floor erosion. Medical treatment with cabergoline therapy was initiated. Clinical signs and symptoms improved with normalization of PRL level and follow up MRI revealed remission of previously macroadenoma, particularly for the proteinaceous or hemorrhagic cystic part. However, challenge in the young lady is about the concern of patient’s willing to have baby in the future and valvulopathy ever reported during long-term treatment at high cumulative doses of dopamine agonist. The importance of awareness of this risk during follow up should be emphasized and monitored.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

GREATER IMPROVEMENT IN INSULIN SENSITIVITY PER UNIT WEIGHT LOSS WITH TIRZEPATIDE COMPARED TO SELECTIVE GLP-1 RECEPTOR AGONISM

李淳權

馬偕紀念醫院

1KJ MATHER, 2A MARI, 1J LI, 3T HEISE, 4JH DEVRIES, 1S URVA, 1T COSKUN, 1Z MILICEVIC, 1A HAUPT, 1MK THOMAS, 5THOMAS LEW

(NON-AUTHOR PRESENTER)

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為

1Eli Lilly and Company, Indianapolis, IN, USA; 2Institute of Medicine and National Research Council, Rome, Italy; 3Profil Institute for Clinical Research, Inc, Neuss, Germany; 4Academic Medical Center, Amsterdam, Netherlands; 5Eli Lilly and Company, Taipei, Taiwan, R.O.C.

、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

OBJECTIVE: Tirzepatide (TZP), a GIP-GLP-1 agonist, improved fasting measures of insulin sensitivity partially attributable to weight loss in Phase 2 studies. Studies in mice demonstrated that GIP receptor agonism with TZP improved insulin sensitivity independent of weight loss.

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

METHODS: To further evaluate insulin-sensitizing actions of TZP, we measured insulin sensitivity with hyperinsulinemic euglycaemic clamps (M-value) in a 28-week double-blind andomized controlled trial comparing effects of TZP 15mg with placebo or semaglutide 1mg (SEMA), a selective GLP-1RA, all subcutaneous QW. Linear regression was used to compare relationships of change in M-value versus change in weight across treatment groups.

RESULTS: Change in M-value was related to absolute change and % change in weight. Slopes of linear relationships with absolute and % weight change differed between TZP and SEMA (absolute change: p = 0.015; % change: p = 0.03). Larger negative slopes were observed for TZP compared with SEMA on change in M-value related to absolute change and to % change in weight.

CONCLUSION: These results suggest that TZP may provide greater improvement in insulin sensitivity than a selective GLP-1RA per unit weight loss, most evident in subjects with greater weight loss.

RELATIONSHIP BETWEEN BODY WEIGHT CHANGE AND GLYCEMIC CONTROL WITH TIRZEPATIDE TREATMENT IN PEOPLE WITH TYPE 2 DIABETES

1SD

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

MELANIE DAVIS

Diabetes Medicine, University of Leicester

PEDERSEN,

2G UMPIERREZ, 3F GIORGINO, 4A RODRIGUEZ, 4VT THIEU, 4R BRAY, 4H SAPIN, 4L FERNÁNDEZ LANDÓ, 4CA KARANIKAS, 4J KILJANSKI, 5THOMAS LEW (NON-AUTHOR PRESENTER)

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

1C-ENDO Diabetes and Endocrinology Clinic, Calgary, Alberta, Canada; 2Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, USA; 3Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy; 4Eli Lilly and Company, Indianapolis, IN, USA

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

OBJECTIVE: Tirzepatide (TZP) is a once-weekly GIP/GLP-1 receptor agonist used for the treatment of type 2 diabetes (T2D). In the SURPASS clinical trial program, TZP demonstrated significant HbA1c and body weight reductions vs placebo, semaglutide, insulin degludec and insulin glargine. This post-hoc analysis assessed the relationship between HbA1c and body weight reductions with TZP treatment (5, 10 or 15mg).

METHODS: HbA1c and body weight data at 40 weeks (SURPASS-1, -2 and -5) and 52 weeks (SURPASS-3 and -4) were analyzed by trial, due to differences in design, background therapy, and baseline characteristics of participants.

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

RESULTS: Across the trials, HbA1c reductions from baseline were observed in 96-99%, 98-99% and 94-99% of participants treated with TZP 5, 10 and 15mg, respectively. Moreover, 87-94%, 8895% and 88-97%, respectively, also experienced weight loss. Significant correlations between HbA1c and body weight changes were observed with TZP in SURPASS-2, -3, -4 (all doses) and -5 (TZP 5mg only) (statistically significant correlation coefficients ranged from 0.1438 to 0.3130 across studies; p ≤ 0.038, for all doses).

CONCLUSIONS: Consistent reductions in HbA1c and body weight, even when used with medications associated with weight gain, were observed in the vast majority of participants treated with TZP at doses of 5, 10, or 15mg.

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

PATIENT CHARACTERISTICS ASSOCIATED WITH ACHIEVEMENT OF NORMOGLYCAEMIA FOLLOWING TREATMENT WITH TIRZEPATIDE IN THE SURPASS 1-4

TRIALS

李淳權

馬偕紀念醫院

1L VÁZQUEZ, 2J ROSENSTOCK, 3S DEL PRATO, 4R FRANCO, 5B DAI, 5G WEERAKKODY, 5L FERNÁNDEZ-LANDÓ, 5

BK BERGMAN,

5A RODRÍGUEZ, 6JESSICA HUANG (NON-AUTHOR PRESENTER)

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為

、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標）

1Hospital Marqués de Valdecilla, Santander, Spain; 2Dallas Diabetes Research Center at Medical City, Dallas, TX; 3Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; 4CPCLIN/DASA, Clinical Research Center, Sao Paulo, Brazil; 5Eli Lilly and Company, Indianapolis, IN, USA

與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

OBJECTIVE: In the SURPASS program 23% to 62% of adults with type 2 diabetes (T2D) treated with tirzepatide (TZP), a GIP/GLP-1 receptor agonist, achieved an HbA1c value below the upper limit of the normal range <5.7% at the primary endpoints. We performed exploratory analysis to identify baseline characteristics potentially associated with increased odds of achieving a normal HbA1c following treatment with TZP in the SURPASS 1-4 clinical trials.

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

METHODS: The analyses included compliant patients (≥75% doses received), on treatment without rescue medication (N=3229). Background medication at baseline included metformin only (63%), combination of oral anti-diabetic medication (26%), and no treatment (9%). Logistic regression models with TZP (5, 10, and 15mg) adjusted as a covariate, were used to obtain odds ratios and assess the impact of individual baseline variables on achieving an HbA1c 5.7%. A multivariate logistic regression model was fitted to further assess the joint impact of these variables.

RESULTS: Higher TZP doses were significantly associated with higher odds of achieving an HbA1c 5.7%. Duration of diabetes, HbA1c, fasting serum glucose (FSG), eGFR and age showed significant associations when assessed by univariate logistic regression models adjusted by TZP doses. Odds of achieving an HbA1c <5.7% at week 40 was reduced by 13% and 24% with a 5-year increase in age or diabetes duration, respectively. Similarly, higher baseline HbA1c (10.93 mmol/mol, or 1% increase) and FSG (2.8 mmol/L increase) were associated with decreased odds of achieving an HbA1c 5.7% (42% and 24%, respectively). Patients receiving metformin-only had a greater chance of achieving this HbA1c target than those on 2 or more antihyperglycaemic medications. A multivariate logistic regression model including age, duration of diabetes, background medication, baseline HbA1c and baseline weight demonstrated similar findings.

CONCLUSION: Patients with shorter duration of diabetes, receiving only metformin as background therapy were more likely to achieve an HbA1c <5.7% when treated with TZP in the SURPASS 1-4 clinical trials.

TIRZEPATIDE SHOWS BENEFICIAL EFFECTS ON BODY FAT

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

DISTRIBUTION PATTERN IN PEOPLE WITH TYPE 2 DIABETES

MELANIE DAVIS

1J LINGE, 2B CARIOU, 3IJ NEELAND, 1OD LEINHARD, 1M PETERSSON, 4L FERNANDEZ LANDO, 4R BRAY4, 4A RODRIGUEZ, 5NON-AUTHOR PRESENTER TBA

Diabetes Medicine, University of Leicester

1AMRA Medical AB, Linköping, Sweden; 2Nantes Université, CHU Nantes, CNRS, Inserm, l’institut du thorax, Nantes, France; 3University Hospitals Cleveland Medical Centre; Case Western University School of Medicine, Cleveland, USA; 4Eli Lilly and Company, Indianapolis, USA; 5Non-author presenter affiliation TBA

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

OBJECTIVES: Tirzepatide (TZP) is a GIP/GLP-1 receptor agonist used for the treatment of type 2 diabetes (T2D). In the SURPASS-3 MRI substudy, people with T2D (metformin ± SGLT-2i, HbA1c 7-10.5%, BMI ≥ 25kg/m2, fatty liver index value ≥ 60) were treated with once-weekly TZP 5mg (N = 71), 10mg (N = 79), 15mg (N = 72) or once-daily insulin degludec (IDeg) (N = 74) (ClinicalTrials. gov Identifier: NCT03882970 substudy). Overall, TZP showed a mean weight loss of -9.6 kg at week 52 and concurrent reductions of visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (aSAT) and liver fat (LF) assessed by MRI, while people treated with IDeg experienced an overall weight gain (mean + 3.2 kg) with increase in VAT and aSAT, and a smaller decrease in LF than TZP. We aimed to describe overall fat distribution pattern at baseline and week 52 and relate actual changes in fat depots to the changes predicted by the difference in two virtual controls groups (VCGs) matching baseline and 52-week data.

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

METHODS: For each study participant at baseline and week 52, a VCG of ≥ 150 sex- and bodysize matched participants were identified from the UK Biobank imaging study (N = 40,174,). Expected levels of VAT, aSAT and LF and deviation from the expected levels (standardized normal z-scores (VATz, aSATz, LFz); units = standard deviation [SD]) were calculated based on individualized matched VCG. The z-score changes from baseline to week 52 were calculated to describe changes in fat distribution pattern, the magnitude of changes in VAT, aSAT and LF, and were compared to that described by the observed weight change.

RESULTS: Baseline fat distribution pattern was similar across pooled TZP and IDeg arms. Compared to matched VCG, study participants had higher baseline VAT and LF, but similar aSAT (aSATz = -0.13 (1.11), p = 0.083). People treated with TZP had a significant decrease in VATz (-0.18 (0.58), p < 0.001) and LFz (-0.54 (0.84), p < 0.001) while aSATz increased (0.11 (0.50), p = 0.011), indicating greater loss of VAT and LF, and smaller loss of aSAT than predicted by their observed weight loss. Comparison with the matched VCG showed people treated with TZP on average lost 0.31 L more VAT (p < 0.001), 5.64 percent points more LF (p < 0.001) and 0.16 L less aSAT (p = 0.018) than would be predicted by observed weight loss.

CONCLUSION: In people with T2D and a skewed fat distribution pattern, TZP resulted in a greater reduction of VAT and LF than would be predicted by observed weight loss alone, indicating a targeted and potentially beneficial shift in fat distribution pattern.

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

李淳權

EFFECT OF SEMAGLUTIDE ON MACE BY BASELINE KIDNEY FUNCTION IN PARTICIPANTS WITH TYPE 2 DIABETES AND HIGH RISK OF CARDIOVASCULAR DISEASE: SUSTAIN 6 AND PIONEER 6 POST HOC ANALYSIS

馬偕紀念醫院

1P. ROSSING, 2S. BAIN, 3H. BOSCH-TRABERG, 3O. FRENKEL, 4H.L. HEERSPINK,

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為

3S. RASMUSSEN, 5L. MELLBIN, 6Y-C CHEN (PRESENTING ON BEHALF OF THE AUTHOR GROUP)

、

；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標） 與微量白蛋白尿篩檢率部份，分別為 51.6、

、

1Steno Diabetes Center Copenhagen, Gentofte, Denmark; 2Swansea University Medical School, Swansea, UK; 3Novo Nordisk A/S, Søborg, Denmark; 4University Medical Center Groningen, Groningen, Netherlands; 5Karolinska Institutet, Stockholm, Sweden; 6Novo Nordisk Taiwan.

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Background and aims: People with type 2 diabetes (T2D) are at increased risk of cardiovascular (CV) disease and chronic kidney disease (CKD). As shown in a previous post hoc analysis, semaglutide (pooled s.c. once-weekly [OW] and oral once-daily) reduces the risk of major adverse CV events (MACE) vs placebo. The current post hoc analysis investigated the association between baseline kidney function and risk of MACE (composite of CV death, nonfatal myocardial infarction and nonfatal stroke), and the effect of semaglutide on risk of MACE by baseline kidney function.

Materials and methods: Participants with T2D and at high CV risk (N=6,480) receiving semaglutide (s.c. OW 0.5 or 1.0 mg or oral 14 mg) or placebo in SUSTAIN 6 and PIONEER 6 were categorised according to baseline kidney parameters: eGFR < 45 (CKD stage 3b or worse), ≥ 45- < 60 (CKD stage 3a) and ≥ 60 mL/min/1.73 m2 (CKD stage 1 or 2) and urine albumin-to-creatinine ratio (UACR) < 30, ≥ 30- ≤ 300 and >300 mg/g. eGFR subgroup analyses used pooled SUSTAIN 6 and PIONEER 6 data; UACR subgroup analyses used SUSTAIN 6 data only (no PIONEER 6 data available). MACE risk by baseline kidney function was analysed with a Cox proportional hazards model (reference groups: eGFR ≥ 60 mL/min/1.73 m2 and UACR < 30 mg/g). The effect of semaglutide on MACE across kidney function subgroups was assessed with unadjusted and adjusted (for important baseline predictors of CV and renal diseases) analyses.

Results: Most participants included in the SUSTAIN 6 and PIONEER 6 trials had normal or mildly decreased kidney function (eGFR < 45, ≥ 45- < 60 and ≥ 60 mL/min/1.73 m2; n = 731, n = 968 and n = 4,762, respectively) and were normoalbuminuric (UACR < 30, ≥ 30- ≤ 300 and >300 mg/g; n = 1,934, n = 884 and n = 420, respectively). Regardless of treatment, MACE risk was higher in participants with eGFR < 45 mL/ min/1.73 m2 (HR 1.52, 95% CI [1.15;1.99], p = 0.0026) and ≥ 45- < 60 mL/min/1.73 m2 (1.36, [1.04;1.76], p = 0.022) vs those with ≥ 60 mL/min/1.73 m2 at baseline. Similarly, MACE risk was higher in participants with UACR ≥ 30- ≤ 300 mg/g (HR 1.53, 95% CI [1.14;2.04], p = 0.0043) and > 300 mg/g (2.52, [1.84;3.42], p < 0.0001) vs those with < 30 mg/g at baseline. Semaglutide reduced the risk of MACE consistently across baseline kidney function subgroups in both the unadjusted and adjusted analyses vs placebo (pinteraction >

0.05 for all analyses).

Conclusion: The risk of MACE was greater for participants with impaired kidney function than in those with normal kidney function. Semaglutide showed consistent reductions in MACE risk across eGFR and UACR subgroups. These findings indicate that semaglutide provides CV benefits in people with T2D and high CV risk across a broad spectrum of kidney function and damage.

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

MELANIE DAVIS

Diabetes Medicine, University of Leicester

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

REDUCED RISK OF KIDNEY FUNCTION LOSS IN PATIENTS WITH TYPE 2 DIABETES TREATED WITH GLP-1 RECEPTOR AGONISTS VERSUS BASAL INSULIN

李淳權

馬偕紀念醫院

1C. MELZER COHEN, 2,3M. SCHECHTER, 2,3I. YANUV, 2,3A. ROZENBERG, 1,4G. CHODICK, 5T. ABRAHAMSEN, 5A. CLARK, 5J. LAWSON, 1,6A. KARASIK, 2,3O. MOSENZON, 7Y-C CHEN (PRESENTING ON BEHALF OF THE AUTHOR GROUP)

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為 67.8%、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標）

與微量白蛋白尿篩檢率部份，分別為 51.6、

1Maccabi Institute for Research and Innovation, Maccabi Health Services, Tel Aviv, Israel; 2Diabetes Unit, Hadassah Medical Center, Jerusalem, Israel; 3Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; 4School of Public Health Sackler, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 5Novo Nordisk A/S, Copenhagen, Denmark; 6Tel Aviv University, Tel Aviv, Israel; 7Novo Nordisk Taiwan.

、

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

Background and aims: Several GLP-1 receptor agonists (GLP-1 RAs) have been shown to reduce albuminuria in populations with type 2 diabetes (T2D), with data also suggesting that they may reduce the rate of kidney function decline. This study used data from Maccabi Healthcare Services, a large Israeli state-mandated care provider, to assess changes in kidney outcomes among initiators of GLP-1 RAs compared with matched initiators of basal insulin (BI) in a real-world setting.

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Materials and methods: Adults with T2D using ≥ 2 glucose lowering agents who initiated GLP1 RAs or BI from 2010 to 2019 were propensity-score matched by 89 baseline characteristics. In the intention to treat (ITT) analysis, subjects were followed until death, the end of data availability or October 2021. In the as-treated (AT) analysis, follow-up was censored also at exposure discontinuation or initiation of the comparator drug. Categorical one-step, single-measurement increase in urine albumin:creatinine (UACR) category (< 30; ≥ 30- < 300; ≥ 300 mg/g, accompanied with > 30% increase) was evaluated. Confirmed estimated glomerular filtration rate (eGFR) decline in a composite endpoint (≥ 40% eGFR decline) including development of end stage kidney disease (ESKD) as well as confirmed declines in eGFR alone (≥ 30%, 40%, 50%, and 57% respectively) was evaluated. Treatment effects were determined using Cox proportional hazard models.

Results: Before matching, 6797 and 9145 patients were included in GLP-1 RAs and BI groups, respectively. Each exposure group constituted 3424 matched patients (mean age, 59.4 years [SD, 9.4]; 45% women; 49% had T2D for more than 10 years; 21% with history of cardiovascular diseases. The study population was generally healthy from a kidney perspective, with a mean eGFR of 90.6 mL/min/1.73 m2 [SD 19.3] and median UACR of 14.6 mg/g [IQR 0.0-54.9]). The median follow-up times were 82.2 months (ITT) and 22.6 months (AT). Compared with BI, initiation of GLP-1 RA was associated with a lower risk of categorical increase in UACR in both the ITT (hazard ratio (HR) [95% CI] 0.90 [0.83-0.97]) and AT (HR: 0.85 [0.76-0.96]) analyses. The HR of the composite outcome of confirmed ≥ 40% eGFR decline or new ESKD was 0.96 [0.82-1.11] and 0.71 [0.54-0.95] in the ITT

PL-1

and AT analyses, respectively. The HR for 30%, 40%, 50%, and 57% confirmed eGFR decline in the ITT analyses were 0.98 [0.87-1.11], 0.96 [0.82-1.12], 1.11 [0.91 -1.37] and 1.04 [0.80-1.34]. In the AT analyses, the respective HRs were 0.74 [0.60-0.91], 0.73 [0.54-0.97], 0.74 [0.49-1.12] and 0.62 [0.351.10], respectively.

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

MELANIE DAVIS

Diabetes Medicine, University of Leicester

Conclusion: The findings suggest that continuous use of GLP-1 RA may be associated with improved kidney outcomes, including a lower risk for kidney function loss, among patients with type 2 diabetes and preserved baseline kidney function. The ongoing FLOW trial will directly determine whether the GLP-1 RA once-weekly subcutaneous semaglutide reduces the risk of kidney disease progression in people with T2D and CKD.

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.

DAROC-TADE-2

從 2022 年糖尿病健康促進機構推動計畫成果談糖尿病疾病照護的

未來

RISK OF STROKE IN PATIENTS WITH TYPE 2 DIABETES RECEIVING SEMAGLUTIDE OR A DIPEPTIDYL PEPTIDASE-4 INHIBITOR: A REAL-WORLD US CLAIMS DATABASE ANALYSIS

李淳權

馬偕紀念醫院

1M. EVANS, 2M. HUSAIN, 3O. FRENKEL, 3K. MANGLA, 4A. SRIVASTAVA, 5I. LINGVAY, 6Y-C CHEN (PRESENTING ON BEHALF OF THE AUTHOR GROUP)

112 年底有 362 家糖尿病健康促進機構，以團隊方式照護糖尿病人。111 年度糖尿病人

照護品質情形，糖尿病衛教服務率，及參與醫療給付改善方案之比率分別為

、65.1%；

ABC 成果（即 A1C ≦ 7%、A1C > 8.5%、BP < 140/90mmHg、LDL-C < 100mg/dL 及 ABC 達標）

1University Hospital, Llandough, Penarth, Cardiff, UK; 2Ted Rogers Centre for Heart Research, Department of Medicine, University of Toronto, Toronto, Canada; 3Novo Nordisk A/S, Søborg, Denmark; 4Novo Nordisk Global Business Services, Bengaluru, India; 5Department of Internal Medicine and Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, USA; 6Novo Nordisk Taiwan.

與微量白蛋白尿篩檢率部份，分別為 51.6、

、

、

檢查≧ 3 次 / 年 (%)、胰島素注射率、足部年檢查率及肥胖率（BMI ≧ 27） 分別為 67.2、23.4、48.0、 26.6%。

Background and aims: People with type 2 diabetes (T2D) have a higher risk of stroke and worse outcomes than those without T2D. A meta-analysis of RCT data has shown that glucagon-like peptide-1 receptor agonists are associated with a significant reduction in the risk of stroke, but there remains a specific evidence gap for the real-world effect of semaglutide. We compared risk of incident stroke in patients with T2D or T2D + atherosclerotic CVD (ASCVD) initiating either semaglutide or a dipeptidyl peptidase-4 inhibitor (DPP-4i).

未來糖尿病管理將面臨「長期化」及「高齡化」的兩大挑戰，及早阻緩高危險族群之併發 症或共病勢必成為新照護議題。推動慢病共照的願景，期盼從糖尿病、慢性腎臟病與心血管共 病風險篩檢與預防出發，以「糖、腎、心」為中心建立多重風險因子共照模式，優化多重慢性 病風險預防標準照護流程，建置跨科別、職別合作模式，實踐以病人為中心的整合照護理念。

Materials and methods: Adults (≥ 18 years) in a US claims database with a claim indicating initiation of semaglutide or a DPP-4i (index date) during the index period (1/1/18-30/9/20), a diagnosis code for T2D on or before index date, and 12 months’ continuous enrolment pre-index were included. Exclusion criteria were a claim for semaglutide, DPP-4i or injectable glucose-lowering medication, or a diagnosis code for type 1 or secondary diabetes in the 12 months pre-index; or a claim associated with pregnancy or gestational diabetes at any time during the study period. Patients were propensity score matched 1:1 on baseline demographic and clinical characteristics (27 variables for T2D; 26 for T2D+ASCVD). Primary outcome was time to first stroke event during follow-up (medical claim with stroke as primary diagnosis during inpatient or emergency room visit).

Results: Post-matching, there were 17,920 pairs with T2D and 4234 pairs with T2D+ASCVD. The groups were well matched on baseline characteristics. Patients with T2D initiating semaglutide had a lower risk of stroke than those initiating a DPP-4i (HR 0.63 [95% CI 0.41, 0.95]; p = 0.029). This was more pronounced for T2D+ASCVD (HR 0.45 [0.24, 0.86]; p = 0.015). Overall, 34 patients with T2D receiving semaglutide (0.2%) experienced a stroke event (incidence rate [IR] per 100 personyears 0.25), compared with 60 patients receiving a DPP-4i (0.3%; IR 0.40; IR ratio [IRR] 0.62 [95% CI 0.40, 0.95]). For T2D+ASCVD, 13 patients receiving semaglutide (0.3%; IR 0.40) and 32 receiving a DPP-4i (0.8%; IR 0.90) experienced a stroke event (IRR 0.44 [0.23-0.85]). The cumulative incidence of stroke over the follow-up period was 237-258 days (median).

Conclusion: Our results provide preliminary information regarding the potential of semaglutide

PL-1

to reduce stroke in patients with T2D in a real-world setting. Analyses with additional comparison groups and longer follow-up are needed to determine the broader clinical and economic implications.

MANAGEMENT OF HYPERGLYCEMIA IN TYPE 2 DIABETES: ADA/EASD

CONSENSUS REPORT

MELANIE DAVIS

Diabetes Medicine, University of Leicester

In this presentation there will be a full and comprehensive review of the recent ADA EASD consensus report. This will describe:

• the overall approaches to care

• the review of the interventions

• personalised approach

• approaches for implementation

It will describe the decision cycle and consider social determinants of health shared decision making in T2D and the importance of self management support. The review of the interventions will include weight management, 24 hour physical behaviours and updates on therapeutics including GLP1RAs and combination therapy. There will be a review of the holistic approach for T2D including approaches to glycaemic control, weight management, cardiovascular risk reduction and the choice of glucose lowering therapies for organ protection.